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

(Rev. June 2022)
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 unless                    of a reduction in hours or an involuntary termination of 
otherwise noted.                                                              employment (assistance eligible individuals). This COBRA 
                                                                              premium assistance was available for periods of coverage 
Contents                                                               Page
                                                                              beginning on or after April 1, 2021, through periods of 
Future Developments      . . . . . . . . . . . . . . . . . . . . . . . .   1  coverage beginning on or before September 30, 2021. A 
What's New   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1  premium payee was entitled to the COBRA premium 
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1  assistance credit at the time an eligible individual elected 
General Instructions: . . . . . . . . . . . . . . . . . . . . . . . . .    5  coverage. Therefore, due to the COBRA notice and election 
Purpose of Form 941-SS . . . . . . . . . . . . . . . . . . .               5  period requirements (generally, employers had 60 days to 
                                                                              provide notice and assistance eligible individuals had 60 
Who Must File Form 941-SS?                 . . . . . . . . . . . . . . .   5  days to elect coverage), the first quarter of 2022 was the last 
When Must You File?            . . . . . . . . . . . . . . . . . . . . .   7  quarter in which most employers may have been eligible to 
How Should You Complete Form 941-SS? . . . . . .                           7  claim the COBRA premium assistance credit.
Where Should You File?             . . . . . . . . . . . . . . . . . . .   8  Under some rare circumstances, it may be possible for a 
Depositing Your Taxes            . . . . . . . . . . . . . . . . . . . .   8  premium payee to become entitled to the COBRA premium 
What About Penalties and Interest? . . . . . . . . . . .                   9  assistance credit after the first quarter of 2022. However, in 
                                                                              those cases, the credit must be claimed on a Form 941-X, 
Where Can You Obtain Forms? . . . . . . . . . . . . . .                    9  Adjusted Employer's QUARTERLY Federal Tax Return or 
Specific Instructions: . . . . . . . . . . . . . . . . . . . . . . . .     10 Claim for Refund. For more information, see the Instructions 
Part 1: Answer These Questions for This                                       for Form 941-X.
Quarter        . . . . . . . . . . . . . . . . . . . . . . . . . . . .     10
Part 2: Tell Us About Your Deposit Schedule                                   Reminders
and Tax Liability for This Quarter                 . . . . . . . . . .     17         Use the March 2022 revision of Form 941-SS only to 
Part 3: Tell Us About Your Business . . . . . . . . . .                    18 !       report taxes for the quarter ending March 31, 2022. 
Part 4: May We Speak With Your Third-Party                                    CAUTION The IRS expects the June 2022 revision of Form 
Designee? . . . . . . . . . . . . . . . . . . . . . . . . . .              20 941-SS and these instructions to be used for the second, 
                                                                              third, and fourth quarters of 2022. If changes in law require 
Part 5: Sign Here (Approved Roles) . . . . . . . . . .                     20 additional changes to Form 941-SS, the form and/or these 
How To Get Forms, Instructions, and Publications                              instructions may be revised. Prior revisions of Form 941-SS 
From the IRS       . . . . . . . . . . . . . . . . . . . . . . . . . .     20 are available at IRS.gov/Form941SS (select the link for "All 
Worksheet 1. Credit for Qualified Sick and Family                             Form 941-SS Revisions" under "Other Items You May Find 
Leave Wages Paid This Quarter of 2022 for                                     Useful").
Leave Taken After March 31, 2020, and Before 
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . .        21 Social security and Medicare tax for 2022. The rate of 
Worksheet 2. Credit for Qualified Sick and Family                             social security tax on taxable wages, including qualified sick 
                                                                              leave wages and qualified family leave wages paid in 2022 
Leave Wages Paid This Quarter of 2022 for 
                                                                              for leave taken after March 31, 2021, and before October 1, 
Leave Taken After March 31, 2021, and Before 
                                                                              2021, is 6.2% each for the employer and employee or 12.4% 
October 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . .            22 for both. Qualified sick leave wages and qualified family 
Future Developments                                                           leave wages paid in 2022 for leave taken after March 31, 
                                                                              2020, and before April 1, 2021, aren't subject to the employer 
For the latest information about developments related to                      share of social security tax; therefore, the tax rate on these 
Form 941-SS and its instructions, such as legislation enacted                 wages is 6.2%. The social security wage base limit is 
after they were published, go to IRS.gov/Form941SS.                           $147,000.
What's New                                                                    The Medicare tax rate is 1.45% each for the employee 
                                                                              and employer, unchanged from 2021. There is no wage base 
Credit for COBRA premium assistance payments.                        The      limit for Medicare tax.
COBRA premium assistance credit lines have been 
“Reserved for future use” on Form 941-SS because the first                    Social security and Medicare taxes apply to the wages of 
quarter of 2022 was the last quarter in which most employers                  household workers you pay $2,400 or more in cash wages in 
may have been eligible to claim the COBRA premium                             2022. Social security and Medicare taxes apply to election 
assistance credit.                                                            workers who are paid $2,000 or more in cash or an 
                                                                              equivalent form of compensation in 2022.
Section 9501 of the American Rescue Plan Act of 2021 
(the ARP) provided for COBRA premium assistance in the                        The COVID-19 related credit for qualified sick and fami-
form of a full reduction in the premium otherwise payable by                  ly leave wages is limited to leave taken after March 31, 
certain individuals and their families who elected COBRA                      2020, and before October 1, 2021. Generally, the credit 
continuation coverage due to a loss of coverage as the result                 for qualified sick and family leave wages, as enacted under 

May 31, 2022                                                           Cat. No. 35530F

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the Families First Coronavirus Response Act (FFCRA) and and you're also claiming a credit for qualified sick and family
amended and extended by the COVID-related Tax Relief Act leave wages for leave taken before April 1, 2021, you must
of 2020, for leave taken after March 31, 2020, and before include any credit that will be claimed on Form 5884-D on
April 1, 2021, and the credit for qualified sick and family leave Worksheet 1 for that quarter. For more information about this
wages under sections 3131, 3132, and 3133 of the Internal credit, go to IRS.gov/Form5884D.
Revenue Code, as enacted under the ARP, for leave taken
Deferral of the employer share of social security tax ex-
after March 31, 2021, and before October 1, 2021, have
pired. The CARES Act allowed employers to defer the
expired. However, employers that pay qualified sick and
deposit and payment of the employer share of social security
family leave wages in 2022 for leave taken after March 31,
tax. The deferred amount of the employer share of social
2020, and before October 1, 2021, are eligible to claim a
security tax was only available for deposits due on or after
credit for qualified sick and family leave wages in the quarter
March 27, 2020, and before January 1, 2021, as well as
of 2022 in which the qualified wages were paid. For more
deposits and payments due after January 1, 2021, that were
information, see the instructions for line 11b line 11d, ,
required for wages paid on or after March 27, 2020, and
line 13c, and line 13e, later.
before January 1, 2021. One half of the employer share of ‐
Use Worksheet 1 to figure the credit for leave taken after social security tax was due by December 31, 2021, and the
March 31, 2020, and before April 1, 2021. Use Worksheet 2 remainder is due by December 31, 2022. Because both
to figure the credit for leave taken after March 31, 2021, and December 31, 2021, and December 31, 2022, are
before October 1, 2021. For more information about the nonbusiness days, payments made on the next business day
credit for qualified sick and family leave wages, go to will be considered timely. Any payments or deposits you
IRS.gov/PLC. made before December 31, 2021, were first applied against
The COVID-19 related employee retention credit has ex- your payment due on December 31, 2021, and then applied
pired. The employee retention credit enacted under the against your payment due on December 31, 2022. For more
Coronavirus Aid, Relief, and Economic Security (CARES) Act information about the deferral of employment tax deposits,
and amended and extended by the Taxpayer Certainty and go to IRS.gov/ETD. See Paying the deferred amount of the
Disaster Tax Relief Act of 2020 was limited to qualified employer share of social security tax and How to pay the
wages paid after March 12, 2020, and before July 1, 2021. deferred amount of the employer and employee share of
The employee retention credit under section 3134 of the social security tax, later, for information about paying the
Internal Revenue Code, as enacted by the ARP and deferred amount of the employer share of social security tax.
amended by the Infrastructure Investment and Jobs Act, was Deferral of the employee share of social security tax ex-
limited to wages paid after June 30, 2021, and before pired. The Presidential Memorandum on Deferring Payroll
October 1, 2021, unless the employer was a recovery startup Tax Obligations in Light of the Ongoing COVID 19 Disaster, ‐
business. An employer that was a recovery startup business issued on August 8, 2020, directed the Secretary of the
could also claim the employee retention credit for wages paid Treasury to defer the withholding, deposit, and payment of
after September 30, 2021, and before January 1, 2022. the employee share of social security tax on wages paid
Advance payment of COVID-19 credits ended. Although during the period from September 1, 2020, through
you may pay qualified sick and family leave wages in 2022 December 31, 2020. The deferral of the withholding and
for leave taken after March 31, 2020, and before October 1, payment of the employee share of social security tax was
2021, you may no longer request an advance payment of any available for employees whose social security wages paid for
credit on Form 7200, Advance Payment of Employer Credits a biweekly pay period were less than $4,000, or the
Due to COVID-19. equivalent threshold amount for other pay periods. The
COVID-related Tax Relief Act of 2020 deferred the due date
Notice 2021-65 effect on deposit schedule. If you for the withholding and payment of the employee share of
became a semiweekly schedule depositor for 2022 under the social security tax until the period beginning on January 1,
$100,000 Next-Day Deposit Rule solely as a result of the 2021, and ending on December 31, 2021. For more
relief provided in Notice 2021-65, 2021-51 I.R.B. 880, information about the deferral of employee social security
available at IRS.gov/irb/2021-51_IRB#NOT-2021-65, tax, see Notice 2020 65, 2020 38 I.R.B. 567, available at ‐ ‐
regarding the early termination of the employee retention IRS.gov/irb/2020-38_IRB#NOT-2020-65; and Notice
credit for the fourth quarter of 2021, you may be converted 2021-11, 2021-06 I.R.B. 827, available at IRS.gov/irb/
back to a monthly schedule depositor by contacting the IRS. 2021-06_IRB#NOT-2021-11. Also see Paying the deferred
You may continue to deposit in accordance with your status amount of the employee share of social security tax and How
as a monthly schedule depositor, but you may receive a to pay the deferred amount of the employer and employee
system-generated failure-to-deposit (FTD) penalty notice share of social security tax, later, for information about paying
after you file your Form 941-SS for the first quarter of 2022. the deferred amount of the employee share of social security
Contact the IRS at the toll-free number on your FTD penalty tax.
notice to request abatement of the FTD penalty and to be
converted back to a monthly schedule depositor. Paying the deferred amount of the employer share of
social security tax. One-half of the employer share of
Payroll tax credit for certain tax-exempt organizations social security tax was due by December 31, 2021, and the
affected by qualified disasters. Section 303(d) of the remainder is due by December 31, 2022. Because both
Taxpayer Certainty and Disaster Tax Relief Act of 2020 December 31, 2021, and December 31, 2022, are
allows for a payroll tax credit for certain tax-exempt nonbusiness days, payments made on the next business day
organizations affected by certain qualified disasters not will be considered timely. Any payments or deposits you
related to COVID-19. This credit is claimed on Form 5884-D made before December 31, 2021, were first applied against
(not on Form 941-SS). Form 5884-D is filed after the Form your payment due on December 31, 2021, and then applied
941-SS for the quarter for which the credit is being claimed against your payment due on December 31, 2022. For
has been filed. If you will claim this credit on Form 5884-D example, if your employer share of social security tax for the

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third quarter of 2020 was $20,000 and you deposited $5,000 For more information about the deferral of social security
of the $20,000 during the third quarter of 2020 and you tax, go to IRS.gov/ETD and see Notice 2020-65 and Notice
deferred $15,000 on Form 941-SS, line 13b, then you were 2021-11.
required to pay $5,000 by December 31, 2021, and must pay
Qualified small business payroll tax credit for increas-
$10,000 by December 31, 2022. However, if your employer
ing research activities. For tax years beginning after 2015,
share of social security tax for the third quarter of 2020 was
a qualified small business may elect to claim up to $250,000
$20,000 and you deposited $15,000 of the $20,000 during
of its credit for increasing research activities as a payroll tax
the third quarter of 2020 and you deferred $5,000 on Form
credit against the employer share of social security tax. The
941-SS, line 13b, then you didn’t need to pay any deferred
payroll tax credit election must be made on or before the due
amount by December 31, 2021, because 50% of the amount
date of the originally filed income tax return (including
that could have been deferred ($10,000) was already paid
extensions). The portion of the credit used against the
and was first applied against your payment that was due on
employer share of social security tax is allowed in the first
December 31, 2021. Accordingly, you must pay the $5,000
calendar quarter beginning after the date that the qualified
deferral by December 31, 2022. Payment of the deferral isn't
small business filed its income tax return. The election and
reported on Form 941-SS. For additional information, go to
determination of the credit amount that will be used against
IRS.gov/ETD.
the employer share of social security tax are made on Form
Paying the deferred amount of the employee share of 6765, Credit for Increasing Research Activities. The amount
social security tax. The due date for the withholding and from Form 6765, line 44, must then be reported on Form
payment of the employee share of social security tax was 8974, Qualified Small Business Payroll Tax Credit for
postponed until the period beginning on January 1, 2021, Increasing Research Activities. Form 8974 is used to
and ending on December 31, 2021. The employer was determine the amount of the credit that can be used in the
required to withhold and pay the total deferred employee current quarter. The amount from Form 8974, line 12, is
share of social security tax ratably from wages paid to the reported on Form 941-SS, line 11a. If you’re claiming the
employee between January 1, 2021, and December 31, research payroll tax credit on your Form 941-SS, you must
2021. If necessary, the employer was allowed to make attach Form 8974 to that Form 941-SS. For more information
arrangements to otherwise collect the total deferred taxes about the payroll tax credit, see Notice 2017-23, 2017-16
from the employee. The employer was liable to pay the I.R.B. 1100, available at IRS.gov/irb/
deferred taxes to the IRS and was required to do so before 2017-16_IRB#NOT-2017-23; and IRS.gov/
January 1, 2022, to avoid interest, penalties, and additions to ResearchPayrollTC. Also see Adjusting tax liability for
tax on those amounts. Because January 1, 2022, was a nonrefundable credits claimed on lines 11a, 11b, and 11d,
nonbusiness day, payments made on January 3, 2022, were later.
considered timely. Payment of the deferral isn't reported on
Certification program for professional employer organi-
Form 941-SS. For more information about the deferral of the
zations (PEOs). The Stephen Beck, Jr., ABLE Act of 2014
employee share of social security tax, see Notice 2020-65
required the IRS to establish a voluntary certification program
and Notice 2021-11.
for PEOs. PEOs handle various payroll administration and
How to pay the deferred amount of the employer and tax reporting responsibilities for their business clients and are
employee share of social security tax. You may pay the typically paid a fee based on payroll costs. To become and
amount you owe electronically using the Electronic Federal remain certified under the certification program, certified
Tax Payment System (EFTPS), by credit or debit card, or by professional employer organizations (CPEOs) must meet
a check or money order. The preferred method of payment is various requirements described in sections 3511 and 7705
EFTPS. For more information, go to EFTPS.gov, or call 800- and related published guidance. Certification as a CPEO
555-4477 or 800-733-4829 (TDD). To pay the deferred may affect the employment tax liabilities of both the CPEO
amount using EFTPS, select Form 941-SS, the calendar and its customers. A CPEO is generally treated for
quarter in 2020 to which the payment relates, and the option employment tax purposes as the employer of any individual
to pay the deferred amount. who performs services for a customer of the CPEO and is
To pay by credit or debit card, go to IRS.gov/PayByCard. covered by a contract described in section 7705(e)(2)
If you pay by check or money order, include a 2020 Form between the CPEO and the customer (CPEO contract), but
941-V(SS), Payment Voucher, for the quarter in which you only for wages and other compensation paid to the individual
originally deferred the deposit and payment. Darken the by the CPEO. To become a CPEO, the organization must
circle identifying the quarter for which the payment is being apply through the IRS Online Registration System. For more
made. The 2020 Form 941-V(SS) is on page 5 of Form information or to apply to become a CPEO, go to IRS.gov/
941-SS and is available at IRS.gov/Form941SS (select the CPEO.
link for "All Form 941-SS Revisions" under "Other Items You CPEOs must generally file Form 941-SS and Schedule R
May Find Useful"). Make the check or money order payable (Form 941), Allocation Schedule for Aggregate Form 941
to “United States Treasury.” Enter your EIN, “Form 941-SS,” Filers, electronically. For more information about a CPEO’s
and the calendar quarter in which you originally deferred the requirement to file electronically, see Rev. Proc. 2017-14,
deposit and payment (for example, “2nd Quarter 2020”). 2017-3 I.R.B. 426, available at IRS.gov/irb/
Payments should be sent to: 2017-03_IRB#RP-2017-14 .
Outsourcing payroll duties. Generally, as an employer,
Department of the Treasury you're responsible to ensure that tax returns are filed and
Internal Revenue Service deposits and payments are made, even if you contract with a
Ogden, UT 84201-0030 third party to perform these acts. You remain responsible if
the third party fails to perform any required action. Before you
choose to outsource any of your payroll and related tax
duties (that is, withholding, reporting, and paying over social

Instructions for Form 941-SS (Rev. 6-2022) -3-

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

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arrangements with your financial institution ahead of time. of hearing, or have a speech disability), Monday–Friday from
Please check with your financial institution regarding 7:00 a.m. to 7:00 p.m. local time.
availability, deadlines, and costs. Your financial institution • 267-941-1000 (toll call), Monday–Friday from 6:00 a.m. to
may charge you a fee for payments made this way. To learn 11:00 p.m. Eastern time.
more about the information you will need to give your
Photographs of missing children. The IRS is a proud
financial institution to make a same-day wire payment, go to
partner with the National Center for Missing & Exploited
IRS.gov/SameDayWire.
Children® (NCMEC). Photographs of missing children
Timeliness of federal tax deposits. If a deposit is selected by the Center may appear in instructions on pages
required to be made on a day that isn't a business day, the that would otherwise be blank. You can help bring these
deposit is considered timely if it is made by the close of the children home by looking at the photographs and calling
next business day. A business day is any day other than a 1-800-THE-LOST (1-800-843-5678) if you recognize a child.
Saturday, Sunday, or legal holiday. The term “legal holiday”
for deposit purposes includes only those legal holidays in the
District of Columbia. Legal holidays in the District of General Instructions:
Columbia are provided in section 8 of Pub. 80.
Electronic filing and payment. Businesses can enjoy the Purpose of Form 941-SS
benefits of filing tax returns and paying their federal taxes Use Form 941-SS to report social security and Medicare
electronically. Whether you rely on a tax professional or taxes for workers in American Samoa, Guam, the
handle your own taxes, the IRS offers you convenient Commonwealth of the Northern Mariana Islands, and the
programs to make filing and paying easier. Spend less time U.S. Virgin Islands.
worrying about taxes and more time running your business.
Use e-file and EFTPS to your benefit. Pub. 80 explains the requirements for withholding,
• For e-file, go to IRS.gov/EmploymentEfile for additional depositing, and paying social security and Medicare taxes. It
information. A fee may be charged to file electronically. explains the forms you must give your employees, those your
• For EFTPS, go to EFTPS.gov, or call one of the numbers employees must give you, and those you must send to the
provided under Federal tax deposits must be made by IRS. See Pub. 15-A for specialized employment tax
electronic funds transfer (EFT), earlier. information supplementing the basic information provided in
• For electronic filing of Forms W-2AS, W-2CM, W-2GU, Pub. 80.
and W-2VI, go to SSA.gov/employer. You may be required to Federal law requires you, as an employer, to withhold
file Forms W-2 electronically. For details, see the General certain taxes from your employees' pay. Each time you pay
Instructions for Forms W-2 and W-3. wages, you must withhold—or take out of your employees'
If you’re filing your tax return or paying your federal pay—certain amounts for social security tax and Medicare
tax. You must also withhold Additional Medicare Tax from
CAUTION number (EIN) is required at the time the return is filed
! taxes electronically, a valid employer identification wages you pay to an employee in excess of $200,000 in a
or the payment is made. If a valid EIN isn't provided, the calendar year. Under the withholding system, taxes withheld
return or payment won't be processed. This may result in from your employees are credited to your employees in
penalties. See Employer identification number (EIN), later, for payment of their tax liabilities.
information about applying for an EIN. Federal law also requires you to pay any liability for the
Electronic funds withdrawal (EFW). If you file Form employer share of social security and Medicare taxes. This
941-SS electronically, you can e-file and use EFW to pay the share of social security and Medicare taxes isn't withheld
balance due in a single step using tax preparation software or from employees.
through a tax professional. However, don't use EFW to make
federal tax deposits. For more information on paying your Who Must File Form 941-SS?
taxes using EFW, go to IRS.gov/EFW. Generally, you must file a return for the first quarter in which
you pay wages subject to social security and Medicare taxes,
Credit or debit card payments. You can pay the balance and for each quarter thereafter until you file a final return. Use
due shown on Form 941-SS by credit or debit card. Your Form 941-SS if your principal place of business is in
payment will be processed by a payment processor who will American Samoa, Guam, the Commonwealth of the Northern
charge a processing fee. Don't use a credit or debit card to Mariana Islands, or the U.S. Virgin Islands, or if you have
make federal tax deposits. For more information on paying employees who are subject to income tax withholding for
your taxes with a credit or debit card, go to IRS.gov/ these jurisdictions.
PayByCard.
Use Form 941-SS to report the following amounts.
Online payment agreement. You may be eligible to apply • Wages you’ve paid.
for an installment agreement online if you can’t pay the full • Tips your employees reported to you.
amount of tax you owe when you file your return. For more • Both the employer and the employee share of social
information, see What if you can't pay in full, later. security and Medicare taxes.
Paid preparers. If you use a paid preparer to complete • Additional Medicare Tax withheld from employees.
Form 941-SS, the paid preparer must complete and sign the • Current quarter's adjustments to social security and
paid preparer's section of the form. Medicare taxes for fractions of cents, sick pay, tips, and
group-term life insurance.
Where can you get telephone help? For answers to your Qualified small business payroll tax credit for increasing
•
questions about completing Form 941-SS or tax deposit research activities.
rules, call the IRS at one of the numbers listed below. Credit for qualified sick and family leave wages paid this
•
• 800-829-4933 (toll free; for use by U.S. Virgin Islands only) quarter of 2022 for leave taken after March 31, 2020, and
or 800-829-4059 (TDD/TTY for persons who are deaf, hard before October 1, 2021.

Instructions for Form 941-SS (Rev. 6-2022) -5-

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  Don't use Form 941-SS if you have both employees who                 Requesting to file Form 944 instead of Forms 941-SS.          If 
are subject to U.S. income tax withholding and employees               you’re required to file Forms 941-SS but believe your 
who aren't subject to U.S. income tax withholding. Instead,            employment taxes for 2022 will be $1,000 or less, you may 
you must file only Form 941 (or Form 944) and include all of           request to file Form 944 instead of Forms 941-SS by calling 
your employees' wages on that form.                                    the IRS at 800-829-4933 toll free (U.S. Virgin Islands only) or 
  Don't use Form 941-SS to report backup withholding or                267-941-1000 (toll call) between January 1, 2022, and April 
income tax withholding on nonpayroll payments such as                  1, 2022, or sending a written request postmarked between 
pensions, annuities, and gambling winnings. Report these               January 1, 2022, and March 15, 2022. After you contact the 
types of withholding on Form 945, Annual Return of Withheld            IRS, the IRS will send you a written notice that your filing 
Federal Income Tax. Also, don't use Form 941-SS to report              requirement has been changed to Form 944. You must 
unemployment taxes. Report unemployment taxes (U.S.                    receive written notice from the IRS to file Form 944 instead of 
Virgin Islands employers only) on Form 940, Employer's                 Forms 941-SS before you may file this form. If you don't 
Annual Federal Unemployment (FUTA) Tax Return.                         receive this notice, you must file Forms 941-SS for calendar 
                                                                       year 2022.
  After you file your first Form 941-SS, you must file a return 
each quarter, even if you have no taxes to report, unless you          Where to send written requests. Written requests should 
filed a final return or one of the exceptions listed next applies.     be sent to:
Exceptions                                                               Department of the Treasury
                                                                         Internal Revenue Service
Special rules apply to some employers.                                   Ogden, UT 84201-0038
• If you received notification to file Form 944, you must file 
Form 944 annually; don't file Form 941-SS quarterly.                     For more information about these procedures, see Rev. 
• Seasonal employers don't have to file a Form 941-SS for              Proc. 2009-51, 2009-45 I.R.B. 625, available at IRS.gov/irb/
quarters in which they have no tax liability because they have         2009-45_IRB#RP-2009-51.
paid no wages. To tell the IRS that you won't file a return for 
one or more quarters during the year, check the box on                 What if You Reorganize or Close Your 
line 18 every quarter you file Form 941-SS. The IRS generally 
won't inquire about unfiled returns if at least one taxable            Business?
return is filed each year. However, you must check the box             If You Sell or Transfer Your Business . . .
on line 18 on every quarterly return you file. Otherwise, the          If you sell or transfer your business during the quarter, you 
IRS will expect a return to be filed for each quarter.                 and the new owner must each file a Form 941-SS for the 
• Employers of household employees don't usually file                  quarter in which the transfer occurred. Report only the wages 
Form 941-SS. See Pub. 80, Pub. 926, and Schedule H (Form               you paid.
1040) for more information.
• Employers of farm employees don't file Form 941-SS for                 When two businesses merge, the continuing firm must file 
wages paid for agricultural labor. See Form 943 and Pub. 51            a return for the quarter in which the change took place and 
for more information.                                                  the other firm should file a final return.
    If none of these exceptions apply and you haven't 
TIP filed a final return, you must file Form 941-SS each                 Changing from one form of business to another—such as 
    quarter even if you didn't pay wages during the                    from a sole proprietorship to a partnership or corporation—is 
quarter. Use IRS e-file, if possible.                                  considered a transfer. If a transfer occurs, you may need a 
                                                                       new EIN. See Pub. 1635 and section 1 of Pub. 80 for more 
                                                                       information.
Requesting To File Forms 941-SS Instead of 
Form 944, or Requesting To File Form 944                                 Attach a statement to your return with:
Instead of Forms 941-SS                                                • The new owner's name (or the new name of the business);
                                                                       • Whether the business is now a sole proprietorship, 
Requesting to file Forms 941-SS instead of Form 944.                   partnership, or corporation;
Employers in American Samoa, Guam, the Commonwealth                    • The kind of change that occurred (a sale or transfer);
of the Northern Mariana Islands, and the U.S. Virgin Islands           • The date of the change; and
that would otherwise be required to file Form 944, Employer's          • The name of the person keeping the payroll records and 
ANNUAL Federal Tax Return, may contact the IRS to request              the address where those records will be kept.
to file quarterly Forms 941-SS instead of annual Form 944. 
To request to file quarterly Forms 941-SS to report your 
social security and Medicare taxes for the 2022 calendar               If Your Business Has Closed . . .
year, you must either call the IRS at 800-829-4933 toll free           If you permanently go out of business or stop paying wages 
(U.S. Virgin Islands only) or 267-941-1000 (toll call) between         to your employees, you must file a final return. To tell the IRS 
January 1, 2022, and April 1, 2022, or send a written request          that Form 941-SS for a particular quarter is your final return, 
postmarked between January 1, 2022, and March 15, 2022.                check the box on line 17 and enter the final date you paid 
After you contact the IRS, the IRS will send you a written             wages. Also attach a statement to your return showing the 
notice that your filing requirement has been changed to                name of the person keeping the payroll records and the 
Forms 941-SS. You must receive written notice from the IRS             address where those records will be kept.
to file Forms 941-SS instead of Form 944 before you may file 
these forms. If you don't receive this notice, you must file             See Terminating a business in the General Instructions for 
Form 944 for calendar year 2022.                                       Forms W-2 and W-3 for information about earlier dates for 
                                                                       the expedited furnishing and filing of the following Wage and 
                                                                       Tax Statements when a final Form 941-SS is filed.

                                                                   -6-             Instructions for Form 941-SS (Rev. 6-2022)

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• W-2AS, American Samoa. individual taxpayer identification number (ITIN). Generally,
• W-2CM, Commonwealth of the Northern Mariana Islands. enter the business (legal) name you used when you applied
• W-2GU, Guam. for your EIN. For example, if you’re a sole proprietor, enter
• W-2VI, U.S. Virgin Islands. “Haleigh Smith” on the “Name” line and “Haleigh's Cycles” on
the “Trade name” line. Leave the “Trade name” line blank if it
If you participated in a statutory merger or consolidation, is the same as your “Name.”
or qualify for predecessor-successor status due to an
acquisition, you should generally file Schedule D (Form 941), If you use a tax preparer to fill out Form 941-SS, make
Report of Discrepancies Caused by Acquisitions, Statutory sure the preparer shows your business name exactly as it
Mergers, or Consolidations. See the Instructions for appeared when you applied for your EIN.
Schedule D (Form 941) to determine whether you should file Employer identification number (EIN). To make sure that
Schedule D (Form 941) and when you should file it. businesses comply with federal tax laws, the IRS monitors
tax filings and payments by using a numerical system to
When Must You File? identify taxpayers. A unique nine-digit EIN is assigned to all
File your initial Form 941-SS for the quarter in which you first corporations, partnerships, and some sole proprietors.
paid wages that are subject to social security and Medicare Businesses needing an EIN must apply for a number and use
taxes. See the table titled When To File Form 941-SS, later. it throughout the life of the business on all tax returns,
payments, and reports.
Then, you must file for every quarter after that—every 3
months—even if you have no taxes to report, unless you’re a Your business should have only one EIN. If you have more
seasonal employer or are filing your final return. See than one and aren't sure which one to use, write to the IRS
Seasonal employers and If Your Business Has Closed, office where you file your returns (using the Without a
earlier. payment address under Where Should You File, later) or call
the IRS at 800-829-4933 (toll free; for use by U.S. Virgin
File Form 941-SS only once for each quarter. If you filed Islands only) or 267-941-1099 (toll call).
electronically, don't file a paper Form 941-SS. For more
If you don't have an EIN, you may apply for one online by
information about filing Form 941-SS electronically, see
visiting IRS.gov/EIN. You may also apply for an EIN by faxing
Electronic filing and payment, earlier.
or mailing Form SS-4 to the IRS. If the principal business was
created outside of the United States or U.S. territories, you
When To File Form 941-SS
may also apply for an EIN by calling 267-941-1099 (toll call).
Your Form 941-SS is due by the last day of the month that follows the end of the If you haven't received your EIN by the due date of Form
quarter. 941-SS, write “Applied For” and the date you applied in this
Form 941-SS entry space.
The Quarter Includes . . . Quarter Ends Is Due If you’re filing your tax return electronically, a valid
1. January, February, March March 31 April 30 ! EIN is required at the time the return is filed. If a valid
2. April, May, June June 30 July 31 CAUTION EIN isn't provided, the return won't be accepted. This
3. July, August, September September 30 October 31 may result in penalties.

4. October, November, December December 31 January 31 Always be sure the EIN on the form you file exactly
TIP matches the EIN the IRS assigned to your business.
For example, you must generally report wages you pay
Don't use your SSN or ITIN on forms that ask for an
during the 1st quarter—which is January through March—by
EIN. If you used an EIN (including a prior owner's EIN) on
April 30. If you made timely deposits in full payment of your
Form 941-SS that is different from the EIN reported on Form
taxes for the quarter, you may file by the 10th day of the 2nd
W-3SS, see Box h—Other EIN used this year in the General
month that follows the end of the quarter. For example, you
Instructions for Forms W-2 and W-3. Filing a Form 941-SS
may file Form 941-SS by May 10 if you made timely deposits
with an incorrect EIN or using another business's EIN may
in full payment of your taxes for the 1st quarter.
result in penalties and delays in processing your return.
If we receive Form 941-SS after the due date, we will treat
Form 941-SS as filed on time if the envelope containing Form If you change your business name, business address,
941-SS is properly addressed, contains sufficient postage, or responsible party . . . Notify the IRS immediately if you
and is postmarked by the U.S. Postal Service on or before change your business name, business address, or
the due date, or sent by an IRS-designated private delivery responsible party.
service (PDS) on or before the due date. If you don't follow • Write to the IRS office where you file your returns (using
these guidelines, we will generally consider Form 941-SS the Without a payment address under Where Should You
filed when it is actually received. For more information about File, later) to notify the IRS of any business name change.
PDSs, see Where Should You File, later. 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
If any due date for filing falls on a Saturday, Sunday, or business address or responsible party change. Don't mail
legal holiday, you may file your return on the next business Form 8822-B with your Form 941-SS. For a definition of
day. “responsible party,” see the Instructions for Form SS-4.

How Should You Complete Form Check the Box for the Quarter
941-SS? Under “Report for this Quarter of 2022” at the top of Form
941-SS, check the appropriate box of the quarter for which
Type or print your EIN, name, and address in the spaces you're filing. Make sure the quarter checked is the same as
provided. Also enter your name and EIN on the top of pages shown on any attached Schedule B (Form 941), Report of
2 and 3. Don't use your social security number (SSN) or

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Tax Liability for Semiweekly Schedule Depositors, and, if Without a
applicable, Schedule R (Form 941). If you’re in . . . payment . . . With a payment . . .
Special filing addresses for Department of the Internal Revenue
Completing and Filing Form 941-SS exempt organizations; federal, Treasury Service
Make entries on Form 941-SS as follows to enable accurate state, and local governmental Internal Revenue P.O. Box 932100
scanning and processing. entities; and Indian tribal Service Louisville, KY
governmental entities, Ogden, UT 40293-2100
• Use 10-point Courier font (if possible) for all entries if regardless of location 84201-0005
you’re typing or using a computer to complete your form.
Portable Document Format (PDF) forms on IRS.gov have
fillable fields with acceptable font specifications. Your filing address may have changed from that
• Don't enter dollar signs and decimal points. Commas are ! used to file your employment tax return in prior years.
optional. Enter dollars to the left of the preprinted decimal CAUTION Don't send Form 941-SS or any payments to the
point and cents to the right of it. Don’t round entries to whole SSA.
dollars. Always show an amount for cents, even if it is zero.
• Leave blank any data field (except lines 1 and 12) with a
value of zero. Depositing Your Taxes
• Enter negative amounts using a minus sign (if possible). You must deposit all depository taxes electronically
Otherwise, use parentheses. ! by EFT. For more information, see Federal tax
• Enter your name and EIN on all pages and attachments. CAUTION deposits must be made by electronic funds transfer
• Enter your name, EIN, “Form 941-SS,” and the tax year (EFT) under Reminders, earlier.
and quarter on all attachments.
• Staple multiple sheets in the upper left corner when filing.
Must You Deposit Your Taxes?
Complete all three pages. You must complete all three You may have to deposit both the employer and employee
pages of Form 941-SS and sign on page 3. Failure to do so social security taxes and Medicare taxes.
may delay processing of your return. • If your total taxes after adjustments and
nonrefundable credits (line 12) are less than $2,500 for
Reconciling Forms 941-SS and W-3SS the current quarter or the prior quarter, and you didn't
The IRS matches amounts reported on your four quarterly incur a $100,000 next-day deposit obligation during the
Forms 941-SS with Form W-2AS, W-2CM, W-2GU, or W-2VI current quarter. You don't have to make a deposit. To avoid
amounts totaled on your yearly Form W-3SS, Transmittal of a penalty, you must pay any amount due in full with a timely
Wage and Tax Statements. If the amounts don't agree, you filed return or you must deposit any amount you owe by the
may be contacted by the IRS or the Social Security due date of the return. For more information on paying with a
Administration (SSA). The following amounts are reconciled. timely filed return, see the instructions for line 14, later. If
• Social security wages. you’re not sure your total tax liability for the current quarter
• Social security tips. will be less than $2,500 (and your liability for the prior quarter
• Medicare wages and tips. wasn't less than $2,500), make deposits using the
semiweekly or monthly rules so you won't be subject to FTD
Use Schedule D (Form 941) to explain certain wage, tax, penalties.
and payment discrepancies between Forms 941-SS and • If your total taxes after adjustments and
Forms W-2AS, W-2CM, W-2GU, W-2VI, W-3SS, and W-2c, nonrefundable credits (line 12) are $2,500 or more for
Corrected Wage and Tax Statement, that were caused by the current quarter and the prior quarter. You must make
acquisitions, statutory mergers, or consolidations. For more deposits according to your deposit schedule. See section 8
information, see the Instructions for Schedule D (Form 941). of Pub. 80 for information about payments made under the
Also see Rev. Proc. 2004-53 for more information. You can accuracy of deposits rule and for rules about federal tax
find Rev. Proc. 2004-53 on page 320 of I.R.B. 2004-34 at deposits.
IRS.gov/irb/2004-34_IRB#RP-2004-53. Reducing your deposits for COVID-19 credits.
Employers eligible to claim the credit for qualified sick and
Where Should You File?
family leave wages paid this quarter of 2022 for leave taken
You're encouraged to file Form 941-SS electronically. Go to after March 31, 2020, and before October 1, 2021, can
IRS.gov/EmploymentEfile for more information on electronic reduce their deposits by the amount of their anticipated
filing. If you file a paper return, where you file depends on credits. Employers won’t be subject to an FTD penalty for
whether you include a payment with Form 941-SS. reducing their deposits if certain conditions are met. See the
PDSs can't deliver to P.O. boxes. You must use the U.S. instructions for line 11b and line 11d, later, for more
Postal Service to mail an item to a P.O. box address. Go to information on these credits. For more information on
IRS.gov/PDS for the current list of PDSs. For the IRS mailing reducing deposits, see Notice 2020-22, 2020-17 I.R.B. 664,
address to use if you're using a PDS, go to IRS.gov/ available at IRS.gov/irb/2020-17_IRB#NOT-2020-22; and
PDSstreetAddresses. Select the address on the webpage Notice 2021-24, 2021-18 I.R.B. 1122, available at
that is given for the Ogden Submission Processing Center. IRS.gov/irb/2021-18_IRB#NOT-2021-24. See the
instructions for line 16, later, for information on adjusting tax
Without a liabilities reported on line 16 or Schedule B (Form 941) for
If you’re in . . . payment . . . With a payment . . . nonrefundable credits.
American Samoa, Guam, Internal Revenue Internal Revenue
Commonwealth of the Northern Service Service
Mariana Islands, U.S. Virgin P.O. Box 409101 P.O. Box 932100
Islands Ogden, UT 84409 Louisville, KY
40293-2100

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When Must You Deposit Your Taxes? Penalties and interest are charged on taxes paid late and
returns filed late at a rate set by law. See section 8 of Pub. 80
Determine if You’re a Monthly or Semiweekly for details.
Schedule Depositor for the Quarter
Use Form 843 to request abatement of assessed
The IRS uses two different sets of deposit rules to determine penalties or interest. Don't request abatement of assessed
when businesses must deposit their social security and penalties or interest on Form 941-SS or Form 941-X.
Medicare taxes. These schedules tell you when a deposit is
due after you have a payday. If you receive a notice about a penalty after you file this
return, reply to the notice with an explanation and we will
Your deposit schedule isn't determined by how often you determine if you meet reasonable-cause criteria. Don't attach
pay your employees. Your deposit schedule depends on the an explanation when you file your return.
total tax liability you reported on Form 941-SS during the If federal income, social security, and Medicare taxes
previous 4-quarter lookback period (July 1 of the second ! that must be withheld (that is, trust fund taxes) aren't
preceding calendar year through June 30 of the preceding CAUTION withheld or aren't deposited or paid to the United
calendar year). See section 8 of Pub. 80 for details. If you States Treasury, the trust fund recovery penalty may apply.
filed Form 944 in either 2020 or 2021, your lookback period is The penalty is 100% of the unpaid trust fund tax. If these
the 2020 calendar year. unpaid taxes can't be immediately collected from the
employer or business, the trust fund recovery penalty may be
Before the beginning of each calendar year, determine imposed on all persons who are determined by the IRS to be
which type of deposit schedule you must use. responsible for collecting, accounting for, or paying over
• If you reported $50,000 or less in taxes during the these taxes, and who acted willfully in not doing so. For more
lookback period, you’re a monthly schedule depositor. information, see section 8 of Pub. 80. The trust fund recovery
• If you reported more than $50,000 of taxes during the penalty won’t apply to any amount of trust fund taxes an
lookback period, you’re a semiweekly schedule depositor. employer holds back in anticipation of any credits they are
If you’re a monthly schedule depositor and entitled to. It also won't apply to applicable taxes deferred
under section 2302 of the CARES Act or applicable taxes
! accumulate a $100,000 tax liability on any day during deferred under Notice 2020-65 and Notice 2021-11 if paid by
CAUTION the deposit period, you become a semiweekly
schedule depositor on the next day and remain so for at least the due date.
the rest of the calendar year and for the following calendar
year. See $100,000 Next-Day Deposit Rule in section 8 of Adjustment of Tax on Tips
Pub. 80 for more information. The $100,000 tax liability If, by the 10th of the month after the month you received an
threshold requiring a next-day deposit is determined before employee's report on tips, you don't have enough employee
you consider any reduction of your liability for nonrefundable funds available to withhold the employee share of social
credits. For more information, including an example, see security and Medicare taxes, you no longer have to collect it.
frequently asked question 17 at IRS.gov/ETD. Report the entire amount of these tips on line 5b (Taxable
social security tips), line 5c (Taxable Medicare wages and
If you became a semiweekly schedule depositor for 2022 tips), and, if the withholding threshold is met, line 5d (Taxable
under the $100,000 Next-Day Deposit Rule solely as a result wages and tips subject to Additional Medicare Tax
of the relief provided in Notice 2021-65 regarding the early withholding). Include as a negative adjustment on line 9 the
termination of the employee retention credit for the fourth total uncollected employee share of the social security and
quarter of 2021, you may be converted back to a monthly Medicare taxes.
schedule depositor by contacting the IRS. You may continue
to deposit in accordance with your status as a monthly Where Can You Obtain Forms?
schedule depositor, but you may receive a system-generated
See Pub. 80 for information on ordering IRS forms. You may
FTD penalty notice after you file your Form 941-SS for the
also be able to get some IRS forms at the addresses listed
first quarter of 2022. Contact the IRS at the toll-free number
next.
on your FTD penalty notice to request abatement of the FTD
penalty and to be converted back to a monthly schedule
depositor. American Samoa Tax Office
Executive Office Building, First Floor
What About Penalties and Interest? Pago Pago, AS 96799
Commonwealth of the CNMI Division of Revenue and Taxation
Avoiding Penalties and Interest Northern Mariana Islands Joeten Dandan Commercial Center
You can avoid paying penalties and interest if you do all of Saipan, MP 96950
the following. Guam Department of Revenue and Taxation
• Deposit or pay your taxes when they are due, unless you Government of Guam
meet the requirements discussed in Notice 2020-22 and 1240 Army Drive
Notice 2021-24. Barrigada, GU 96913
• File your fully completed Form 941-SS on time. U.S. Virgin Islands Bureau of Internal Revenue
• Report your tax liability accurately. 6115 Estate Smith Bay
• Submit valid checks for tax payments. St. Thomas, VI 00802
• Furnish accurate Forms W-2AS, W-2CM, W-2GU, or
W-2VI to employees.
• File Form W-3SS and Copy A of Forms W-2AS, W-2CM,
W-2GU, or W-2VI with the SSA on time and accurately.

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15-A for more information about sick pay reporting. See the
Specific Instructions: instructions for line 8 for an adjustment that you may need to
make on Form 941-SS for sick pay.
Part 1: Answer These Questions for Enter the amount before payroll deductions. Don't include
This Quarter tips on this line. For information on types of wages subject to
social security taxes, see section 4 of Pub. 80.
1. Number of Employees Who Received Wages, For 2022, the rate of social security tax on taxable wages,
Tips, or Other Compensation except for qualified sick leave wages and qualified family
leave wages paid in 2022 for leave taken after March 31,
Enter the number of employees on your payroll for the pay 2020, and before April 1, 2021, is 6.2% (0.062) each for the
period including June 12, September 12, or December 12, for employer and employee or 12.4% (0.124) for both. Stop
the quarter indicated at the top of the Form 941-SS. Don't paying social security tax on and entering an employee's
include: wages on line 5a when the employee's taxable wages,
• Household employees, including qualified sick leave wages paid in 2022 that are
• Employees in nonpay status for the pay period, reported on line 5a(i), qualified family leave wages paid in
• Farm employees, 2022 that are reported on line 5a(ii), and tips, reach $147,000
• Pensioners, or for the year. However, continue to withhold Medicare taxes
• Active members of the U.S. Armed Forces. for the whole year on all wages, including qualified sick leave
wages paid in 2022, qualified family leave wages paid in
4. If No Wages, Tips, and Other Compensation 2022, and tips, even when the social security wage base of
Are Subject to Social Security or Medicare $147,000 has been reached.
Tax . . . For purposes of the credit for qualified sick and family
If no wages, tips, and compensation are subject to social leave wages, qualified sick leave and family leave wages are
security or Medicare tax, check the box on line 4. If this wages for social security and Medicare tax purposes,
question doesn't apply to you, leave the box blank. For more determined without regard to the exclusions from the
information about exempt wages, see section 12 of Pub. 80. definition of employment under sections 3121(b)(1)–(22),
For religious exemptions, see section 4 of Pub. 15-A. that an employer pays that otherwise meet the requirements
If you’re a governmental employer, wages you pay of the Emergency Paid Sick Leave Act (EPSLA) or the
Emergency Family and Medical Leave Expansion Act
! aren't automatically exempt from social security and (Expanded FMLA), as enacted under the FFCRA and
CAUTION Medicare taxes. Your employees may be covered by
law or by a voluntary Section 218 Agreement with the SSA. amended for purposes of the ARP. However, don't include
For more information, see Pub. 963, Federal-State any wages otherwise excluded under section 3121(b) when
Reference Guide. reporting qualified sick and family leave wages on lines 5a,
5a(i), 5a(ii), 5c, and, if applicable, 5d. See the instructions for
For purposes of these instructions, all references to line 11d for information about the credit for qualified sick and
TIP “sick pay” mean ordinary sick pay, not “qualified sick family leave wages for leave taken after March 31, 2021, and
leave wages” that are reported on line 5a(i) for leave before October 1, 2021.
taken after March 31, 2020, and before April 1, 2021, or line 5a (column 1)
reported on line 5a for leave taken after March 31, 2021, and
before October 1, 2021. x 0.124
line 5a (column 2)
5a–5e. Taxable Social Security and Medicare
Wages and Tips EPSLA. Employers with fewer than 500 employees and,
for leave taken after March 31, 2021, and before October 1,
Qualified sick leave wages and qualified family leave 2021, certain governmental employers without regard to
! wages paid this quarter of 2022 for leave taken after number of employees (except for the federal government and
CAUTION March 31, 2020, and before April 1, 2021, are
its agencies and instrumentalities unless described in section
reported on lines 5a(i) and 5a(ii), respectively. Qualified sick 501(c)(1)) are entitled to a credit if they provide paid sick
leave wages and qualified family leave wages paid this leave to employees that otherwise meets the requirements of
quarter of 2022 for leave taken after March 31, 2021, and the EPSLA. Under the EPSLA, as amended for purposes of
before October 1, 2021, are reported on line 5a. the ARP, wages are qualified sick leave wages if paid to
employees that are unable to work or telework before
5a. Taxable social security wages. Enter the total wages,
October 1, 2021, because the employee:
including qualified sick leave wages and qualified family
leave wages paid this quarter of 2022 for leave taken after 1. Is subject to a federal, state (including U.S. territories),
March 31, 2021, and before October 1, 2021; sick pay; and or local quarantine or isolation order related to COVID-19;
taxable fringe benefits subject to social security taxes you 2. Has been advised by a health care provider to
paid to your employees during the quarter. Don't include the self-quarantine due to concerns related to COVID-19;
qualified sick leave wages paid this quarter of 2022 that are 3. Is experiencing symptoms of COVID-19 and seeking a
reported on line 5a(i) or qualified family leave wages paid this medical diagnosis; or, for leave taken after March 31, 2021,
quarter of 2022 that are reported on line 5a(ii) for leave taken and before October 1, 2021, is seeking or awaiting the
after March 31, 2020, and before April 1, 2021. For this results of a diagnostic test for, or a medical diagnosis of,
purpose, sick pay includes payments made by an insurance COVID-19 (and the employee has been exposed to
company to your employees for which you received timely COVID-19 or the employee's employer has requested such
notice from the insurance company. See section 6 of Pub. test or diagnosis), or the employee is obtaining

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immunizations related to COVID-19 or recovering from an             closed, or the childcare provider for that child is unavailable, 
injury, disability, illness, or condition related to such           due to a public health emergency. See Son or daughter, 
immunization;                                                       earlier, for more information. For leave taken after March 31, 
   4. Is caring for an individual subject to an order described     2021, and before October 1, 2021, the leave can be granted 
in (1) or who has been advised as described in (2);                 for any other reason provided by the EPSLA, as amended for 
                                                                    purposes of the ARP.
   5. Is caring for a son or daughter because the school or 
place of care for that child has been closed, or the childcare      For leave taken after March 31, 2020, and before April 1, 
provider for that child is unavailable, due to COVID-19             2021, the first 10 days for which an employee takes leave 
precautions; or                                                     may be unpaid. During this period, employees may use other 
                                                                    forms of paid leave, such as qualified sick leave, accrued 
   6. Is experiencing any other substantially similar               sick leave, annual leave, or other paid time off. After an 
condition specified by the U.S. Department of Health and            employee takes leave for 10 days, the employer must 
Human Services, which for leave taken after March 31, 2021,         provide the employee paid leave (that is, qualified family 
and before October 1, 2021, includes to accompany an                leave wages) for up to 10 weeks. For leave taken after March 
individual to obtain immunization related to COVID-19, or to        31, 2021, and before October 1, 2021, the 10-day rule 
care for an individual who is recovering from any injury,           discussed above doesn't apply and the paid leave can be 
disability, illness, or condition related to the immunization.      provided for up to 12 weeks.
Son or daughter. A son or daughter must generally have              Rate of pay and limit on wages.    The rate of pay must be 
been under 18 years of age or incapable of self-care                at least two-thirds of the employee’s regular rate of pay (as 
because of a mental or physical disability. A son or daughter       determined under the Fair Labor Standards Act of 1938), 
includes a biological child, adopted child, stepchild, foster       multiplied by the number of hours the employee otherwise 
child, legal ward, or a child for whom the employee assumes         would have been scheduled to work. For leave taken after 
parental status and carries out the obligations of a parent.        March 31, 2020, and before April 1, 2021, the total qualified 
Limits on qualified sick leave wages. The EPSLA, as                 family leave wages can’t exceed $200 per day or $10,000 in 
amended for purposes of the ARP, provides different                 the aggregate per employee. For leave taken after March 31, 
limitations for different circumstances under which qualified       2021, and before October 1, 2021, the limit resets and the 
sick leave wages are paid. For paid sick leave qualifying           total qualified family leave wages can't exceed $200 per day 
under (1), (2), or (3) earlier, the amount of qualified sick leave  or $12,000 in the aggregate per employee.
wages is determined at the employee's regular rate of pay,          For more information about qualified family leave wages, 
but the wages may not exceed $511 for any day (or portion of        go to IRS.gov/PLC.
a day) for which the individual is paid sick leave. For paid sick 
leave qualifying under (4), (5), or (6) earlier, the amount of      5a(i). Qualified sick leave wages. Enter the qualified 
qualified sick leave wages is determined at two-thirds the          taxable (subject to social security tax) sick leave wages you 
employee's regular rate of pay, but the wages may not               paid this quarter of 2022 to your employees for leave taken 
exceed $200 for any day (or portion of a day) for which the         after March 31, 2020, and before April 1, 2021. Qualified sick 
individual is paid sick leave. The EPSLA also limits each           leave wages for leave taken after March 31, 2020, and before 
individual to a maximum of up to 80 hours of paid sick leave        April 1, 2021, aren't subject to the employer share of social 
in total for leave taken after March 31, 2020, and before April     security tax; therefore, the tax rate on these wages is 6.2% 
1, 2021. The ARP resets this limit at 80 hours of paid sick         (0.062). Stop paying social security tax on and entering an 
leave for leave taken after March 31, 2021, and before              employee's wages on line 5a(i) when the employee's taxable 
October 1, 2021. Therefore, for leave taken after March 31,         wages, including wages reported on line 5a, qualified sick 
2020, and before April 1, 2021, the maximum amount of paid          leave wages reported on line 5a(i), qualified family leave 
sick leave wages can't exceed $5,110 for an employee for            wages reported on line 5a(ii), and tips, reach $147,000 for 
leave under (1), (2), or (3), and it can't exceed $2,000 for an     the year. See the instructions for line 5c for reporting 
employee for leave under (4), (5), or (6). These maximum            Medicare tax on qualified sick leave wages, including the 
amounts also reset and apply to leave taken after March 31,         portion above the social security wage base.
2021, and before October 1, 2021.                                   For purposes of the credit for qualified sick and family 
   For more information about qualified sick leave wages, go        leave wages, qualified sick leave wages are wages for social 
to IRS.gov/PLC.                                                     security and Medicare tax purposes, determined without 
                                                                    regard to the exclusions from the definition of employment 
Expanded FMLA.   Employers with fewer than 500 
                                                                    under sections 3121(b)(1)–(22), that an employer pays that 
employees and, for leave taken after March 31, 2021, and 
                                                                    otherwise meet the requirements of the EPSLA, as enacted 
before October 1, 2021, certain governmental employers 
                                                                    under the FFCRA and amended by the COVID-related Tax 
without regard to number of employees (except for the 
                                                                    Relief Act of 2020. However, don't include any wages 
federal government and its agencies and instrumentalities 
                                                                    otherwise excluded under section 3121(b) when reporting 
unless described in section 501(c)(1)) are entitled to a credit 
                                                                    qualified sick leave wages on lines 5a(i), 5c, and, if 
under the FFCRA, as amended for purposes of the ARP, if 
                                                                    applicable, 5d. See the instructions for line 11b for 
they provide paid family leave to employees that otherwise 
                                                                    information about the credit for qualified sick and family leave 
meets the requirements of the Expanded FMLA. For leave 
                                                                    wages for leave taken after March 31, 2020, and before April 
taken after March 31, 2020, and before April 1, 2021, wages 
                                                                    1, 2021.
are qualified family leave wages if paid to an employee who 
has been employed for at least 30 calendar days when an                                 line 5a(i)  (column 1)
employee is unable to work or telework due to the need to                             x    0.062
care for a son or daughter under 18 years of age or incapable 
                                                                                        line 5a(i)  (column 2)
of self-care because of a mental or physical disability 
because the school or place of care for that child has been 

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5a(ii). Qualified family leave wages. Enter the qualified 941-SS and aren't subject to withholding of social security or
taxable (subject to social security tax) family leave wages Medicare taxes.
you paid this quarter of 2022 to your employees for leave
line 5b (column 1)
taken after March 31, 2020, and before April 1, 2021.
Qualified family leave wages for leave taken after March 31, x 0.124
2020, and before April 1, 2021, aren't subject to the employer line 5b (column 2)
share of social security tax; therefore, the tax rate on these
wages is 6.2% (0.062). Stop paying social security tax on
and entering an employee's wages on line 5a(ii) when the 5c. Taxable Medicare wages & tips. Enter all wages,
employee's taxable wages, including wages reported on including qualified sick leave wages paid this quarter of 2022,
line 5a, qualified sick leave wages reported on line 5a(i), and qualified family leave wages paid this quarter of 2022;
qualified family leave wages reported on line 5a(ii), and tips, tips; sick pay; and taxable fringe benefits that are subject to
reach $147,000 for the year. See the instructions for line 5c Medicare tax. Unlike social security wages, there is no limit
for reporting Medicare tax on qualified family leave wages, on the amount of wages subject to Medicare tax.
including the portion above the social security wage base. The rate of Medicare tax is 1.45% (0.0145) each for the
For purposes of the credit for qualified sick and family employer and employee or 2.9% (0.029) for both. Include all
leave wages, qualified family leave wages are wages for tips your employees reported during the quarter, even if you
social security and Medicare tax purposes, determined were unable to withhold the employee tax of 1.45%.
without regard to the exclusions from the definition of
employment under sections 3121(b)(1)–(22), that an line 5c (column 1)
employer pays that otherwise meet the requirements of the x 0.029
Expanded FMLA, as enacted under the FFCRA and line 5c (column 2)
amended by the COVID-related Tax Relief Act of 2020.
However, don't include any wages otherwise excluded under
section 3121(b) when reporting qualified family leave wages For more information on tips, see section 5 of Pub. 80.
on lines 5a(ii), 5c, and, if applicable, 5d. See the instructions See the instructions for line 8 for an adjustment that you may
for line 11b for information about the credit for qualified sick need to make on Form 941-SS for sick pay.
and family leave wages for leave taken after March 31, 2020, 5d. Taxable wages & tips subject to Additional Medicare
and before April 1, 2021. Tax withholding. Enter all wages, including qualified sick
line 5a(ii) (column 1) leave wages paid this quarter of 2022, and qualified family
x 0.062 leave wages paid this quarter of 2022; tips; sick pay; and
taxable fringe benefits that are subject to Additional Medicare
line 5a(ii) (column 2)
Tax withholding. You’re required to begin withholding
Additional Medicare Tax in the pay period in which you pay
wages in excess of $200,000 to an employee and continue to
5b. Taxable social security tips. Enter all tips your withhold it each pay period until the end of the calendar year.
employees reported to you during the quarter until the total of Additional Medicare Tax is only imposed on the employee.
the tips and taxable wages, including wages reported on There is no employer share of Additional Medicare Tax. All
line 5a, qualified sick leave wages reported on line 5a(i), and wages that are subject to Medicare tax are subject to
qualified family leave wages reported on line 5a(ii), for an Additional Medicare Tax withholding if paid in excess of the
employee reach $147,000 for the year. Include all tips your $200,000 withholding threshold.
employee reported to you even if you were unable to
For more information on what wages are subject to
withhold the employee tax of 6.2%. You will reduce your total
Medicare tax, see the chart, Special Rules for Various Types
taxes by the amount of any uncollected employee share of
of Employment and Payments, in section 12 of Pub. 80. For
social security and Medicare taxes on tips later on line 9; see
more information on Additional Medicare Tax, go to IRS.gov/
Current quarter's adjustments for tips and group-term life
ADMT. See the instructions for line 8 for an adjustment that
insurance, later. Don't include service charges on line 5b. For
you may need to make on Form 941-SS for sick pay.
details about the difference between tips and service
charges, see Rev. Rul. 2012-18, 2012-26 I.R.B. 1032, Once wages and tips exceed the $200,000 withholding
available at IRS.gov/irb/2012-26_IRB#RR-2012-18. threshold, include all tips your employees reported during the
quarter, even if you were unable to withhold the employee tax
Your employee must report cash tips to you by the 10th
of 0.9%.
day of the month after the month the tips are received. Cash
tips include tips paid by cash, check, debit card, and credit line 5d (column 1)
card. The report should include charged tips (for example, x 0.009
credit and debit card charges) you paid over to the employee line 5d (column 2)
for charge customers, tips the employee 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 5e. Total social security and Medicare taxes. Add the
is required for months when tips are less than $20. column 2 amounts on lines 5a–5d. Enter the result on line 5e.
Employees may use Form 4070 (available only in Pub. 1244)
or submit a written statement or electronic tip record. 5f. Section 3121(q) Notice and Demand—Tax
Don't include allocated tips on this line. Instead, report Due on Unreported Tips
them on Form 8027. Allocated tips aren't reportable on Form Enter the tax due from your Section 3121(q) Notice and
Demand on line 5f. The IRS issues a Section 3121(q) Notice

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and Demand to advise an employer of the amount of tips No adjustment is reported on line 8 for sick pay that is paid
received by employees who failed to report or underreported through a third party as an employer’s agent. An employer’s
tips to the employer. An employer isn't liable for the employer agent bears no insurance risk and is reimbursed on a
share of the social security and Medicare taxes on cost-plus-fee basis for payment of sick pay and similar
unreported tips until notice and demand for the taxes is made amounts. If an employer uses an agent to pay sick pay, the
to the employer by the IRS in a Section 3121(q) Notice and employer reports the wages on line 5a, line 5c, and, if the
Demand. The tax due may have been determined from tips withholding threshold is met, line 5d, unless the employer
reported to the IRS on employees' Forms 4137, Social has an agency agreement with the third-party payer that
Security and Medicare Tax on Unreported Tip Income, or requires the third-party payer to do the collecting, reporting,
other tips that weren't reported to their employer as and/or paying or depositing employment taxes on the sick
determined by the IRS during an examination. For additional pay. See section 6 of Pub. 15-A for more information about
information, see Rev. Rul. 2012-18. sick pay reporting.
9. Current quarter's adjustments for tips and
Deposit the tax within the time period required under your group-term life insurance. Enter a negative adjustment
deposit schedule to avoid any possible deposit penalty. The for:
tax is treated as accumulated by the employer on the “Date • Any uncollected employee share of social security and
of Notice and Demand” as printed on the Section 3121(q) Medicare taxes on tips, and
Notice and Demand. The employer must include this amount • The uncollected employee share of social security and
on the appropriate line of the record of federal tax liability Medicare taxes on group-term life insurance premiums paid
(Part 2 of Form 941-SS for a monthly schedule depositor or for former employees.
Schedule B (Form 941) for a semiweekly schedule
See the General Instructions for Forms W-2 and W-3 for
depositor).
information on how to report the uncollected employee share
6. Total Taxes Before Adjustments of social security and Medicare taxes on tips and group-term
life insurance on Form W-2.
Add the total social security and Medicare taxes before
adjustments (line 5e) and any tax due under a Section Prior quarter's adjustments. If you need to correct any
3121(q) Notice and Demand (line 5f). Enter the result on adjustment reported on a previously filed Form 941-SS,
line 6. complete and file Form 941-X. Form 941-X is an adjusted
return or claim for refund and is filed separately from Form
7–9. Tax Adjustments 941-SS. See section 9 of Pub. 80.
Enter tax amounts on lines 7–9 that result from current
quarter adjustments. Use a minus sign (if possible) to show 10. Total Taxes After Adjustments
an adjustment that decreases the total taxes shown on line 6 Combine the amounts shown on lines 6–9 and enter the
instead of parentheses. Doing so enhances the accuracy of result on line 10.
our scanning software. For example, enter “-10.59” instead of
“(10.59).” However, if your software only allows for 11a. Qualified Small Business Payroll Tax Credit
parentheses in entering negative amounts, you may use for Increasing Research Activities
them. Enter the amount of the credit from Form 8974, line 12.
Current quarter's adjustments. In certain cases, you must If you enter an amount on line 11a, you must attach
adjust the amounts you entered as social security and ! Form 8974. The December 2017 revision of Form
Medicare taxes in column 2 of lines 5a–5d to figure your CAUTION 8974 instructs you to enter the amount from Form
correct tax liability for this quarter's Form 941-SS. See 8974, line 12, on Form 941-SS, line 11. Instead, the amount
section 9 of Pub. 80. from Form 8974, line 12, should be entered on Form 941-SS,
7. Current quarter's adjustment for fractions of cents. line 11a.
Enter adjustments for fractions of cents (due to rounding)
relating to the employee share of social security and Form 941-SS and these instructions use the terms
Medicare taxes withheld. The employee share of amounts TIP “nonrefundable” and “refundable” when discussing
shown in column 2 of lines 5a–5d may differ slightly from credits. The term “nonrefundable” means the portion
amounts actually withheld from employees' pay due to the of the credit which is limited by law to the amount of certain
rounding of social security and Medicare taxes based on taxes. The term “refundable” means the portion of the credit
statutory rates. This adjustment may be a positive or negative which is in excess of those taxes.
adjustment.
8. Current quarter's adjustment for sick pay. If your 11b. Nonrefundable Portion of Credit for
third-party payer of sick pay that isn't your agent (for
Qualified Sick and Family Leave Wages for
example, an insurance company) transfers the liability for the
employer share of the social security and Medicare taxes to Leave Taken After March 31, 2020, and Before
you, enter a negative adjustment on line 8 for the employee April 1, 2021
share of social security and Medicare taxes that were Complete line 11b only if qualified sick leave wages
withheld and deposited by your third-party sick pay payer on ! and/or qualified family leave wages were paid this
the sick pay. If you’re the third-party sick pay payer and you CAUTION quarter of 2022 for leave taken after March 31, 2020,
transferred the liability for the employer share of the social and before April 1, 2021.
security and Medicare taxes to the employer, enter a
negative adjustment on line 8 for any employer share of Certain private employers with fewer than 500 employees
these taxes required to be paid by the employer. The sick that provide paid sick leave under the EPSLA and/or provide
pay should be included on line 5a, line 5c, and, if the paid family leave under the Expanded FMLA are eligible to
withholding threshold is met, line 5d. claim the credit for qualified sick and family leave wages for

Instructions for Form 941-SS (Rev. 6-2022) -13-

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leave taken after March 31, 2020, and before April 1, 2021.               You must include the full amount (both the 
For purposes of this credit, qualified sick leave wages and           TIP nonrefundable and refundable portions) of the credit 
qualified family leave wages are wages for social security                for qualified sick and family leave wages in your 
and Medicare tax purposes, determined without regard to the      gross income for the tax year that includes the last day of any 
exclusions from the definition of employment under sections      calendar quarter in which a credit is allowed.
3121(b)(1)–(22), that an employer pays that otherwise meet 
the requirements of the EPSLA or Expanded FMLA. Enter            11d. Nonrefundable Portion of Credit for 
the nonrefundable portion of the credit for qualified sick and 
family leave wages from Worksheet 1, Step 2, line 2j. The        Qualified Sick and Family Leave Wages for 
credit for qualified sick and family leave wages consists of     Leave Taken After March 31, 2021, and Before 
the qualified sick leave wages, the qualified family leave       October 1, 2021
wages, the qualified health plan expenses allocable to those 
                                                                          Complete line 11d only if qualified sick leave wages 
wages, and the employer share of Medicare tax allocable to 
                                                                          and/or qualified family leave wages were paid this 
those wages. The nonrefundable portion of the credit is          CAUTION!
                                                                          quarter of 2022 for leave taken after March 31, 2021, 
limited to the employer share of social security tax reported 
                                                                 and before October 1, 2021.
on Form 941-SS, lines 5a and 5b, after that share is first 
reduced by any credit claimed on Form 8974 for the qualified     Employers with fewer than 500 employees and certain 
small business payroll tax credit for increasing research        governmental employers without regard to number of 
activities, any credit to be claimed on Form 5884-C for the      employees (except for the federal government and its 
work opportunity credit for qualified tax-exempt organizations   agencies and instrumentalities unless described in section 
hiring qualified veterans, and/or any credit to be claimed on    501(c)(1)) are entitled to a credit if they provide paid sick 
Form 5884-D for the disaster credit for qualified tax-exempt     leave to employees that otherwise meets the requirements of 
organizations.                                                   the EPSLA, as amended for purposes of the ARP, and/or 
                                                                 provide paid family leave to employees that otherwise meets 
        If you're a third-party payer of sick pay that isn't an 
                                                                 the requirements under the Expanded FMLA, as amended 
!       agent (for example, an insurance company) and            for purposes of the ARP, for qualified sick and family leave 
CAUTION you're claiming the credit for qualified sick and family 
                                                                 wages for leave taken after March 31, 2021, and before 
leave wages for amounts paid to your own employees, the 
                                                                 October 1, 2021. For purposes of this credit, qualified sick 
amount of the employer share of social security tax reported 
                                                                 leave wages and qualified family leave wages are wages for 
on line 5a must be reduced by any adjustment you make on 
                                                                 social security and Medicare tax purposes, determined 
line 8 for the employer share of social security tax transferred 
                                                                 without regard to the exclusions from the definition of 
to your client. If you received a Section 3121(q) Notice and 
                                                                 employment under sections 3121(b)(1)–(22), that an 
Demand for tax due on unreported tips (Letter 3263 or Letter 
                                                                 employer pays that otherwise meet the requirements of the 
4520) during the quarter, you report the amount for the 
                                                                 EPSLA or Expanded FMLA, as enacted under the FFCRA 
employer share of social security tax and Medicare tax on 
                                                                 and amended for purposes of the ARP. Enter the 
Form 941-SS, line 5f. Letter 3263 or Letter 4520 includes an 
                                                                 nonrefundable portion of the credit for qualified sick and 
attachment that shows the employer share of social security 
                                                                 family leave wages from Worksheet 2, Step 2, line 2p.
tax. This amount of the employer share of social security tax 
can also be reduced by the nonrefundable portion of the               The credit for qualified sick and family leave wages 
credit. See Worksheet 1 to figure your credit.                   consists of the:
                                                                 •    Qualified sick leave wages and/or qualified family leave 
Any credit in excess of the remaining amount of the              wages;
employer share of social security tax is refundable and          •    Qualified health plan expenses allocable to qualified sick 
reported on Form 941-SS, line 13c. For more information on       leave and family leave wages;
the credit for qualified sick and family leave wages, go to      •    Collectively bargained defined benefit pension plan 
IRS.gov/PLC.                                                     contributions, subject to the qualified leave wage limitations, 
Qualified health plan expenses allocable to qualified            allocable to the qualified sick and family leave wages;
sick leave and family leave wages. The credit for qualified      •    Collectively bargained apprenticeship program 
sick leave wages and qualified family leave wages is             contributions, subject to the qualified leave wage limitations, 
increased to cover the qualified health plan expenses that       allocable to the qualified sick and family leave wages; and
are properly allocable to the qualified leave wages for which    •    Employer share of social security and Medicare tax 
the credit is allowed. These qualified health plan expenses      allocable to the qualified sick and family leave wages.
are amounts paid or incurred by the employer to provide and           The nonrefundable portion of the credit is limited to the 
maintain a group health plan but only to the extent such         employer share of Medicare tax reported on Form 941-SS, 
amounts are excluded from the employees’ income as               line 5c. You can’t claim the credit for leave taken after March 
coverage under an accident or health plan. The amount of         31, 2021, and before October 1, 2021, if, during the 
qualified health plan expenses generally includes both the       applicable quarter in which the leave was taken, you 
portion of the cost paid by the employer and the portion of the  provided the leave in a manner that discriminates in favor of 
cost paid by the employee with pre-tax salary reduction          highly compensated employees, full-time employees, or 
contributions. However, qualified health plan expenses don’t     employees on the basis of employment tenure when making 
include amounts that the employee paid for with after-tax        qualified sick and/or family leave available to employees. 
contributions. For more information, go to IRS.gov/PLC.          See Highly compensated employee, later, for the definition.
                                                                      For leave taken after March 31, 2021, and before October 
                                                                 1, 2021, the credit for qualified sick and family leave wages is 
                                                                 reduced by the amount of the credit allowed under section 41 
                                                                 (for the credit for increasing research activities) with respect 

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to wages taken into account for determining the credit for • Required to be made under the terms of a collective
qualified sick and family leave wages; and any wages taken bargaining agreement in effect for the quarter.
into account in determining the credit for qualified sick and Pension contribution rate. The pension contribution rate
family leave wages can't be taken into account as wages for is the contribution rate that the employer is obligated to pay
purposes of the credits under sections 45A, 45P, 45S, and under the terms of a collective bargaining agreement to a
51. For leave taken after March 31, 2021, and before defined benefit plan, as the rate is applied to contribution
October 1, 2021, qualified wages also don't include wages base units, as defined by section 4001(a)(11) of the
that were used as payroll costs in connection with a Employee Retirement Income Security Act of 1974 (ERISA).
Shuttered Venue Operator Grant under section 324 of the Allocation rules. The amount of collectively bargained
Economic Aid to Hard-Hit Small Businesses, Nonprofits, and defined benefit pension plan contributions allocated to
Venues Act; or a restaurant revitalization grant under section qualified sick leave wages and/or qualified family leave
5003 of the ARP. Employers can receive both a Small wages in a quarter is the pension contribution rate
Business Interruption Loan under the Paycheck Protection (expressed as an hourly rate) multiplied by the number of
Program (PPP) and the credit for qualified sick and family hours qualified sick leave wages and/or qualified family leave
leave wages; however, employers can't receive both loan wages were provided to employees covered under the
forgiveness and a credit for the same wages. The same collective bargaining agreement during the quarter.
wages can’t be treated as both qualified sick leave wages
and qualified family leave wages. Collectively bargained apprenticeship program contri-
butions. For purposes of qualified sick and family leave
If you're a third-party payer of sick pay that isn't an wages, collectively bargained apprenticeship program
! agent (for example, an insurance company) and contributions are contributions for a calendar quarter that are:
CAUTION you're claiming the credit for qualified sick and family Paid or incurred by an employer on behalf of its employees
•
leave wages for amounts paid to your own employees, the to a registered apprenticeship program, which is an
amount of the employer share of Medicare tax reported on apprenticeship registered under the National Apprenticeship
line 5c must be reduced by any adjustment you make on Act of August 16, 1937, and meets the standards of Federal
line 8 for the employer share of Medicare tax transferred to Regulations under subpart A of Part 29 and Part 30 of title 29;
your client. If you received a Section 3121(q) Notice and • Made based on an apprenticeship program contribution
Demand for tax due on unreported tips (Letter 3263 or Letter rate; and
4520) during the quarter, you report the amount for the • Required to be made under the terms of a collective
employer share of social security tax and Medicare tax on bargaining agreement in effect for the quarter.
Form 941-SS, line 5f. Letter 3263 or Letter 4520 includes an Apprenticeship program contribution rate. The
attachment that shows the employer share of Medicare tax. apprenticeship program contribution rate is the contribution
This amount of the employer share of Medicare tax can also rate that the employer is obligated to pay under the terms of a
be reduced by the nonrefundable portion of the credit. See collective bargaining agreement for benefits under a
Worksheet 2 to figure your credit. registered apprenticeship program, as the rate is applied to
contribution base units, as defined by section 4001(a)(11) of
Any credit in excess of the remaining amount of the ERISA.
employer share of Medicare tax is refundable and reported Allocation rules. The amount of collectively bargained
on Form 941-SS, line 13e. For more information on the credit apprenticeship program contributions allocated to qualified
for qualified sick and family leave wages, go to IRS.gov/PLC. sick leave wages and/or qualified family leave wages in a
Qualified health plan expenses allocable to qualified quarter is the apprenticeship program contribution rate
sick leave and family leave wages. The credit for qualified (expressed as an hourly rate) multiplied by the number of
sick leave wages and qualified family leave wages is hours qualified sick leave wages and/or qualified family leave
increased to cover the qualified health plan expenses that wages were provided to employees covered under the
are properly allocable to the qualified leave wages for which collective bargaining agreement during the quarter.
the credit is allowed. These qualified health plan expenses Highly compensated employee. A highly compensated
are amounts paid or incurred by the employer to provide and employee is an employee who meets either of the following
maintain a group health plan but only to the extent such tests.
amounts are excluded from the employees' income as
coverage under an accident or health plan. The amount of 1. The employee was a 5% owner at any time during the
qualified health plan expenses generally includes both the year or the preceding year.
portion of the cost paid by the employer and the portion of the 2. The employee received more than $130,000 in pay for
cost paid by the employee with pre-tax salary reduction the preceding year.
contributions. However, qualified health plan expenses don't
You can choose to ignore test (2) if the employee wasn’t
include amounts that the employee paid for with after-tax
also in the top 20% of employees when ranked by pay for the
contributions. For more information, go to IRS.gov/PLC.
preceding year.
Collectively bargained defined benefit pension plan
contributions. For purposes of qualified sick and family 11g. Total Nonrefundable Credits
leave wages, collectively bargained defined benefit pension Add lines 11a, 11b, and 11d. Enter the total on line 11g.
plan contributions are contributions for a calendar quarter
that are: 12. Total Taxes After Adjustments and
• Paid or incurred by an employer on behalf of its employees Nonrefundable Credits
to a defined benefit plan, as defined in section 414(j), which
meets the requirements of section 401(a); Subtract line 11g from line 10 and enter the result on line 12.
• Made based on a pension contribution rate; and The amount entered on line 12 can't be less than zero.

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• If line 12 is less than $2,500 or line 12 on the prior 13e. Refundable Portion of Credit for Qualified
quarterly return was less than $2,500, and you didn't Sick and Family Leave Wages for Leave Taken
incur a $100,000 next-day deposit obligation during the
current quarter. You may pay the amount with Form 941-SS After March 31, 2021, and Before October 1,
or you may deposit the amount. To avoid a penalty, you must 2021
pay any amount you owe in full with a timely filed return or Complete line 13e only if qualified sick leave wages
you must deposit any amount you owe before the due date of ! and/or qualified family leave wages were paid this
the return. For more information on paying with a timely filed CAUTION quarter of 2022 for leave taken after March 31, 2021,
return, see the instructions for line 14, later. and before October 1, 2021.
• If line 12 is $2,500 or more and line 12 on the prior
quarterly return was $2,500 or more, or if you incurred a Employers with fewer than 500 employees and certain
$100,000 next-day deposit obligation during the current governmental employers without regard to number of
quarter. You must make required deposits according to your employees (except for the federal government and its
deposit schedule. See Notice 2020-22 and Notice 2021-24 agencies and instrumentalities unless described in section
for information on reducing deposits for certain credits. The 501(c)(1)) are entitled to a credit if they provide paid sick
amount shown on line 12 must equal the “Total liability for leave to employees that otherwise meets the requirements of
quarter” shown on line 16 or the “Total liability for the quarter” the EPSLA, as amended for purposes of the ARP, and/or
shown on Schedule B (Form 941). For more information, see provide paid family leave to employees that otherwise meets
the line 16 instructions, later. the requirements under the Expanded FMLA, as amended
for purposes of the ARP, for leave taken after March 31,
For more information and rules about federal tax deposits, 2021, and before October 1, 2021. Enter the refundable
see Depositing Your Taxes, earlier, and section 8 of Pub. 80. portion of the credit for qualified sick and family leave wages
If you’re a semiweekly schedule depositor, you must from Worksheet 2, Step 2, line 2q. The refundable portion of
the credit is allowed after the employer share of Medicare tax
! complete Schedule B (Form 941). If you fail to is reduced to zero by nonrefundable credits that are applied
CAUTION complete and submit Schedule B (Form 941), the
IRS may assess deposit penalties based on available against the employer share of Medicare tax.
information.
13g. Total Deposits and Refundable Credits
Add lines 13a, 13c, and 13e. Enter the total on line 13g.
13a. Total Deposits for This Quarter
Enter your deposits for this quarter, including any 14. Balance Due
overpayment from a prior quarter that you applied to this If line 12 is more than line 13g, enter the difference on
return. Also include in the amount shown any overpayment line 14. Otherwise, see the instructions for line 15, later.
that you applied from filing Form 941-X, 944-X, or 944-X (SP)
in the current quarter. Don't include any amount that you Never make an entry on both lines 14 and 15.
didn't deposit because you reduced your deposits in You don't have to pay if line 14 is under $1. Generally, you
anticipation of the credit for qualified sick and family leave should have a balance due only if your total taxes after
wages, as discussed in Notice 2020-22 and Notice 2021-24. adjustments and nonrefundable credits (line 12) for the
current quarter or prior quarter are less than $2,500, and you
13c. Refundable Portion of Credit for didn't incur a $100,000 next-day deposit obligation during the
Qualified Sick and Family Leave Wages for current quarter. However, see section 8 of Pub. 80 for
Leave Taken After March 31, 2020, and Before information about payments made under the accuracy of
April 1, 2021 deposits rule.
Complete line 13c only if qualified sick leave wages If you were required to make federal tax deposits, pay the
amount shown on line 14 by EFT. If you weren't required to
! and/or qualified family leave wages were paid this make federal tax deposits (see Must You Deposit Your
CAUTION quarter of 2022 for leave taken after March 31, 2020,
and before April 1, 2021. Taxes, earlier) or you're a monthly schedule depositor
making a payment under the accuracy of deposits rule, you
Certain private employers with fewer than 500 employees may pay the amount shown on line 14 by EFT, credit card,
that provide paid sick leave under the EPSLA and/or provide debit card, check, money order, or EFW. For more
paid family leave under the Expanded FMLA are eligible to information on electronic payment options, go to IRS.gov/
claim the credit for qualified sick and family leave wages. Payments.
Enter the refundable portion of the credit for qualified sick
and family leave wages from Worksheet 1, Step 2, line 2k. If you pay by EFT, credit card, or debit card, file your
The credit for qualified sick and family leave wages consists return using the Without a payment address under Where
of the qualified sick leave wages, the qualified family leave Should You File, earlier, and don't file Form 941-V(SS),
wages, the qualified health plan expenses allocable to those Payment Voucher.
wages, and the employer share of Medicare tax allocable to If you pay by check or money order, make it payable to
those wages. The refundable portion of the credit is allowed “United States Treasury.” Enter your EIN, “Form 941-SS,”
after the employer share of social security tax is reduced to and the tax period (“1st Quarter 2022,” “2nd Quarter 2022,”
zero by nonrefundable credits that are applied against the “3rd Quarter 2022,” or “4th Quarter 2022”) on your check or
employer share of social security tax. money order. Complete Form 941-V(SS) and enclose it with
Form 941-SS.
If line 12 is $2,500 or more on both your prior and current
quarter Form 941-SS, and you’ve deposited all taxes when
due, the balance due on line 14 should be zero.

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If you’re required to make deposits and instead pay Monthly schedule depositor. If you reported $50,000 or
! the taxes with Form 941-SS, you may be subject to a less in taxes during the lookback period, you’re a monthly
CAUTION penalty. See Must You Deposit Your Taxes, earlier.
schedule depositor unless the $100,000 Next-Day Deposit
What if you can't pay in full? If you can't pay the full Rule discussed in section 8 of Pub. 80 applies. Check the
amount of tax you owe, you can apply for an installment second box on line 16 and enter your tax liability for each
agreement online. You can apply for an installment month in the quarter. Enter your tax liabilities in the month
agreement online if: that corresponds to the dates you paid wages to your
• You can't pay the full amount shown on line 14, employees, not the date payroll liabilities were accrued or
• The total amount you owe is $25,000 or less, and deposits were made. Add the amounts for each month. Enter
• You can pay the liability in full in 24 months. the result in the “Total liability for quarter” box.
To apply using the Online Payment Agreement Note that your total tax liability for the quarter must equal
Application, go to IRS.gov/OPA. your total taxes shown on line 12. If it doesn't, your tax
deposits and payments may not be counted as timely. Don't
Under an installment agreement, you can pay what you reduce your total liability reported on line 16 by the
owe in monthly installments. There are certain conditions you refundable portion of the credit for qualified sick and family
must meet to enter into and maintain an installment leave wages. Don't change your tax liability on line 16 by
agreement, such as paying the liability within 24 months, and adjustments reported on any Forms 941-X.
making all required deposits and timely filing tax returns
during the length of the agreement. You’re a monthly schedule depositor for the calendar year
if the amount of your Form 941-SS taxes reported for the
If your installment agreement is accepted, you will be lookback period is $50,000 or less. The lookback period is
charged a fee and you will be subject to penalties and the 4 consecutive quarters ending on June 30 of the prior
interest on the amount of tax not paid by the due date of the year. For 2022, the lookback period begins July 1, 2020, and
return. ends June 30, 2021. For details on the deposit rules, see
15. Overpayment section 8 of Pub. 80. If you filed Form 944 in either 2020 or
2021, your lookback period is the 2020 calendar year.
If line 13g is more than line 12, enter the difference on
line 15. The amounts entered on line 16 are a summary of
your monthly tax liability, not a summary of deposits
Never make an entry on both lines 14 and 15. CAUTION! you made. If you don't properly report your liabilities
when required or if you’re a semiweekly schedule depositor
If you deposited more than the correct amount for the and enter your liabilities on line 16 instead of on Schedule B
quarter, you can choose to have the IRS either refund the (Form 941), you may be assessed an “averaged” FTD
overpayment or apply it to your next return. Check only one penalty. See Deposit Penalties in section 8 of Pub. 80 for
box on line 15. If you don't check either box or if you check more information.
both boxes, we will generally apply the overpayment to your
next return. Regardless of any boxes you check or don’t Reporting adjustments from lines 7–9 on line 16. If
check on line 15, we may apply your overpayment to any your net adjustment during a month is negative and it
past due tax account that is shown in our records under your exceeds your total tax liability for the month, don't enter a
EIN. negative amount for the month. Instead, enter "-0-" for the
month and carry over the unused portion of the adjustment to
If line 15 is under $1, we will send a refund or apply it to the next month.
your next return only if you ask us in writing to do so. Semiweekly schedule depositor. If you reported more
than $50,000 of taxes for the lookback period, you’re a
Part 2: Tell Us About Your Deposit semiweekly schedule depositor. Check the third box on
Schedule and Tax Liability for This line 16.
You must complete Schedule B (Form 941) and submit it
Quarter
with your Form 941-SS. Don't file Schedule B (Form 941)
with your Form 941-SS if you’re a monthly schedule
16. Tax Liability for the Quarter depositor.
Check one of the boxes on line 16. Follow the instructions for
Don't change your tax liability on Schedule B (Form 941)
each box to determine if you need to enter your monthly tax
by adjustments reported on any Forms 941-X.
liability on Form 941-SS or your daily tax liability on
Schedule B (Form 941). Adjusting tax liability for nonrefundable credits claimed
on lines 11a, 11b, and 11d. Monthly schedule depositors
De minimis exception. If line 12 is less than $2,500 or
and semiweekly schedule depositors must account for
line 12 on the prior quarterly return was less than $2,500, and
nonrefundable credits claimed on lines 11a, 11b, and 11d
you didn't incur a $100,000 next-day deposit obligation
when reporting their tax liabilities on line 16 or Schedule B
during the current quarter, check the first box on line 16 and
(Form 941). The total tax liability for the quarter must equal
go to Part 3.
the amount reported on line 12. Failure to account for the
If you meet the de minimis exception based on the nonrefundable credits on line 16 or Schedule B (Form 941)
! prior quarter and line 12 for the current quarter is may cause line 16 or Schedule B (Form 941) to report more
CAUTION $100,000 or more, you must provide a record of your than the total tax liability reported on line 12. Don't reduce
federal tax liability. If you’re a monthly schedule depositor, your monthly tax liability reported on line 16 or your daily tax
complete the deposit schedule on line 16. If you’re a liability reported on Schedule B (Form 941) below zero.
semiweekly schedule depositor, attach Schedule B (Form Qualified small business payroll tax credit for
941). increasing research activities (line 11a). The qualified

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small business payroll tax credit for increasing research hiring qualified veterans; and/or any credit to be claimed on
activities is limited to the employer share of social security tax Form 5884-D for the disaster credit for qualified tax-exempt
on wages paid in the quarter that begins after the income tax organizations. In completing line 16 or Schedule B (Form
return electing the credit has been filed. In completing line 16 941), you take into account the entire quarter's
or Schedule B (Form 941), you take into account the payroll nonrefundable portion of the credit for qualified sick and
tax credit against the liability for the employer share of social family leave wages against the liability for the first payroll
security tax starting with the first payroll payment of the payment of the quarter, but not below zero. Then reduce the
quarter that includes payments of wages subject to social liability for each successive payroll payment in the quarter
security tax to your employees. The credit may be taken to until the nonrefundable portion of the credit is used. Any
the extent of the employer share of social security tax on credit for qualified sick and family leave wages paid this
wages associated with the first payroll payment, and then to quarter of 2022 for leave taken after March 31, 2020, and
the extent of the employer share of social security tax before April 1, 2021, that is remaining at the end of the
associated with succeeding payroll payments in the quarter quarter because it exceeds the employer share of social
until the credit is used. Consistent with the entries on line 16 security tax for the quarter is claimed on line 13c as a
or Schedule B (Form 941), the payroll tax credit should be refundable credit. The refundable portion of the credit doesn’t
taken into account in making deposits of employment tax. If reduce the liability reported on line 16 or Schedule B (Form
any payroll tax credit is remaining at the end of the quarter 941).
that hasn’t been used completely because it exceeds the Example. Maple Co. is a semiweekly schedule depositor
employer share of social security tax for the quarter, the that pays employees every other Friday. In the second
excess credit may be carried forward to the succeeding quarter of 2022, Maple Co. had pay dates of April 1, April 15,
quarter and allowed as a payroll tax credit for the succeeding April 29, May 13, May 27, June 10, and June 24. Maple Co.
quarter. The payroll tax credit may not be taken as a credit paid qualified sick and family leave wages on April 15 and
against income tax withholding, Medicare tax, or the April 29 for leave taken after March 31, 2020, and before
employee share of social security tax. Also, the remaining April 1, 2021. The nonrefundable portion of the credit for
payroll tax credit may not be carried back and taken as a qualified sick and family leave wages for the quarter is
credit against wages paid from preceding quarters. $10,000. On Schedule B (Form 941), Maple Co. will use the
Example. Rose Co. is an employer with a calendar tax $10,000 to reduce the liability for the April 1 pay date, but not
year that filed its timely income tax return on April 15, 2022. below zero. If any nonrefundable portion of the credit
Rose Co. elected to take the qualified small business payroll remains, Maple Co. applies it to the liability for the April 15
tax credit for increasing research activities on Form 6765. pay date, then the April 29 pay date, and so forth until the
The third quarter of 2022 is the first quarter that begins after entire $10,000 is used.
Rose Co. filed the income tax return making the payroll tax Nonrefundable portion of credit for qualified sick and
credit election. Therefore, the payroll tax credit applies family leave wages for leave taken after March 31, 2021,
against Rose Co.'s share of social security tax on wages paid and before October 1, 2021 (line 11d). The
to employees in the third quarter of 2022. Rose Co. is a nonrefundable portion of the credit for qualified sick and
semiweekly schedule depositor. Rose Co. completes family leave wages paid this quarter of 2022 for leave taken
Schedule B (Form 941) by reducing the amount of liability after March 31, 2021, and before October 1, 2021, is limited
entered for the first payroll payment in the third quarter of to the employer share of Medicare tax on wages paid in the
2022 that includes wages subject to social security tax by the quarter. In completing line 16 or Schedule B (Form 941), you
lesser of (1) its share of social security tax on the wages, or take into account the entire quarter's nonrefundable portion
(2) the available payroll tax credit. If the payroll tax credit of the credit for qualified sick and family leave wages paid
elected is more than Rose Co.'s share of social security tax this quarter of 2022 against the liability for the first payroll
on the first payroll payment of the quarter, the excess payroll payment of the quarter, but not below zero. Then reduce the
tax credit would be carried forward to succeeding payroll liability for each successive payroll payment in the quarter
payments in the third quarter until it is used. If the amount of until the nonrefundable portion of the credit is used. Any
the payroll tax credit exceeds Rose Co.'s share of social credit for qualified sick and family leave wages that is
security tax on wages paid to its employees in the third remaining at the end of the quarter because it exceeds the
quarter, the excess credit would be treated as a payroll tax employer share of Medicare tax for the quarter is claimed on
credit against its share of social security tax on wages paid in line 13e as a refundable credit. The refundable portion of the
the fourth quarter. If the amount of the payroll tax credit credit doesn’t reduce the liability reported on line 16 or
remaining exceeded Rose Co.'s share of social security tax Schedule B (Form 941).
on wages paid in the fourth quarter, it could be carried You may reduce your deposits by the amount of the
forward and treated as a payroll tax credit for the first quarter TIP nonrefundable and refundable portions of the credit
of 2023. for qualified sick and family leave wages, as
Nonrefundable portion of credit for qualified sick and discussed earlier under Reducing your deposits for
family leave wages for leave taken after March 31, 2020, COVID-19 credits.
and before April 1, 2021 (line 11b). The nonrefundable
portion of the credit for qualified sick and family leave wages
Part 3: Tell Us About Your Business
paid this quarter of 2022 for leave taken after March 31,
2020, and before April 1, 2021, is limited to the employer In Part 3, answer only those questions that apply to your
share of social security tax on wages paid in the quarter that business. If the questions don't apply, leave them blank and
is remaining after that share is first reduced by any credit go to Part 4.
claimed on Form 941-SS, line 11a, for the qualified small
business payroll tax credit for increasing research activities; 17. If Your Business Has Closed . . .
any credit to be claimed on Form 5884-C, line 11, for the If you go out of business or stop paying wages, you must file
work opportunity credit for qualified tax-exempt organizations a final return. To tell the IRS that a particular Form 941-SS is

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your final return, check the box on line 17 and enter the final about qualified sick leave wages for leave taken after March
date you paid wages in the space provided. For additional 31, 2021, and before October 1, 2021. This amount is also
filing requirements, including information about attaching a entered on Worksheet 2, Step 2, line 2a.
statement to your final return, see If Your Business Has
Closed, earlier. 24. Qualified Health Plan Expenses Allocable to
Qualified Sick Leave Wages Reported on
18. If You’re a Seasonal Employer . . . Line 23
If you hire employees seasonally—such as for summer or Enter the qualified health plan expenses allocable to qualified
winter only—check the box on line 18. Checking the box tells sick leave wages paid this quarter of 2022 for leave taken
the IRS not to expect four Forms 941-SS from you after March 31, 2021, and before October 1, 2021. This
throughout the year because you haven't paid wages amount is also entered on Worksheet 2, Step 2, line 2b.
regularly.
Generally, we won't ask about unfiled returns if at least 25. Amounts Under Certain Collectively
one taxable return is filed each year. However, you must Bargained Agreements Allocable to Qualified
check the box on line 18 on every Form 941-SS you file. Sick Leave Wages Reported on Line 23
Otherwise, the IRS will expect a return to be filed for each Enter the collectively bargained defined benefit pension plan
quarter. contributions and collectively bargained apprenticeship
Also, when you complete Form 941-SS, be sure to check program contributions allocable to qualified sick leave wages
the box on the top of the form that corresponds to the quarter paid this quarter of 2022 for leave taken after March 31,
reported. 2021, and before October 1, 2021. This amount is also
entered on Worksheet 2, Step 2, line 2c.
The amounts entered on lines 19 through 28 are
TIP amounts that you use on the worksheets at the end Complete lines 26, 27, and 28 only if qualified family
of these instructions to figure certain credits. If you’re ! leave wages were paid this quarter of 2022 for leave
claiming these credits, you must enter the applicable CAUTION taken after March 31, 2021, and before October 1,
amounts. 2021.

Complete lines 19 and 20 only if qualified health plan 26. Qualified Family Leave Wages for Leave
! expenses allocable to qualified sick leave wages Taken After March 31, 2021, and Before October
CAUTION and/or qualified family leave wages were paid this
quarter of 2022 for leave taken after March 31, 2020, and 1, 2021
before April 1, 2021. Enter the qualified family leave wages you paid this quarter of
2022 to your employees for leave taken after March 31,
19. Qualified Health Plan Expenses Allocable to 2021, and before October 1, 2021, including any qualified
family leave wages that were above the social security wage
Qualified Sick Leave Wages for Leave Taken base and any qualified family leave wages excluded from the
After March 31, 2020, and Before April 1, 2021 definition of employment under sections 3121(b)(1)–(22).
Enter the qualified health plan expenses allocable to qualified See the instructions for line 11d, earlier, for more information
sick leave wages paid this quarter of 2022 for leave taken about qualified family leave wages for leave taken after
after March 31, 2020, and before April 1, 2021. This amount March 31, 2021, and before October 1, 2021. This amount is
is also entered on Worksheet 1, Step 2, line 2b. also entered on Worksheet 2, Step 2, line 2g.

20. Qualified Health Plan Expenses Allocable to 27. Qualified Health Plan Expenses Allocable to
Qualified Family Leave Wages for Leave Taken Qualified Family Leave Wages Reported on
After March 31, 2020, and Before April 1, 2021 Line 26
Enter the qualified health plan expenses allocable to qualified Enter the qualified health plan expenses allocable to qualified
family leave wages paid this quarter of 2022 for leave taken family leave wages paid this quarter of 2022 for leave taken
after March 31, 2020, and before April 1, 2021. This amount after March 31, 2021, and before October 1, 2021. This
is also entered on Worksheet 1, Step 2, line 2f. amount is also entered on Worksheet 2, Step 2, line 2h.

Complete lines 23, 24, and 25 only if qualified sick 28. Amounts Under Certain Collectively
! leave wages were paid this quarter of 2022 for leave Bargained Agreements Allocable to Qualified
CAUTION taken after March 31, 2021, and before October 1,
2021. Family Leave Wages Reported on Line 26
Enter the collectively bargained defined benefit pension plan
23. Qualified Sick Leave Wages for Leave Taken contributions and collectively bargained apprenticeship
program contributions allocable to qualified family leave
After March 31, 2021, and Before October 1, wages paid this quarter of 2022 for leave taken after March
2021 31, 2021, and before October 1, 2021. This amount is also
Enter the qualified sick leave wages you paid this quarter of entered on Worksheet 2, Step 2, line 2i.
2022 to your employees for leave taken after March 31,
2021, and before October 1, 2021, including any qualified
sick leave wages that were above the social security wage
base and any qualified sick leave wages excluded from the
definition of employment under sections 3121(b)(1)–(22).
See the instructions for line 11d, earlier, for more information

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Part 4: May We Speak With Your • Trust or estate—The fiduciary.
Form 941-SS may be signed by a duly authorized agent of
Third-Party Designee?
the taxpayer if a valid power of attorney has been filed.
If you want to allow an employee, a paid tax preparer, or Alternative signature method. Corporate officers or duly
another person to discuss your Form 941-SS with the IRS, authorized agents may sign Form 941-SS by rubber stamp,
check the “Yes” box in Part 4. Enter the name, phone mechanical device, or computer software program. For
number, and five-digit personal identification number (PIN) of details and required documentation, see Rev. Proc. 2005-39,
the specific person to speak with—not the name of the firm 2005-28 I.R.B. 82, available at IRS.gov/irb/
that prepared your tax return. The designee may choose any 2005-28_IRB#RP-2005-39.
five numbers as his or her PIN.
By checking “Yes,” you authorize the IRS to talk to the Paid Preparer Use Only
person you named (your designee) about any questions we A paid preparer must sign Form 941-SS and provide the
may have while we process your return. You also authorize information in the Paid Preparer Use Only section of Part 5 if
your designee to do all of the following. the preparer was paid to prepare Form 941-SS and isn't an
• Give us any information that is missing from your return. employee of the filing entity. Paid preparers must sign paper
• Call us for information about processing your return. returns with a manual signature. The preparer must give you
• Respond to certain IRS notices that you’ve shared with a copy of the return in addition to the copy to be filed with the
your designee about math errors and return preparation. The IRS.
IRS won't send notices to your designee.
If you’re a paid preparer, enter your Preparer Tax
You’re not authorizing your designee to bind you to Identification Number (PTIN) in the space provided. Include
anything (including additional tax liability) or to otherwise your complete address. If you work for a firm, enter the firm's
represent you before the IRS. If you want to expand your name and the EIN of the firm. You can apply for a PTIN
designee's authorization, see Pub. 947. online or by filing Form W-12. For more information about
The authorization will automatically expire 1 year from the applying for a PTIN online, go to IRS.gov/PTIN. You can't use
due date (without regard to extensions) for filing your Form your PTIN in place of the EIN of the tax preparation firm.
941-SS. If you or your designee wants to terminate the
authorization, write to the IRS office for your location using Generally, don't complete this section if you’re filing the
the Without a payment address under Where Should You return as a reporting agent and have a valid Form 8655 on
File, earlier. file with the IRS. However, a reporting agent must complete
this section if the reporting agent offered legal advice, for
Part 5: Sign Here (Approved Roles) example, advising the client on determining whether its
workers are employees or independent contractors for
Complete all information and sign Form 941-SS. The federal tax purposes.
following persons are authorized to sign the return for each
type of business entity.
• Sole proprietorship—The individual who owns the How To Get Forms, Instructions, and
business. Publications From the IRS
• Corporation (including a limited liability company
(LLC) treated as a corporation)—The president, vice You can view, download, or print most of the forms,
president, or other principal officer duly authorized to sign. instructions, and publications you may need at
• Partnership (including an LLC treated as a IRS.gov/Forms. Otherwise, you can go to IRS.gov/
partnership) or unincorporated organization—A OrderForms to place an order and have them mailed to you.
responsible and duly authorized partner, member, or officer The IRS will process your order for forms and publications as
having knowledge of its affairs. soon as possible. Don't resubmit requests you've already
• Single-member LLC treated as a disregarded entity sent us. You can get forms and publications faster online.
for federal income tax purposes—The owner of the LLC
or a principal officer duly authorized to sign.

-20- Instructions for Form 941-SS (Rev. 6-2022)

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

Worksheet 1. Credit for Qualified Sick and Family Leave Wages 
Paid This Quarter of 2022 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 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 2022 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 941-SS, Part 1, line 11a (credit from Form 8974) . . . . . . . . .                                   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

Instructions for Form 941-SS (Rev. 6-2022)                         -21-

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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 2022 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 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 2022 for leave 
taken after March 31, 2020, and before April 1, 2021.
Step 1.         Determine the employer share of Medicare tax
        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              
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 1f 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

                                                                 -22-                           Instructions for Form 941-SS (Rev. 6-2022)

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