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SCHEDULE Q                  Tax Liability of Qualified Derivatives Dealer (QDD)                                                             OMB No. 1545-0123
(Form 1120-F)
                                                         Attach to Form 1120-F. 
Department of the Treasury            Go to www.irs.gov/Form1120F for the latest information.                                               2023
Internal Revenue Service 
Name of corporation                                                                                                                Employer identification number

Name of QDD                                                                                                                        QI-EIN

QDD Taxable Year (enter month, day, and year for beginning and ending dates)
Beginning                           , 20       , and ending                                         , 20
Indicate the year or portion of the year to which the schedule relates (enter month, day, and year for beginning and ending dates) Schedule of
Beginning                           , 20       , and ending                                         , 20
                                                                                                 (a)                               (b)        (c) 
                         Summary of QDD Tax Liability                                        Gross Amount    Withholding Tax Rate           Amount of Tax Liability 
                                                                                                                                            (column (a) x column (b))
1     Total section 871(m) amount   .   .    . . .     . . .                . . . .     1
2     Total dividends received in equity derivatives dealer capacity .            .     2
3     Total QDD tax liability pursuant to section 3.09(A) of the Qualified 
      Intermediary Agreement  . .   .   .    . . .     . . .                . . . .     3
4     Total QDD tax liability pursuant to section 3.09(B) of the Qualified 
      Intermediary Agreement  . .   .   .    . . .     . . .                . . . .     4
5     Total QDD tax liability pursuant to section 3.09(C) of the Qualified 
      Intermediary Agreement:
a     Income Type:                                                                    5a
b     Income Type:                                                                    5b
c     Income Type:                                                                    5c
d     Income Type:                                                                    5d
6     Total of line 5 amounts . .   .   .    . . .     . . .                . . . .     6
What’s New                                                                      Number of schedules filed. A QDD may be required to file 
                                                                                multiple Schedules Q, for example, if it has multiple branches 
Schedule Q (Form 1120-F) has been amended to reflect Notice                     that are QDDs or if it is a fiscal year taxpayer (as explained in 
2022-37, 2022-37 I.R.B. 234, which further delays the                           General Instructions above). Indicate the number of each 
effective/applicability date of certain rules in the section 871(m)             Schedule Q filed, as well as the total number of Schedules Q 
regulations and extends the phase-in period provided in                         being filed by the corporation in the entry spaces provided.
Notice 2020-2, 2020-3 I.R.B. 327, for certain provisions of the 
section 871(m) regulations.                                                     Column (c), Amount of Tax Liability. Except as provided in the 
                                                                                Note that immediately follows this paragraph, the amount in 
Who Must File                                                                   column (c) is determined by multiplying column (a) by column (b). 
                                                                                This column is not reduced by any withholding that has occurred.
If the corporation or any branch of the corporation was a 
qualified derivatives dealer (QDD) (defined below) during the tax               Note: For calendar years 2018 through 2024, certain information 
year, Schedule Q must be completed and filed for each of those                  is not required, as indicated in the line instructions below. 
QDDs. The corporation must file Schedule Q as an attachment                     However, if the corporation has a fiscal year (rather than a 
to Form 1120-F even if the QDD has zero tax liability.                          calendar year) that begins in 2024 and ends in 2025, information 
                                                                                is required for any amounts paid or accrued on or after January 
Qualified derivatives dealer (QDD). A QDD is a home office or                   1, 2025.
branch that, in accordance with the qualified intermediary 
agreement (QIA) (defined below), qualifies and has been                         Line 1. The gross amount to be entered in column (a) is the sum 
approved for QDD status and satisfies the requirements of the                   of each section 871(m) amount for the QDD for the relevant 
QIA. See the QIA for additional information.                                    period. See section 2.73 of the QIA for the definition of section 
                                                                                871(m) amount.
Qualified intermediary agreement (QIA). The QIA is section 6 
of Rev. Proc. 2022-43, 2022-52 I.R.B. 570.                                      Note: For calendar years 2019 through 2024, this information is 
                                                                                not required.
General Instructions                                                            Line 2. For calendar years 2019 through 2024, only the gross 
A separate Schedule Q is required for each QDD. In addition, if                 amount (column (a)) and tax rate (column (b)) are required.
a corporation has a fiscal year rather than a calendar year, the                Line 3. Column (c) is the sum of each section 3.09(A) amount for 
corporation must provide a separate Schedule Q for each QDD                     the QDD for the relevant period.
for each portion of the fiscal year that falls within the calendar              Note: For calendar years 2019 through 2024, this information is 
year.                                                                           not required.
Example: A QDD with a fiscal year beginning September 1 and                     Line 4. Enter the information requested in columns (a), (b), and (c).
ending August 31 would complete two schedules (one for the 
period of September 1, 2023 through December 31, 2023, and                      Line 5. In addition to specifying the type of income (for 
one for the period of January 1, 2024 through August 31, 2024).                 example, dividends or interest), enter the information requested 
                                                                                in columns (a), (b), and (c) separately for each income type. For 
Specific Instructions                                                           dividends, include all dividends, including dividends separately 
                                                                                stated on line 2.
Name of QDD. The name of the QDD should follow the naming 
protocol used for applying to be a QDD.                                         Note: For calendar years 2019 through 2024, do not include 
                                                                                dividends included on line 2.
For Paperwork Reduction Act Notice, see the Instructions for Form 1120-F.                    Cat. No. 71803X                       Schedule Q (Form 1120-F) 2023






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