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                                                                                                         Department of the Treasury
                                                                                                         Internal Revenue Service
Instructions for Form 941-SS

(Rev. March 2023)
Employer's QUARTERLY Federal Tax Return—American Samoa, Guam, the 
Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands

Section references are to the Internal Revenue Code                          therefore, the tax rate on these wages is 6.2%. The social 
unless otherwise noted.                                                      security wage base limit is $160,200.
Contents                                                            Page     The Medicare tax rate is 1.45% each for the employee 
Future Developments     . . . . . . . . . . . . . . . . . . . . . . . .   1  and employer, unchanged from 2022 There is no wage 
What's New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1  base limit for Medicare tax.
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2  Social security and Medicare taxes apply to the wages 
General Instructions: . . . . . . . . . . . . . . . . . . . . . . . . .   4  of household workers you pay $2,600 or more in cash 
                                                                             wages in 2023. Social security and Medicare taxes apply 
Purpose of Form 941-SS . . . . . . . . . . . . . . . . . . .              4  to election workers who are paid $2,200 or more in cash 
Who Must File Form 941-SS?                . . . . . . . . . . . . . . .   4  or an equivalent form of compensation in 2023.
When Must You File?           . . . . . . . . . . . . . . . . . . . . .   6
                                                                             Qualified small business payroll tax credit for in-
How Should You Complete Form 941-SS? . . . . . .                          6  creasing research activities. For tax years beginning 
Where Should You File?            . . . . . . . . . . . . . . . . . . .   7  before January 1, 2023, a qualified small business may 
Depositing Your Taxes           . . . . . . . . . . . . . . . . . . . .   7  elect to claim up to $250,000 of its credit for increasing 
What About Penalties and Interest? . . . . . . . . . . .                  8  research activities as a payroll tax credit. The Inflation 
Where Can You Obtain Forms? . . . . . . . . . . . . . .                   9  Reduction Act of 2022 (the IRA) increases the election 
Specific Instructions: . . . . . . . . . . . . . . . . . . . . . . . . .  9  amount to $500,000 for tax years beginning after 
                                                                             December 31, 2022. The payroll tax credit election must 
Part 1: Answer These Questions for This                                      be made on or before the due date of the originally filed 
Quarter       . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   9
                                                                             income tax return (including extensions). The portion of 
Part 2: Tell Us About Your Deposit Schedule                                  the credit used against payroll taxes is allowed in the first 
and Tax Liability for This Quarter                . . . . . . . . . .     17 calendar quarter beginning after the date that the qualified 
Part 3: Tell Us About Your Business               . . . . . . . . . .     19 small business filed its income tax return. The election 
Part 4: May We Speak With Your Third-Party                                   and determination of the credit amount that will be used 
Designee? . . . . . . . . . . . . . . . . . . . . . . . . . .             20 against the employer’s payroll taxes are made on Form 
Part 5: Sign Here (Approved Roles) . . . . . . . . . .                    20 6765, Credit for Increasing Research Activities. The 
How To Get Forms, Instructions, and Publications                             amount from Form 6765, line 44, must then be reported 
From the IRS      . . . . . . . . . . . . . . . . . . . . . . . . . .     21 on Form 8974, Qualified Small Business Payroll Tax 
                                                                             Credit for Increasing Research Activities.
Worksheet 1. Credit for Qualified Sick and Family 
Leave Wages Paid This Quarter of 2023 for                                    Starting in the first quarter of 2023, the payroll tax credit 
Leave Taken After March 31, 2020, and Before                                 is first used to reduce the employer share of social 
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . .       22 security tax up to $250,000 per quarter and any remaining 
Worksheet 2. Credit for Qualified Sick and Family                            credit reduces the employer share of Medicare tax for the 
Leave Wages Paid This Quarter of 2023 for                                    quarter. Any remaining credit, after reducing the employer 
Leave Taken After March 31, 2021, and Before                                 share of social security tax and the employer share of 
October 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . .           23 Medicare tax, is then carried forward to the next quarter. 
                                                                             Form 8974 is used to determine the amount of the credit 
Future Developments                                                          that can be used in the current quarter. The amount from 
For the latest information about developments related to                     Form 8974, line 12 or, if applicable, line 17, is reported on 
Form 941-SS and its instructions, such as legislation                        line 11a. For more information about the payroll tax credit, 
enacted after they were published, go to IRS.gov/                            see IRS.gov/ResearchPayrollTC. Also see Adjusting tax 
Form941SS.                                                                   liability for nonrefundable credits claimed on lines 11a, 
                                                                             11b, and 11d, later.
What's New
                                                                             Forms 941-SS and 941-PR discontinued after 2023. 
Social security and Medicare tax for 2023.                  The rate of      Form 941-SS and Form 941-PR, Planilla para la 
social security tax on taxable wages, including qualified                    Declaración Federal TRIMESTRAL del Patrono, will no 
sick leave wages and qualified family leave wages paid in                    longer be available after the fourth quarter of 2023. 
2023 for leave taken after March 31, 2021, and before                        Instead, employers in the U.S. territories will file Form 941, 
October 1, 2021, is 6.2% each for the employer and                           Employer’s QUARTERLY Federal Tax Return, or, if you 
employee or 12.4% for both. Qualified sick leave wages                       prefer your form and instructions in Spanish, you can file 
and qualified family leave wages paid in 2023 for leave                      new Form 941 (sp), Declaración del Impuesto Federal 
taken after March 31, 2020, and before April 1, 2021,                        TRIMESTRAL del Empleador.
aren't subject to the employer share of social security tax; 

Jan 10, 2023                                                          Cat. No. 35530F

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Pubs. 80, 51, and 179 discontinued after 2023. Pub. 2020 allows for a payroll tax credit for certain tax-exempt
80, Federal Tax Guide for Employers in the U.S. Virgin organizations affected by certain qualified disasters not
Islands, Guam, American Samoa, and the Commonwealth related to COVID-19. This credit is claimed on Form
of the Northern Mariana Islands; Pub. 51, Agricultural 5884-D (not on Form 941-SS). Form 5884-D is filed after
Employer's Tax Guide; and Pub. 179, Guía Contributiva the Form 941-SS for the quarter for which the credit is
Federal para Patronos Puertorriqueños, will no longer be being claimed has been filed. If you will claim this credit
available after 2023. Instead, information specific to on Form 5884-D and you're also claiming a credit for
employers in the U.S. territories and agricultural qualified sick and family leave wages for leave taken
employers will be included in Pub. 15, Employer's Tax before April 1, 2021, you must include any credit that will
Guide, beginning with the Pub. 15 for use in 2024 be claimed on Form 5884-D on Worksheet 1 for that
(published December 2023). Beginning in 2024, there will quarter. For more information about this credit, go to
be a new Pub. 15 (sp) that is a Spanish-language version IRS.gov/Form5884D.
of Pub. 15. Certification program for professional employer or-
ganizations (PEOs). The Stephen Beck, Jr., ABLE Act
Reminders of 2014 required the IRS to establish a voluntary
Use the March 2023 revision of Form 941-SS to certification program for PEOs. PEOs handle various
payroll administration and tax reporting responsibilities for
CAUTION an earlier revision to report taxes for 2023. At this
! report taxes for the first quarter of 2023; don't use their business clients and are typically paid a fee based on
time, the IRS expects the March 2023 revision of Form payroll costs. To become and remain certified under the
941-SS and these instructions to also be used for the certification program, certified professional employer
second, third, and fourth quarters of 2023. If changes in organizations (CPEOs) must meet various requirements
law require additional changes to Form 941-SS, the form described in sections 3511 and 7705 and related
and/or these instructions may be revised. Prior revisions published guidance. Certification as a CPEO may affect
of Form 941-SS are available at IRS.gov/Form941SS the employment tax liabilities of both the CPEO and its
(select the link for "All Form 941-SS Revisions" under customers. A CPEO is generally treated for employment
"Other Items You May Find Useful"). tax purposes as the employer of any individual who
performs services for a customer of the CPEO and is
The COVID-19 related credit for qualified sick and covered by a contract described in section 7705(e)(2)
family leave wages is limited to leave taken after between the CPEO and the customer (CPEO contract),
March 31, 2020, and before October 1, 2021. but only for wages and other compensation paid to the
Generally, the credit for qualified sick and family leave individual by the CPEO. To become a CPEO, the
wages, as enacted under the Families First Coronavirus organization must apply through the IRS Online
Response Act (FFCRA) and amended and extended by Registration System. For more information or to apply to
the COVID-related Tax Relief Act of 2020, for leave taken become a CPEO, go to IRS.gov/CPEO.
after March 31, 2020, and before April 1, 2021, and the CPEOs must generally file Form 941-SS and
credit for qualified sick and family leave wages under Schedule R (Form 941), Allocation Schedule for
sections 3131, 3132, and 3133 of the Internal Revenue Aggregate Form 941 Filers, electronically. For more
Code, as enacted under American Rescue Plan Act of information about a CPEO’s requirement to file
2021 (the ARP), for leave taken after March 31, 2021, and electronically, see Rev. Proc. 2017-14, 2017-3 I.R.B. 426,
before October 1, 2021, have expired. However, available at IRS.gov/irb/2017-03_IRB#RP-2017-14.
employers that pay qualified sick and family leave wages
in 2023 for leave taken after March 31, 2020, and before Outsourcing payroll duties. Generally, as an employer,
October 1, 2021, are eligible to claim a credit for qualified you're responsible to ensure that tax returns are filed and
sick and family leave wages in the quarter of 2023 in deposits and payments are made, even if you contract
which the qualified wages were paid. For more with a third party to perform these acts. You remain
information, see the instructions for line 11b line 11d, , responsible if the third party fails to perform any required
line 13c, and line 13e, later. action. Before you choose to outsource any of your payroll
and related tax duties (that is, withholding, reporting, and
Use Worksheet 1 to figure the credit for leave taken paying over social security, Medicare, FUTA, and income
after March 31, 2020, and before April 1, 2021. Use taxes) to a third-party payer, such as a payroll service
Worksheet 2 to figure the credit for leave taken after provider or reporting agent, go to IRS.gov/
March 31, 2021, and before October 1, 2021. For more OutsourcingPayrollDuties for helpful information on this
information about the credit for qualified sick and family topic. If a CPEO pays wages and other compensation to
leave wages, go to IRS.gov/PLC. an individual performing services for you, and the services
Advance payment of COVID-19 credits ended. are covered by a CPEO contract, then the CPEO is
Although you may pay qualified sick and family leave generally treated for employment tax purposes as the
wages in 2023 for leave taken after March 31, 2020, and employer, but only for wages and other compensation
before October 1, 2021, you may no longer request an paid to the individual by the CPEO. However, with respect
advance payment of any credit on Form 7200, Advance to certain employees covered by a CPEO contract, you
Payment of Employer Credits Due to COVID-19. may also be treated as an employer of the employees
and, consequently, may also be liable for federal
Payroll tax credit for certain tax-exempt organiza-
employment taxes imposed on wages and other
tions affected by qualified disasters. Section 303(d) of
compensation paid by the CPEO to such employees. For
the Taxpayer Certainty and Disaster Tax Relief Act of

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more information on the different types of third-party payer agreement with the third-party payer, the third-party payer
arrangements, see section 16 of Pub. 15. includes the qualified sick leave wages on the third party's
aggregate Form 941-SS, claims the sick leave credit on
COVID-19 employment tax credits when return filed
behalf of the employer on the aggregate Form 941-SS,
by a third-party payer. If you're the common-law
and separately reports the credit allocable to the
employer of the individuals that are paid qualified sick or
employers on Schedule R (Form 941). See section 6 of
family leave wages, you're entitled to the credit for the sick
Pub. 15-A, Employer's Supplemental Tax Guide, for more
and family leave wages, regardless of whether you use a
information about sick pay reporting.
third-party payer (such as a PEO, CPEO, or section 3504
agent) to report and pay your federal employment taxes. Work opportunity tax credit for qualified tax-exempt
The third-party payer isn't entitled to the credits with organizations hiring qualified veterans. Qualified
respect to the wages and taxes it remits on your behalf tax-exempt organizations that hire eligible unemployed
(regardless of whether the third party is considered an veterans may be able to claim the work opportunity tax
"employer" for other purposes). credit against their payroll tax liability using Form 5884-C.
For more information, go to IRS.gov/WOTC.
Aggregate Form 941-SS filers. Approved section 3504
agents and CPEOs must complete and file Schedule R Correcting a previously filed Form 941-SS. If you
(Form 941) when filing an aggregate Form 941-SS. discover an error on a previously filed Form 941-SS or if
Aggregate Forms 941-SS are filed by agents approved by you otherwise need to amend a previously filed Form
the IRS under section 3504. To request approval to act as 941-SS, make the correction using Form 941-X. Form
an agent for an employer, the agent files Form 2678 with 941-X is filed separately from Form 941-SS. For more
the IRS unless you’re a state or local government agency information, see the Instructions for Form 941-X, section 9
acting as an agent under the special procedures provided of Pub. 80, or go to IRS.gov/CorrectingEmploymentTaxes.
in Rev. Proc. 2013-39, 2013-52 I.R.B. 830, available at
Federal tax deposits must be made by electronic
IRS.gov/irb/2013-52_IRB#RP-2013-39. Aggregate Forms
funds transfer (EFT). You must use EFT to make all
941-SS are also filed by CPEOs approved by the IRS
federal tax deposits. Generally, an EFT is made using the
under section 7705. To become a CPEO, the organization
Electronic Federal Tax Payment System (EFTPS). If you
must apply through the IRS Online Registration System at
don't want to use EFTPS, you can arrange for your tax
IRS.gov/CPEO. CPEOs file Form 8973, Certified
professional, financial institution, payroll service, or other
Professional Employer Organization/Customer Reporting
trusted third party to make electronic deposits on your
Agreement, to notify the IRS that they started or ended a
behalf. Also, you may arrange for your financial institution
service contract with a customer. CPEOs must generally
to initiate a same-day wire payment on your behalf.
file Form 941-SS and Schedule R (Form 941)
EFTPS is a free service provided by the Department of the
electronically. For more information about a CPEO’s
Treasury. Services provided by your tax professional,
requirement to file electronically, see Rev. Proc. 2017-14,
financial institution, payroll service, or other third party
2017-3 I.R.B. 426, available at IRS.gov/irb/ may have a fee.
2017-03_IRB#RP-2017-14.
For more information on making federal tax deposits,
Other third-party payers that file aggregate Forms
see section 8 of Pub. 80. To get more information about
941-SS, such as non-certified PEOs, must complete and
EFTPS or to enroll in EFTPS, go to EFTPS.gov or call one
file Schedule R (Form 941) if they have clients that are
of the following numbers.
claiming the qualified small business payroll tax credit for
• 800-555-4477 (toll free; for use by U.S. Virgin Islands
increasing research activities, and/or the credit for
only).
qualified sick and family leave wages.
• 800-244-4829 (Spanish).
If both an employer and a section 3504 authorized • 303-967-5916 (toll call).
TIP agent (or a CPEO or other third-party payer) paid To contact EFTPS using Telecommunications Relay
wages to an employee during a quarter, both the Services (TRS) for people who are deaf, hard of hearing,
employer and the section 3504 authorized agent (or or have a speech disability, dial 711 and then provide the
CPEO or other third-party payer, if applicable) should file TRS assistant the 800-555-4477 number above or
Form 941-SS reporting the wages each entity paid to the 800-733-4829.
employee during the applicable quarter and issue Forms Additional information about EFTPS is also available in
W-2 reporting the wages each entity paid to the employee Pub. 966.
during the year.
For an EFTPS deposit to be on time, you must
If a third-party payer of sick pay is also paying qualified ! submit the deposit by 8 p.m. Eastern time the day
sick leave wages on behalf of an employer, the third party CAUTION before the date the deposit is due.
would be making the payments as an agent of the
employer. The employer is required to do the reporting Same-day wire payment option. If you fail to submit a
and payment of employment taxes with respect to the deposit transaction on EFTPS by 8 p.m. Eastern time the
qualified sick leave wages and claim the credit for the day before the date a deposit is due, you can still make
qualified sick leave wages, unless the employer has an your deposit on time by using the Federal Tax Collection
agency agreement with the third-party payer that requires Service (FTCS) to make a same-day wire payment. To
the third-party payer to do the collecting, reporting, and/or use the same-day wire payment method, you will need to
paying or depositing employment taxes on the qualified make arrangements with your financial institution ahead of
sick leave wages. If the employer has an agency time. Please check with your financial institution regarding

Instructions for Form 941-SS (Rev. 3-2023) -3-

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availability, deadlines, and costs. Your financial institution Where can you get telephone help? For answers to
may charge you a fee for payments made this way. To your questions about completing Form 941-SS or tax
learn more about the information you will need to give deposit rules, call the IRS at one of the numbers listed
your financial institution to make a same-day wire below.
payment, go to IRS.gov/SameDayWire. • 800-829-4933 (toll free; for use by U.S. Virgin Islands
Timeliness of federal tax deposits. If a deposit is only) or 800-829-4059 (TDD/TTY for persons who are
required to be made on a day that isn't a business day, the deaf, hard of hearing, or have a speech disability),
deposit is considered timely if it is made by the close of Monday–Friday from 7:00 a.m. to 7:00 p.m. local time.
the next business day. A business day is any day other • 267-941-1000 (toll call), Monday–Friday from 6:00 a.m.
than a Saturday, Sunday, or legal holiday. The term “legal to 11:00 p.m. Eastern time.
holiday” for deposit purposes includes only those legal
holidays in the District of Columbia. Legal holidays in the Photographs of missing children. The IRS is a proud
District of Columbia are provided in section 8 of Pub. 80. partner with the National Center for Missing & Exploited
Children® (NCMEC). Photographs of missing children
Electronic filing and payment. Businesses can enjoy selected by the Center may appear in instructions on
the benefits of filing tax returns and paying their federal pages that would otherwise be blank. You can help bring
taxes electronically. Whether you rely on a tax these children home by looking at the photographs and
professional or handle your own taxes, the IRS offers you calling 1-800-THE-LOST (1-800-843-5678) if you
convenient programs to make filing and paying easier. recognize a child.
Spend less time worrying about taxes and more time
running your business. Use e-file and EFTPS to your
benefit. General Instructions:
• For e-file, go to IRS.gov/EmploymentEfile for additional
information. A fee may be charged to file electronically. Purpose of Form 941-SS
• For EFTPS, go to EFTPS.gov or call one of the Use Form 941-SS to report social security and Medicare
numbers provided under Federal tax deposits must be taxes for workers in American Samoa, Guam, the
made by electronic funds transfer (EFT), earlier. Commonwealth of the Northern Mariana Islands (CNMI),
• For electronic filing of Forms W-2AS, W-2CM, W-2GU, and the U.S. Virgin Islands.
and W-2VI, go to SSA.gov/employer. You may be
required to file Forms W-2 electronically. For details, see Pub. 80 explains the requirements for withholding,
the General Instructions for Forms W-2 and W-3. depositing, and paying social security and Medicare
If you’re filing your tax return or paying your taxes. It explains the forms you must give your
employees, those your employees must give you, and
! federal taxes electronically, a valid employer those you must send to the IRS. See Pub. 15-A for
CAUTION identification number (EIN) is required at the time
the return is filed or the payment is made. If a valid EIN specialized employment tax information supplementing
isn't provided, the return or payment won't be processed. the basic information provided in Pub. 80.
This may result in penalties. See Employer identification Federal law requires you, as an employer, to withhold
number (EIN), later, for information about applying for an certain taxes from your employees' pay. Each time you
EIN. pay wages, you must withhold—or take out of your
Electronic funds withdrawal (EFW). If you file Form employees' pay—certain amounts for social security tax
941-SS electronically, you can e-file and use EFW to pay and Medicare tax. You must also withhold Additional
the balance due in a single step using tax preparation Medicare Tax from wages you pay to an employee in
software or through a tax professional. However, don't use excess of $200,000 in a calendar year. Under the
EFW to make federal tax deposits. For more information withholding system, taxes withheld from your employees
on paying your taxes using EFW, go to IRS.gov/EFW. are credited to your employees in payment of their tax
liabilities.
Credit or debit card payments. You can pay the
balance due shown on Form 941-SS by credit or debit Federal law also requires you to pay any liability for the
card. Your payment will be processed by a payment employer share of social security and Medicare taxes.
processor who will charge a processing fee. Don't use a This share of social security and Medicare taxes isn't
credit or debit card to make federal tax deposits. For more withheld from employees.
information on paying your taxes with a credit or debit
card, go to IRS.gov/PayByCard. Who Must File Form 941-SS?
Online payment agreement. You may be eligible to Generally, you must file a return for the first quarter in
apply for an installment agreement online if you can’t pay which you pay wages subject to social security and
the full amount of tax you owe when you file your return. Medicare taxes, and for each quarter thereafter until you
For more information, see What if you can't pay in full, file a final return. Use Form 941-SS if your principal place
later. of business is in American Samoa, Guam, the CNMI, or
the U.S. Virgin Islands, or if you have employees who are
Paid preparers. If you use a paid preparer to complete subject to income tax withholding for these jurisdictions.
Form 941-SS, the paid preparer must complete and sign
the paid preparer's section of the form. Use Form 941-SS to report the following amounts.
• Wages you’ve paid.
• Tips your employees reported to you.

-4- Instructions for Form 941-SS (Rev. 3-2023)

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• Both the employer and the employee share of social             and the U.S. Virgin Islands that would otherwise be 
security and Medicare taxes.                                     required to file Form 944 may contact the IRS to request 
• Additional Medicare Tax withheld from employees.               to file quarterly Forms 941-SS instead of annual Form 
• Current quarter's adjustments to social security and           944. To request to file quarterly Forms 941-SS to report 
Medicare taxes for fractions of cents, sick pay, tips, and       your social security and Medicare taxes for the 2023 
group-term life insurance.                                       calendar year, you must either call the IRS at 
• Qualified small business payroll tax credit for increasing     800-829-4933 toll free (U.S. Virgin Islands only) or 
research activities.                                             267-941-1000 (toll call) between January 1, 2023, and 
• Credit for qualified sick and family leave wages paid          April 3, 2023, or send a written request postmarked 
this quarter of 2023 for leave taken after March 31, 2020,       between January 1, 2023, and March 15, 2023. After you 
and before October 1, 2021.                                      contact the IRS, the IRS will send you a written notice that 
  Don't use Form 941-SS if you have both employees               your filing requirement has been changed to Forms 
who are subject to U.S. income tax withholding and               941-SS. You must receive written notice from the IRS to 
employees who aren't subject to U.S. income tax                  file Forms 941-SS instead of Form 944 before you may file 
withholding. Instead, you must file only Form 941 (or Form       these forms. If you don't receive this notice, you must file 
944, Employer's ANNUAL Federal Tax Return) and                   Form 944 for calendar year 2023.
include all of your employees' wages on that form.               Requesting to file Form 944 instead of Forms 
  Don't use Form 941-SS to report backup withholding or          941-SS. If you’re required to file Forms 941-SS but 
income tax withholding on nonpayroll payments such as            believe your employment taxes for 2023 will be $1,000 or 
pensions, annuities, and gambling winnings. Report these         less, you may request to file Form 944 instead of Forms 
types of withholding on Form 945, Annual Return of               941-SS by calling the IRS at 800-829-4933 toll free (U.S. 
Withheld Federal Income Tax. Also, don't use Form                Virgin Islands only) or 267-941-1000 (toll call) between 
941-SS to report unemployment taxes. Report                      January 1, 2023, and April 3, 2023, or sending a written 
unemployment taxes (U.S. Virgin Islands employers only)          request postmarked between January 1, 2023, and March 
on Form 940, Employer's Annual Federal Unemployment              15, 2023. After you contact the IRS, the IRS will send you 
(FUTA) Tax Return.                                               a written notice that your filing requirement has been 
                                                                 changed to Form 944. You must receive written notice 
  After you file your first Form 941-SS, you must file a         from the IRS to file Form 944 instead of Forms 941-SS 
return each quarter, even if you have no taxes to report,        before you may file this form. If you don't receive this 
unless you filed a final return or one of the exceptions         notice, you must file Forms 941-SS for calendar year 
listed next applies.                                             2023.
Exceptions                                                       Where to send written requests. Written requests 
Special rules apply to some employers.                           should be sent to:

• If you received notification to file Form 944, you must        Department of the Treasury
file Form 944 annually; don't file Form 941-SS quarterly.        Internal Revenue Service
• Seasonal employers don't have to file a Form 941-SS            Ogden, UT 84201-0038
for quarters in which they have no tax liability because 
they have paid no wages. To tell the IRS that you won't file 
                                                                 For more information about these procedures, see Rev. 
a return for one or more quarters during the year, check 
                                                                 Proc. 2009-51, 2009-45 I.R.B. 625, available at 
the box on line 18 every quarter you file Form 941-SS. 
                                                                 IRS.gov/irb/2009-45_IRB#RP-2009-51.
The IRS generally won't inquire about unfiled returns if at 
least one taxable return is filed each year. However, you        What if You Reorganize or Close Your 
must check the box on line 18 on every quarterly return 
                                                                 Business?
you file. Otherwise, the IRS will expect a return to be filed 
for each quarter.                                                If You Sell or Transfer Your Business . . .
• Employers of household employees don't usually file 
Form 941-SS. See Pub. 80, Pub. 926, and Schedule H               If you sell or transfer your business during the quarter, you 
(Form 1040) for more information.                                and the new owner must each file a Form 941-SS for the 
• Employers of farm employees don't file Form 941-SS             quarter in which the transfer occurred. Report only the 
for wages paid for agricultural labor. See Form 943 and          wages you paid.
Pub. 51 for more information.
     If none of these exceptions apply and you haven't           When two businesses merge, the continuing firm must 
TIP  filed a final return, you must file Form 941-SS             file a return for the quarter in which the change took place 
     each quarter even if you didn't pay wages during            and the other firm should file a final return.
the quarter. Use IRS e-file, if possible.
                                                                 Changing from one form of business to another—such 
                                                                 as from a sole proprietorship to a partnership or 
Requesting To File Forms 941-SS Instead of                       corporation—is considered a transfer. If a transfer occurs, 
Form 944, or Requesting To File Form 944                         you may need a new EIN. See Pub. 1635 and section 1 of 
Instead of Forms 941-SS                                          Pub. 80 for more information.
Requesting to file Forms 941-SS instead of Form 
944. Employers in American Samoa, Guam, the CNMI,                Attach a statement to your return with:

Instructions for Form 941-SS (Rev. 3-2023)                    -5-

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• The new owner's name (or the new name of the For example, you must generally report wages you pay
business); during the 1st quarter—which is January through
• Whether the business is now a sole proprietorship, March—by April 30. If you made timely deposits in full
partnership, or corporation; payment of your taxes for the quarter, you may file by the
• The kind of change that occurred (a sale or transfer); 10th day of the 2nd month that follows the end of the
• The date of the change; and quarter. For example, you may file Form 941-SS by May
• The name of the person keeping the payroll records 10 if you made timely deposits in full payment of your
and the address where those records will be kept. taxes for the 1st quarter.
If we receive Form 941-SS after the due date, we will
If Your Business Has Closed . . . treat Form 941-SS as filed on time if the envelope
containing Form 941-SS is properly addressed, contains
If you permanently go out of business or stop paying
sufficient postage, and is postmarked by the U.S. Postal
wages to your employees, you must file a final return. To
Service on or before the due date, or sent by an
tell the IRS that Form 941-SS for a particular quarter is
IRS-designated private delivery service (PDS) on or
your final return, check the box on line 17 and enter the
before the due date. If you don't follow these guidelines,
final date you paid wages. Also attach a statement to your
we will generally consider Form 941-SS filed when it is
return showing the name of the person keeping the payroll
actually received. For more information about PDSs, see
records and the address where those records will be kept.
Where Should You File, later.
See Terminating a business in the General Instructions If any due date for filing falls on a Saturday, Sunday, or
for Forms W-2 and W-3 for information about earlier dates legal holiday, you may file your return on the next
for the expedited furnishing and filing of the following business day.
Wage and Tax Statements when a final Form 941-SS is
filed. How Should You Complete Form
• W-2AS, American Samoa.
941-SS?
• W-2CM, CNMI.
• W-2GU, Guam. Type or print your EIN, name, and address in the spaces
• W-2VI, U.S. Virgin Islands. provided. Also enter your name and EIN on the top of
pages 2 and 3. Don't use your social security number
If you participated in a statutory merger or (SSN) or individual taxpayer identification number (ITIN).
consolidation, or qualify for predecessor-successor status Generally, enter the business (legal) name you used when
due to an acquisition, you should generally file you applied for your EIN. For example, if you’re a sole
Schedule D (Form 941), Report of Discrepancies Caused proprietor, enter “Haleigh Smith” on the “Name” line and
by Acquisitions, Statutory Mergers, or Consolidations. “Haleigh's Cycles” on the “Trade name” line. Leave the
See the Instructions for Schedule D (Form 941) to “Trade name” line blank if it is the same as your “Name.”
determine whether you should file Schedule D (Form 941)
and when you should file it. If you use a tax preparer to fill out Form 941-SS, make
sure the preparer shows your business name exactly as it
When Must You File? appeared when you applied for your EIN.
File your initial Form 941-SS for the quarter in which you Employer identification number (EIN). To make sure
first paid wages that are subject to social security and that businesses comply with federal tax laws, the IRS
Medicare taxes. See the table titled When To File Form monitors tax filings and payments by using a numerical
941-SS, later. system to identify taxpayers. A unique nine-digit EIN is
Then, you must file for every quarter after that—every 3 assigned to all corporations, partnerships, and some sole
months—even if you have no taxes to report, unless proprietors. Businesses needing an EIN must apply for a
you’re a seasonal employer or are filing your final return. number and use it throughout the life of the business on all
See Seasonal employers and If Your Business Has tax returns, payments, and reports.
Closed, earlier. Your business should have only one EIN. If you have
File Form 941-SS only once for each quarter. If you more than one and aren't sure which one to use, write to
filed electronically, don't file a paper Form 941-SS. For the IRS office where you file your returns (using the
more information about filing Form 941-SS electronically, Without a payment address under Where Should You
see Electronic filing and payment, earlier. File, later) or call the IRS at 800-829-4933 (toll free; for
use by U.S. Virgin Islands only) or 267-941-1099 (toll call).
When To File Form 941-SS If you don't have an EIN, you may apply for one online
by going to IRS.gov/EIN. You may also apply for an EIN
Your Form 941-SS is due by the last day of the month that follows the end of the by faxing or mailing Form SS-4 to the IRS. If the principal
quarter.
business was created outside of the United States or U.S.
Form 941-SS
The Quarter Includes . . . Quarter Ends Is Due territories, you may also apply for an EIN by calling
267-941-1099 (toll call). If you haven't received your EIN
1. January, February, March March 31 April 30 by the due date of Form 941-SS, write “Applied For” and
2. April, May, June June 30 July 31 the date you applied in this entry space.
3. July, August, September September 30 October 31
4. October, November, December December 31 January 31

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If you’re filing your tax return electronically, a valid Reconciling Forms 941-SS With Form W-3SS
! EIN is required at the time the return is filed. If a The IRS matches amounts reported on your four quarterly
CAUTION valid EIN isn't provided, the return won't be
Forms 941-SS with Form W-2AS, W-2CM, W-2GU, or
accepted. This may result in penalties. W-2VI amounts totaled on your yearly Form W-3SS,
Transmittal of Wage and Tax Statements. If the amounts
Always be sure the EIN on the form you file
don't agree, you may be contacted by the IRS or the
TIP exactly matches the EIN the IRS assigned to your Social Security Administration (SSA). The following
business. Don't use your SSN or ITIN on forms
amounts are reconciled.
that ask for an EIN. If you used an EIN (including a prior
owner's EIN) on Form 941-SS that is different from the • Social security wages.
EIN reported on Form W-3SS, see Box h—Other EIN • Social security tips.
used this year in the General Instructions for Forms W-2 • Medicare wages and tips.
and W-3. Filing a Form 941-SS with an incorrect EIN or
using another business's EIN may result in penalties and Use Schedule D (Form 941) to explain certain wage,
delays in processing your return. tax, and payment discrepancies between Forms 941-SS
and Forms W-2AS, W-2CM, W-2GU, W-2VI, W-3SS, and
If you change your business name, business ad- W-2c, Corrected Wage and Tax Statement, that were
dress, or responsible party . . . Notify the IRS caused by acquisitions, statutory mergers, or
immediately if you change your business name, business consolidations. For more information, see the Instructions
address, or responsible party. for Schedule D (Form 941). Also see Rev. Proc. 2004-53
• Write to the IRS office where you file your returns (using for more information. You can find Rev. Proc. 2004-53 on
the Without a payment address under Where Should You page 320 of I.R.B. 2004-34 at IRS.gov/irb/
File, later) to notify the IRS of any business name change. 2004-34_IRB#RP-2004-53.
See Pub. 1635 to see if you need to apply for a new EIN.
• Complete and mail Form 8822-B to notify the IRS of a Where Should You File?
business address or responsible party change. Don't mail You're encouraged to file Form 941-SS electronically. Go
Form 8822-B with your Form 941-SS. For a definition of to IRS.gov/EmploymentEfile for more information on
“responsible party,” see the Instructions for Form SS-4. electronic filing. If you file a paper return, where you file
depends on whether you include a payment with Form
Check the Box for the Quarter 941-SS.
Under “Report for this Quarter of 2023” at the top of Form
941-SS, check the appropriate box of the quarter for PDSs can't deliver to P.O. boxes. You must use the
which you're filing. Make sure the quarter checked is the U.S. Postal Service to mail an item to a P.O. box address.
same as shown on any attached Schedule B (Form 941), Go to IRS.gov/PDS for the current list of PDSs. For the
Report of Tax Liability for Semiweekly IRS mailing address to use if you're using a PDS, go to
Schedule Depositors, and, if applicable, Schedule R IRS.gov/PDSstreetAddresses. Select the address on the
(Form 941). webpage that is given for the Ogden Submission
Processing Center.
Completing and Filing Form 941-SS
Without a
Make entries on Form 941-SS as follows to enable If you’re in . . . payment . . . With a payment . . .
accurate scanning and processing. American Samoa, Guam, CNMI, Internal Revenue Internal Revenue
• Use 10-point Courier font (if possible) for all entries if U.S. Virgin Islands Service Service
you’re typing or using a computer to complete your form. P.O. Box 409101 P.O. Box 932100
Portable Document Format (PDF) forms on IRS.gov have Ogden, UT 84409 Louisville, KY
fillable fields with acceptable font specifications. 40293-2100
• Don't enter dollar signs and decimal points. Commas Special filing addresses for Department of the Internal Revenue
are optional. Enter dollars to the left of the preprinted exempt organizations; federal, Treasury Service
decimal point and cents to the right of it. Don’t round state, and local governmental Internal Revenue P.O. Box 932100
entities; and Indian tribal Service Louisville, KY
entries to whole dollars. Always show an amount for governmental entities, Ogden, UT 40293-2100
cents, even if it is zero. regardless of location 84201-0005
• Leave blank any data field (except lines 1 and 12) with
a value of zero.
• Enter negative amounts using a minus sign (if possible). Your filing address may have changed from that
Otherwise, use parentheses. ! used to file your employment tax return in prior
• Enter your name and EIN on all pages and CAUTION years. Don't send Form 941-SS or any payments
attachments. to the SSA.
• Enter your name, EIN, “Form 941-SS,” and the tax year
and quarter on all attachments. Depositing Your Taxes
• Staple multiple sheets in the upper left corner when
filing. You must deposit all depository taxes
electronically by EFT. For more information, see
Complete all three pages. You must complete all three CAUTION! Federal tax deposits must be made by electronic
pages of Form 941-SS and sign on page 3. Failure to do funds transfer (EFT) under Reminders, earlier.
so may delay processing of your return.

Instructions for Form 941-SS (Rev. 3-2023) -7-

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Must You Deposit Your Taxes? • If you reported $50,000 or less in taxes during the
You may have to deposit both the employer and lookback period, you’re a monthly schedule depositor.
employee social security taxes and Medicare taxes. • If you reported more than $50,000 of taxes during the
• If your total taxes after adjustments and lookback period, you’re a semiweekly schedule
nonrefundable credits (line 12) are less than $2,500 depositor.
for the current quarter or the prior quarter, and you If you’re a monthly schedule depositor and
didn't incur a $100,000 next-day deposit obligation ! accumulate a $100,000 tax liability on any day
during the current quarter. You don't have to make a CAUTION during the deposit period, you become a
deposit. To avoid a penalty, you must pay any amount semiweekly schedule depositor on the next day and
due in full with a timely filed return or you must deposit any remain so for at least the rest of the calendar year and for
amount you owe by the due date of the return. For more the following calendar year. See $100,000 Next-Day
information on paying with a timely filed return, see the Deposit Rule in section 8 of Pub. 80 for more information.
instructions for line 14, later. If you’re not sure your total The $100,000 tax liability threshold requiring a next-day
tax liability for the current quarter will be less than $2,500 deposit is determined before you consider any reduction
(and your liability for the prior quarter wasn't less than of your liability for nonrefundable credits. For more
$2,500), make deposits using the semiweekly or monthly information, including an example, see frequently asked
rules so you won't be subject to failure-to-deposit (FTD) question 17 at IRS.gov/ETD.
penalties.
• If your total taxes after adjustments and What About Penalties and Interest?
nonrefundable credits (line 12) are $2,500 or more
for the current quarter and the prior quarter. You Avoiding Penalties and Interest
must make deposits according to your deposit schedule.
You can avoid paying penalties and interest if you do all of
See section 8 of Pub. 80 for information about payments
the following.
made under the accuracy of deposits rule and for rules
about federal tax deposits. • Deposit or pay your taxes when they are due, unless
you meet the requirements discussed in Notice 2020-22
Reducing your deposits for the credit for qualified and Notice 2021-24.
sick and family leave wages. Employers eligible to • File your fully completed Form 941-SS on time.
claim the credit for qualified sick and family leave wages • Report your tax liability accurately.
paid this quarter of 2023 for leave taken after March 31, • Submit valid checks for tax payments.
2020, and before October 1, 2021, can reduce their • Furnish accurate Forms W-2AS, W-2CM, W-2GU, or
deposits by the amount of their anticipated credit. W-2VI to employees.
Employers won’t be subject to an FTD penalty for • File Form W-3SS and Copy A of Forms W-2AS,
reducing their deposits if certain conditions are met. See W-2CM, W-2GU, or W-2VI with the SSA on time and
the instructions for line 11b and line 11d, later, for more accurately.
information on these credits. For more information on
reducing deposits, see Notice 2020-22, 2020-17 I.R.B. Penalties and interest are charged on taxes paid late
664, available at IRS.gov/irb/2020-17_IRB#NOT-2020-22; and returns filed late at a rate set by law. See section 8 of
and Notice 2021-24, 2021-18 I.R.B. 1122, available at Pub. 80 for details.
IRS.gov/irb/2021-18_IRB#NOT-2021-24. See the
instructions for line 16, later, for information on adjusting Use Form 843 to request abatement of assessed
tax liabilities reported on line 16 or Schedule B (Form 941) penalties or interest. Don't request abatement of
for nonrefundable credits. assessed penalties or interest on Form 941-SS or Form
941-X.
When Must You Deposit Your Taxes?
If you receive a notice about a penalty after you file this
Determine if You’re a Monthly or Semiweekly return, reply to the notice with an explanation and we will
Schedule Depositor for the Quarter determine if you meet reasonable-cause criteria. Don't
attach an explanation when you file your return.
The IRS uses two different sets of deposit rules to
determine when businesses must deposit their social If federal income, social security, and Medicare
security and Medicare taxes. These schedules tell you ! taxes that must be withheld (that is, trust fund
when a deposit is due after you have a payday. CAUTION taxes) aren't withheld or aren't deposited or paid
to the United States Treasury, the trust fund recovery
Your deposit schedule isn't determined by how often penalty may apply. The penalty is 100% of the unpaid
you pay your employees. Your deposit schedule depends trust fund tax. If these unpaid taxes can't be immediately
on the total tax liability you reported on Form 941-SS collected from the employer or business, the trust fund
during the previous 4-quarter lookback period (July 1 of recovery penalty may be imposed on all persons who are
the second preceding calendar year through June 30 of determined by the IRS to be responsible for collecting,
the preceding calendar year). See section 8 of Pub. 80 for accounting for, or paying over these taxes, and who acted
details. If you filed Form 944 in either 2021 or 2022, your willfully in not doing so. For more information, see section
lookback period is the 2021 calendar year. 8 of Pub. 80. The trust fund recovery penalty won’t apply
to any amount of trust fund taxes an employer holds back
Before the beginning of each calendar year, determine in anticipation of any credits they are entitled to.
which type of deposit schedule you must use.

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Adjustment of Tax on Tips If you’re a governmental employer, wages you pay
If, by the 10th of the month after the month you received ! aren't automatically exempt from social security
an employee's report on tips, you don't have enough CAUTION and Medicare taxes. Your employees may be
employee funds available to withhold the employee share covered by law or by a voluntary Section 218 Agreement
of social security and Medicare taxes, you no longer have with the SSA. For more information, see Pub. 963,
to collect it. Report the entire amount of these tips on Federal-State Reference Guide.
line 5b (Taxable social security tips), line 5c (Taxable
For purposes of these instructions, all references
Medicare wages and tips), and, if the withholding
to “sick pay” mean ordinary sick pay, not “qualified
threshold is met, line 5d (Taxable wages and tips subject TIP
sick leave wages” that are reported on line 5a(i)
to Additional Medicare Tax withholding). Include as a
for leave taken after March 31, 2020, and before April 1,
negative adjustment on line 9 the total uncollected
2021, or reported on line 5a for leave taken after March
employee share of the social security and Medicare taxes.
31, 2021, and before October 1, 2021.
Where Can You Obtain Forms?
5a–5e. Taxable Social Security and Medicare
See Pub. 80 for information on ordering IRS forms. You
Wages and Tips
may also be able to get some IRS forms at the addresses
listed next. Qualified sick leave wages and qualified family
leave wages paid this quarter of 2023 for leave
American Samoa Tax Office CAUTION! taken after March 31, 2020, and before April 1,
Executive Office Building, First Floor 2021, are reported on lines 5a(i) and 5a(ii), respectively.
Pago Pago, AS 96799 Qualified sick leave wages and qualified family leave
wages paid this quarter of 2023 for leave taken after
CNMI CNMI Division of Revenue and Taxation
Joeten Dandan Commercial Center March 31, 2021, and before October 1, 2021, are reported
Saipan, MP 96950 on line 5a.

Guam Department of Revenue and Taxation 5a. Taxable social security wages. Enter the total
Government of Guam wages, including qualified sick leave wages and qualified
1240 Army Drive
Barrigada, GU 96913 family leave wages paid this quarter of 2023 for leave
taken after March 31, 2021, and before October 1, 2021;
U.S. Virgin Islands Bureau of Internal Revenue sick pay; and taxable fringe benefits subject to social
6115 Estate Smith Bay, Ste 225 security taxes you paid to your employees during the
St. Thomas, VI 00802
quarter. Don't include the qualified sick leave wages paid
this quarter of 2023 that are reported on line 5a(i) or
qualified family leave wages paid this quarter of 2023 that
are reported on line 5a(ii) for leave taken after March 31,
Specific Instructions: 2020, and before April 1, 2021. For this purpose, sick pay
includes payments made by an insurance company to
Part 1: Answer These Questions for your employees for which you received timely notice from
This Quarter the insurance company. See section 6 of Pub. 15-A for
more information about sick pay reporting. See the
1. Number of Employees Who Received Wages, instructions for line 8 for an adjustment that you may need
Tips, or Other Compensation to make on Form 941-SS for sick pay.
Enter the number of employees on your payroll for the pay Enter the amount before payroll deductions. Don't
period including March 12, June 12, September 12, or include tips on this line. For information on types of wages
December 12, for the quarter indicated at the top of the subject to social security taxes, see section 4 of Pub. 80.
Form 941-SS. Don't include: For 2023, the rate of social security tax on taxable
• Household employees, wages, except for qualified sick leave wages and qualified
• Employees in nonpay status for the pay period, family leave wages paid in 2023 for leave taken after
• Farm employees, March 31, 2020, and before April 1, 2021, is 6.2% (0.062)
• Pensioners, or each for the employer and employee or 12.4% (0.124) for
• Active members of the U.S. Armed Forces. both. Stop paying social security tax on and entering an
employee's wages on line 5a when the employee's
4. If No Wages, Tips, and Other Compensation taxable wages, including qualified sick leave wages paid
Are Subject to Social Security or Medicare in 2023 that are reported on line 5a(i), qualified family
Tax . . . leave wages paid in 2023 that are reported on line 5a(ii),
and tips, reach $160,200 for the year. However, continue
If no wages, tips, and compensation are subject to social
to withhold Medicare taxes for the whole year on all
security or Medicare tax, check the box on line 4. If this
wages, including qualified sick leave wages paid in 2023,
question doesn't apply to you, leave the box blank. For
qualified family leave wages paid in 2023, and tips, even
more information about exempt wages, see section 12 of
when the social security wage base of $160,200 has been
Pub. 80. For religious exemptions, see section 4 of Pub.
reached.
15-A.

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For purposes of the credit for qualified sick and family        COVID-19, or to care for an individual who is recovering 
leave wages, qualified sick leave and family leave wages        from any injury, disability, illness, or condition related to 
are wages for social security and Medicare tax purposes,        the immunization.
determined without regard to the exclusions from the 
                                                                     Son or daughter. A son or daughter must generally 
definition of employment under sections 3121(b)(1)–(22), 
                                                                have been under 18 years of age or incapable of self-care 
that an employer pays that otherwise meet the 
                                                                because of a mental or physical disability. A son or 
requirements of the Emergency Paid Sick Leave Act 
                                                                daughter includes a biological child, adopted child, 
(EPSLA) or the Emergency Family and Medical Leave 
                                                                stepchild, foster child, legal ward, or a child for whom the 
Expansion Act (Expanded FMLA), as enacted under the 
                                                                employee assumes parental status and carries out the 
FFCRA and amended for purposes of the ARP. However, 
                                                                obligations of a parent.
don't include any wages otherwise excluded under 
section 3121(b) when reporting qualified sick and family             Limits on qualified sick leave wages. The EPSLA, 
leave wages on lines 5a, 5a(i), 5a(ii), 5c, and, if             as amended for purposes of the ARP, provides different 
applicable, 5d. See the instructions for line 11d for           limitations for different circumstances under which 
information about the credit for qualified sick and family      qualified sick leave wages are paid. For paid sick leave 
leave wages for leave taken after March 31, 2021, and           qualifying under (1), (2), or (3) above, the amount of 
before October 1, 2021.                                         qualified sick leave wages is determined at the 
                                                                employee's regular rate of pay, but the wages may not 
              line 5a  (column 1)                               exceed $511 for any day (or portion of a day) for which the 
              x  0.124                                          individual is paid sick leave. For paid sick leave qualifying 
              line 5a  (column 2)                               under (4), (5), or (6) above, the amount of qualified sick 
                                                                leave wages is determined at two-thirds the employee's 
                                                                regular rate of pay, but the wages may not exceed $200 
EPSLA.    Employers with fewer than 500 employees               for any day (or portion of a day) for which the individual is 
and, for leave taken after March 31, 2021, and before           paid sick leave. The EPSLA also limits each individual to a 
October 1, 2021, certain governmental employers without         maximum of up to 80 hours of paid sick leave in total for 
regard to number of employees (except for the federal           leave taken after March 31, 2020, and before April 1, 
government and its agencies and instrumentalities unless        2021. The ARP resets this limit at 80 hours of paid sick 
described in section 501(c)(1)) are entitled to a credit if     leave for leave taken after March 31, 2021, and before 
they provide paid sick leave to employees that otherwise        October 1, 2021. Therefore, for leave taken after March 
meets the requirements of the EPSLA. Under the EPSLA,           31, 2020, and before April 1, 2021, the maximum amount 
as amended for purposes of the ARP, wages are qualified         of paid sick leave wages can't exceed $5,110 for an 
sick leave wages if paid to employees that are unable to        employee for leave under (1), (2), or (3), and it can't 
work or telework before October 1, 2021, because the            exceed $2,000 for an employee for leave under (4), (5), or 
employee:                                                       (6). These maximum amounts also reset and apply to 
1. Is subject to a federal, state (including U.S.               leave taken after March 31, 2021, and before October 1, 
territories), or local quarantine or isolation order related to 2021.
COVID-19;                                                            For more information about qualified sick leave wages, 
2. Has been advised by a health care provider to                go to IRS.gov/PLC.
self-quarantine due to concerns related to COVID-19;                 Expanded FMLA.   Employers with fewer than 500 
3. Is experiencing symptoms of COVID-19 and                     employees and, for leave taken after March 31, 2021, and 
seeking a medical diagnosis; or, for leave taken after          before October 1, 2021, certain governmental employers 
March 31, 2021, and before October 1, 2021, is seeking          without regard to number of employees (except for the 
or awaiting the results of a diagnostic test for, or a medical  federal government and its agencies and instrumentalities 
diagnosis of, COVID-19 (and the employee has been               unless described in section 501(c)(1)) are entitled to a 
exposed to COVID-19 or the employee's employer has              credit under the FFCRA, as amended for purposes of the 
requested such test or diagnosis), or the employee is           ARP, if they provide paid family leave to employees that 
obtaining immunizations related to COVID-19 or                  otherwise meets the requirements of the Expanded 
recovering from an injury, disability, illness, or condition    FMLA. For leave taken after March 31, 2020, and before 
related to such immunization;                                   April 1, 2021, wages are qualified family leave wages if 
                                                                paid to an employee who has been employed for at least 
4. Is caring for an individual subject to an order              30 calendar days when an employee is unable to work or 
described in (1) or who has been advised as described in        telework due to the need to care for a son or daughter 
(2);                                                            under 18 years of age or incapable of self-care because of 
5. Is caring for a son or daughter because the school           a mental or physical disability because the school or place 
or place of care for that child has been closed, or the         of care for that child has been closed, or the childcare 
childcare provider for that child is unavailable, due to        provider for that child is unavailable, due to a public health 
COVID-19 precautions; or                                        emergency. See Son or daughter, earlier, for more 
6. Is experiencing any other substantially similar              information. For leave taken after March 31, 2021, and 
condition specified by the U.S. Department of Health and        before October 1, 2021, the leave can be granted for any 
Human Services, which for leave taken after March 31,           other reason provided by the EPSLA, as amended for 
2021, and before October 1, 2021, includes to                   purposes of the ARP.
accompany an individual to obtain immunization related to 

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For leave taken after March 31, 2020, and before April 5a(ii). Qualified family leave wages. Enter the qualified
1, 2021, the first 10 days for which an employee takes taxable (subject to social security tax) family leave wages
leave may be unpaid. During this period, employees may you paid this quarter of 2023 to your employees for leave
use other forms of paid leave, such as qualified sick leave, taken after March 31, 2020, and before April 1, 2021.
accrued sick leave, annual leave, or other paid time off. Qualified family leave wages for leave taken after March
After an employee takes leave for 10 days, the employer 31, 2020, and before April 1, 2021, aren't subject to the
must provide the employee paid leave (that is, qualified employer share of social security tax; therefore, the tax
family leave wages) for up to 10 weeks. For leave taken rate on these wages is 6.2% (0.062). Stop paying social
after March 31, 2021, and before October 1, 2021, the security tax on and entering an employee's wages on
10-day rule discussed above doesn't apply and the paid line 5a(ii) when the employee's taxable wages, including
leave can be provided for up to 12 weeks. wages reported on line 5a, qualified sick leave wages
Rate of pay and limit on wages. The rate of pay must reported on line 5a(i), qualified family leave wages
be at least two-thirds of the employee’s regular rate of pay reported on line 5a(ii), and tips, reach $160,200 for the
(as determined under the Fair Labor Standards Act of year. See the instructions for line 5c for reporting
1938), multiplied by the number of hours the employee Medicare tax on qualified family leave wages, including
would have otherwise been scheduled to work. For leave the portion above the social security wage base.
taken after March 31, 2020, and before April 1, 2021, the
For purposes of the credit for qualified sick and family
total qualified family leave wages can’t exceed $200 per
leave wages, qualified family leave wages are wages for
day or $10,000 in the aggregate per employee. For leave
social security and Medicare tax purposes, determined
taken after March 31, 2021, and before October 1, 2021,
without regard to the exclusions from the definition of
the limit resets and the total qualified family leave wages
employment under sections 3121(b)(1)–(22), that an
can't exceed $200 per day or $12,000 in the aggregate
employer pays that otherwise meet the requirements of
per employee.
the Expanded FMLA, as enacted under the FFCRA and
For more information about qualified family leave amended by the COVID-related Tax Relief Act of 2020.
wages, go to IRS.gov/PLC. However, don't include any wages otherwise excluded
5a(i). Qualified sick leave wages. Enter the qualified under section 3121(b) when reporting qualified family
taxable (subject to social security tax) sick leave wages leave wages on lines 5a(ii), 5c, and, if applicable, 5d. See
you paid this quarter of 2023 to your employees for leave the instructions for line 11b for information about the credit
taken after March 31, 2020, and before April 1, 2021. for qualified sick and family leave wages for leave taken
Qualified sick leave wages for leave taken after March 31, after March 31, 2020, and before April 1, 2021.
2020, and before April 1, 2021, aren't subject to the line 5a(ii) (column 1)
employer share of social security tax; therefore, the tax x 0.062
rate on these wages is 6.2% (0.062). Stop paying social
line 5a(ii) (column 2)
security tax on and entering an employee's wages on
line 5a(i) when the employee's taxable wages, including
wages reported on line 5a, qualified sick leave wages
reported on line 5a(i), qualified family leave wages 5b. Taxable social security tips. Enter all tips your
reported on line 5a(ii), and tips, reach $160,200 for the employees reported to you during the quarter until the
year. See the instructions for line 5c for reporting total of the tips and taxable wages, including wages
Medicare tax on qualified sick leave wages, including the reported on line 5a, qualified sick leave wages reported
portion above the social security wage base. on line 5a(i), and qualified family leave wages reported on
line 5a(ii), for an employee reach $160,200 for the year.
For purposes of the credit for qualified sick and family Include all tips your employee reported to you even if you
leave wages, qualified sick leave wages are wages for were unable to withhold the employee tax of 6.2%. You
social security and Medicare tax purposes, determined will reduce your total taxes by the amount of any
without regard to the exclusions from the definition of uncollected employee share of social security and
employment under sections 3121(b)(1)–(22), that an Medicare taxes on tips later on line 9; see Current
employer pays that otherwise meet the requirements of quarter's adjustments for tips and group-term life
the EPSLA, as enacted under the FFCRA and amended insurance, later. Don't include service charges on line 5b.
by the COVID-related Tax Relief Act of 2020. However, For details about the difference between tips and service
don't include any wages otherwise excluded under charges, see Rev. Rul. 2012-18, 2012-26 I.R.B. 1032,
section 3121(b) when reporting qualified sick leave wages available at IRS.gov/irb/2012-26_IRB#RR-2012-18.
on lines 5a(i), 5c, and, if applicable, 5d. See the
instructions for line 11b for information about the credit for Your employee must report cash tips to you by the 10th
qualified sick and family leave wages for leave taken after day of the month after the month the tips are received.
March 31, 2020, and before April 1, 2021. Cash tips include tips paid by cash, check, debit card, and
credit card. The report should include charged tips (for
line 5a(i) (column 1) example, credit and debit card charges) you paid over to
x 0.062 the employee for charge customers, tips the employee
line 5a(i) (column 2) received directly from customers, and tips received from
other employees under any tip-sharing arrangement. Both
directly and indirectly tipped employees must report tips to
you. No report is required for months when tips are less
than $20. Employees may use Form 4070 (available only

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in Pub. 1244) or submit a written statement or electronic line 5d (column 1)
tip record. x 0.009
Don't include allocated tips on this line. Instead, report line 5d (column 2)
them on Form 8027. Allocated tips aren't reportable on
Form 941-SS and aren't subject to withholding of social
security or Medicare taxes. 5e. Total social security and Medicare taxes. Add the
column 2 amounts on lines 5a–5d. Enter the result on
line 5b (column 1)
line 5e.
x 0.124
line 5b (column 2) 5f. Section 3121(q) Notice and Demand—Tax
Due on Unreported Tips
Enter the tax due from your Section 3121(q) Notice and
5c. Taxable Medicare wages & tips. Enter all wages,
Demand on line 5f. The IRS issues a Section 3121(q)
including qualified sick leave wages paid this quarter of
Notice and Demand to advise an employer of the amount
2023, and qualified family leave wages paid this quarter of
of tips received by employees who failed to report or
2023; tips; sick pay; and taxable fringe benefits that are
underreported tips to the employer. An employer isn't
subject to Medicare tax. Unlike social security wages,
liable for the employer share of the social security and
there is no limit on the amount of wages subject to
Medicare taxes on unreported tips until notice and
Medicare tax.
demand for the taxes is made to the employer by the IRS
The rate of Medicare tax is 1.45% (0.0145) each for the in a Section 3121(q) Notice and Demand. The tax due
employer and employee or 2.9% (0.029) for both. Include may have been determined from tips reported to the IRS
all tips your employees reported during the quarter, even if on employees' Forms 4137, Social Security and Medicare
you were unable to withhold the employee tax of 1.45%. Tax on Unreported Tip Income, or other tips that weren't
reported to their employer as determined by the IRS
line 5c (column 1)
during an examination. For additional information, see
x 0.029
Rev. Rul. 2012-18.
line 5c (column 2)
Deposit the tax within the time period required under
your deposit schedule to avoid any possible deposit
For more information on tips, see section 5 of Pub. 80. penalty. The tax is treated as accumulated by the
See the instructions for line 8 for an adjustment that you employer on the “Date of Notice and Demand” as printed
may need to make on Form 941-SS for sick pay. on the Section 3121(q) Notice and Demand. The
5d. Taxable wages & tips subject to Additional Medi- employer must include this amount on the appropriate line
care Tax withholding. Enter all wages, including of the record of federal tax liability (Part 2 of Form 941-SS
qualified sick leave wages paid this quarter of 2023, and for a monthly schedule depositor or Schedule B (Form
qualified family leave wages paid this quarter of 2023; 941) for a semiweekly schedule depositor).

tips; sick pay; and taxable fringe benefits that are subject 6. Total Taxes Before Adjustments
to Additional Medicare Tax withholding. You’re required to
begin withholding Additional Medicare Tax in the pay Add the total social security and Medicare taxes before
period in which you pay wages in excess of $200,000 to adjustments (line 5e) and any tax due under a Section
an employee and continue to withhold it each pay period 3121(q) Notice and Demand (line 5f). Enter the result on
until the end of the calendar year. Additional Medicare line 6.
Tax is only imposed on the employee. There is no
7–9. Tax Adjustments
employer share of Additional Medicare Tax. All wages that
are subject to Medicare tax are subject to Additional Enter tax amounts on lines 7–9 that result from current
Medicare Tax withholding if paid in excess of the quarter adjustments. Use a minus sign (if possible) to
$200,000 withholding threshold. show an adjustment that decreases the total taxes shown
on line 6 instead of parentheses. Doing so enhances the
For more information on what wages are subject to accuracy of our scanning software. For example, enter
Medicare tax, see the chart, Special Rules for Various “-10.59” instead of “(10.59).” However, if your software
Types of Employment and Payments, in section 12 of only allows for parentheses in entering negative amounts,
Pub. 80. For more information on Additional Medicare you may use them.
Tax, go to IRS.gov/ADMTfaqs. See the instructions for
line 8 for an adjustment that you may need to make on Current quarter's adjustments. In certain cases, you
Form 941-SS for sick pay. must adjust the amounts you entered as social security
Once wages and tips exceed the $200,000 withholding and Medicare taxes in column 2 of lines 5a–5d to figure
threshold, include all tips your employees reported during your correct tax liability for this quarter's Form 941-SS.
the quarter, even if you were unable to withhold the See section 9 of Pub. 80.
employee tax of 0.9%. 7. Current quarter's adjustment for fractions of
cents. Enter adjustments for fractions of cents (due to
rounding) relating to the employee share of social security
and Medicare taxes withheld. The employee share of
amounts shown in column 2 of lines 5a–5d may differ
slightly from amounts actually withheld from employees'

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pay due to the rounding of social security and Medicare Form 941-SS and these instructions use the terms
taxes based on statutory rates. This adjustment may be a TIP “nonrefundable” and “refundable” when
positive or negative adjustment. discussing credits. The term “nonrefundable”
8. Current quarter's adjustment for sick pay. If means the portion of the credit which is limited by law to
your third-party payer of sick pay that isn't your agent (for the amount of certain taxes. The term “refundable” means
example, an insurance company) transfers the liability for the portion of the credit which is in excess of those taxes.
the employer share of the social security and Medicare
taxes to you, enter a negative adjustment on line 8 for the 11b. Nonrefundable Portion of Credit for
employee share of social security and Medicare taxes that Qualified Sick and Family Leave Wages for
were withheld and deposited by your third-party sick pay
Leave Taken After March 31, 2020, and Before
payer on the sick pay. If you’re the third-party sick pay
payer and you transferred the liability for the employer April 1, 2021
share of the social security and Medicare taxes to the Complete line 11b only if qualified sick leave
employer, enter a negative adjustment on line 8 for any ! wages and/or qualified family leave wages were
employer share of these taxes required to be paid by the CAUTION paid this quarter of 2023 for leave taken after
employer. The sick pay should be included on line 5a, March 31, 2020, and before April 1, 2021.
line 5c, and, if the withholding threshold is met, line 5d.
Certain private employers with fewer than 500
No adjustment is reported on line 8 for sick pay that is employees that provide paid sick leave under the EPSLA
paid through a third party as an employer’s agent. An and/or provide paid family leave under the Expanded
employer’s agent bears no insurance risk and is FMLA are eligible to claim the credit for qualified sick and
reimbursed on a cost-plus-fee basis for payment of sick family leave wages for leave taken after March 31, 2020,
pay and similar amounts. If an employer uses an agent to and before April 1, 2021. For purposes of this credit,
pay sick pay, the employer reports the wages on line 5a, qualified sick leave wages and qualified family leave
line 5c, and, if the withholding threshold is met, line 5d, wages are wages for social security and Medicare tax
unless the employer has an agency agreement with the purposes, determined without regard to the exclusions
third-party payer that requires the third-party payer to do from the definition of employment under sections 3121(b)
the collecting, reporting, and/or paying or depositing (1)–(22), that an employer pays that otherwise meet the
employment taxes on the sick pay. See section 6 of Pub. requirements of the EPSLA or Expanded FMLA. Enter the
15-A for more information about sick pay reporting. nonrefundable portion of the credit for qualified sick and
9. Current quarter's adjustments for tips and family leave wages from Worksheet 1, Step 2, line 2j. The
group-term life insurance. Enter a negative adjustment credit for qualified sick and family leave wages consists of
for: the qualified sick leave wages, the qualified family leave
• Any uncollected employee share of social security and wages, the qualified health plan expenses allocable to
Medicare taxes on tips, and those wages, and the employer share of Medicare tax
• The uncollected employee share of social security and allocable to those wages. The nonrefundable portion of
Medicare taxes on group-term life insurance premiums the credit is limited to the employer share of social
paid for former employees. security tax reported on Form 941-SS, lines 5a and 5b,
See the General Instructions for Forms W-2 and W-3 after that share is first reduced by any credit claimed
for information on how to report the uncollected employee against the employer share of social security tax on Form
share of social security and Medicare taxes on tips and 8974 for the qualified small business payroll tax credit for
group-term life insurance on Form W-2. increasing research activities, any credit to be claimed on
Form 5884-C for the work opportunity credit for qualified
Prior quarter's adjustments. If you need to correct any
tax-exempt organizations hiring qualified veterans, and/or
adjustment reported on a previously filed Form 941-SS,
any credit to be claimed on Form 5884-D for the disaster
complete and file Form 941-X. Form 941-X is an adjusted
credit for qualified tax-exempt organizations.
return or claim for refund and is filed separately from Form
941-SS. See section 9 of Pub. 80. If you're a third-party payer of sick pay that isn't an
agent (for example, an insurance company) and
10. Total Taxes After Adjustments CAUTION! you're claiming the credit for qualified sick and
Combine the amounts shown on lines 6–9 and enter the family leave wages for amounts paid to your own
result on line 10. employees, the amount of the employer share of social
security tax reported on line 5a must be reduced by any
11a. Qualified Small Business Payroll Tax Credit adjustment you make on line 8 for the employer share of
for Increasing Research Activities social security tax transferred to your client. If you
Enter the amount of the credit from Form 8974, line 12 or, received a Section 3121(q) Notice and Demand for tax
if applicable, line 17. due on unreported tips (Letter 3263 or Letter 4520) during
the quarter, you report the amount for the employer share
If you enter an amount on line 11a, you must of social security tax and Medicare tax on Form 941-SS,
! attach Form 8974. line 5f. Letter 3263 or Letter 4520 includes an attachment
CAUTION
that shows the employer share of social security tax. This
amount of the employer share of social security tax can
also be reduced by the nonrefundable portion of the
credit. See Worksheet 1 to figure your credit.

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   Any credit in excess of the remaining amount of the      •    Qualified sick leave wages and/or qualified family leave 
employer share of social security tax is refundable and     wages;
reported on Form 941-SS, line 13c. For more information     •    Qualified health plan expenses allocable to qualified 
on the credit for qualified sick and family leave wages, go sick leave and family leave wages;
to IRS.gov/PLC.                                             •    Collectively bargained defined benefit pension plan 
                                                            contributions, subject to the qualified leave wage 
Qualified health plan expenses allocable to qualified 
                                                            limitations, allocable to the qualified sick and family leave 
sick leave and family leave wages.   The credit for 
                                                            wages;
qualified sick leave wages and qualified family leave 
wages is increased to cover the qualified health plan       •    Collectively bargained apprenticeship program 
                                                            contributions, subject to the qualified leave wage 
expenses that are properly allocable to the qualified leave 
                                                            limitations, allocable to the qualified sick and family leave 
wages for which the credit is allowed. These qualified 
                                                            wages; and
health plan expenses are amounts paid or incurred by the 
employer to provide and maintain a group health plan but    •    Employer share of social security and Medicare tax 
                                                            allocable to the qualified sick and family leave wages.
only to the extent such amounts are excluded from the 
employees’ income as coverage under an accident or               The nonrefundable portion of the credit is limited to the 
health plan. The amount of qualified health plan expenses   employer share of Medicare tax reported on Form 
generally includes both the portion of the cost paid by the 941-SS, line 5c, after that share is first reduced by any 
employer and the portion of the cost paid by the employee   credit claimed against the employer share of Medicare tax 
with pre-tax salary reduction contributions. However,       on Form 8974 for the qualified small business payroll tax 
qualified health plan expenses don’t include amounts that   credit for increasing research activities. You can’t claim 
the employee paid for with after-tax contributions. For     the credit for leave taken after March 31, 2021, and before 
more information, go to IRS.gov/PLC.                        October 1, 2021, if, during the applicable quarter in which 
        You must include the full amount (both the          the qualified sick or family leave wages were paid, you 
TIP     nonrefundable and refundable portions) of the       made qualified sick or family leave wages available in a 
        credit for qualified sick and family leave wages in manner that discriminates in favor of highly compensated 
your gross income for the tax year that includes the last   employees, full-time employees, or employees on the 
day of any calendar quarter in which a credit is allowed.   basis of employment tenure. See Highly compensated 
                                                            employee, later, for the definition.
11d. Nonrefundable Portion of Credit for                         For leave taken after March 31, 2021, and before 
Qualified Sick and Family Leave Wages for                   October 1, 2021, the credit for qualified sick and family 
Leave Taken After March 31, 2021, and Before                leave wages is reduced by the amount of the credit 
October 1, 2021                                             allowed under section 41 (for the credit for increasing 
                                                            research activities) with respect to wages taken into 
        Complete line 11d only if qualified sick leave      account for determining the credit for qualified sick and 
   !    wages and/or qualified family leave wages were      family leave wages; and any wages taken into account in 
CAUTION paid this quarter of 2023 for leave taken after 
                                                            determining the credit for qualified sick and family leave 
March 31, 2021, and before October 1, 2021.                 wages can't be taken into account as wages for purposes 
   Employers with fewer than 500 employees and certain      of the credits under sections 45A, 45P, 45S, and 51. For 
governmental employers without regard to number of          leave taken after March 31, 2021, and before October 1, 
employees (except for the federal government and its        2021, qualified wages also don't include wages that were 
agencies and instrumentalities unless described in          used as payroll costs in connection with a Shuttered 
section 501(c)(1)) are entitled to a credit if they provide Venue Operator Grant under section 324 of the Economic 
paid sick leave to employees that otherwise meets the       Aid to Hard-Hit Small Businesses, Nonprofits, and Venues 
requirements of the EPSLA, as amended for purposes of       Act; or a restaurant revitalization grant under section 5003 
the ARP, and/or provide paid family leave to employees      of the ARP. Employers can receive both a Small Business 
that otherwise meets the requirements under the             Interruption Loan under the Paycheck Protection Program 
Expanded FMLA, as amended for purposes of the ARP,          (PPP) and the credit for qualified sick and family leave 
for qualified sick and family leave wages for leave taken   wages; however, employers can't receive both loan 
after March 31, 2021, and before October 1, 2021. For       forgiveness and a credit for the same wages. The same 
purposes of this credit, qualified sick leave wages and     wages can’t be treated as both qualified sick leave wages 
qualified family leave wages are wages for social security  and qualified family leave wages.
and Medicare tax purposes, determined without regard to             If you're a third-party payer of sick pay that isn't an 
the exclusions from the definition of employment under           !  agent (for example, an insurance company) and 
sections 3121(b)(1)–(22), that an employer pays that        CAUTION you're claiming the credit for qualified sick and 
otherwise meet the requirements of the EPSLA or             family leave wages for amounts paid to your own 
Expanded FMLA, as enacted under the FFCRA and               employees, the amount of the employer share of 
amended for purposes of the ARP. Enter the                  Medicare tax reported on line 5c must be reduced by any 
nonrefundable portion of the credit for qualified sick and  adjustment you make on line 8 for the employer share of 
family leave wages from Worksheet 2, Step 2, line 2p.       Medicare tax transferred to your client. If you received a 
   The credit for qualified sick and family leave wages     Section 3121(q) Notice and Demand for tax due on 
consists of the:                                            unreported tips (Letter 3263 or Letter 4520) during the 
                                                            quarter, you report the amount for the employer share of 

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social security tax and Medicare tax on Form 941-SS, is an apprenticeship registered under the National
line 5f. Letter 3263 or Letter 4520 includes an attachment Apprenticeship Act of August 16, 1937, and meets the
that shows the employer share of Medicare tax. This standards of Federal Regulations under subpart A of Part
amount of the employer share of Medicare tax can also be 29 and Part 30 of title 29;
reduced by the nonrefundable portion of the credit. See • Made based on an apprenticeship program contribution
Worksheet 2 to figure your credit. rate; and
• Required to be made under the terms of a collective
Any credit in excess of the remaining amount of the bargaining agreement in effect for the quarter.
employer share of Medicare tax is refundable and Apprenticeship program contribution rate. The
reported on Form 941-SS, line 13e. For more information apprenticeship program contribution rate is the
on the credit for qualified sick and family leave wages, go contribution rate that the employer is obligated to pay
to IRS.gov/PLC. under the terms of a collective bargaining agreement for
benefits under a registered apprenticeship program, as
Qualified health plan expenses allocable to qualified the rate is applied to contribution base units, as defined by
sick leave and family leave wages. The credit for section 4001(a)(11) of ERISA.
qualified sick leave wages and qualified family leave
Allocation rules. The amount of collectively bargained
wages is increased to cover the qualified health plan
apprenticeship program contributions allocated to
expenses that are properly allocable to the qualified leave
qualified sick leave wages and/or qualified family leave
wages for which the credit is allowed. These qualified
wages in a quarter is the apprenticeship program
health plan expenses are amounts paid or incurred by the
contribution rate (expressed as an hourly rate) multiplied
employer to provide and maintain a group health plan but
by the number of hours qualified sick leave wages and/or
only to the extent such amounts are excluded from the
qualified family leave wages were provided to employees
employees' income as coverage under an accident or
covered under the collective bargaining agreement during
health plan. The amount of qualified health plan expenses
the quarter.
generally includes both the portion of the cost paid by the
employer and the portion of the cost paid by the employee Highly compensated employee. A highly compensated
with pre-tax salary reduction contributions. However, employee is an employee who meets either of the
qualified health plan expenses don't include amounts that following tests.
the employee paid for with after-tax contributions. For 1. The employee was a 5% owner at any time during
more information, go to IRS.gov/PLC. the year or the preceding year.
Collectively bargained defined benefit pension plan 2. The employee received more than $135,000 in pay
contributions. For purposes of qualified sick and family for the preceding year.
leave wages, collectively bargained defined benefit
You can choose to ignore test (2) if the employee
pension plan contributions are contributions for a calendar
wasn’t also in the top 20% of employees when ranked by
quarter that are:
pay for the preceding year.
• Paid or incurred by an employer on behalf of its
employees to a defined benefit plan, as defined in section 11g. Total Nonrefundable Credits
414(j), which meets the requirements of section 401(a);
• Made based on a pension contribution rate; and Add lines 11a, 11b, and 11d. Enter the total on line 11g.

• Required to be made under the terms of a collective 12. Total Taxes After Adjustments and
bargaining agreement in effect for the quarter.
Nonrefundable Credits
Pension contribution rate. The pension contribution
rate is the contribution rate that the employer is obligated Subtract line 11g from line 10 and enter the result on
to pay under the terms of a collective bargaining line 12. The amount entered on line 12 can't be less than
agreement to a defined benefit plan, as the rate is applied zero.
to contribution base units, as defined by section 4001(a)
(11) of the Employee Retirement Income Security Act of • If line 12 is less than $2,500 or line 12 on the prior
quarterly return was less than $2,500, and you didn't
1974 (ERISA).
incur a $100,000 next-day deposit obligation during
Allocation rules. The amount of collectively bargained
the current quarter. You may pay the amount with Form
defined benefit pension plan contributions allocated to 941-SS or you may deposit the amount. To avoid a
qualified sick leave wages and/or qualified family leave
penalty, you must pay any amount you owe in full with a
wages in a quarter is the pension contribution rate timely filed return or you must deposit any amount you
(expressed as an hourly rate) multiplied by the number of
owe before the due date of the return. For more
hours qualified sick leave wages and/or qualified family information on paying with a timely filed return, see the
leave wages were provided to employees covered under
instructions for line 14, later.
the collective bargaining agreement during the quarter. If line 12 is $2,500 or more and line 12 on the prior
•
Collectively bargained apprenticeship program con- quarterly return was $2,500 or more, or if you
tributions. For purposes of qualified sick and family incurred a $100,000 next-day deposit obligation
leave wages, collectively bargained apprenticeship during the current quarter. You must make required
program contributions are contributions for a calendar deposits according to your deposit schedule. See Notice
quarter that are: 2020-22 and Notice 2021-24 for information on reducing
• Paid or incurred by an employer on behalf of its deposits for certain credits. The amount shown on line 12
employees to a registered apprenticeship program, which must equal the “Total liability for quarter” shown on line 16

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or the “Total liability for the quarter” shown on Schedule B requirements of the EPSLA, as amended for purposes of
(Form 941). For more information, see the line 16 the ARP, and/or provide paid family leave to employees
instructions, later. that otherwise meets the requirements under the
Expanded FMLA, as amended for purposes of the ARP,
For more information and rules about federal tax for leave taken after March 31, 2021, and before October
deposits, see Depositing Your Taxes, earlier, and section 1, 2021. Enter the refundable portion of the credit for
8 of Pub. 80. qualified sick and family leave wages from Worksheet 2,
If you’re a semiweekly schedule depositor, you Step 2, line 2q. The refundable portion of the credit is
! must complete Schedule B (Form 941). If you fail allowed after the employer share of Medicare tax is
CAUTION to complete and submit Schedule B (Form 941), reduced to zero by nonrefundable credits that are applied
the IRS may assess deposit penalties based on available against the employer share of Medicare tax.
information.
13g. Total Deposits and Refundable Credits
13a. Total Deposits for This Quarter Add lines 13a, 13c, and 13e. Enter the total on line 13g.

Enter your deposits for this quarter, including any 14. Balance Due
overpayment from a prior quarter that you applied to this
return. Also include in the amount shown any If line 12 is more than line 13g, enter the difference on
overpayment that you applied from filing Form 941-X, line 14. Otherwise, see the instructions for line 15, later.
944-X, or 944-X (SP) in the current quarter. Don't include Never make an entry on both lines 14 and 15.
any amount that you didn't deposit because you reduced
your deposits in anticipation of the credit for qualified sick You don't have to pay if line 14 is under $1. Generally,
and family leave wages, as discussed in Notice 2020-22 you should have a balance due only if your total taxes
and Notice 2021-24. after adjustments and nonrefundable credits (line 12) for
the current quarter or prior quarter are less than $2,500,
13c. Refundable Portion of Credit for Qualified and you didn't incur a $100,000 next-day deposit
Sick and Family Leave Wages for Leave Taken obligation during the current quarter. However, see
After March 31, 2020, and Before April 1, 2021 section 8 of Pub. 80 for information about payments made
under the accuracy of deposits rule.
Complete line 13c only if qualified sick leave
If you were required to make federal tax deposits, pay
CAUTION paid this quarter of 2023 for leave taken after
! wages and/or qualified family leave wages were the amount shown on line 14 by EFT. If you weren't
March 31, 2020, and before April 1, 2021. required to make federal tax deposits (see Must You
Deposit Your Taxes, earlier) or you're a monthly schedule
Certain private employers with fewer than 500 depositor making a payment under the accuracy of
employees that provide paid sick leave under the EPSLA deposits rule, you may pay the amount shown on line 14
and/or provide paid family leave under the Expanded by EFT, credit card, debit card, check, money order, or
FMLA are eligible to claim the credit for qualified sick and EFW. For more information on electronic payment
family leave wages. Enter the refundable portion of the options, go to IRS.gov/Payments.
credit for qualified sick and family leave wages from
Worksheet 1, Step 2, line 2k. The credit for qualified sick If you pay by EFT, credit card, or debit card, file your
and family leave wages consists of the qualified sick leave return using the Without a payment address under Where
wages, the qualified family leave wages, the qualified Should You File, earlier, and don't file Form 941-V(SS),
health plan expenses allocable to those wages, and the Payment Voucher.
employer share of Medicare tax allocable to those wages.
The refundable portion of the credit is allowed after the If you pay by check or money order, make it payable to
employer share of social security tax is reduced to zero by “United States Treasury.” Enter your EIN, “Form 941-SS,”
nonrefundable credits that are applied against the and the tax period (“1st Quarter 2023,” “2nd Quarter
employer share of social security tax. 2023,” “3rd Quarter 2023,” or “4th Quarter 2023”) on your
check or money order. Complete Form 941-V(SS) and
13e. Refundable Portion of Credit for Qualified enclose it with Form 941-SS.
Sick and Family Leave Wages for Leave Taken If line 12 is $2,500 or more on both your prior and
After March 31, 2021, and Before October 1, current quarter Form 941-SS, and you’ve deposited all
2021 taxes when due, the balance due on line 14 should be
zero.
Complete line 13e only if qualified sick leave
If you’re required to make deposits and instead
! wages and/or qualified family leave wages were
CAUTION paid this quarter of 2023 for leave taken after ! pay the taxes with Form 941-SS, you may be
March 31, 2021, and before October 1, 2021. CAUTION subject to a penalty. See Must You Deposit Your
Taxes, earlier.
Employers with fewer than 500 employees and certain
governmental employers without regard to number of What if you can't pay in full? If you can't pay the full
employees (except for the federal government and its amount of tax you owe, you can apply for an installment
agencies and instrumentalities unless described in agreement online. You can apply for an installment
section 501(c)(1)) are entitled to a credit if they provide agreement online if:
paid sick leave to employees that otherwise meets the • You can't pay the full amount shown on line 14,

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• The total amount you owe is $25,000 or less, and paid wages to your employees, not the date payroll
• You can pay the liability in full in 24 months. liabilities were accrued or deposits were made. Add the
To apply using the Online Payment Agreement amounts for each month. Enter the result in the “Total
Application, go to IRS.gov/OPA. liability for quarter” box.
Under an installment agreement, you can pay what you Note that your total tax liability for the quarter must
owe in monthly installments. There are certain conditions equal your total taxes shown on line 12. If it doesn't, your
you must meet to enter into and maintain an installment tax deposits and payments may not be counted as timely.
agreement, such as paying the liability within 24 months, Don't reduce your total liability reported on line 16 by the
and making all required deposits and timely filing tax refundable portion of the credit for qualified sick and
returns during the length of the agreement. family leave wages. Don't change your tax liability on
line 16 by adjustments reported on any Forms 941-X.
If your installment agreement is accepted, you will be
charged a fee and you will be subject to penalties and You’re a monthly schedule depositor for the calendar
interest on the amount of tax not paid by the due date of year if the amount of your Form 941-SS taxes reported for
the return. the lookback period is $50,000 or less. The lookback
period is the 4 consecutive quarters ending on June 30 of
15. Overpayment the prior year. For 2023, the lookback period begins July
If line 13g is more than line 12, enter the difference on 1, 2021, and ends June 30, 2022. For details on the
line 15. deposit rules, see section 8 of Pub. 80. If you filed Form
944 in either 2021 or 2022, your lookback period is the
Never make an entry on both lines 14 and 15. 2021 calendar year.
If you deposited more than the correct amount for the The amounts entered on line 16 are a summary of
quarter, you can choose to have the IRS either refund the ! your monthly tax liability, not a summary of
overpayment or apply it to your next return. Check only CAUTION deposits you made. If you don't properly report
one box on line 15. If you don't check either box or if you your liabilities when required or if you’re a semiweekly
check both boxes, we will generally apply the schedule depositor and enter your liabilities on line 16
overpayment to your next return. Regardless of any boxes instead of on Schedule B (Form 941), you may be
you check or don’t check on line 15, we may apply your assessed an “averaged” FTD penalty. See Deposit
overpayment to any past due tax account that is shown in Penalties in section 8 of Pub. 80 for more information.
our records under your EIN.
Reporting adjustments from lines 7–9 on line 16. If
If line 15 is under $1, we will send a refund or apply it to
your net adjustment during a month is negative and it
your next return only if you ask us in writing to do so.
exceeds your total tax liability for the month, don't enter a
Part 2: Tell Us About Your Deposit negative amount for the month. Instead, enter "-0-" for the
month and carry over the unused portion of the
Schedule and Tax Liability for This adjustment to the next month.
Quarter Semiweekly schedule depositor. If you reported more
than $50,000 of taxes for the lookback period, you’re a
16. Tax Liability for the Quarter semiweekly schedule depositor. Check the third box on
Check one of the boxes on line 16. Follow the instructions line 16.
for each box to determine if you need to enter your You must complete Schedule B (Form 941) and submit
monthly tax liability on Form 941-SS or your daily tax it with your Form 941-SS. Don't file Schedule B (Form
liability on Schedule B (Form 941). 941) with your Form 941-SS if you’re a monthly schedule
De minimis exception. If line 12 is less than $2,500 or depositor.
line 12 on the prior quarterly return was less than $2,500, Don't change your tax liability on Schedule B (Form
and you didn't incur a $100,000 next-day deposit 941) by adjustments reported on any Forms 941-X.
obligation during the current quarter, check the first box Adjusting tax liability for nonrefundable credits
on line 16 and go to Part 3. claimed on lines 11a, 11b, and 11d. Monthly schedule
If you meet the de minimis exception based on the depositors and semiweekly schedule depositors must
! prior quarter and line 12 for the current quarter is account for nonrefundable credits claimed on lines 11a,
CAUTION $100,000 or more, you must provide a record of 11b, and 11d when reporting their tax liabilities on line 16
your federal tax liability. If you’re a monthly schedule or Schedule B (Form 941). The total tax liability for the
depositor, complete the deposit schedule on line 16. If quarter must equal the amount reported on line 12. Failure
you’re a semiweekly schedule depositor, attach to account for the nonrefundable credits on line 16 or
Schedule B (Form 941). Schedule B (Form 941) may cause line 16 or Schedule B
(Form 941) to report more than the total tax liability
Monthly schedule depositor. If you reported $50,000 or reported on line 12. Don't reduce your monthly tax liability
less in taxes during the lookback period, you’re a monthly reported on line 16 or your daily tax liability reported on
schedule depositor unless the $100,000 Next-Day Schedule B (Form 941) below zero.
Deposit Rule discussed in section 8 of Pub. 80 applies. Qualified small business payroll tax credit for
Check the second box on line 16 and enter your tax increasing research activities (line 11a). Beginning
liability for each month in the quarter. Enter your tax with the first quarter of 2023, the qualified small business
liabilities in the month that corresponds to the dates you

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payroll tax credit for increasing research activities is first remainder would be treated as a payroll tax credit against
used to reduce the employer share of social security tax its share of social security tax (up to $250,000) and
(up to $250,000) for the quarter and any remaining credit Medicare tax on wages paid in the fourth quarter. If the
is then used to reduce the employer share of Medicare tax amount of the payroll tax credit remaining exceeded Rose
for the quarter until it reaches zero. In completing line 16 Co.'s share of social security tax (up to $250,000) and
or Schedule B (Form 941), you take into account the Medicare tax on wages paid in the fourth quarter, it could
payroll tax credit against the liability for the employer be carried forward and treated as a payroll tax credit for
share of social security tax starting with the first payroll the first quarter of 2024.
payment of the quarter that includes payments of wages Nonrefundable portion of credit for qualified sick
subject to social security tax to your employees until you and family leave wages for leave taken after March
use up to $250,000 of credit against the employer share of 31, 2020, and before April 1, 2021 (line 11b). The
social security tax and you then take into account any nonrefundable portion of the credit for qualified sick and
remaining payroll tax credit against the liability for the family leave wages paid this quarter of 2023 for leave
employer share of Medicare tax starting with the first taken after March 31, 2020, and before April 1, 2021, is
payroll payment of the quarter that includes payments of limited to the employer share of social security tax on
wages subject to Medicare tax to employees. Consistent wages paid in the quarter that is remaining after that share
with the entries on line 16 or Schedule B (Form 941), the is first reduced by any credit claimed against the employer
payroll tax credit should be taken into account in making share of social security tax on Form 8974, line 12, for the
deposits of employment tax. If any payroll tax credit is qualified small business payroll tax credit for increasing
remaining at the end of the quarter that hasn’t been used research activities; any credit to be claimed on Form
completely because it exceeds $250,000 of the employer 5884-C, line 11, for the work opportunity credit for
share of social security tax and the employer share of qualified tax-exempt organizations hiring qualified
Medicare tax for the quarter, the excess credit may be veterans; and/or any credit to be claimed on Form 5884-D
carried forward to the succeeding quarter and allowed as for the disaster credit for qualified tax-exempt
a payroll tax credit for the succeeding quarter. The payroll organizations. In completing line 16 or Schedule B (Form
tax credit may not be taken as a credit against income tax 941), you take into account the entire quarter's
withholding, the employee share of social security tax, or nonrefundable portion of the credit for qualified sick and
the employee share of Medicare tax. Also, the remaining family leave wages against the liability for the first payroll
payroll tax credit may not be carried back and taken as a payment of the quarter, but not below zero. Then reduce
credit against wages paid from preceding quarters. the liability for each successive payroll payment in the
Example. Rose Co. is an employer with a calendar tax quarter until the nonrefundable portion of the credit is
year that filed its timely 2022 income tax return on April used. Any credit for qualified sick and family leave wages
18, 2023. Rose Co. elected to take the qualified small paid this quarter of 2023 for leave taken after March 31,
business payroll tax credit for increasing research 2020, and before April 1, 2021, that is remaining at the
activities on Form 6765. The third quarter of 2023 is the end of the quarter because it exceeds the employer share
first quarter that begins after Rose Co. filed the income tax of social security tax for the quarter is claimed on line 13c
return making the payroll tax credit election. Therefore, as a refundable credit. The refundable portion of the credit
the payroll tax credit applies against Rose Co.'s share of doesn’t reduce the liability reported on line 16 or
social security tax (up to $250,000) and Medicare tax on Schedule B (Form 941).
wages paid to employees in the third quarter of 2023. Example. Maple Co. is a semiweekly schedule
Rose Co. is a semiweekly schedule depositor. Rose Co. depositor that pays employees every other Friday. In the
completes Schedule B (Form 941) by reducing the first quarter of 2023, Maple Co. had pay dates of January
amount of liability entered for the first payroll payment in 6, January 20, February 3, February 17, March 3, March
the third quarter of 2023 that includes wages subject to 17, and March 31. Maple Co. paid qualified sick and
social security tax by the lesser of (1) its share of social family leave wages on January 6 and January 20 for leave
security tax (up to $250,000) on the wages, or (2) the taken after March 31, 2020, and before April 1, 2021. The
available payroll tax credit. If the payroll tax credit elected nonrefundable portion of the credit for qualified sick and
is more than Rose Co.'s share of social security tax on the family leave wages for the quarter is $10,000. On
first payroll payment of the quarter, the excess payroll tax Schedule B (Form 941), Maple Co. will use the $10,000 to
credit would be carried forward to succeeding payroll reduce the liability for the January 6 pay date, but not
payments in the third quarter until it is used against up to below zero. If any nonrefundable portion of the credit
$250,000 of Rose Co.'s share of social security tax for the remains, Maple Co. applies it to the liability for the
quarter. If the amount of the payroll tax credit exceeds January 20 pay date, then the February 3 pay date, and
Rose Co.'s share of social security tax (up to $250,000) so forth until the entire $10,000 is used.
on wages paid to its employees in the third quarter, any Nonrefundable portion of credit for qualified sick
remaining credit is used against Rose Co.'s share of and family leave wages for leave taken after March
Medicare tax on the first payroll payment of the quarter 31, 2021, and before October 1, 2021 (line 11d). The
and then the excess payroll tax credit would be carried nonrefundable portion of the credit for qualified sick and
forward to succeeding payroll payments in the third family leave wages paid this quarter of 2023 for leave
quarter until it is used against Rose Co.'s share of taken after March 31, 2021, and before October 1, 2021,
Medicare tax for the quarter. If Rose Co. still has credit is limited to the employer share of Medicare tax on wages
remaining after reducing its share of social security tax (up paid in the quarter that is remaining after that share is first
to $250,000) and Medicare tax for the third quarter, the reduced by any credit claimed against the employer share

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of Medicare tax on Form 8974, line 16, for the qualified Complete lines 19 and 20 only if qualified health
small business payroll tax credit for increasing research ! plan expenses allocable to qualified sick leave
activities. In completing line 16 or Schedule B (Form 941), CAUTION wages and/or qualified family leave wages were
you take into account the entire quarter's nonrefundable paid this quarter of 2023 for leave taken after March 31,
portion of the credit for qualified sick and family leave 2020, and before April 1, 2021.
wages paid this quarter of 2023 against the liability for the
first payroll payment of the quarter, but not below zero. 19. Qualified Health Plan Expenses Allocable to
Then reduce the liability for each successive payroll Qualified Sick Leave Wages for Leave Taken
payment in the quarter until the nonrefundable portion of
the credit is used. Any credit for qualified sick and family After March 31, 2020, and Before April 1, 2021
leave wages paid this quarter of 2023 for leave taken after Enter the qualified health plan expenses allocable to
March 31, 2021, and before October 1, 2021, that is qualified sick leave wages paid this quarter of 2023 for
remaining at the end of the quarter because it exceeds the leave taken after March 31, 2020, and before April 1,
employer share of Medicare tax for the quarter is claimed 2021. This amount is also entered on Worksheet 1, Step
on line 13e as a refundable credit. The refundable portion 2, line 2b.
of the credit doesn’t reduce the liability reported on line 16
or Schedule B (Form 941). 20. Qualified Health Plan Expenses Allocable to
Qualified Family Leave Wages for Leave Taken
You may reduce your deposits by the amount of
After March 31, 2020, and Before April 1, 2021
TIP the nonrefundable and refundable portions of the
credit for qualified sick and family leave wages, as Enter the qualified health plan expenses allocable to
discussed earlier under Reducing your deposits for the qualified family leave wages paid this quarter of 2023 for
credit for qualified sick and family leave wages. leave taken after March 31, 2020, and before April 1,
2021. This amount is also entered on Worksheet 1, Step
2, line 2f.
Part 3: Tell Us About Your Business
Complete lines 23, 24, and 25 only if qualified
In Part 3, answer only those questions that apply to your ! sick leave wages were paid this quarter of 2023
business. If the questions don't apply, leave them blank CAUTION for leave taken after March 31, 2021, and before
and go to Part 4. October 1, 2021.
17. If Your Business Has Closed . . .
23. Qualified Sick Leave Wages for Leave Taken
If you go out of business or stop paying wages, you must
file a final return. To tell the IRS that a particular Form After March 31, 2021, and Before October 1,
941-SS is your final return, check the box on line 17 and 2021
enter the final date you paid wages in the space provided. Enter the qualified sick leave wages you paid this quarter
For additional filing requirements, including information of 2023 to your employees for leave taken after March 31,
about attaching a statement to your final return, see If 2021, and before October 1, 2021, including any qualified
Your Business Has Closed, earlier. sick leave wages that were above the social security wage
base and any qualified sick leave wages excluded from
18. If You’re a Seasonal Employer . . . the definition of employment under sections 3121(b)(1)–
If you hire employees seasonally—such as for summer or (22). See the instructions for line 11d, earlier, for more
winter only—check the box on line 18. Checking the box information about qualified sick leave wages for leave
tells the IRS not to expect four Forms 941-SS from you taken after March 31, 2021, and before October 1, 2021.
throughout the year because you haven't paid wages This amount is also entered on Worksheet 2, Step 2,
regularly. line 2a.

Generally, we won't ask about unfiled returns if at least 24. Qualified Health Plan Expenses Allocable to
one taxable return is filed each year. However, you must
Qualified Sick Leave Wages Reported on
check the box on line 18 on every Form 941-SS you file.
Otherwise, the IRS will expect a return to be filed for each Line 23
quarter. Enter the qualified health plan expenses allocable to
qualified sick leave wages paid this quarter of 2023 for
Also, when you complete Form 941-SS, be sure to leave taken after March 31, 2021, and before October 1,
check the box on the top of the form that corresponds to 2021. This amount is also entered on Worksheet 2, Step
the quarter reported. 2, line 2b.
The amounts entered on lines 19 through 28 are
TIP amounts that you use on the worksheets at the 25. Amounts Under Certain Collectively
end of these instructions to figure certain credits. Bargained Agreements Allocable to Qualified
If you’re claiming these credits, you must enter the Sick Leave Wages Reported on Line 23
applicable amounts. Enter the collectively bargained defined benefit pension
plan contributions and collectively bargained
apprenticeship program contributions allocable to
qualified sick leave wages paid this quarter of 2023 for
leave taken after March 31, 2021, and before October 1,

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2021. This amount is also entered on Worksheet 2, Step You’re not authorizing your designee to bind you to
2, line 2c. anything (including additional tax liability) or to otherwise
represent you before the IRS. If you want to expand your
Complete lines 26, 27, and 28 only if qualified
designee's authorization, see Pub. 947.
! family leave wages were paid this quarter of 2023
CAUTION for leave taken after March 31, 2021, and before The authorization will automatically expire 1 year from
October 1, 2021. the due date (without regard to extensions) for filing your
Form 941-SS. If you or your designee wants to terminate
26. Qualified Family Leave Wages for Leave the authorization, write to the IRS office for your location
Taken After March 31, 2021, and Before October using the Without a payment address under Where
Should You File, earlier.
1, 2021
Enter the qualified family leave wages you paid this Part 5: Sign Here (Approved Roles)
quarter of 2023 to your employees for leave taken after
March 31, 2021, and before October 1, 2021, including Complete all information and sign Form 941-SS. The
any qualified family leave wages that were above the following persons are authorized to sign the return for
social security wage base and any qualified family leave each type of business entity.
wages excluded from the definition of employment under • Sole proprietorship—The individual who owns the
sections 3121(b)(1)–(22). See the instructions for line 11d, business.
earlier, for more information about qualified family leave • Corporation (including a limited liability company
wages for leave taken after March 31, 2021, and before (LLC) treated as a corporation)—The president, vice
October 1, 2021. This amount is also entered on president, or other principal officer duly authorized to sign.
Worksheet 2, Step 2, line 2g. • Partnership (including an LLC treated as a
partnership) or unincorporated organization—A
27. Qualified Health Plan Expenses Allocable to responsible and duly authorized partner, member, or
Qualified Family Leave Wages Reported on officer having knowledge of its affairs.
Line 26 • Single-member LLC treated as a disregarded entity
for federal income tax purposes—The owner of the
Enter the qualified health plan expenses allocable to LLC or a principal officer duly authorized to sign.
qualified family leave wages paid this quarter of 2023 for • Trust or estate—The fiduciary.
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step Form 941-SS may be signed by a duly authorized
2, line 2h. agent of the taxpayer if a valid power of attorney has been
filed.
28. Amounts Under Certain Collectively Alternative signature method. Corporate officers or
Bargained Agreements Allocable to Qualified duly authorized agents may sign Form 941-SS by rubber
Family Leave Wages Reported on Line 26 stamp, mechanical device, or computer software
Enter the collectively bargained defined benefit pension program. For details and required documentation, see
plan contributions and collectively bargained Rev. Proc. 2005-39, 2005-28 I.R.B. 82, available at
apprenticeship program contributions allocable to IRS.gov/irb/2005-28_IRB#RP-2005-39.
qualified family leave wages paid this quarter of 2023 for
leave taken after March 31, 2021, and before October 1, Paid Preparer Use Only
2021. This amount is also entered on Worksheet 2, Step A paid preparer must sign Form 941-SS and provide the
2, line 2i. information in the Paid Preparer Use Only section of Part
5 if the preparer was paid to prepare Form 941-SS and
Part 4: May We Speak With Your isn't an employee of the filing entity. Paid preparers must
Third-Party Designee? sign paper returns with a manual signature. The preparer
must give you a copy of the return in addition to the copy
If you want to allow an employee, a paid tax preparer, or to be filed with the IRS.
another person to discuss your Form 941-SS with the IRS, If you’re a paid preparer, enter your Preparer Tax
check the “Yes” box in Part 4. Enter the name, phone Identification Number (PTIN) in the space provided.
number, and five-digit personal identification number Include your complete address. If you work for a firm,
(PIN) of the specific person to speak with—not the name enter the firm's name and the EIN of the firm. You can
of the firm that prepared your tax return. The designee apply for a PTIN online or by filing Form W-12. For more
may choose any five numbers as their PIN. information about applying for a PTIN online, go to
By checking “Yes,” you authorize the IRS to talk to the IRS.gov/PTIN. You can't use your PTIN in place of the EIN
person you named (your designee) about any questions of the tax preparation firm.
we may have while we process your return. You also Generally, don't complete this section if you’re filing the
authorize your designee to do all of the following. return as a reporting agent and have a valid Form 8655 on
• Give us any information that is missing from your return. file with the IRS. However, a reporting agent must
• Call us for information about processing your return. complete this section if the reporting agent offered legal
• Respond to certain IRS notices that you’ve shared with advice, for example, advising the client on determining
your designee about math errors and return preparation. whether its workers are employees or independent
The IRS won't send notices to your designee. contractors for federal tax purposes.

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How To Get Forms, Instructions, and 
Publications From the IRS
You can view, download, or print most of the 
forms, instructions, and publications you may 
need at IRS.gov/Forms. Otherwise, you can go to 
IRS.gov/OrderForms to place an order and have them 
mailed to you. The IRS will process your order for forms 
and publications as soon as possible. Don't resubmit 
requests you've already sent us. You can get forms and 
publications faster online.

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Worksheet 1. Credit for Qualified Sick and Family Leave Wages 
Paid This Quarter of 2023 for Leave Taken After March 31, 2020, 
and Before April 1, 2021                                                                                                                           Keep for Your Records
Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which 
it is applicable, on a client-by-client basis.)
If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2020, and before April 1, 
2021, complete Step 1 and Step 2. Caution: Use Worksheet 2 to figure the credit for qualified sick and family leave wages paid this quarter of 2023 for 
leave taken after March 31, 2021, and before October 1, 2021.
Step 1.         Determine the employer share of social security tax this quarter after it is reduced by any credit claimed on Form 8974 
                and any credit to be claimed on Form 5884-C and/or Form 5884-D
        1a      Enter the amount of social security tax from Form 941-SS, Part 1, line 5a, 
                column 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    1a       
        1b      Enter the amount of social security tax from Form 941-SS, Part 1, line 5b, 
                column 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    1b       
        1c      Add lines 1a and 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         1c       
        1d      Multiply line 1c by 50% (0.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .            1d       
        1e      If you’re a third-party payer of sick pay that isn't an agent and you're claiming credits for 
                amounts paid to your employees, enter the employer share of social security tax included 
                on Form 941-SS, Part 1, line 8 (enter as a positive number) . . . . . . . . . . . . . . . . . . . . . .                         1e       
        1f      Subtract line 1e from line 1d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           1f       
        1g      If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount 
                of the employer share of social security tax from the notice . . . . . . . . . . . . . . . . . . . . . .                        1g       
        1h      Employer share of social security tax. Add lines 1f and 1g . . . . . . . . . . . . . . . . . . . .                                       1h              
        1i      Enter the amount from Form 8974, line 12, for this quarter . . . . . . . . . . . . . . . . . . . . . . .                        1i       
        1j      Enter the amount to be claimed on Form 5884-C, line 11, for this quarter . . . . . . . . . . . . .                              1j       
        1j(i)   Enter the amount to be claimed on Form 5884-D, line 12, for this quarter . . . . . . . . . . . . .                              1j(i)    
        1k      Total nonrefundable credits already used against the employer share of social 
                security tax. Add lines 1i, 1j, and 1j(i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                      1k  
        1l      Employer share of social security tax remaining. Subtract line 1k from line 1h . . . . . .                                               1l  
Step 2.         Figure the sick and family leave credit
        2a      Qualified sick leave wages reported on Form 941-SS, Part 1, line 5a(i), column 1 . . . . . .                                    2a       
        2a(i)   Qualified sick leave wages included on Form 941-SS, Part 1, line 5c, but not included on 
                Form 941-SS, Part 1, line 5a(i), column 1, because the wages reported on that line were 
                limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                2a(i)    
        2a(ii)  Total qualified sick leave wages. Add lines 2a and 2a(i) . . . . . . . . . . . . . . . . . . . . . . . . .                      2a(ii)   
        2a(iii) Qualified sick leave wages excluded from the definition of employment under sections 
                3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       2a(iii)  
        2b      Qualified health plan expenses allocable to qualified sick leave wages (Form 941-SS, Part 
                3, line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2b       
        2c      Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45% 
                (0.0145)    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c       
        2d      Credit for qualified sick leave wages. Add lines 2a(ii), 2a(iii), 2b, and 2c . . . . . . . . . . .                                       2d  
        2e      Qualified family leave wages reported on Form 941-SS, Part 1, line 5a(ii), 
                column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    2e       
        2e(i)   Qualified family leave wages included on Form 941-SS, Part 1, line 5c, but not included on 
                Form 941-SS, Part 1, line 5a(ii), column 1, because the wages reported on that line were 
                limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                2e(i)    
        2e(ii)  Total qualified family leave wages. Add lines 2e and 2e(i)   . . . . . . . . . . . . . . . . . . . . . . .                      2e(ii)   
        2e(iii) Qualified family leave wages excluded from the definition of employment under sections 
                3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       2e(iii)  
        2f      Qualified health plan expenses allocable to qualified family leave wages (Form 941-SS, 
                Part 3, line 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    2f       
        2g      Employer share of Medicare tax on qualified family leave wages. Multiply line 2e(ii) by 
                1.45% (0.0145)    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     2g       
        2h      Credit for qualified family leave wages. Add lines 2e(ii), 2e(iii), 2f, and 2g . . . . . . . . .                                         2h  
        2i      Credit for qualified sick and family leave wages. Add lines 2d and 2h . . . . . . . . . . . .                                            2i  
        2j      Nonrefundable portion of credit for qualified sick and family leave wages for leave 
                taken after March 31, 2020, and before April 1, 2021. Enter the smaller of line 1l or 
                line 2i. Enter this amount on Form 941-SS, Part 1, line 11b . . . . . . . . . . . . . . . . . . . . . . .                                2j
        2k      Refundable portion of credit for qualified sick and family leave wages for leave 
                taken after March 31, 2020, and before April 1, 2021. Subtract line 2j from line 2i and 
                enter this amount on Form 941-SS, Part 1, line 13c . . . . . . . . . . . . . . . . . . . . . . . . . . . .                               2k

                                                                 -22-                            Instructions for Form 941-SS (Rev. 3-2023)

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Page 23 of 23            Fileid: … s/i941ss/202303/a/xml/cycle05/source                                                                                9:00 - 25-Jan-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Worksheet 2. Credit for Qualified Sick and Family Leave Wages 
Paid This Quarter of 2023 for Leave Taken After March 31, 2021, 
and Before October 1, 2021                                                                                                                       Keep for Your Records
Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which 
it is applicable, on a client-by-client basis.)
If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2021, and before October 
1, 2021, complete Step 1 and Step 2. Caution: Use Worksheet 1 to figure the credit for qualified sick and family leave wages paid this quarter of 2023 
for leave taken after March 31, 2020, and before April 1, 2021.
Step 1.         Determine the employer share of Medicare tax this quarter after it is reduced by any credit claimed on Form 8974 
        1a      Enter the amount of Medicare tax from Form 941-SS, Part 1, line 5c, column 2 . . . . . . . .                                  1a       
        1b      Multiply line 1a by 50% (0.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          1b       
        1c      If you’re a third-party payer of sick pay that isn't an agent and you're claiming credits for 
                amounts paid to your employees, enter the employer share of Medicare tax included on 
                Form 941-SS, Part 1, line 8 (enter as a positive number) . . . . . . . . . . . . . . . . . . . . . . . .                      1c       
        1d      Subtract line 1c from line 1b  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        1d       
        1e      If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount 
                of the employer share of Medicare tax from the notice . . . . . . . . . . . . . . . . . . . . . . . . . .                     1e       
        1f      Employer share of Medicare tax. Add lines 1d and 1e . . . . . . . . . . . . . . . . . . . . . . . .                           1f                       
        1g      Enter the amount from Form 8974, line 16, for this quarter . . . . . . . . . . . . . . . . . . . . . . .                      1g       
        1h      Employer share of Medicare tax remaining. Subtract line 1g from line 1f . . . . . . . . . .                                   1h                       
Step 2.         Figure the sick and family leave credit
        2a      Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 
                2021 (Form 941-SS, Part 3, line 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             2a       
        2a(i)   Qualified sick leave wages included on Form 941-SS, Part 3, line 23, that were not 
                included as wages reported on Form 941-SS, Part 1, lines 5a and 5c, because the 
                qualified sick leave wages were excluded from the definition of employment under sections 
                3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     2a(i)    
        2a(ii)  Subtract line 2a(i) from line 2a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        2a(ii)   
        2a(iii) Qualified sick leave wages included on Form 941-SS, Part 3, line 23, that were not 
                included as wages reported on Form 941-SS, Part 1, line 5a, because the qualified sick 
                leave wages were limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . .                         2a(iii)  
        2a(iv)  Subtract line 2a(iii) from line 2a(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        2a(iv)   
        2b      Qualified health plan expenses allocable to qualified sick leave wages for leave taken after 
                March 31, 2021, and before October 1, 2021 (Form 941-SS, Part 3, line 24) . . . . . . . . . .                                 2b       
        2c      Amounts under certain collectively bargained agreements allocable to qualified sick leave 
                wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941-SS, 
                Part 3, line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2c       
        2d      Employer share of social security tax on qualified sick leave wages. Multiply line 2a(iv) by 
                6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    2d       
        2e      Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45% 
                (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2e       
        2f      Credit for qualified sick leave wages. Add lines 2a, 2b, 2c, 2d, and 2e . . . . . . . . . . . .                                        2f  
        2g      Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 
                2021 (Form 941-SS, Part 3, line 26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             2g       
        2g(i)   Qualified family leave wages included on Form 941-SS, Part 3, line 26, that were not 
                included as wages reported on Form 941-SS, Part 1, lines 5a and 5c, because the 
                qualified family leave wages were excluded from the definition of employment under 
                sections 3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        2g(i)    
        2g(ii)  Subtract line 2g(i) from line 2g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        2g(ii)   
        2g(iii) Qualified family leave wages included on Form 941-SS, Part 3, line 26, that were not 
                included as wages reported on Form 941-SS, Part 1, line 5a, because the qualified family 
                leave wages were limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . .                         2g(iii)  
        2g(iv)  Subtract line 2g(iii) from line 2g(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        2g(iv)   
        2h      Qualified health plan expenses allocable to qualified family leave wages for leave taken 
                after March 31, 2021, and before October 1, 2021 (Form 941-SS, Part 3, line 27)    . . . . . .                                2h       
        2i      Amounts under certain collectively bargained agreements allocable to qualified family 
                leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 
                941-SS, Part 3, line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      2i       
        2j      Employer share of social security tax on qualified family leave wages. Multiply line 2g(iv) 
                by 6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     2j       
        2k      Employer share of Medicare tax on qualified family leave wages. Multiply line 2g(ii) by 
                1.45% (0.0145)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     2k       
        2l      Credit for qualified family leave wages. Add lines 2g, 2h, 2i, 2j, and 2k . . . . . . . . . . . .                                      2l  
        2m      Credit for qualified sick and family leave wages. Add lines 2f and 2l . . . . . . . . . . . . .                                        2m  
        2n      Enter any credit claimed under section 41 for increasing research activities with respect to 
                any wages taken into account for the credit for qualified sick and family leave 
                wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2n       
        2o      Credit for qualified sick and family leave wages after adjusting for other credits. 
                Subtract line 2n from line 2m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  2o  
        2p      Nonrefundable portion of credit for qualified sick and family leave wages for leave 
                taken after March 31, 2021, and before October 1, 2021. Enter the smaller of line 1h or 
                line 2o. Enter this amount on Form 941-SS, Part 1, line 11d . . . . . . . . . . . . . . . . . . . . . .                                2p
        2q      Refundable portion of credit for qualified sick and family leave wages for leave 
                taken after March 31, 2021, and before October 1, 2021. Subtract line 2p from line 2o 
                and enter this amount on Form 941-SS, Part 1, line 13e . . . . . . . . . . . . . . . . . . . . . . . . .                               2q

Instructions for Form 941-SS (Rev. 3-2023)                       -23-

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