Form  943-A                            Agricultural Employer’s Record of                                               OMB No. 1545-0035 
(Rev. December 2020)                       Federal Tax Liability
Department of the Treasury     ▶ Go to www.irs.gov/Form943A for instructions and the latest information.
Internal Revenue Service                  ▶ File with Form 943 or Form 943-X.                                          Calendar Year 
Name (as shown on Form 943)                                                              Employer identification number (EIN) 

You must complete this form if you’re a semiweekly schedule depositor or became one because your accumulated tax liability during 
any month was $100,000 or more. Show tax liability here, not deposits. (The IRS gets deposit data from electronic funds transfers.) 
Don’t change your current year tax liability by adjustments reported on any Forms 943-X. 
      January Tax Liability                February Tax Liability                                  March Tax Liability
1                           16         1                    16                           1                           16
2                           17         2                    17                           2                           17
3                           18         3                    18                           3                           18
4                           19         4                    19                           4                           19
5                           20         5                    20                           5                           20
6                           21         6                    21                           6                           21
7                           22         7                    22                           7                           22
8                           23         8                    23                           8                           23
9                           24         9                    24                           9                           24
10                          25         10                   25                           10                          25
11                          26         11                   26                           11                          26
12                          27         12                   27                           12                          27
13                          28         13                   28                           13                          28
14                          29         14                   29                           14                          29
15                          30         15                                                15                          30
                            31                                                                                       31
A  Total liability for month ▶         B  Total liability for month ▶                    C  Total liability for month ▶

      April Tax Liability                  May Tax Liability                                            June Tax Liability
1                           16         1                    16                           1                           16
2                           17         2                    17                           2                           17
3                           18         3                    18                           3                           18
4                           19         4                    19                           4                           19
5                           20         5                    20                           5                           20
6                           21         6                    21                           6                           21
7                           22         7                    22                           7                           22
8                           23         8                    23                           8                           23
9                           24         9                    24                           9                           24
10                          25         10                   25                           10                          25
11                          26         11                   26                           11                          26
12                          27         12                   27                           12                          27
13                          28         13                   28                           13                          28
14                          29         14                   29                           14                          29
15                          30         15                   30                           15                          30
                                                            31
D  Total liability for month ▶         E  Total liability for month ▶                    F  Total liability for month ▶
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 17030C      Form 943-A (Rev. 12-2020) 

Form 943-A (Rev. 12-2020)                                                                                                      Page 2 
   July Tax Liability                                    August Tax Liability                        September Tax Liability
1                         16   1                         16                                      1                           16
2                         17   2                         17                                      2                           17
3                         18   3                         18                                      3                           18
4                         19   4                         19                                      4                           19
5                         20   5                         20                                      5                           20
6                         21   6                         21                                      6                           21
7                         22   7                         22                                      7                           22
8                         23   8                         23                                      8                           23
9                         24   9                         24                                      9                           24
10                        25   10                        25                                      10                          25
11                        26   11                        26                                      11                          26
12                        27   12                        27                                      12                          27
13                        28   13                        28                                      13                          28
14                        29   14                        29                                      14                          29
15                        30   15                        30                                      15                          30
                          31                             31
G  Total liability for month ▶ H  Total liability for month ▶                                    I  Total liability for month ▶

   October Tax Liability                                 November Tax Liability                      December Tax Liability
1                         16   1                         16                                      1                           16
2                         17   2                         17                                      2                           17
3                         18   3                         18                                      3                           18
4                         19   4                         19                                      4                           19
5                         20   5                         20                                      5                           20
6                         21   6                         21                                      6                           21
7                         22   7                         22                                      7                           22
8                         23   8                         23                                      8                           23
9                         24   9                         24                                      9                           24
10                        25   10                        25                                      10                          25
11                        26   11                        26                                      11                          26
12                        27   12                        27                                      12                          27
13                        28   13                        28                                      13                          28
14                        29   14                        29                                      14                          29
15                        30   15                        30                                      15                          30
                          31                                                                                                 31
J  Total liability for month ▶ K  Total liability for month ▶                                    L  Total liability for month ▶
M  Total tax liability for year (add lines A through L). This must equal line 13 on Form 943 . . .  ▶
                                                                                                     Form 943-A (Rev. 12-2020)