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                                                                                                         Department of the Treasury
                                                                                                         Internal Revenue Service
Instructions for Form 941

(Rev. March 2023)
Employer's QUARTERLY Federal Tax Return

Section references are to the Internal Revenue Code                          The Medicare tax rate is 1.45% each for the employee 
unless otherwise noted.                                                      and employer, unchanged from 2022. There is no wage 
                                                                             base limit for Medicare tax.
Contents                                                            Page
Future Developments     . . . . . . . . . . . . . . . . . . . . . . . .   1  Social security and Medicare taxes apply to the wages 
What's New  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1  of household workers you pay $2,600 or more in cash 
                                                                             wages in 2023. Social security and Medicare taxes apply 
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
                                                                             to election workers who are paid $2,200 or more in cash 
General Instructions: . . . . . . . . . . . . . . . . . . . . . . . . .   4  or an equivalent form of compensation in 2023.
Purpose of Form 941           . . . . . . . . . . . . . . . . . . . . .   4
                                                                             Qualified small business payroll tax credit for in-
Who Must File Form 941? . . . . . . . . . . . . . . . . . .               4
                                                                             creasing research activities. For tax years beginning 
When Must You File?           . . . . . . . . . . . . . . . . . . . . .   6  before January 1, 2023, a qualified small business may 
How Should You Complete Form 941? . . . . . . . . .                       6  elect to claim up to $250,000 of its credit for increasing 
Where Should You File?            . . . . . . . . . . . . . . . . . . .   7  research activities as a payroll tax credit. The Inflation 
Depositing Your Taxes           . . . . . . . . . . . . . . . . . . . .   7  Reduction Act of 2022 (the IRA) increases the election 
What About Penalties and Interest? . . . . . . . . . . .                  8  amount to $500,000 for tax years beginning after 
                                                                             December 31, 2022. The payroll tax credit election must 
Adjustment of Tax on Tips . . . . . . . . . . . . . . . . . .             9
                                                                             be made on or before the due date of the originally filed 
Specific Instructions: . . . . . . . . . . . . . . . . . . . . . . . . .  9  income tax return (including extensions). The portion of 
Part 1: Answer These Questions for This                                      the credit used against payroll taxes is allowed in the first 
Quarter       . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   9  calendar quarter beginning after the date that the qualified 
Part 2: Tell Us About Your Deposit Schedule                                  small business filed its income tax return. The election 
and Tax Liability for This Quarter                . . . . . . . . . .     17 and determination of the credit amount that will be used 
Part 3: Tell Us About Your Business               . . . . . . . . . .     19 against the employer’s payroll taxes are made on Form 
Part 4: May We Speak With Your Third-Party                                   6765, Credit for Increasing Research Activities. The 
Designee? . . . . . . . . . . . . . . . . . . . . . . . . . .             20 amount from Form 6765, line 44, must then be reported 
Part 5: Sign Here (Approved Roles) . . . . . . . . . .                    20 on Form 8974, Qualified Small Business Payroll Tax 
                                                                             Credit for Increasing Research Activities.
How To Get Forms, Instructions, and Publications . . .                    21
                                                                             Starting in the first quarter of 2023, the payroll tax credit 
Worksheet 1. Credit for Qualified Sick and Family 
                                                                             is first used to reduce the employer share of social 
Leave Wages Paid This Quarter of 2023 for 
Leave Taken After March 31, 2020, and Before                                 security tax up to $250,000 per quarter and any remaining 
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . .       22 credit reduces the employer share of Medicare tax for the 
                                                                             quarter. Any remaining credit, after reducing the employer 
Worksheet 2. Credit for Qualified Sick and Family                            share of social security tax and the employer share of 
Leave Wages Paid This Quarter of 2023 for                                    Medicare tax, is then carried forward to the next quarter. 
Leave Taken After March 31, 2021, and Before 
                                                                             Form 8974 is used to determine the amount of the credit 
October 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . .           23
                                                                             that can be used in the current quarter. The amount from 
Future Developments                                                          Form 8974, line 12, or, if applicable, line 17, is reported on 
                                                                             line 11a. For more information about the payroll tax credit, 
For the latest information about developments related to 
                                                                             see IRS.gov/ResearchPayrollTC. Also see Adjusting tax 
Form 941 and its instructions, such as legislation enacted 
                                                                             liability for nonrefundable credits claimed on lines 11a, 
after they were published, go to IRS.gov/Form941.
                                                                             11b, and 11d, later.
What's New                                                                   Forms 941-SS and 941-PR discontinued after 2023. 
Social security and Medicare tax for 2023.                  The rate of      Form 941-SS, Employer’s QUARTERLY Federal Tax 
social security tax on taxable wages, including qualified                    Return—American Samoa, Guam, the Commonwealth of 
sick leave wages and qualified family leave wages paid in                    the Northern Mariana Islands, and the U.S. Virgin Islands; 
2023 for leave taken after March 31, 2021, and before                        and Form 941-PR, Planilla para la Declaración Federal 
October 1, 2021, is 6.2% each for the employer and                           TRIMESTRAL del Patrono, will no longer be available 
employee or 12.4% for both. Qualified sick leave wages                       after the fourth quarter of 2023. Instead, employers in the 
and qualified family leave wages paid in 2023 for leave                      U.S. territories will file Form 941, or, if you prefer your form 
taken after March 31, 2020, and before April 1, 2021,                        and instructions in Spanish, you can file new Form 941 
aren't subject to the employer share of social security tax;                 (sp), Declaración del Impuesto Federal TRIMESTRAL del 
therefore, the tax rate on these wages is 6.2%. The social                   Empleador.
security wage base limit is $160,200.                                        Pubs. 51, 80, and 179 discontinued after 2023.       Pub. 
                                                                             51, Agricultural Employer’s Tax Guide; Pub. 80, Federal 

Feb 2, 2023                                                           Cat. No. 14625L

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Tax Guide for Employers in the U.S. Virgin Islands, Guam, 5884-D (not on Form 941). Form 5884-D is filed after the
American Samoa, and the Commonwealth of the Northern Form 941 for the quarter for which the credit is being
Mariana Islands; and Pub. 179, Guía Contributiva Federal claimed has been filed. If you will claim this credit on Form
para Patronos Puertorriqueños, will no longer be available 5884-D and you're also claiming a credit for qualified sick
after 2023. Instead, information specific to agricultural and family leave wages for leave taken before April 1,
employers and employers in the U.S. territories will be 2021, you must include any credit that will be claimed on
included in Pub. 15, Employer's Tax Guide, beginning with Form 5884-D on Worksheet 1 for that quarter. For more
the Pub. 15 for use in 2024 (published December 2023). information about this credit, go to IRS.gov/Form5884D.
Beginning in 2024, there will be a new Pub. 15 (sp) that is
2023 withholding tables. The federal income tax
a Spanish-language version of Pub. 15.
withholding tables are included in Pub. 15-T, Federal
Reminders Income Tax Withholding Methods.
Use the March 2023 revision of Form 941 to Certification program for professional employer or-
ganizations (PEOs). The Stephen Beck, Jr., ABLE Act
CAUTION an earlier revision to report taxes for 2023. At this
! report taxes for the first quarter of 2023; don't use of 2014 required the IRS to establish a voluntary
time, the IRS expects the March 2023 revision of Form certification program for PEOs. PEOs handle various
941 and these instructions to also be used for the second, payroll administration and tax reporting responsibilities for
third, and fourth quarters of 2023. If changes in law their business clients and are typically paid a fee based on
require additional changes to Form 941, the form and/or payroll costs. To become and remain certified under the
these instructions may be revised. Prior revisions of Form certification program, certified professional employer
941 are available at IRS.gov/Form941 (select the link for organizations (CPEOs) must meet various requirements
“All Form 941 Revisions” under “Other Items You May described in sections 3511 and 7705 and related
Find Useful”). published guidance. Certification as a CPEO may affect
the employment tax liabilities of both the CPEO and its
The COVID-19 related credit for qualified sick and customers. A CPEO is generally treated for employment
family leave wages is limited to leave taken after tax purposes as the employer of any individual who
March 31, 2020, and before October 1, 2021. performs services for a customer of the CPEO and is
Generally, the credit for qualified sick and family leave covered by a contract described in section 7705(e)(2)
wages, as enacted under the Families First Coronavirus between the CPEO and the customer (CPEO contract),
Response Act (FFCRA) and amended and extended by but only for wages and other compensation paid to the
the COVID-related Tax Relief Act of 2020, for leave taken individual by the CPEO. To become a CPEO, the
after March 31, 2020, and before April 1, 2021, and the organization must apply through the IRS Online
credit for qualified sick and family leave wages under Registration System. For more information or to apply to
sections 3131, 3132, and 3133 of the Internal Revenue become a CPEO, go to IRS.gov/CPEO.
Code, as enacted under the American Rescue Plan Act of CPEOs must generally file Form 941 and Schedule R
2021 (the ARP) for leave taken after March 31, 2021, and (Form 941), Allocation Schedule for Aggregate Form 941
before October 1, 2021, have expired. However, Filers, electronically. For more information about a
employers that pay qualified sick and family leave wages CPEO’s requirement to file electronically, see Rev. Proc.
in 2023 for leave taken after March 31, 2020, and before 2017-14, 2017-3 I.R.B. 426, available at IRS.gov/irb/
October 1, 2021, are eligible to claim a credit for qualified 2017-03_IRB#RP-2017-14.
sick and family leave wages in the quarter of 2023 in
which the qualified wages were paid. For more Outsourcing payroll duties. Generally, as an employer,
information, see the instructions for line 11b line 11d, , you're responsible to ensure that tax returns are filed and
line 13c, and line 13e, later. deposits and payments are made, even if you contract
with a third party to perform these acts. You remain
Use Worksheet 1 to figure the credit for leave taken responsible if the third party fails to perform any required
after March 31, 2020, and before April 1, 2021. Use action. Before you choose to outsource any of your payroll
Worksheet 2 to figure the credit for leave taken after and related tax duties (that is, withholding, reporting, and
March 31, 2021, and before October 1, 2021. For more paying over social security, Medicare, FUTA, and income
information about the credit for qualified sick and family taxes) to a third-party payer, such as a payroll service
leave wages, go to IRS.gov/PLC. provider or reporting agent, go to IRS.gov/
Advance payment of COVID-19 credits ended. OutsourcingPayrollDuties for helpful information on this
Although you may pay qualified sick and family leave topic. If a CPEO pays wages and other compensation to
wages in 2023 for leave taken after March 31, 2020, and an individual performing services for you, and the services
before October 1, 2021, you may no longer request an are covered by a CPEO contract, then the CPEO is
advance payment of any credit on Form 7200, Advance generally treated for employment tax purposes as the
Payment of Employer Credits Due to COVID-19. employer, but only for wages and other compensation
paid to the individual by the CPEO. However, with respect
Payroll tax credit for certain tax-exempt organiza-
to certain employees covered by a CPEO contract, you
tions affected by qualified disasters. Section 303(d) of
may also be treated as an employer of the employees
the Taxpayer Certainty and Disaster Tax Relief Act of
and, consequently, may also be liable for federal
2020 allows for a payroll tax credit for certain tax-exempt
employment taxes imposed on wages and other
organizations affected by certain qualified disasters not
compensation paid by the CPEO to such employees. For
related to COVID-19. This credit is claimed on Form

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more information on the different types of third-party payer includes the qualified sick leave wages on the third party's
arrangements, see section 16 of Pub. 15. aggregate Form 941, claims the sick leave credit on
behalf of the employer on the aggregate Form 941, and
COVID-19 employment tax credits when return filed
separately reports the credit allocable to the employers on
by a third-party payer. If you're the common-law
Schedule R (Form 941). See section 6 of Pub. 15-A,
employer of the individuals that are paid qualified sick or
Employer's Supplemental Tax Guide, for more information
family leave wages, you're entitled to the credit for the sick
about sick pay reporting.
and family leave wages regardless of whether you use a
third-party payer (such as a PEO, CPEO, or section 3504 Work opportunity tax credit for qualified tax-exempt
agent) to report and pay your federal employment taxes. organizations hiring qualified veterans. Qualified
The third-party payer isn't entitled to the credits with tax-exempt organizations that hire eligible unemployed
respect to the wages and taxes it remits on your behalf veterans may be able to claim the work opportunity tax
(regardless of whether the third party is considered an credit against their payroll tax liability using Form 5884-C.
"employer" for other purposes). For more information, go to IRS.gov/WOTC.
Aggregate Form 941 filers. Approved section 3504 Correcting a previously filed Form 941. If you
agents and CPEOs must complete and file Schedule R discover an error on a previously filed Form 941, or if you
(Form 941) when filing an aggregate Form 941. Aggregate otherwise need to amend a previously filed Form 941,
Forms 941 are filed by agents approved by the IRS under make the correction using Form 941-X. Form 941-X is
section 3504. To request approval to act as an agent for filed separately from Form 941. For more information, see
an employer, the agent files Form 2678 with the IRS the Instructions for Form 941-X, section 13 of Pub. 15, or
unless you're a state or local government agency acting go to IRS.gov/CorrectingEmploymentTaxes.
as an agent under the special procedures provided in Federal tax deposits must be made by electronic
Rev. Proc. 2013-39, 2013-52 I.R.B. 830, available at funds transfer (EFT). You must use EFT to make all
IRS.gov/irb/2013-52_IRB#RP-2013-39. Aggregate Forms federal tax deposits. Generally, an EFT is made using the
941 are also filed by CPEOs approved by the IRS under Electronic Federal Tax Payment System (EFTPS). If you
section 7705. To become a CPEO, the organization must don't want to use EFTPS, you can arrange for your tax
apply through the IRS Online Registration System at professional, financial institution, payroll service, or other
IRS.gov/CPEO. CPEOs file Form 8973, Certified trusted third party to make electronic deposits on your
Professional Employer Organization/Customer Reporting behalf. Also, you may arrange for your financial institution
Agreement, to notify the IRS that they started or ended a to initiate a same-day wire payment on your behalf.
service contract with a customer. CPEOs must generally EFTPS is a free service provided by the Department of the
file Form 941 and Schedule R (Form 941) electronically. Treasury. Services provided by your tax professional,
For more information about a CPEO’s requirement to file financial institution, payroll service, or other third party
electronically, see Rev. Proc. 2017-14, 2017-3 I.R.B. 426, may have a fee.
available at IRS.gov/irb/2017-03_IRB#RP-2017-14.
For more information on making federal tax deposits,
Other third-party payers that file aggregate Forms 941, see section 11 of Pub. 15. To get more information about
such as non-certified PEOs, must complete and file EFTPS or to enroll in EFTPS, go to EFTPS.gov or call
Schedule R (Form 941) if they have clients that are 800-555-4477. To contact EFTPS using
claiming the qualified small business payroll tax credit for Telecommunications Relay Services (TRS) for people
increasing research activities, and/or the credit for who are deaf, hard of hearing, or have a speech disability,
qualified sick and family leave wages. dial 711 and then provide the TRS assistant the
If both an employer and a section 3504 authorized 800-555-4477 number above or 800-733-4829. Additional
TIP agent (or CPEO or other third-party payer) paid information about EFTPS is also available in Pub. 966.
wages to an employee during a quarter, both the For an EFTPS deposit to be on time, you must
employer and the section 3504 authorized agent (or ! submit the deposit by 8 p.m. Eastern time the day
CPEO or other third-party payer, if applicable) should file CAUTION before the date the deposit is due.
Form 941 reporting the wages each entity paid to the
employee during the applicable quarter and issue Forms Same-day wire payment option. If you fail to submit a
W-2 reporting the wages each entity paid to the employee deposit transaction on EFTPS by 8 p.m. Eastern time the
during the year. day before the date a deposit is due, you can still make
your deposit on time by using the Federal Tax Collection
If a third-party payer of sick pay is also paying qualified Service (FTCS) to make a same-day wire payment. To
sick leave wages on behalf of an employer, the third party use the same-day wire payment method, you will need to
would be making the payments as an agent of the make arrangements with your financial institution ahead of
employer. The employer is required to do the reporting time. Please check with your financial institution regarding
and payment of employment taxes with respect to the availability, deadlines, and costs. Your financial institution
qualified sick leave wages and claim the credit for the may charge you a fee for payments made this way. To
qualified sick leave wages, unless the employer has an learn more about the information you will need to give
agency agreement with the third-party payer that requires your financial institution to make a same-day wire
the third-party payer to do the collecting, reporting, and/or payment, go to IRS.gov/SameDayWire.
paying or depositing employment taxes on the qualified Timeliness of federal tax deposits. If a deposit is
sick leave wages. If the employer has an agency required to be made on a day that isn't a business day, the
agreement with the third-party payer, the third-party payer deposit is considered timely if it is made by the close of

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

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the next business day. A business day is any day other Photographs of missing children. The IRS is a proud
than a Saturday, Sunday, or legal holiday. The term “legal partner with the National Center for Missing & Exploited
holiday” for deposit purposes includes only those legal Children® (NCMEC). Photographs of missing children
holidays in the District of Columbia. Legal holidays in the selected by the Center may appear in instructions on
District of Columbia are provided in section 11 of Pub. 15. pages that would otherwise be blank. You can help bring
Electronic filing and payment. Businesses can enjoy these children home by looking at the photographs and
the benefits of filing tax returns and paying their federal calling 1-800-THE-LOST (1-800-843-5678) if you
taxes electronically. Whether you rely on a tax recognize a child.
professional or handle your own taxes, the IRS offers you
convenient programs to make filing and paying easier.
General Instructions:
Spend less time worrying about taxes and more time
running your business. Use e-file and EFTPS to your Purpose of Form 941
benefit.
• For e-file, go to IRS.gov/EmploymentEfile for additional These instructions give you some background information
information. A fee may be charged to file electronically. about Form 941. They tell you who must file Form 941,
• For EFTPS, go to EFTPS.gov or call 800-555-4477. To how to complete it line by line, and when and where to file
contact EFTPS using TRS for people who are deaf, hard it.
of hearing, or have a speech disability, dial 711 and then
If you want more in-depth information about payroll tax
provide the TRS assistant the 800-555-4477 number
topics relating to Form 941, see Pub. 15 or go to IRS.gov/
above or 800-733-4829.
EmploymentTaxes.
• For electronic filing of Forms W-2, Wage and Tax
Statement, go to SSA.gov/employer. You may be required Federal law requires you, as an employer, to withhold
to file Forms W-2 electronically. For details, see the certain taxes from your employees' pay. Each time you
General Instructions for Forms W-2 and W-3. pay wages, you must withhold—or take out of your
employees' pay—certain amounts for federal income tax,
If you’re filing your tax return or paying your
social security tax, and Medicare tax. You must also
! federal taxes electronically, a valid employer withhold Additional Medicare Tax from wages you pay to
CAUTION identification number (EIN) is required at the time
an employee in excess of $200,000 in a calendar year.
the return is filed or the payment is made. If a valid EIN
Under the withholding system, taxes withheld from your
isn't provided, the return or payment won't be processed.
employees are credited to your employees in payment of
This may result in penalties. See Employer identification
their tax liabilities.
number (EIN), later, for information about applying for an
EIN. Federal law also requires you to pay any liability for the
employer share of social security and Medicare taxes.
Electronic funds withdrawal (EFW). If you file Form
This share of social security and Medicare taxes isn't
941 electronically, you can e-file and use EFW to pay the
withheld from employees.
balance due in a single step using tax preparation
software or through a tax professional. However, don't use Who Must File Form 941?
EFW to make federal tax deposits. For more information
on paying your taxes using EFW, go to IRS.gov/EFW. If you pay wages subject to federal income tax withholding
or social security and Medicare taxes, you must file Form
Credit or debit card payments. You can pay the
941 quarterly to report the following amounts.
balance due shown on Form 941 by credit or debit card.
Your payment will be processed by a payment processor • Wages you’ve paid.
who will charge a processing fee. Don't use a credit or • Tips your employees reported to you.
debit card to make federal tax deposits. For more • Federal income tax you withheld.
information on paying your taxes with a credit or debit • Both the employer and the employee share of social
security and Medicare taxes.
card, go to IRS.gov/PayByCard.
• Additional Medicare Tax withheld from employees.
Online payment agreement. You may be eligible to • Current quarter's adjustments to social security and
apply for an installment agreement online if you can't pay Medicare taxes for fractions of cents, sick pay, tips, and
the full amount of tax you owe when you file your return. group-term life insurance.
For more information, see What if you can't pay in full, • Qualified small business payroll tax credit for increasing
later. research activities.
Paid preparers. If you use a paid preparer to complete • Credit for qualified sick and family leave wages paid
Form 941, the paid preparer must complete and sign the this quarter of 2023 for leave taken after March 31, 2020,
paid preparer's section of the form. and before October 1, 2021.
Where can you get telephone help? For answers to Don't use Form 941 to report backup withholding or
your questions about completing Form 941 or tax deposit income tax withholding on nonpayroll payments such as
rules, you can call the IRS at 800-829-4933 or pensions, annuities, and gambling winnings. Report these
800-829-4059 (TDD/TTY for persons who are deaf, hard types of withholding on Form 945, Annual Return of
of hearing, or have a speech disability), Monday–Friday Withheld Federal Income Tax. Also, don't use Form 941 to
from 7:00 a.m. to 7:00 p.m. local time (Alaska and Hawaii report unemployment taxes. Report unemployment taxes
follow Pacific time). on Form 940, Employer's Annual Federal Unemployment
(FUTA) Tax Return.

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

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  After you file your first Form 941, you must file a return     Department of the Treasury           Department of the Treasury
for each quarter, even if you have no taxes to report,           Internal Revenue Service    or       Internal Revenue Service 
unless you filed a final return or one of the exceptions         Ogden, UT 84201-0038                 Cincinnati, OH 45999-0038
listed next applies.

Exceptions                                                         If you would mail your return filed without a payment to 
Special rules apply to some employers.                           Ogden, as shown under Where Should You File, later, 
• If you received notification to file Form 944, Employer's      send your request to the Ogden address shown above. If 
ANNUAL Federal Tax Return, you must file Form 944                you would mail your return filed without a payment to 
annually; don't file Form 941 quarterly.                         Kansas City, send your request to the address for 
• Seasonal employers don't have to file a Form 941 for           Cincinnati shown above. For more information about 
quarters in which they have no tax liability because they        these procedures, see Rev. Proc. 2009-51, 2009-45 
have paid no wages. To tell the IRS that you won't file a        I.R.B. 625, available at IRS.gov/irb/
return for one or more quarters during the year, check the       2009-45_IRB#RP-2009-51.
box on line 18 every quarter you file Form 941. See 
section 12 of Pub. 15 for more information.                      What if You Reorganize or Close Your 
• Employers of household employees don't usually file            Business?
Form 941. See Pub. 926 and Schedule H (Form 1040) for 
more information.                                                If You Sell or Transfer Your Business . . .
• Employers of farm employees don't file Form 941 for 
                                                                 If you sell or transfer your business during the quarter, you 
wages paid for agricultural labor. See Form 943 and Pub. 
                                                                 and the new owner must each file a Form 941 for the 
51 for more information.
                                                                 quarter in which the transfer occurred. Report only the 
    If none of these exceptions apply and you haven't            wages you paid.
TIP filed a final return, you must file Form 941 each 
    quarter even if you didn't pay wages during the                When two businesses merge, the continuing firm must 
quarter. Use IRS e-file, if possible.                            file a return for the quarter in which the change took place 
                                                                 and the other firm should file a final return.

Requesting To File Forms 941 Instead of Form                       Changing from one form of business to another—such 
944, or Requesting To File Form 944 Instead of                   as from a sole proprietorship to a partnership or 
Forms 941                                                        corporation—is considered a transfer. If a transfer occurs, 
Requesting to file Forms 941 instead of Form 944.                you may need a new EIN. See Pub. 1635 and section 1 of 
Employers that would otherwise be required to file Form          Pub. 15 for more information.
944 may contact the IRS to request to file quarterly Forms 
                                                                   Attach a statement to your return with:
941 instead of annual Form 944. To request to file 
quarterly Forms 941 to report your social security and           • The new owner's name (or the new name of the 
                                                                 business);
Medicare taxes for the 2023 calendar year, you must 
either call the IRS at 800-829-4933 between January 1,           • Whether the business is now a sole proprietorship, 
                                                                 partnership, or corporation;
2023, and April 3, 2023, or send a written request 
postmarked between January 1, 2023, and March 15,                • The kind of change that occurred (a sale or transfer);
2023. After you contact the IRS, the IRS will send you a         • The date of the change; and
written notice that your filing requirement has been             • The name of the person keeping the payroll records 
                                                                 and the address where those records will be kept.
changed to Forms 941. You must receive written notice 
from the IRS to file Forms 941 instead of Form 944 before 
you may file these forms. If you don't receive this notice,      If Your Business Has Closed . . .
you must file Form 944 for calendar year 2023.
                                                                 If you permanently go out of business or stop paying 
Requesting to file Form 944 instead of Forms 941.        If      wages to your employees, you must file a final return. To 
you’re required to file Forms 941 but believe your               tell the IRS that Form 941 for a particular quarter is your 
employment taxes for calendar year 2023 will be $1,000           final return, check the box on line 17 and enter the final 
or less, you may request to file Form 944 instead of Forms       date you paid wages. Also attach a statement to your 
941 by calling the IRS at 800-829-4933 between January           return showing the name of the person keeping the payroll 
1, 2023, and April 3, 2023, or sending a written request         records and the address where those records will be kept.
postmarked between January 1, 2023, and March 15, 
2023. After you contact the IRS, the IRS will send you a           See Terminating a business in the General Instructions 
written notice that your filing requirement has been             for Forms W-2 and W-3 for information about earlier dates 
changed to Form 944. You must receive written notice             for the expedited furnishing and filing of Forms W-2 when 
from the IRS to file Form 944 instead of Forms 941 before        a final Form 941 is filed.
you may file this form. If you don't receive this notice, you 
must file Forms 941 for calendar year 2023.                        If you participated in a statutory merger or 
                                                                 consolidation, or qualify for predecessor-successor status 
Where to send written requests.        Written requests          due to an acquisition, you should generally file 
should be sent to:                                               Schedule D (Form 941), Report of Discrepancies Caused 
                                                                 by Acquisitions, Statutory Mergers, or Consolidations. 

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

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See the Instructions for Schedule D (Form 941) to “Haleigh's Cycles” on the “Trade name” line. Leave the
determine whether you should file Schedule D (Form 941) “Trade name” line blank if it is the same as your “Name.”
and when you should file it.
If you use a tax preparer to fill out Form 941, make sure
When Must You File? the preparer shows your business name exactly as it
appeared when you applied for your EIN.
File your initial Form 941 for the quarter in which you first
Employer identification number (EIN). To make sure
paid wages that are subject to social security and
businesses comply with federal tax laws, the IRS monitors
Medicare taxes or subject to federal income tax
tax filings and payments by using a numerical system to
withholding. See the table titled When To File Form 941,
identify taxpayers. A unique nine-digit EIN is assigned to
later.
all corporations, partnerships, and some sole proprietors.
Then, you must file for every quarter after that—every 3 Businesses needing an EIN must apply for a number and
months—even if you have no taxes to report, unless use it throughout the life of the business on all tax returns,
you’re a seasonal employer or are filing your final return. payments, and reports.
See Seasonal employers and If Your Business Has Your business should have only one EIN. If you have
Closed, earlier. more than one and aren't sure which one to use, write to
File Form 941 only once for each quarter. If you filed the IRS office where you file your returns (using the
electronically, don't file a paper Form 941. For more Without a payment address under Where Should You
information about filing Form 941 electronically, see File, later) or call the IRS at 800-829-4933.
Electronic filing and payment, earlier. If you don't have an EIN, you may apply for one online
by going to IRS.gov/EIN. You may also apply for an EIN
When To File Form 941 by faxing or mailing Form SS-4 to the IRS. If the principal
business was created or organized outside of the United
Your Form 941 is due by the last day of the month that follows the end of the States or U.S. territories, you may also apply for an EIN by
quarter.
calling 267-941-1099 (toll call). If you haven't received
Form 941
The Quarter Includes . . . Quarter Ends Is Due your EIN by the due date of Form 941, file a paper return
and write “Applied For” and the date you applied in this
1. January, February, March March 31 April 30 entry space.
2. April, May, June June 30 July 31
3. July, August, September September 30 October 31 If you’re filing your tax return electronically, a valid
EIN is required at the time the return is filed. If a
4. October, November, December December 31 January 31 CAUTION!
valid EIN isn't provided, the return won't be
For example, you must generally report wages you pay accepted. This may result in penalties.
during the 1st quarter—which is January through
March—by April 30. If you made timely deposits in full Always be sure the EIN on the form you file
payment of your taxes for the quarter, you may file by the TIP exactly matches the EIN the IRS assigned to your
10th day of the 2nd month that follows the end of the business. Don't use your SSN or ITIN on forms
quarter. For example, you may file Form 941 by May 10 if that ask for an EIN. If you used an EIN (including a prior
you made timely deposits in full payment of your taxes for owner's EIN) on Form 941 that is different from the EIN
the 1st quarter. reported on Form W-3, see Box h—Other EIN used this
year in the General Instructions for Forms W-2 and W-3.
If we receive Form 941 after the due date, we will treat Filing a Form 941 with an incorrect EIN or using another
Form 941 as filed on time if the envelope containing Form business's EIN may result in penalties and delays in
941 is properly addressed, contains sufficient postage, processing your return.
and is postmarked by the U.S. Postal Service on or before
the due date, or sent by an IRS-designated private If you change your business name, business ad-
delivery service (PDS) on or before the due date. If you dress, or responsible party... Notify the IRS
don't follow these guidelines, we will generally consider immediately if you change your business name, business
Form 941 filed when it is actually received. For more address, or responsible party.
information about PDSs, see Where Should You File, • Write to the IRS office where you file your returns (using
later. the Without a payment address under Where Should You
File, later) to notify the IRS of any business name change.
If any due date for filing falls on a Saturday, Sunday, or See Pub.1635 to see if you need to apply for a new EIN.
legal holiday, you may file your return on the next Complete and mail Form 8822-B to notify the IRS of a
•
business day. business address or responsible party change. Don't mail
How Should You Complete Form 941? Form 8822-B with your Form 941. For a definition of
“responsible party,” see the Instructions for Form SS-4.
Type or print your EIN, name, and address in the spaces
provided. Also enter your name and EIN on the top of Check the Box for the Quarter
pages 2 and 3. Don't use your social security number Under “Report for this Quarter of 2023” at the top of Form
(SSN) or individual taxpayer identification number (ITIN). 941, check the appropriate box of the quarter for which
Generally, enter the business (legal) name you used when you’re filing. Make sure the quarter checked is the same
you applied for your EIN. For example, if you’re a sole as shown on any attached Schedule B (Form 941), Report
proprietor, enter “Haleigh Smith” on the “Name” line and

-6- Instructions for Form 941 (Rev. 3-2023)

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of Tax Liability for Semiweekly Schedule Depositors, and, depends on whether you include a payment with Form
if applicable, Schedule R (Form 941). 941. Mail your return to the address listed for your location
in the table that follows.
Completing and Filing Form 941
PDSs can't deliver to P.O. boxes. You must use the
Make entries on Form 941 as follows to enable accurate
U.S. Postal Service to mail an item to a P.O. box address.
scanning and processing.
Go to IRS.gov/PDS for the current list of PDSs. For the
• Use 10-point Courier font (if possible) for all entries if
IRS mailing address to use if you’re using a PDS, go to
you’re typing or using a computer to complete your form.
IRS.gov/PDSstreetAddresses. Select the mailing address
Portable Document Format (PDF) forms on IRS.gov have
listed on the webpage that is in the same state as the
fillable fields with acceptable font specifications.
address to which you would mail returns filed without a
• Don't enter dollar signs and decimal points. Commas
payment, as shown next.
are optional. Enter dollars to the left of the preprinted
decimal point and cents to the right of it. Don’t round Mailing Addresses for Form 941

entries to whole dollars. Always show an amount for If you’re in . . . Without a With a
cents, even if it is zero. payment . . . payment . . .
• Leave blank any data field (except lines 1, 2, and 12)
with a value of zero. Connecticut, Delaware, District of Department of Internal
• Enter negative amounts using a minus sign (if possible). Columbia, Georgia, Illinois, the Treasury Revenue
Otherwise, use parentheses. Indiana, Kentucky, Maine, Internal Service
• Enter your name and EIN on all pages. Maryland, Massachusetts, Revenue P.O. Box
• Enter your name, EIN, “Form 941,” and the tax year and Michigan, New Hampshire, New Service 806532
Jersey, New York, North Carolina, Kansas City, Cincinnati, OH
quarter on all attachments. Ohio, Pennsylvania, Rhode MO 64999-0005 45280-6532
• Staple multiple sheets in the upper left corner when Island, South Carolina,
filing. Tennessee, Vermont, Virginia,
Complete all three pages. You must complete all three West Virginia, Wisconsin
pages of Form 941 and sign on page 3. Failure to do so Alabama, Alaska, Arizona, Department of Internal
may delay processing of your return. Arkansas, California, Colorado, the Treasury Revenue
Florida, Hawaii, Idaho, Iowa, Internal Service
Required Notice to Employees About the Kansas, Louisiana, Minnesota, Revenue P.O. Box
Earned Income Credit (EIC) Mississippi, Missouri, Montana, Service 932100
Nebraska, Nevada, New Mexico, Ogden, UT Louisville, KY
To notify employees about the EIC, you must give the North Dakota, Oklahoma, 84201-0005 40293-2100
employees one of the following items. Oregon, South Dakota, Texas,
• Form W-2 which has the required information about the Utah, Washington, Wyoming
EIC on the back of Copy B.
• A substitute Form W-2 with the same EIC information No legal residence or principal Internal Internal
on the back of the employee's copy that is on Copy B of place of business in any state Revenue Revenue
the IRS Form W-2. Service Service
• Notice 797, Possible Federal Tax Refund Due to the P.O. Box P.O. Box
409101 932100
Earned Income Credit (EIC). Ogden, UT Louisville, KY
• Your written statement with the same wording as 84409 40293-2100
Notice 797.
For more information, see section 10 of Pub. 15, Pub. Special filing address for Department of Internal
exempt organizations; federal, the Treasury Revenue
596, and IRS.gov/EIC. state, and local governmental Internal Service
entities; and Indian tribal Revenue P.O. Box
Reconciling Forms 941 With Form W-3 governmental entities, regardless Service 932100
The IRS matches amounts reported on your four quarterly of location Ogden, UT Louisville, KY
Forms 941 with Form W-2 amounts totaled on your yearly 84201-0005 40293-2100
Form W-3, Transmittal of Wage and Tax Statements. If
the amounts don't agree, you may be contacted by the Your filing address may have changed from that
IRS or the Social Security Administration (SSA). The ! used to file your employment tax return in prior
following amounts are reconciled. CAUTION years. Don't send Form 941 or any payments to
• Federal income tax withholding. the SSA.
• Social security wages.
• Social security tips. Depositing Your Taxes
• Medicare wages and tips.
You must deposit all depository taxes
For more information, see section 12 of Pub. 15 and ! electronically by EFT. For more information, see
the Instructions for Schedule D (Form 941). CAUTION Federal tax deposits must be made by electronic
funds transfer (EFT) under Reminders, earlier.
Where Should You File?
You’re encouraged to file Form 941 electronically. Go to
IRS.gov/EmploymentEfile for more information on
electronic filing. If you file a paper return, where you file

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

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Must You Deposit Your Taxes? Before the beginning of each calendar year, determine
You may have to deposit the federal income taxes you which type of deposit schedule you must use.
withheld and both the employer and employee social • If you reported $50,000 or less in taxes during the
security taxes and Medicare taxes. lookback period, you’re a monthly schedule depositor.
• If your total taxes after adjustments and • If you reported more than $50,000 of taxes during the
nonrefundable credits (line 12) are less than $2,500 lookback period, you’re a semiweekly schedule
for the current quarter or the prior quarter, and you depositor.
didn't incur a $100,000 next-day deposit obligation If you’re a monthly schedule depositor and
during the current quarter. You don't have to make a ! accumulate a $100,000 tax liability on any day
deposit. To avoid a penalty, you must pay any amount CAUTION during the deposit period, you become a
due in full with a timely filed return or you must deposit any semiweekly schedule depositor on the next day and
amount you owe by the due date of the return. For more remain so for at least the rest of the calendar year and for
information on paying with a timely filed return, see the the following calendar year. See $100,000 Next-Day
instructions for line 14, later. If you’re not sure your total Deposit Rule in section 11 of Pub. 15 for more
tax liability for the current quarter will be less than $2,500 information. The $100,000 tax liability threshold requiring
(and your liability for the prior quarter wasn't less than a next-day deposit is determined before you consider any
$2,500), make deposits using the semiweekly or monthly reduction of your liability for nonrefundable credits. For
rules so you won't be subject to failure-to-deposit (FTD) more information, including an example, see frequently
penalties. asked question 17 at IRS.gov/ETD.
• If your total taxes after adjustments and
nonrefundable credits (line 12) are $2,500 or more What About Penalties and Interest?
for the current quarter and the prior quarter. You
must make deposits according to your deposit schedule. Avoiding Penalties and Interest
See section 11 of Pub. 15 for information about payments
You can avoid paying penalties and interest if you do all of
made under the accuracy of deposits rule and for rules
the following.
about federal tax deposits.
• Deposit or pay your taxes when they are due, unless
Reducing your deposits for the credit for qualified you meet the requirements discussed in Notice 2020-22
sick and family leave wages. Employers eligible to and Notice 2021-24.
claim the credit for qualified sick and family leave wages • File your fully completed Form 941 on time.
paid this quarter of 2023 for leave taken after March 31, • Report your tax liability accurately.
2020, and before October 1, 2021, can reduce their • Submit valid checks for tax payments.
deposits by the amount of their anticipated credit. • Furnish accurate Forms W-2 to employees.
Employers won’t be subject to an FTD penalty for • File Form W-3 and Copy A of Forms W-2 with the SSA
reducing their deposits if certain conditions are met. See on time and accurately.
the instructions for line 11b and line 11d, later, for more
information on these credits. For more information on Penalties and interest are charged on taxes paid late
reducing deposits, see Notice 2020-22, 2020-17 I.R.B. and returns filed late at a rate set by law. See sections 11
664, available at IRS.gov/irb/2020-17_IRB#NOT-2020-22; and 12 of Pub. 15 for details.
and Notice 2021-24, 2021-18 I.R.B. 1122, available at
IRS.gov/irb/2021-18_IRB#NOT-2021-24. See the Use Form 843 to request abatement of assessed
instructions for line 16, later, for information on adjusting penalties or interest. Don't request abatement of
tax liabilities reported on line 16 or Schedule B (Form 941) assessed penalties or interest on Form 941 or Form
for nonrefundable credits. 941-X.

When Must You Deposit Your Taxes? If you receive a notice about a penalty after you file this
return, reply to the notice with an explanation and we will
Determine if You’re a Monthly or Semiweekly determine if you meet reasonable-cause criteria. Don't
Schedule Depositor for the Quarter attach an explanation when you file your return.
If federal income, social security, and Medicare
The IRS uses two different sets of deposit rules to ! taxes that must be withheld (that is, trust fund
determine when businesses must deposit their social CAUTION taxes) aren't withheld or aren't deposited or paid
security, Medicare, and withheld federal income taxes. to the United States Treasury, the trust fund recovery
These schedules tell you when a deposit is due after you penalty may apply. The penalty is 100% of the unpaid
have a payday. trust fund tax. If these unpaid taxes can't be immediately
collected from the employer or business, the trust fund
Your deposit schedule isn't determined by how often recovery penalty may be imposed on all persons who are
you pay your employees. Your deposit schedule depends determined by the IRS to be responsible for collecting,
on the total tax liability you reported on Form 941 during accounting for, or paying over these taxes, and who acted
the previous 4-quarter lookback period (July 1 of the willfully in not doing so. For more information, see section
second preceding calendar year through June 30 of the 11 of Pub. 15. The trust fund recovery penalty won't apply
preceding calendar year). See section 11 of Pub. 15 for to any amount of trust fund taxes an employer holds back
details. If you filed Form 944 in either 2021 or 2022, your in anticipation of any credits they are entitled to.
lookback period is the 2021 calendar year.

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Adjustment of Tax on Tips this quarter of 2023 for leave taken after March 31, 2020,
and before October 1, 2021, and qualified family leave
If, by the 10th of the month after the month you received wages paid this quarter of 2023 for leave taken after
an employee's report on tips, you don't have enough March 31, 2020, and before October 1, 2021; tips; taxable
employee funds available to withhold the employee share fringe benefits; and supplemental unemployment
of social security and Medicare taxes, you no longer have compensation benefits. Don't include any income tax
to collect it. Report the entire amount of these tips on withheld by a third-party payer of sick pay even if you
line 5b (Taxable social security tips), line 5c (Taxable reported it on Forms W-2. You will reconcile this
Medicare wages and tips), and, if the withholding difference on Form W-3. Also include here any excise
threshold is met, line 5d (Taxable wages and tips subject taxes you were required to withhold on golden parachute
to Additional Medicare Tax withholding). Include as a payments (section 4999). For information on the
negative adjustment on line 9 the total uncollected employment tax treatment of fringe benefits, see Pub.
employee share of the social security and Medicare taxes. 15-B, Employer's Tax Guide to Fringe Benefits. For
information about supplemental unemployment
compensation benefits and golden parachute payments,
Specific Instructions: see section 5 of Pub. 15-A.
Part 1: Answer These Questions for If you’re a third-party payer of sick pay, enter the
federal income tax you withheld (or were required to
This Quarter withhold) on third-party sick pay here.

1. Number of Employees Who Received Wages, 4. If No Wages, Tips, and Other Compensation
Tips, or Other Compensation Are Subject to Social Security or Medicare
Enter the number of employees on your payroll for the pay Tax . . .
period including March 12, June 12, September 12, or If no wages, tips, and other compensation on line 2 are
December 12, for the quarter indicated at the top of Form subject to social security or Medicare tax, check the box
941. Don't include: on line 4. If this question doesn't apply to you, leave the
• Household employees, box blank. For more information about exempt wages, see
• Employees in nonpay status for the pay period, section 15 of Pub. 15. For religious exemptions, see
• Farm employees, section 4 of Pub. 15-A.
• Pensioners, or
• Active members of the U.S. Armed Forces. If you’re a governmental employer, wages you pay
aren't automatically exempt from social security
For purposes of these instructions, all references CAUTION! and Medicare taxes. Your employees may be
TIP to “sick pay” mean ordinary sick pay, not “qualified covered by law or by a voluntary Section 218 Agreement
sick leave wages” that are reported on line 5a(i) with the SSA. For more information, see Pub. 963,
for leave taken after March 31, 2020, and before April 1, Federal-State Reference Guide.
2021, or reported on line 5a for leave taken after March
31, 2021, and before October 1, 2021.
5a–5e. Taxable Social Security and Medicare
Wages and Tips
2. Wages, Tips, and Other Compensation
Enter amounts on line 2 that would also be included in Qualified sick leave wages and qualified family
box 1 of your employees' Forms W-2. See Box ! leave wages paid this quarter of 2023 for leave
1—Wages, tips, other compensation in the General CAUTION taken after March 31, 2020, and before April 1,
Instructions for Forms W-2 and W-3 for details. Include 2021, are reported on lines 5a(i) and 5a(ii), respectively.
sick pay paid by your agent. Also include sick pay paid by Qualified sick leave wages and qualified family leave
a third party that isn't your agent (for example, an wages paid this quarter of 2023 for leave taken after
insurance company) if you were given timely notice of the March 31, 2021, and before October 1, 2021, are reported
payments and the third party transferred liability for the on line 5a.
employer's taxes to you.
5a. Taxable social security wages. Enter the total
If you’re a third-party payer of sick pay and not an agent wages, including qualified sick leave wages and qualified
of the employer, don't include sick pay that you paid to family leave wages paid this quarter of 2023 for leave
policyholders' employees here if you gave the taken after March 31, 2021, and before October 1, 2021;
policyholders timely notice of the payments. See section 6 sick pay; and taxable fringe benefits subject to social
of Pub. 15-A for more information about sick pay reporting security taxes you paid to your employees during the
and the procedures for transferring the liability to the quarter. Don't include the qualified sick leave wages paid
employer. this quarter of 2023 that are reported on line 5a(i) or
qualified family leave wages paid this quarter of 2023 that
3. Federal Income Tax Withheld From Wages, are reported on line 5a(ii) for leave taken after March 31,
Tips, and Other Compensation 2020, and before April 1, 2021. For this purpose, sick pay
Enter the federal income tax you withheld (or were includes payments made by an insurance company to
required to withhold) from your employees on this your employees for which you received timely notice from
quarter's wages, including qualified sick leave wages paid the insurance company. See section 6 of Pub. 15-A for

Instructions for Form 941 (Rev. 3-2023) -9-

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more information about sick pay reporting. See the               3. Is experiencing symptoms of COVID-19 and 
instructions for line 8 for an adjustment that you may need  seeking a medical diagnosis; or, for leave taken after 
to make on Form 941 for sick pay.                            March 31, 2021, and before October 1, 2021, is seeking 
Enter the amount before payroll deductions. Don't            or awaiting the results of a diagnostic test for, or a medical 
include tips on this line. For information on types of wages diagnosis of, COVID-19 (and the employee has been 
subject to social security taxes, see section 5 of Pub. 15.  exposed to COVID-19 or the employee's employer has 
                                                             requested such test or diagnosis), or the employee is 
For 2023, the rate of social security tax on taxable 
                                                             obtaining immunizations related to COVID-19 or 
wages, except for qualified sick leave wages and qualified 
                                                             recovering from an injury, disability, illness, or condition 
family leave wages paid in 2023 for leave taken after 
                                                             related to such immunization;
March 31, 2020, and before April 1, 2021, is 6.2% (0.062) 
each for the employer and employee or 12.4% (0.124) for          4. Is caring for an individual subject to an order 
both. Stop paying social security tax on and entering an     described in (1) or who has been advised as described in 
employee's wages on line 5a when the employee's              (2);
taxable wages, including qualified sick leave wages paid         5. Is caring for a son or daughter because the school 
in 2023 that are reported on line 5a(i), qualified family    or place of care for that child has been closed, or the 
leave wages paid in 2023 that are reported on line 5a(ii),   childcare provider for that child is unavailable, due to 
and tips, reach $160,200 for the year. However, continue     COVID-19 precautions; or
to withhold income and Medicare taxes for the whole year         6. Is experiencing any other substantially similar 
on all wages, including qualified sick leave wages paid in   condition specified by the U.S. Department of Health and 
2023, qualified family leave wages paid in 2023, and tips,   Human Services, which for leave taken after March 31, 
even when the social security wage base of $160,200 has      2021, and before October 1, 2021, includes to 
been reached.                                                accompany an individual to obtain immunization related to 
For purposes of the credit for qualified sick and family     COVID-19, or to care for an individual who is recovering 
leave wages, qualified sick leave and family leave wages     from any injury, disability, illness, or condition related to 
are wages for social security and Medicare tax purposes,     the immunization.
determined without regard to the exclusions from the 
                                                                 Son or daughter. A son or daughter must generally 
definition of employment under sections 3121(b)(1)–(22), 
                                                             have been under 18 years of age or incapable of self-care 
that an employer pays that otherwise meet the 
                                                             because of a mental or physical disability. A son or 
requirements of the Emergency Paid Sick Leave Act 
                                                             daughter includes a biological child, adopted child, 
(EPSLA) or the Emergency Family and Medical Leave 
                                                             stepchild, foster child, legal ward, or a child for whom the 
Expansion Act (Expanded FMLA), as enacted under the 
                                                             employee assumes parental status and carries out the 
FFCRA and amended for purposes of the ARP. However, 
                                                             obligations of a parent.
don't include any wages otherwise excluded under 
section 3121(b) when reporting qualified sick and family         Limits on qualified sick leave wages. The EPSLA, 
leave wages on lines 5a, 5a(i), 5a(ii), 5c, and, if          as amended for purposes of the ARP, provides different 
applicable, 5d. See the instructions for line 11d for        limitations for different circumstances under which 
information about the credit for qualified sick and family   qualified sick leave wages are paid. For paid sick leave 
leave wages for leave taken after March 31, 2021, and        qualifying under (1), (2), or (3) above, the amount of 
before October 1, 2021.                                      qualified sick leave wages is determined at the 
                                                             employee's regular rate of pay, but the wages may not 
                       line 5a  (column 1)                   exceed $511 for any day (or portion of a day) for which the 
                 x    0.124                                  individual is paid sick leave. For paid sick leave qualifying 
                       line 5a  (column 2)                   under (4), (5), or (6) above, the amount of qualified sick 
                                                             leave wages is determined at two-thirds the employee's 
                                                             regular rate of pay, but the wages may not exceed $200 
EPSLA.    Employers with fewer than 500 employees            for any day (or portion of a day) for which the individual is 
and, for leave taken after March 31, 2021, and before        paid sick leave. The EPSLA also limits each individual to a 
October 1, 2021, certain governmental employers without      maximum of up to 80 hours of paid sick leave in total for 
regard to number of employees (except for the federal        leave taken after March 31, 2020, and before April 1, 
government and its agencies and instrumentalities unless     2021. The ARP resets this limit at 80 hours of paid sick 
described in section 501(c)(1)) are entitled to a credit if  leave for leave taken after March 31, 2021, and before 
they provide paid sick leave to employees that otherwise     October 1, 2021. Therefore, for leave taken after March 
meets the requirements of the EPSLA. Under the EPSLA,        31, 2020, and before April 1, 2021, the maximum amount 
as amended for purposes of the ARP, wages are qualified      of paid sick leave wages can't exceed $5,110 for an 
sick leave wages if paid to employees that are unable to     employee for leave under (1), (2), or (3), and it can't 
work or telework before October 1, 2021, because the         exceed $2,000 for an employee for leave under (4), (5), or 
employee:                                                    (6). These maximum amounts also reset and apply to 
1. Is subject to a federal, state, or local quarantine or    leave taken after March 31, 2021, and before October 1, 
isolation order related to COVID-19;                         2021.
2. Has been advised by a health care provider to                 For more information about qualified sick leave wages, 
self-quarantine due to concerns related to COVID-19;         go to IRS.gov/PLC.
                                                                 Expanded FMLA.   Employers with fewer than 500 
                                                             employees and, for leave taken after March 31, 2021, and 

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before October 1, 2021, certain governmental employers          For purposes of the credit for qualified sick and family 
without regard to number of employees (except for the          leave wages, qualified sick leave wages are wages for 
federal government and its agencies and instrumentalities      social security and Medicare tax purposes, determined 
unless described in section 501(c)(1)) are entitled to a       without regard to the exclusions from the definition of 
credit under the FFCRA, as amended for purposes of the         employment under sections 3121(b)(1)–(22), that an 
ARP, if they provide paid family leave to employees that       employer pays that otherwise meet the requirements of 
otherwise meets the requirements of the Expanded               the EPSLA, as enacted under the FFCRA and amended 
FMLA. For leave taken after March 31, 2020, and before         by the COVID-related Tax Relief Act of 2020. However, 
April 1, 2021, wages are qualified family leave wages if       don't include any wages otherwise excluded under 
paid to an employee who has been employed for at least         section 3121(b) when reporting qualified sick leave wages 
30 calendar days when an employee is unable to work or         on lines 5a(i), 5c, and, if applicable, 5d. See the 
telework due to the need to care for a son or daughter         instructions for line 11b for information about the credit for 
under 18 years of age or incapable of self-care because of     qualified sick and family leave wages for leave taken after 
a mental or physical disability because the school or place    March 31, 2020, and before April 1, 2021.
of care for that child has been closed, or the childcare 
provider for that child is unavailable, due to a public health                      line 5a(i)  (column 1)
emergency. See Son or daughter, earlier, for more                               x    0.062
information. For leave taken after March 31, 2021, and                              line 5a(i)  (column 2)
before October 1, 2021, the leave can be granted for any 
other reason provided by the EPSLA, as amended for 
purposes of the ARP.                                           5a(ii). Qualified family leave wages.       Enter the qualified 
For leave taken after March 31, 2020, and before April         taxable (subject to social security tax) family leave wages 
1, 2021, the first 10 days for which an employee takes         you paid this quarter of 2023 to your employees for leave 
leave may be unpaid. During this period, employees may         taken after March 31, 2020, and before April 1, 2021. 
use other forms of paid leave, such as qualified sick leave,   Qualified family leave wages for leave taken after March 
accrued sick leave, annual leave, or other paid time off.      31, 2020, and before April 1, 2021, aren't subject to the 
After an employee takes leave for 10 days, the employer        employer share of social security tax; therefore, the tax 
must provide the employee paid leave (that is, qualified       rate on these wages is 6.2% (0.062). Stop paying social 
family leave wages) for up to 10 weeks. For leave taken        security tax on and entering an employee's wages on 
after March 31, 2021, and before October 1, 2021, the          line 5a(ii) when the employee's taxable wages, including 
10-day rule discussed above doesn't apply and the paid         wages reported on line 5a, qualified sick leave wages 
leave can be provided for up to 12 weeks.                      reported on line 5a(i), qualified family leave wages 
                                                               reported on line 5a(ii), and tips, reach $160,200 for the 
Rate of pay and limit on wages.       The rate of pay must 
                                                               year. See the instructions for line 5c for reporting 
be at least two-thirds of the employee’s regular rate of pay 
                                                               Medicare tax on qualified family leave wages, including 
(as determined under the Fair Labor Standards Act of 
                                                               the portion above the social security wage base.
1938), multiplied by the number of hours the employee 
otherwise would have been scheduled to work. For leave          For purposes of the credit for qualified sick and family 
taken after March 31, 2020, and before April 1, 2021, the      leave wages, qualified family leave wages are wages for 
total qualified family leave wages can’t exceed $200 per       social security and Medicare tax purposes, determined 
day or $10,000 in the aggregate per employee. For leave        without regard to the exclusions from the definition of 
taken after March 31, 2021, and before October 1, 2021,        employment under sections 3121(b)(1)–(22), that an 
the limit resets and the total qualified family leave wages    employer pays that otherwise meet the requirements of 
can't exceed $200 per day or $12,000 in the aggregate          the Expanded FMLA, as enacted under the FFCRA and 
per employee.                                                  amended by the COVID-related Tax Relief Act of 2020. 
                                                               However, don't include any wages otherwise excluded 
For more information about qualified family leave 
                                                               under section 3121(b) when reporting qualified family 
wages, go to IRS.gov/PLC.
                                                               leave wages on lines 5a(ii), 5c, and, if applicable, 5d. See 
5a(i). Qualified sick leave wages.    Enter the qualified      the instructions for line 11b for information about the credit 
taxable (subject to social security tax) sick leave wages      for qualified sick and family leave wages for leave taken 
you paid this quarter of 2023 to your employees for leave      after March 31, 2020, and before April 1, 2021.
taken after March 31, 2020, and before April 1, 2021. 
Qualified sick leave wages for leave taken after March 31,                          line 5a(ii)  (column 1)
2020, and before April 1, 2021, aren't subject to the                           x    0.062
employer share of social security tax; therefore, the tax                           line 5a(ii)  (column 2)
rate on these wages is 6.2% (0.062). Stop paying social 
security tax on and entering an employee's wages on 
line 5a(i) when the employee's taxable wages, including        5b. Taxable social security tips. Enter all tips your 
wages reported on line 5a, qualified sick leave wages          employees reported to you during the quarter until the 
reported on line 5a(i), qualified family leave wages           total of the tips and taxable wages, including wages 
reported on line 5a(ii), and tips, reach $160,200 for the      reported on line 5a, qualified sick leave wages reported 
year. See the instructions for line 5c for reporting           on line 5a(i), and qualified family leave wages reported on 
Medicare tax on qualified sick leave wages, including the      line 5a(ii), for an employee reach $160,200 for the year. 
portion above the social security wage base.                   Include all tips your employee reported to you even if you 

Instructions for Form 941 (Rev. 3-2023)                     -11-

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were unable to withhold the employee tax of 6.2%. You until the end of the calendar year. Additional Medicare
will reduce your total taxes by the amount of any Tax is only imposed on the employee. There is no
uncollected employee share of social security and employer share of Additional Medicare Tax. All wages that
Medicare taxes on tips later on line 9; see Current are subject to Medicare tax are subject to Additional
quarter's adjustments for tips and group-term life Medicare Tax withholding if paid in excess of the
insurance, later. Don’t include service charges on line 5b. $200,000 withholding threshold.
For details about the difference between tips and service For more information on what wages are subject to
charges, see Rev. Rul. 2012-18, 2012-26 I.R.B. 1032, Medicare tax, see the chart, Special Rules for Various
available at IRS.gov/irb/2012-26_IRB#RR-2012-18. Types of Services and Payments, in section 15 of Pub. 15.
Your employee must report cash tips to you by the 10th For more information on Additional Medicare Tax, go to
day of the month after the month the tips are received. IRS.gov/ADMTfaqs. See the instructions for line 8 for an
Cash tips include tips paid by cash, check, debit card, and adjustment that you may need to make on Form 941 for
credit card. The report should include charged tips (for sick pay.
example, credit and debit card charges) you paid over to Once wages and tips exceed the $200,000 withholding
the employee for charge customers, tips the employee threshold, include all tips your employees reported during
received directly from customers, and tips received from the quarter, even if you were unable to withhold the
other employees under any tip-sharing arrangement. Both employee tax of 0.9%.
directly and indirectly tipped employees must report tips to
you. No report is required for months when tips are less line 5d (column 1)
than $20. Employees may use Form 4070 (available only x 0.009
in Pub. 1244), or submit a written statement or electronic line 5d (column 2)
tip record.
Don't include allocated tips (described in section 6 of
Pub. 15) on this line. Instead, report them on Form 8027. 5e. Total social security and Medicare taxes. Add the
Allocated tips aren't reportable on Form 941 and aren't column 2 amounts on lines 5a–5d. Enter the result on
subject to withholding of federal income, social security, line 5e.
or Medicare taxes.
5f. Section 3121(q) Notice and Demand—Tax
line 5b (column 1) Due on Unreported Tips
x 0.124 Enter the tax due from your Section 3121(q) Notice and
line 5b (column 2) Demand on line 5f. The IRS issues a Section 3121(q)
Notice and Demand to advise an employer of the amount
of tips received by employees who failed to report or
5c. Taxable Medicare wages & tips. Enter all wages, underreported tips to the employer. An employer isn't
including qualified sick leave wages paid this quarter of liable for the employer share of the social security and
2023 and qualified family leave wages paid this quarter of Medicare taxes on unreported tips until notice and
2023; tips; sick pay; and taxable fringe benefits that are demand for the taxes is made to the employer by the IRS
subject to Medicare tax. Unlike social security wages, in a Section 3121(q) Notice and Demand. The tax due
there is no limit on the amount of wages subject to may have been determined from tips reported to the IRS
Medicare tax. on employees' Forms 4137, Social Security and Medicare
The rate of Medicare tax is 1.45% (0.0145) each for the Tax on Unreported Tip Income, or other tips that weren't
employer and employee or 2.9% (0.029) for both. Include reported to their employer as determined by the IRS
all tips your employees reported during the quarter, even if during an examination. For additional information, see
you were unable to withhold the employee tax of 1.45%. Rev. Rul. 2012-18.
line 5c (column 1) Deposit the tax within the time period required under
x 0.029 your deposit schedule to avoid any possible deposit
line 5c (column 2) penalty. The tax is treated as accumulated by the
employer on the “Date of Notice and Demand” as printed
on the Section 3121(q) Notice and Demand. The
For more information on tips, see section 6 of Pub. 15. employer must include this amount on the appropriate line
See the instructions for line 8 for an adjustment that you of the record of federal tax liability (Part 2 of Form 941 for
may need to make on Form 941 for sick pay. a monthly schedule depositor or Schedule B (Form 941)
for a semiweekly schedule depositor).
5d. Taxable wages & tips subject to Additional Medi-
care Tax withholding. Enter all wages, including 6. Total Taxes Before Adjustments
qualified sick leave wages paid this quarter of 2023 and Add the total federal income tax withheld from wages,
qualified family leave wages paid this quarter of 2023; tips, and other compensation (line 3); the total social
tips; sick pay; and taxable fringe benefits that are subject security and Medicare taxes before adjustments (line 5e);
to Additional Medicare Tax withholding. You’re required to and any tax due under a Section 3121(q) Notice and
begin withholding Additional Medicare Tax in the pay Demand (line 5f). Enter the result on line 6.
period in which you pay wages in excess of $200,000 to
an employee and continue to withhold it each pay period

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7–9. Tax Adjustments Prior quarter's adjustments. If you need to correct any
Enter tax amounts on lines 7–9 that result from current adjustment reported on a previously filed Form 941,
quarter adjustments. Use a minus sign (if possible) to complete and file Form 941-X. Form 941-X is an adjusted
show an adjustment that decreases the total taxes shown return or claim for refund and is filed separately from Form
on line 6 instead of parentheses. Doing so enhances the 941. See section 13 of Pub. 15.
accuracy of our scanning software. For example, enter
“-10.59” instead of “(10.59).” However, if your software 10. Total Taxes After Adjustments
only allows for parentheses in entering negative amounts, Combine the amounts shown on lines 6–9 and enter the
you may use them. result on line 10.

Current quarter's adjustments. In certain cases, you 11a. Qualified Small Business Payroll Tax Credit
must adjust the amounts you entered as social security
for Increasing Research Activities
and Medicare taxes in column 2 of lines 5a–5d to figure
your correct tax liability for this quarter's Form 941. See Enter the amount of the credit from Form 8974, line 12 or,
section 13 of Pub. 15. if applicable, line 17.
7. Current quarter's adjustment for fractions of If you enter an amount on line 11a, you must
cents. Enter adjustments for fractions of cents (due to ! attach Form 8974.
rounding) relating to the employee share of social security CAUTION
and Medicare taxes withheld. The employee share of
amounts shown in column 2 of lines 5a–5d may differ Form 941 and these instructions use the terms
slightly from amounts actually withheld from employees' TIP “nonrefundable” and “refundable” when
pay due to the rounding of social security and Medicare discussing credits. The term “nonrefundable”
taxes based on statutory rates. This adjustment may be a means the portion of the credit which is limited by law to
positive or a negative adjustment. the amount of certain taxes. The term “refundable” means
the portion of the credit which is in excess of those taxes.
8. Current quarter's adjustment for sick pay. If your
third-party payer of sick pay that isn't your agent (for
example, an insurance company) transfers the liability for 11b. Nonrefundable Portion of Credit for
the employer share of the social security and Medicare Qualified Sick and Family Leave Wages for
taxes to you, enter a negative adjustment on line 8 for the Leave Taken After March 31, 2020, and Before
employee share of social security and Medicare taxes that April 1, 2021
were withheld and deposited by your third-party sick pay
payer on the sick pay. If you’re the third-party sick pay Complete line 11b only if qualified sick leave
payer and you transferred the liability for the employer ! wages and/or qualified family leave wages were
share of the social security and Medicare taxes to the CAUTION paid this quarter of 2023 for leave taken after
employer, enter a negative adjustment on line 8 for any March 31, 2020, and before April 1, 2021.
employer share of these taxes required to be paid by the Certain private employers with fewer than 500
employer. The sick pay should be included on line 5a, employees that provide paid sick leave under the EPSLA
line 5c, and, if the withholding threshold is met, line 5d. and/or provide paid family leave under the Expanded
No adjustment is reported on line 8 for sick pay that is FMLA are eligible to claim the credit for qualified sick and
paid through a third party as an employer’s agent. An family leave wages for leave taken after March 31, 2020,
employer’s agent bears no insurance risk and is and before April 1, 2021. For purposes of this credit,
reimbursed on a cost-plus-fee basis for payment of sick qualified sick leave wages and qualified family leave
pay and similar amounts. If an employer uses an agent to wages are wages for social security and Medicare tax
pay sick pay, the employer reports the wages on line 5a, purposes, determined without regard to the exclusions
line 5c, and, if the withholding threshold is met, line 5d, from the definition of employment under sections 3121(b)
unless the employer has an agency agreement with the (1)–(22), that an employer pays that otherwise meet the
third-party payer that requires the third-party payer to do requirements of the EPSLA or Expanded FMLA. Enter the
the collecting, reporting, and/or paying or depositing nonrefundable portion of the credit for qualified sick and
employment taxes on the sick pay. See section 6 of Pub. family leave wages from Worksheet 1, Step 2, line 2j. The
15-A for more information about sick pay reporting. credit for qualified sick and family leave wages consists of
9. Current quarter's adjustments for tips and the qualified sick leave wages, the qualified family leave
group-term life insurance. Enter a negative adjustment wages, the qualified health plan expenses allocable to
for: those wages, and the employer share of Medicare tax
• Any uncollected employee share of social security and allocable to those wages. The nonrefundable portion of
Medicare taxes on tips, and the credit is limited to the employer share of social
• The uncollected employee share of social security and security tax reported on Form 941, lines 5a and 5b, after
Medicare taxes on group-term life insurance premiums that share is first reduced by any credit claimed against
paid for former employees. the employer share of social security tax on Form 8974 for
See the General Instructions for Forms W-2 and W-3 the qualified small business payroll tax credit for
for information on how to report the uncollected employee increasing research activities, any credit to be claimed on
share of social security and Medicare taxes on tips and Form 5884-C for the work opportunity credit for qualified
group-term life insurance on Form W-2. tax-exempt organizations hiring qualified veterans, and/or

Instructions for Form 941 (Rev. 3-2023) -13-

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any credit to be claimed on Form 5884-D for the disaster        paid sick leave to employees that otherwise meets the 
credit for qualified tax-exempt organizations.                  requirements of the EPSLA, as amended for purposes of 
                                                                the ARP, and/or provide paid family leave to employees 
        If you're a third-party payer of sick pay that isn't an 
                                                                that otherwise meets the requirements under the 
!       agent (for example, an insurance company) and           Expanded FMLA, as amended for purposes of the ARP, 
CAUTION you're claiming the credit for qualified sick and 
                                                                for qualified sick and family leave wages for leave taken 
family leave wages for amounts paid to your own 
                                                                after March 31, 2021, and before October 1, 2021. For 
employees, the amount of the employer share of social 
                                                                purposes of this credit, qualified sick leave wages and 
security tax reported on line 5a must be reduced by any 
                                                                qualified family leave wages are wages for social security 
adjustment you make on line 8 for the employer share of 
                                                                and Medicare tax purposes, determined without regard to 
social security tax transferred to your client. If you 
                                                                the exclusions from the definition of employment under 
received a Section 3121(q) Notice and Demand for tax 
                                                                sections 3121(b)(1)–(22), that an employer pays that 
due on unreported tips (Letter 3263 or Letter 4520) during 
                                                                otherwise meet the requirements of the EPSLA or 
the quarter, you report the amount for the employer share 
                                                                Expanded FMLA, as enacted under the FFCRA and 
of social security tax and Medicare tax on Form 941, 
                                                                amended for purposes of the ARP. Enter the 
line 5f. Letter 3263 or Letter 4520 includes an attachment 
                                                                nonrefundable portion of the credit for qualified sick and 
that shows the employer share of social security tax. This 
                                                                family leave wages from Worksheet 2, Step 2, line 2p.
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 
                                                                •
reported on Form 941, line 13c. For more information on         sick 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 
Qualified health plan expenses allocable to qualified           limitations, allocable to the qualified sick and family leave 
sick leave and family leave wages.  The credit for              wages;
qualified sick leave wages and qualified family leave           • Collectively bargained apprenticeship program 
wages is increased to cover the qualified health plan           contributions, subject to the qualified leave wage 
expenses that are properly allocable to the qualified leave     limitations, allocable to the qualified sick and family leave 
wages for which the credit is allowed. These qualified          wages; and
health plan expenses are amounts paid or incurred by the        • Employer share of social security and Medicare tax 
employer to provide and maintain a group health plan but        allocable to the qualified sick and family leave wages.
only to the extent such amounts are excluded from the 
                                                                  The nonrefundable portion of the credit is limited to the 
employees’ income as coverage under an accident or 
                                                                employer share of Medicare tax reported on Form 941, 
health plan. The amount of qualified health plan expenses 
                                                                line 5c, after that share is first reduced by any credit 
generally includes both the portion of the cost paid by the 
                                                                claimed against the employer share of Medicare tax on 
employer and the portion of the cost paid by the employee 
                                                                Form 8974 for the qualified small business payroll tax 
with pre-tax salary reduction contributions. However, 
                                                                credit for increasing research activities. You can’t claim 
qualified health plan expenses don’t include amounts that 
                                                                the credit for leave taken after March 31, 2021, and before 
the employee paid for with after-tax contributions. For 
                                                                October 1, 2021, if, during the applicable quarter in which 
more information, go to IRS.gov/PLC.
                                                                the qualified sick or family leave wages were paid, you 
        You must include the full amount (both the              made qualified sick or family leave wages available in a 
TIP     nonrefundable and refundable portions) of the           manner that discriminates in favor of highly compensated 
        credit for qualified sick and family leave wages in     employees, full-time employees, or employees on the 
your gross income for the tax year that includes the last       basis of employment tenure. See Highly compensated 
day of any calendar quarter in which a credit is allowed.       employee, later, for the definition.
                                                                  For leave taken after March 31, 2021, and before 
11d. Nonrefundable Portion of Credit for                        October 1, 2021, the credit for qualified sick and family 
Qualified Sick and Family Leave Wages for                       leave wages is reduced by the amount of the credit 
Leave Taken After March 31, 2021, and Before                    allowed under section 41 (for the credit for increasing 
October 1, 2021                                                 research activities) with respect to wages taken into 
                                                                account for determining the credit for qualified sick and 
        Complete line 11d only if qualified sick leave 
                                                                family leave wages; and any wages taken into account in 
!       wages and/or qualified family leave wages were          determining the credit for qualified sick and family leave 
CAUTION paid this quarter of 2023 for leave taken after 
                                                                wages can't be taken into account as wages for purposes 
March 31, 2021, and before October 1, 2021.
                                                                of the credits under sections 45A, 45P, 45S, and 51. For 
Employers with fewer than 500 employees and certain             leave taken after March 31, 2021, and before October 1, 
governmental employers without regard to number of              2021, qualified wages also don't include wages that were 
employees (except for the federal government and its            used as payroll costs in connection with a Shuttered 
agencies and instrumentalities unless described in              Venue Operator Grant under section 324 of the Economic 
section 501(c)(1)) are entitled to a credit if they provide     Aid to Hard-Hit Small Businesses, Nonprofits, and Venues 

                                                            -14-                Instructions for Form 941 (Rev. 3-2023)

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Act; or a restaurant revitalization grant under section 5003 agreement to a defined benefit plan, as the rate is applied
of the ARP. Employers can receive both a Small Business to contribution base units, as defined by section 4001(a)
Interruption Loan under the Paycheck Protection Program (11) of the Employee Retirement Income Security Act of
(PPP) and the credit for qualified sick and family leave 1974 (ERISA).
wages; however, employers can't receive both loan Allocation rules. The amount of collectively bargained
forgiveness and a credit for the same wages. The same defined benefit pension plan contributions allocated to
wages can’t be treated as both qualified sick leave wages qualified sick leave wages and/or qualified family leave
and qualified family leave wages. wages in a quarter is the pension contribution rate
If you're a third-party payer of sick pay that isn't an (expressed as an hourly rate) multiplied by the number of
hours qualified sick leave wages and/or qualified family
! agent (for example, an insurance company) and leave wages were provided to employees covered under
CAUTION you're claiming the credit for qualified sick and
family leave wages for amounts paid to your own the collective bargaining agreement during the quarter.
employees, the amount of the employer share of Collectively bargained apprenticeship program con-
Medicare tax reported on line 5c must be reduced by any tributions. For purposes of qualified sick and family
adjustment you make on line 8 for the employer share of leave wages, collectively bargained apprenticeship
Medicare tax transferred to your client. If you received a program contributions are contributions for a calendar
Section 3121(q) Notice and Demand for tax due on quarter that are:
unreported tips (Letter 3263 or Letter 4520) during the • Paid or incurred by an employer on behalf of its
quarter, you report the amount for the employer share of employees to a registered apprenticeship program, which
social security tax and Medicare tax on Form 941, line 5f. is an apprenticeship registered under the National
Letter 3263 or Letter 4520 includes an attachment that Apprenticeship Act of August 16, 1937, and meets the
shows the employer share of Medicare tax. This amount standards of Federal Regulations under subpart A of Part
of the employer share of Medicare tax can also be 29 and Part 30 of title 29;
reduced by the nonrefundable portion of the credit. See • Made based on an apprenticeship program contribution
Worksheet 2 to figure your credit. rate; and
• Required to be made under the terms of a collective
Any credit in excess of the remaining amount of the bargaining agreement in effect for the quarter.
employer share of Medicare tax is refundable and Apprenticeship program contribution rate. The
reported on Form 941, line 13e. For more information on apprenticeship program contribution rate is the
the credit for qualified sick and family leave wages, go to contribution rate that the employer is obligated to pay
IRS.gov/PLC. under the terms of a collective bargaining agreement for
benefits under a registered apprenticeship program, as
Qualified health plan expenses allocable to qualified
the rate is applied to contribution base units, as defined by
sick leave and family leave wages. The credit for
section 4001(a)(11) of ERISA.
qualified sick leave wages and qualified family leave
wages is increased to cover the qualified health plan Allocation rules. The amount of collectively bargained
expenses that are properly allocable to the qualified leave apprenticeship program contributions allocated to
wages for which the credit is allowed. These qualified qualified sick leave wages and/or qualified family leave
health plan expenses are amounts paid or incurred by the wages in a quarter is the apprenticeship program
employer to provide and maintain a group health plan but contribution rate (expressed as an hourly rate) multiplied
only to the extent such amounts are excluded from the by the number of hours qualified sick leave wages and/or
employees' income as coverage under an accident or qualified family leave wages were provided to employees
health plan. The amount of qualified health plan expenses covered under the collective bargaining agreement during
generally includes both the portion of the cost paid by the the quarter.
employer and the portion of the cost paid by the employee Highly compensated employee. A highly compensated
with pre-tax salary reduction contributions. However, employee is an employee who meets either of the
qualified health plan expenses don't include amounts that following tests.
the employee paid for with after-tax contributions. For 1. The employee was a 5% owner at any time during
more information, go to IRS.gov/PLC. the year or the preceding year.
Collectively bargained defined benefit pension plan 2. The employee received more than $135,000 in pay
contributions. For purposes of qualified sick and family for the preceding year.
leave wages, collectively bargained defined benefit
pension plan contributions are contributions for a calendar You can choose to ignore test (2) if the employee
quarter that are: wasn’t also in the top 20% of employees when ranked by
• Paid or incurred by an employer on behalf of its pay for the preceding year.
employees to a defined benefit plan, as defined in section
11g. Total Nonrefundable Credits
414(j), which meets the requirements of section 401(a);
• Made based on a pension contribution rate; and Add lines 11a, 11b, and 11d. Enter the total on line 11g.
• Required to be made under the terms of a collective
bargaining agreement in effect for the quarter.
Pension contribution rate. The pension contribution
rate is the contribution rate that the employer is obligated
to pay under the terms of a collective bargaining

Instructions for Form 941 (Rev. 3-2023) -15-

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12. Total Taxes After Adjustments and and family leave wages consists of the qualified sick leave
Nonrefundable Credits wages, the qualified family leave wages, the qualified
health plan expenses allocable to those wages, and the
Subtract line 11g from line 10 and enter the result on
employer share of Medicare tax allocable to those wages.
line 12. The amount entered on line 12 can’t be less than
The refundable portion of the credit is allowed after the
zero.
employer share of social security tax is reduced to zero by
• If line 12 is less than $2,500 or line 12 on the prior nonrefundable credits that are applied against the
quarterly return was less than $2,500, and you didn't employer share of social security tax.
incur a $100,000 next-day deposit obligation during
the current quarter. You may pay the amount with Form 13e. Refundable Portion of Credit for Qualified
941 or you may deposit the amount. To avoid a penalty, Sick and Family Leave Wages for Leave Taken
you must pay any amount you owe in full with a timely filed After March 31, 2021, and Before October 1,
return or you must deposit any amount you owe before the 2021
due date of the return. For more information on paying
with a timely filed return, see the instructions for line 14, Complete line 13e only if qualified sick leave
later. ! wages and/or qualified family leave wages were
• If line 12 is $2,500 or more and line 12 on the prior CAUTION paid this quarter of 2023 for leave taken after
quarterly return was $2,500 or more, or if you March 31, 2021, and before October 1, 2021.
incurred a $100,000 next-day deposit obligation Employers with fewer than 500 employees and certain
during the current quarter. You must make required governmental employers without regard to number of
deposits according to your deposit schedule. See Notice employees (except for the federal government and its
2020-22 and Notice 2021-24 for information on reducing agencies and instrumentalities unless described in
deposits for certain credits. The amount shown on line 12 section 501(c)(1)) are entitled to a credit if they provide
must equal the “Total liability for quarter” shown on line 16 paid sick leave to employees that otherwise meets the
or the “Total liability for the quarter” shown on Schedule B requirements of the EPSLA, as amended for purposes of
(Form 941). For more information, see the line 16 the ARP, and/or provide paid family leave to employees
instructions, later. that otherwise meets the requirements under the
Expanded FMLA, as amended for purposes of the ARP,
For more information and rules about federal tax for leave taken after March 31, 2021, and before October
deposits, see Depositing Your Taxes, earlier, and section 1, 2021. Enter the refundable portion of the credit for
11 of Pub. 15. qualified sick and family leave wages from Worksheet 2,
If you’re a semiweekly schedule depositor, you Step 2, line 2q. The refundable portion of the credit is
! must complete Schedule B (Form 941). If you fail allowed after the employer share of Medicare tax is
CAUTION to complete and submit Schedule B (Form 941), reduced to zero by nonrefundable credits that are applied
the IRS may assess deposit penalties based on available against the employer share of Medicare tax.
information.
13g. Total Deposits and Refundable Credits
13a. Total Deposits for This Quarter Add lines 13a, 13c, and 13e. Enter the total on line 13g.

Enter your deposits for this quarter, including any 14. Balance Due
overpayment from a prior quarter that you applied to this
return. Also include in the amount shown any If line 12 is more than line 13g, enter the difference on
overpayment that you applied from filing Form 941-X, line 14. Otherwise, see the instructions for line 15, later.
941-X (PR), 944-X, or 944-X (SP) in the current quarter. Never make an entry on both lines 14 and 15.
Don't include any amount that you didn't deposit because You don't have to pay if line 14 is under $1. Generally,
you reduced your deposits in anticipation of the credit for you should have a balance due only if your total taxes
qualified sick and family leave wages, as discussed in after adjustments and nonrefundable credits (line 12) for
Notice 2020-22 and Notice 2021-24. the current quarter or prior quarter are less than $2,500,
and you didn't incur a $100,000 next-day deposit
13c. Refundable Portion of Credit for Qualified
obligation during the current quarter. However, see
Sick and Family Leave Wages for Leave Taken section 11 of Pub. 15 for information about payments
After March 31, 2020, and Before April 1, 2021 made under the accuracy of deposits rule.
Complete line 13c only if qualified sick leave If you were required to make federal tax deposits, pay
! wages and/or qualified family leave wages were the amount shown on line 14 by EFT. If you weren't
CAUTION paid this quarter of 2023 for leave taken after required to make federal tax deposits (see Must You
March 31, 2020, and before April 1, 2021. Deposit Your Taxes, earlier) or you're a monthly schedule
Certain private employers with fewer than 500 depositor making a payment under the accuracy of
employees that provide paid sick leave under the EPSLA deposits rule, you may pay the amount shown on line 14
and/or provide paid family leave under the Expanded by EFT, credit card, debit card, check, money order, or
FMLA are eligible to claim the credit for qualified sick and EFW. For more information on electronic payment
family leave wages. Enter the refundable portion of the options, go to IRS.gov/Payments.
credit for qualified sick and family leave wages from If you pay by EFT, credit card, or debit card, file your
Worksheet 1, Step 2, line 2k. The credit for qualified sick return using the Without a payment address under Where

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

Instructions for Form 941 (Rev. 3-2023) -17-

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You must complete Schedule B (Form 941) and submit Rose Co. is a semiweekly schedule depositor. Rose Co.
it with your Form 941. Don't file Schedule B (Form 941) completes Schedule B (Form 941) by reducing the
with your Form 941 if you’re a monthly schedule amount of liability entered for the first payroll payment in
depositor. the third quarter of 2023 that includes wages subject to
Don't change your tax liability on Schedule B (Form social security tax by the lesser of (1) its share of social
941) by adjustments reported on any Forms 941-X. security tax (up to $250,000) on the wages, or (2) the
available payroll tax credit. If the payroll tax credit elected
Adjusting tax liability for nonrefundable credits is more than Rose Co.'s share of social security tax on the
claimed on lines 11a, 11b, and 11d. Monthly schedule first payroll payment of the quarter, the excess payroll tax
depositors and semiweekly schedule depositors must credit would be carried forward to succeeding payroll
account for nonrefundable credits claimed on lines 11a, payments in the third quarter until it is used against up to
11b, and 11d when reporting their tax liabilities on line 16 $250,000 of Rose Co.'s share of social security tax for the
or Schedule B (Form 941). The total tax liability for the quarter. If the amount of the payroll tax credit exceeds
quarter must equal the amount reported on line 12. Failure Rose Co.'s share of social security tax (up to $250,000)
to account for the nonrefundable credits on line 16 or on wages paid to its employees in the third quarter, any
Schedule B (Form 941) may cause line 16 or Schedule B remaining credit is used against Rose Co.'s share of
(Form 941) to report more than the total tax liability Medicare tax on the first payroll payment of the quarter
reported on line 12. Don't reduce your monthly tax liability and then the excess payroll tax credit would be carried
reported on line 16 or your daily tax liability reported on forward to succeeding payroll payments in the third
Schedule B (Form 941) below zero. quarter until it is used against Rose Co.'s share of
Qualified small business payroll tax credit for Medicare tax for the quarter. If Rose Co. still has credit
increasing research activities (line 11a). Beginning remaining after reducing its share of social security tax (up
with the first quarter of 2023, the qualified small business to $250,000) and Medicare tax for the third quarter, the
payroll tax credit for increasing research activities is first remainder would be treated as a payroll tax credit against
used to reduce the employer share of social security tax its share of social security tax (up to $250,000) and
(up to $250,000) for the quarter and any remaining credit Medicare tax on wages paid in the fourth quarter. If the
is then used to reduce the employer share of Medicare tax amount of the payroll tax credit remaining exceeded Rose
for the quarter until it reaches zero. In completing line 16 Co.'s share of social security tax (up to $250,000) and
or Schedule B (Form 941), you take into account the Medicare tax on wages paid in the fourth quarter, it could
payroll tax credit against the liability for the employer be carried forward and treated as a payroll tax credit for
share of social security tax starting with the first payroll the first quarter of 2024.
payment of the quarter that includes payments of wages Nonrefundable portion of credit for qualified sick
subject to social security tax to your employees until you and family leave wages for leave taken after March
use up to $250,000 of credit against the employer share of 31, 2020, and before April 1, 2021 (line 11b). The
social security tax and you then take into account any nonrefundable portion of the credit for qualified sick and
remaining payroll tax credit against the liability for the family leave wages paid this quarter of 2023 for leave
employer share of Medicare tax starting with the first taken after March 31, 2020, and before April 1, 2021, is
payroll payment of the quarter that includes payments of limited to the employer share of social security tax on
wages subject to Medicare tax to employees. Consistent wages paid in the quarter that is remaining after that share
with the entries on line 16 or Schedule B (Form 941), the is first reduced by any credit claimed against the employer
payroll tax credit should be taken into account in making share of social security tax on Form 8974, line 12, for the
deposits of employment tax. If any payroll tax credit is qualified small business payroll tax credit for increasing
remaining at the end of the quarter that hasn’t been used research activities; any credit to be claimed on Form
completely because it exceeds $250,000 of the employer 5884-C, line 11, for the work opportunity credit for
share of social security tax and the employer share of qualified tax-exempt organizations hiring qualified
Medicare tax for the quarter, the excess credit may be veterans; and/or any credit to be claimed on Form 5884-D
carried forward to the succeeding quarter and allowed as for the disaster credit for qualified tax-exempt
a payroll tax credit for the succeeding quarter. The payroll organizations. In completing line 16 or Schedule B (Form
tax credit may not be taken as a credit against income tax 941), you take into account the entire quarter's
withholding, the employee share of social security tax, or nonrefundable portion of the credit for qualified sick and
the employee share of Medicare tax. Also, the remaining family leave wages against the liability for the first payroll
payroll tax credit may not be carried back and taken as a payment of the quarter, but not below zero. Then reduce
credit against wages paid from preceding quarters. the liability for each successive payroll payment in the
Example. Rose Co. is an employer with a calendar tax quarter until the nonrefundable portion of the credit is
year that filed its timely 2022 income tax return on April used. Any credit for qualified sick and family leave wages
18, 2023. Rose Co. elected to take the qualified small paid this quarter of 2023 for leave taken after March 31,
business payroll tax credit for increasing research 2020, and before April 1, 2021, that is remaining at the
activities on Form 6765. The third quarter of 2023 is the end of the quarter because it exceeds the employer share
first quarter that begins after Rose Co. filed the income tax of social security tax for the quarter is claimed on line 13c
return making the payroll tax credit election. Therefore, as a refundable credit. The refundable portion of the credit
the payroll tax credit applies against Rose Co.'s share of doesn’t reduce the liability reported on line 16 or
social security tax (up to $250,000) and Medicare tax on Schedule B (Form 941).
wages paid to employees in the third quarter of 2023.

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Example. Maple Co. is a semiweekly schedule 18. If You’re a Seasonal Employer . . .
depositor that pays employees every other Friday. In the If you hire employees seasonally—such as for summer or
first quarter of 2023, Maple Co. had pay dates of January winter only—check the box on line 18. Checking the box
6, January 20, February 3, February 17, March 3, March tells the IRS not to expect four Forms 941 from you
17, and March 31. Maple Co. paid qualified sick and throughout the year because you haven't paid wages
family leave wages on January 6 and January 20 for leave regularly.
taken after March 31, 2020, and before April 1, 2021. The
nonrefundable portion of the credit for qualified sick and Generally, we won't ask about unfiled returns if at least
family leave wages for the quarter is $10,000. On one taxable return is filed each year. However, you must
Schedule B (Form 941), Maple Co. will use the $10,000 to check the box on line 18 on every Form 941 you file.
reduce the liability for the January 6 pay date, but not Otherwise, the IRS will expect a return to be filed for each
below zero. If any nonrefundable portion of the credit quarter.
remains, Maple Co. applies it to the liability for the Also, when you complete Form 941, be sure to check
January 20 pay date, then the February 3 pay date, and the box on the top of the form that corresponds to the
so forth until the entire $10,000 is used. quarter reported.
Nonrefundable portion of credit for qualified sick The amounts entered on lines 19 through 28 are
and family leave wages for leave taken after March TIP amounts that you use on the worksheets at the
31, 2021, and before October 1, 2021 (line 11d). The end of these instructions to figure certain credits.
nonrefundable portion of the credit for qualified sick and If you’re claiming these credits, you must enter the
family leave wages paid this quarter of 2023 for leave applicable amounts.
taken after March 31, 2021, and before October 1, 2021,
is limited to the employer share of Medicare tax on wages Complete lines 19 and 20 only if qualified health
paid in the quarter that is remaining after that share is first ! plan expenses allocable to qualified sick leave
reduced by any credit claimed against the employer share CAUTION wages and/or qualified family leave wages were
of Medicare tax on Form 8974, line 16, for the qualified paid this quarter of 2023 for leave taken after March 31,
small business payroll tax credit for increasing research 2020, and before April 1, 2021.
activities. In completing line 16 or Schedule B (Form 941),
you take into account the entire quarter's nonrefundable
portion of the credit for qualified sick and family leave 19. Qualified Health Plan Expenses Allocable to
wages paid this quarter of 2023 against the liability for the Qualified Sick Leave Wages for Leave Taken
first payroll payment of the quarter, but not below zero. After March 31, 2020, and Before April 1, 2021
Then reduce the liability for each successive payroll Enter the qualified health plan expenses allocable to
payment in the quarter until the nonrefundable portion of qualified sick leave wages paid this quarter of 2023 for
the credit is used. Any credit for qualified sick and family leave taken after March 31, 2020, and before April 1,
leave wages paid this quarter of 2023 for leave taken after 2021. This amount is also entered on Worksheet 1, Step
March 31, 2021, and before October 1, 2021, that is 2, line 2b.
remaining at the end of the quarter because it exceeds the
employer share of Medicare tax for the quarter is claimed 20. Qualified Health Plan Expenses Allocable to
on line 13e as a refundable credit. The refundable portion Qualified Family Leave Wages for Leave Taken
of the credit doesn’t reduce the liability reported on line 16 After March 31, 2020, and Before April 1, 2021
or Schedule B (Form 941).
Enter the qualified health plan expenses allocable to
You may reduce your deposits by the amount of qualified family leave wages paid this quarter of 2023 for
TIP the nonrefundable and refundable portions of the leave taken after March 31, 2020, and before April 1,
credit for qualified sick and family leave wages, as 2021. This amount is also entered on Worksheet 1, Step
discussed earlier under Reducing your deposits for the 2, line 2f.
credit for qualified sick and family leave wages.
Complete lines 23, 24, and 25 only if qualified
sick leave wages were paid this quarter of 2023
Part 3: Tell Us About Your Business CAUTION! for leave taken after March 31, 2021, and before
In Part 3, answer only those questions that apply to your October 1, 2021.
business. If the questions don't apply, leave them blank
and go to Part 4. 23. Qualified Sick Leave Wages for Leave Taken
After March 31, 2021, and Before October 1,
17. If Your Business Has Closed . . . 2021
If you go out of business or stop paying wages, you must Enter the qualified sick leave wages you paid this quarter
file a final return. To tell the IRS that a particular Form 941 of 2023 to your employees for leave taken after March 31,
is your final return, check the box on line 17 and enter the 2021, and before October 1, 2021, including any qualified
final date you paid wages in the space provided. For sick leave wages that were above the social security wage
additional filing requirements, including information about base and any qualified sick leave wages excluded from
attaching a statement to your final return, see If Your the definition of employment under sections 3121(b)(1)–
Business Has Closed, earlier. (22). See the instructions for line 11d, earlier, for more
information about qualified sick leave wages for leave
taken after March 31, 2021, and before October 1, 2021.

Instructions for Form 941 (Rev. 3-2023) -19-

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This amount is also entered on Worksheet 2, Step 2, Part 4: May We Speak With Your
line 2a.
Third-Party Designee?
24. Qualified Health Plan Expenses Allocable to
Qualified Sick Leave Wages Reported on If you want to allow an employee, a paid tax preparer, or
another person to discuss your Form 941 with the IRS,
Line 23
check the “Yes” box in Part 4. Enter the name, phone
Enter the qualified health plan expenses allocable to number, and five-digit personal identification number
qualified sick leave wages paid this quarter of 2023 for (PIN) of the specific person to speak with—not the name
leave taken after March 31, 2021, and before October 1, of the firm that prepared your tax return. The designee
2021. This amount is also entered on Worksheet 2, Step may choose any five numbers as their PIN.
2, line 2b.
By checking “Yes,” you authorize the IRS to talk to the
25. Amounts Under Certain Collectively person you named (your designee) about any questions
Bargained Agreements Allocable to Qualified we may have while we process your return. You also
Sick Leave Wages Reported on Line 23 authorize your designee to do all of the following.
• Give us any information that is missing from your return.
Enter the collectively bargained defined benefit pension Call us for information about processing your return.
•
plan contributions and collectively bargained Respond to certain IRS notices that you’ve shared with
•
apprenticeship program contributions allocable to your designee about math errors and return preparation.
qualified sick leave wages paid this quarter of 2023 for The IRS won't send notices to your designee.
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step You’re not authorizing your designee to bind you to
2, line 2c. anything (including additional tax liability) or to otherwise
Complete lines 26, 27, and 28 only if qualified represent you before the IRS. If you want to expand your
designee's authorization, see Pub. 947.
! family leave wages were paid this quarter of 2023
CAUTION for leave taken after March 31, 2021, and before The authorization will automatically expire 1 year from
October 1, 2021. the due date (without regard to extensions) for filing your
Form 941. If you or your designee wants to terminate the
26. Qualified Family Leave Wages for Leave authorization, write to the IRS office for your location using
Taken After March 31, 2021, and Before October the Without a payment address under Where Should You
File, earlier.
1, 2021
Enter the qualified family leave wages you paid this Part 5: Sign Here (Approved Roles)
quarter of 2023 to your employees for leave taken after
March 31, 2021, and before October 1, 2021, including Complete all information and sign Form 941. The
any qualified family leave wages that were above the following persons are authorized to sign the return for
social security wage base and any qualified family leave each type of business entity.
wages excluded from the definition of employment under • Sole proprietorship—The individual who owns the
sections 3121(b)(1)–(22). See the instructions for line 11d, business.
earlier, for more information about qualified family leave • Corporation (including a limited liability company
wages for leave taken after March 31, 2021, and before (LLC) treated as a corporation)—The president, vice
October 1, 2021. This amount is also entered on president, or other principal officer duly authorized to sign.
Worksheet 2, Step 2, line 2g. • Partnership (including an LLC treated as a
partnership) or unincorporated organization—A
27. Qualified Health Plan Expenses Allocable to responsible and duly authorized partner, member, or
Qualified Family Leave Wages Reported on officer having knowledge of its affairs.
Line 26 • Single-member LLC treated as a disregarded entity
for federal income tax purposes—The owner of the
Enter the qualified health plan expenses allocable to LLC or a principal officer duly authorized to sign.
qualified family leave wages paid this quarter of 2023 for Trust or estate—The fiduciary.
•
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step Form 941 may be signed by a duly authorized agent of
2, line 2h. the taxpayer if a valid power of attorney has been filed.
28. Amounts Under Certain Collectively Alternative signature method. Corporate officers or
duly authorized agents may sign Form 941 by rubber
Bargained Agreements Allocable to Qualified stamp, mechanical device, or computer software
Family Leave Wages Reported on Line 26 program. For details and required documentation, see
Enter the collectively bargained defined benefit pension Rev. Proc. 2005-39, 2005-28 I.R.B. 82, available at
plan contributions and collectively bargained IRS.gov/irb/2005-28_IRB#RP-2005-39.
apprenticeship program contributions allocable to
qualified family leave wages paid this quarter of 2023 for Paid Preparer Use Only
leave taken after March 31, 2021, and before October 1, A paid preparer must sign Form 941 and provide the
2021. This amount is also entered on Worksheet 2, Step information in the Paid Preparer Use Only section of Part
2, line 2i. 5 if the preparer was paid to prepare Form 941 and isn't

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an employee of the filing entity. Paid preparers must sign  advice, for example, advising the client on determining 
paper returns with a manual signature. The preparer must    whether its workers are employees or independent 
give you a copy of the return in addition to the copy to be contractors for federal tax purposes.
filed with the IRS.
If you’re a paid preparer, enter your Preparer Tax          How To Get Forms, Instructions, and 
Identification Number (PTIN) in the space provided. 
Include your complete address. If you work for a firm,      Publications
enter the firm's name and the EIN of the firm. You can          You can view, download, or print most of the 
apply for a PTIN online or by filing Form W-12. For more        forms, instructions, and publications you may 
information about applying for a PTIN online, go to             need at IRS.gov/Forms. Otherwise, you can go to 
IRS.gov/PTIN. You can't use your PTIN in place of the EIN   IRS.gov/OrderForms to place an order and have them 
of the tax preparation firm.                                mailed to you. The IRS will process your order for forms 
Generally, don't complete this section if you’re filing the and publications as soon as possible. Don't resubmit 
return as a reporting agent and have a valid Form 8655 on   requests you've already sent us. You can get forms and 
file with the IRS. However, a reporting agent must          publications faster online.
complete this section if the reporting agent offered legal 

Instructions for Form 941 (Rev. 3-2023)                     -21-

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Worksheet 1. Credit for Qualified Sick and Family Leave Wages 
Paid This Quarter of 2023 for Leave Taken After March 31, 2020, 
and Before April 1, 2021                                                                                                                          Keep for Your Records
Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which 
it is applicable, on a client-by-client basis.)
If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2020, and before April 1, 
2021, complete Step 1 and Step 2. Caution: Use Worksheet 2 to figure the credit for qualified sick and family leave wages paid this quarter of 2023 for 
leave taken after March 31, 2021, and before October 1, 2021.
Step 1.         Determine the employer share of social security tax this quarter after it is reduced by any credit claimed on Form 8974 
                and any credit to be claimed on Form 5884-C and/or Form 5884-D
        1a      Enter the amount of social security tax from Form 941, Part 1, line 5a, column 2 . . . . . . .                                 1a       
        1b      Enter the amount of social security tax from Form 941, 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, Part 1, line 8 (enter as a positive number) . . . . . . . . . . . . . . . . . . . . . . . . .                     1e       
        1f      Subtract line 1e from line 1d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          1f       
        1g      If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount 
                of the employer share of social security tax from the notice . . . . . . . . . . . . . . . . . . . . . .                       1g       
        1h      Employer share of social security tax. Add lines 1f and 1g . . . . . . . . . . . . . . . . . . . .                                      1h              
        1i      Enter the amount from Form 8974, line 12, for this quarter . . . . . . . . . . . . . . . . . . . . . . .                       1i       
        1j      Enter the amount to be claimed on Form 5884-C, line 11, for this quarter . . . . . . . . . . . . .                             1j       
        1j(i)   Enter the amount to be claimed on Form 5884-D, line 12, for this quarter . . . . . . . . . . . . .                             1j(i)    
        1k      Total nonrefundable credits already used against the employer share of social 
                security tax. Add lines 1i, 1j, and 1j(i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                     1k  
        1l      Employer share of social security tax remaining. Subtract line 1k from line 1h . . . . . .                                              1l  
Step 2.         Figure the sick and family leave credit
        2a      Qualified sick leave wages reported on Form 941, Part 1, line 5a(i), column 1 . . . . . . . . .                                2a       
        2a(i)   Qualified sick leave wages included on Form 941, Part 1, line 5c, but not included on Form 
                941, 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, 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, Part 1, line 5a(ii), column 1 . . . . . . .                                 2e       
        2e(i)   Qualified family leave wages included on Form 941, Part 1, line 5c, but not included on 
                Form 941, 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, 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, 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, Part 1, line 13c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                           2k

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

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Page 23 of 23            Fileid: … ons/i941/202303/a/xml/cycle05/source                                                                                   16:05 - 2-Feb-2023

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

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

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

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