Fillable Printable Form 941

What is a Form 941 ?

Form 941, Employer's Quarterly Federal Tax Return, is an IRS payroll tax form that every employer needs to know about. It is used by employers to report income taxes, social security tax, or Medicare tax withheld from employee's paychecks, and pay the employer's portion of social security or Medicare tax. Fill fillable form 941 online, download blank or editable online with Handypdf.com.

Fillable Printable Form 941

What is a Form 941 ?

Form 941

Form 941 for 2017:

(Rev. January 2017)

Employer’s QUARTERLY Federal Tax Return

Department of the Treasury — Internal Revenue Service

950117

OMB No. 1545-0029

Employer identification number (EIN)

—

Name (not your trade name)

Trade name (if any)

Address

Number Street Suite or room number

City State ZIP code

Foreign country name

Foreign province/county

Foreign postal code

Report for this Quarter of 2017

(Check one.)

1: January, February, March

2: April, May, June

3: July, August, September

4: October, November, December

Instructions and prior year forms are

available at www.irs.gov/form941.

Read the separate instructions before you complete Form 941. Type or print within the boxes.

Part 1:

Answer these questions for this quarter.

Number of employees who received wages, tips, or other compensation for the pay period

including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)

2 Wages, tips, and other compensation . . . . . . . . . . . . . . . . . 2

3 Federal income tax withheld from wages, tips, and other compensation . . . . . . 3

4 If no wages, tips, and other compensation are subject to social security or Medicare tax Check and go to line 6.

Column 1 Column 2

5a Taxable social security wages . .

× 0.124 =

5b Taxable social security tips . . .

× 0.124 =

5c Taxable Medicare wages & tips. .

× 0.029 =

Taxable wages & tips subject to

Additional Medicare Tax withholding

× 0.009 =

5e Add Column 2 from lines 5a, 5b, 5c, and 5d . . . . . . . . . . . . . . . 5e

5f Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions) . . 5f

6 Total taxes before adjustments. Add lines 3, 5e, and 5f . . . . . . . . . . . . 6

7 Current quarter’s adjustment for fractions of cents . . . . . . . . . . . . . 7

8 Current quarter’s adjustment for sick pay . . . . . . . . . . . . . . . . 8

Current quarter’s adjustments for tips and group-term life insurance . . . . . . .

10 Total taxes after adjustments. Combine lines 6 through 9 . . . . . . . . . . . 10

Qualified small business payroll tax credit for increasing research activities. Attach Form 8974

12 Total taxes after adjustments and credits. Subtract line 11 from line 10 . . . . . . . 12

Total deposits for this quarter, including overpayment applied from a prior quarter and

overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter

14 Balance due. If line 12 is more than line 13, enter the difference and see instructions . . . 14

Overpayment. If line 13 is more than line 12, enter the difference

Check one:

Apply to next return.

Send a refund.

▶

You MUST complete both pages of Form 941 and SIGN it.

■

▶

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.

Cat. No. 17001Z

Form

941 (Rev. 1-2017)

950217

Name (not your trade name)

Employer identification number (EIN)

Part 2:

Tell us about your deposit schedule and tax liability for this quarter.

If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see section 11

of Pub. 15.

16 Check one:

Line 12 on this return is less than $2,500 or line 12 (line 10 if the prior quarter was the fourth quarter of 2016) on the return

for the prior quarter was less than $2,500, and you didn’t incur a $100,000 next-day deposit obligation during the current

quarter. If line 12 (line 10 if the prior quarter was the fourth quarter of 2016) for the prior quarter was less than $2,500 but line 12 on

this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule depositor,

complete the deposit schedule below; if you are a semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3.

You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total

liability for the quarter, then go to Part 3.

Tax liability: Month 1

Month 2

Month 3

Total liability for quarter

Total must equal line 12.

You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941),

Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941.

Tell us about your business. If a question does NOT apply to your business, leave it blank.Part 3:

17 If your business has closed or you stopped paying wages . . . . . . . . . . . . . . . Check here, and

enter the final date you paid wages

/ / .

18 If you are a seasonal employer and you don’t have to file a return for every quarter of the year . .

Check here.

May we speak with your third-party designee?Part 4:

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions

for details.

Yes. Designee’s name and phone number

Select a 5-digit Personal Identification Number (PIN) to use when talking to the IRS.

No.

Sign here. You MUST complete both pages of Form 941 and SIGN it.Part 5:

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge

and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

✗

Sign your

name here

Print your

name here

Print your

title here

Date / / Best daytime phone

Paid Preparer Use Only

Check if you are self-employed . . .

Preparer’s name

PTIN

Preparer’s signature

Date / /

Firm’s name (or yours

if self-employed)

Address

City State

EIN

Phone

ZIP code

Page 2 Form 941 (Rev. 1-2017)

Form 941-V,

Payment Voucher

Purpose of Form

Complete Form 941-V if you're making a payment with

Form 941. We will use the completed voucher to credit

your payment more promptly and accurately, and to

improve our service to you.

Making Payments With Form 941

To avoid a penalty, make your payment with Form 941

only if:

• Your total taxes for either the current quarter (Form 941,

line 12) or the preceding quarter (Form 941, line 12 (line

10 if the preceding quarter was the fourth quarter of

2016)) are less than $2,500, you didn't incur a $100,000

next-day deposit obligation during the current quarter,

and you're paying in full with a timely filed return; or

• You are a monthly schedule depositor making a

payment in accordance with the Accuracy of Deposits

Rule. See section 11 of Pub. 15 for details. In this case,

the amount of your payment may be $2,500 or more.

Otherwise, you must make deposits by electronic funds

transfer. See section 11 of Pub. 15 for deposit

instructions. Don't use Form 941-V to make federal tax

deposits.

▲

CAUTION

Use Form 941-V when making any payment with

Form 941. However, if you pay an amount with

Form 941 that should've been deposited, you

may be subject to a penalty. See Deposit Penalties in

section 11 of Pub. 15.

Specific Instructions

Box 1—Employer identification number (EIN). If you

don't have an EIN, you may apply for one online by

visiting the IRS website at www.irs.gov/ein. You may also

apply for an EIN by faxing or mailing Form SS-4 to the

IRS. If you haven't received your EIN by the due date of

Form 941, write “Applied For” and the date you applied in

this entry space.

Box 2—Amount paid. Enter the amount paid with

Form 941.

Box 3—Tax period. Darken the circle identifying the

quarter for which the payment is made. Darken only

one circle.

Box 4—Name and address. Enter your name and

address as shown on Form 941.

• Enclose your check or money order made payable to

“United States Treasury.” Be sure to enter your

EIN, “Form 941,” and the tax period (“1st Quarter 2017,”

“2nd Quarter 2017,” “3rd Quarter 2017,” or “4th Quarter

2017”) on your check or money order. Don't send cash.

Don't staple Form 941-V or your payment to Form 941 (or

to each other).

• Detach Form 941-V and send it with your payment

and Form 941 to the address in the Instructions for

Form 941.

Note: You must also complete the entity information

above Part 1 on Form 941.

✁

▼

Detach Here and Mail With Your Payment and Form 941.

▼

✃

Form

941-V

Department of the Treasury

Internal Revenue Service

Payment Voucher

▶

Don't staple this voucher or your payment to Form 941.

OMB No. 1545-0029

2017

1 Enter your employer identification

number (EIN).

Enter the amount of your payment.

▶

Make your check or money order payable to “United States Treasury”

Dollars Cents

3 Tax Period

1st

Quarter

2nd

Quarter

3rd

Quarter

4th

Quarter

Enter your business name (individual name if sole proprietor).

Enter your address.

Enter your city, state, and ZIP code or your city, foreign country name, foreign province/county, and foreign postal code.

Form 941 (Rev. 1-2017)

Privacy Act and Paperwork Reduction Act Notice.

We ask for the information on Form 941 to carry out the

Internal Revenue laws of the United States. We need it to

figure and collect the right amount of tax. Subtitle C,

Employment Taxes, of the Internal Revenue Code

imposes employment taxes on wages and provides for

income tax withholding. Form 941 is used to determine

the amount of taxes that you owe. Section 6011 requires

you to provide the requested information if the tax is

applicable to you. Section 6109 requires you to provide

your identification number. If you fail to provide this

information in a timely manner, or provide false or

fraudulent information, you may be subject to penalties.

You're not required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books and records relating to a form or

its instructions must be retained as long as their contents

may become material in the administration of any Internal

Revenue law.

Generally, tax returns and return information are

confidential, as required by section 6103. However,

section 6103 allows or requires the IRS to disclose or

give the information shown on your tax return to others

as described in the Code. For example, we may

disclose your tax information to the Department of

Justice for civil and criminal litigation, and to cities,

states, the District of Columbia, and U.S. commonwealths

and possessions for use in administering their tax laws.

We may also disclose this information to other countries

under a tax treaty, to federal and state agencies to

enforce federal nontax criminal laws, or to federal law

enforcement and intelligence agencies to combat

terrorism.

The time needed to complete and file Form 941 will

vary depending on individual circumstances. The

estimated average time is:

Recordkeeping . . . . . . . . . . 13 hr., 52 min.

Learning about the law or the form . . . . 47 min.

Preparing, copying, assembling, and

sending the form to the IRS . . . . . 1 hr., 3 min.

If you have comments concerning the accuracy of

these time estimates or suggestions for making Form 941

simpler, we would be happy to hear from you. You can

send us comments from www.irs.gov/formcomment. Or

you can send your comments to Internal Revenue

Service, Tax Forms and Publications Division, 1111

Constitution Ave. NW, IR-6526, Washington, DC 20224.

Don't send Form 941 to this address. Instead, see Where

Should You File? in the Instructions for Form 941.