Part 1: Answer these questions for this year.
Employers in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, and Puerto Rico can skip lines 1 and 2, unless you have employees who are subject to U.S. income tax withholding.
- Line 4: Taxable social security and Medicare wages and tips:
Include taxable qualified sick and family leave wages for leave taken after March 31, 2021, on line 4a. Use lines 4a(i) and 4a(ii) only to report wages paid for leave taken before April 1, 2021 Line 13: Enter your tax liability for each month.
If you’re a semiweekly schedule depositor or you became one because you accumulated $100,000 or more of liability on any day during a deposit period, you must complete Form 945-A instead of the boxes below.
13a. JANUARY
13b. February
13c. March
13d. April
13e. May
13f. June
13g. July
13h. August
13i. September
13j. October
13k. November
13l. December
Part 3: Tell us about your business. If any question does NOT apply to your business, leave it blank.
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Part 4: May we speak with your third-party designee?
Part 5: Sign here. You MUST complete both pages of this form and SIGN it.
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MM slash DD slash YYYY
944-V: Payment Voucher
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