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
• 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
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.
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
Box 3—Tax period. Darken the circle identifying the
quarter for which the payment is made. Darken only
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
Note: You must also complete the entity information
above Part 1 on Form 941.
Detach Here and Mail With Your Payment and Form 941.
Department of the Treasury
Internal Revenue Service
Don't staple this voucher or your payment to Form 941.
OMB No. 1545-0029
1 Enter your employer identification
Enter the amount of your payment.
Make your check or money order payable to “United States Treasury”
3 Tax Period
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.