Form 941 Schedule B
Schedule B (Form 941):
Report of Tax Liability for Semiweekly Schedule Depositors
(Rev. January 2017) Department of the Treasury — Internal Revenue Service
960311
OMB No. 1545-0029
Employer identification number
(EIN)
—
Name (not your trade name)
Calendar year (Also check quarter)
Report for this Quarter...
(Check one.)
1: January, February, March
2: April, May, June
3: July, August, September
4: October, November, December
Use this schedule to show your TAX LIABILITY for the quarter; don't use it to show your deposits. When you file this form with Form 941 or
Form 941-SS, don't change your tax liability by adjustments reported on any Forms 941-X or 944-X. You must fill out this form and attach it to
Form 941 or Form 941-SS if you're a semiweekly schedule depositor or became one because your accumulated tax liability on any day was
$100,000 or more. Write your daily tax liability on the numbered space that corresponds to the date wages were paid. See Section 11 in
Pub. 15 for details.
Month 1
1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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13
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14
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15
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16
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17
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18
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19
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20
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21
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22
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23
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24
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25
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26
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27
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28
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29
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30
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31
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Tax liability for Month 1
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Month 2
1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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13
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14
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15
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16
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17
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18
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19
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20
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21
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22
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23
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24
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25
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26
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27
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28
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29
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30
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31
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Tax liability for Month 2
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Month 3
1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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13
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14
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15
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16
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17
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18
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19
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20
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21
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22
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23
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24
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25
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26
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27
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28
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29
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30
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31
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Tax liability for Month 3
.
Total must equal line 12 on Form 941 or Form 941-SS.
Fill in your total liability for the quarter (Month 1 + Month 2 + Month 3)
▶
Total liability for the quarter
.
For Paperwork Reduction Act Notice, see separate instructions.
IRS.gov/form941 Cat. No. 11967Q Schedule B (Form 941) (Rev. 1-2017)
