Schedule R (Form 940):                   Allocation Schedule for Aggregate Form 940 Filers                                                                                       OMB No. 1545-0029
(Rev. December 2024)                                                                                                                                                                               860517
Department of the Treasury — Internal Revenue Service
                                                                                                                                                    Report for calendar year:
Employer identification number (EIN)                  —                                                                                             (Same as Form 940):

Name as shown on Form 940

Type of filer (check one):         Section 3504 Agent        Certified Professional Employer Organization (CPEO)

Read the instructions before you complete Schedule R. Type or print within the boxes. Complete a separate line for the amounts allocated 
to each of your clients. The term “client” as used on this form includes the term “customer.” See the instructions.
              (a)                      (b)                 (c)                   (d)                            (e)                 (f)                     (g)                      (h) 
     Client’s employer                 State      Type of wages, tips, and Total taxable FUTA    Total adjustments           Credit reduction amount Total FUTA tax         Total FUTA tax deposits 
   identification number            abbreviation     other compensation    wages allocated to         to FUTA tax            allocated to the        after adjustments      from Form 940, line 13, 
              (EIN)                 from Form         (CPEO use only)      the listed client EIN allocated to the            listed client EIN from  allocated to the       plus any payment made 
                                    940, line 1a,                          from Form 940,line 7  listed client EIN from      Form 940, line 11       listed client EIN from with the return allocated 
                                    or Schedule A                                                Form 940, line 9 or line 10                         Form 940,line 12        to the listed client EIN
                                    (Form 940)  
1                                                                                            .                       .                         .                       .                          .
2                                                                                            .                       .                         .                       .                          .
3                                                                                            .                       .                         .                       .                          .
4                                                                                            .                       .                         .                       .                          .
5                                                                                            .                       .                         .                       .                          .
6                                                                                            .                       .                         .                       .                          .
7                                                                                            .                       .                         .                       .                          .
8                                                                                            .                       .                         .                       .                          .
9                                                                                            .                       .                         .                       .                          .
10                                                                                           .                       .                         .                       .                          .
11                                                                                           .                       .                         .                       .                          .
12                                                                                           .                       .                         .                       .                          .
13                                                                                           .                       .                         .                       .                          .
14                                                                                           .                       .                         .                       .                          .
15                                                                                           .                       .                         .                       .                          .
16 Subtotals for clients. Add all 
   amounts on lines 1 through 15.                                                            .                       .                         .                       .                          .
17 Enter the combined subtotal 
   from line 23 of all Continuation 
   Sheets for Schedule R (Form 
   940).                                                                                     .                       .                         .                       .                          .
18 Enter Form 940 amounts for 
   your employees.                                                                           .                       .                         .                       .                          .
19 Totals. Add lines 16, 17, and 
   18. The column totals must 
   match the related lines on the 
   aggregate Form 940.                                                                       .                       .                         .                       .                          .
For Paperwork Reduction Act Notice, see the instructions.                             www.irs.gov/Form940                    Cat. No. 53082A                       Schedule R (Form 940) (Rev. 12-2024)

Page    of
Continuation Sheet for Schedule R (Form 940)
                                                                                                                                                                                                   860617
(Rev. December 2024)

                                                                                                                                                    Report for calendar year:
Employer identification number (EIN)              —                                                                                                 (Same as Form 940):

Name as shown on Form 940

Type of filer (check one):    Section 3504 Agent         Certified Professional Employer Organization (CPEO)

              (a)                      (b)              (c)                      (d)                        (e)                     (f)                     (g)                      (h) 
     Client’s employer                 State      Type of wages, tips, and Total taxable FUTA    Total adjustments           Credit reduction amount Total FUTA tax         Total FUTA tax deposits 
     identification number          abbreviation  other compensation       wages allocated to         to FUTA tax            allocated to the        after adjustments      from Form 940, line 13, 
              (EIN)                 from Form     (CPEO use only)          the listed client EIN allocated to the            listed client EIN from  allocated to the       plus any payment made 
                                    940, line 1a,                          from Form 940,line 7  listed client EIN from      Form 940, line 11       listed client EIN from with the return allocated 
                                    or Schedule A                                                Form 940, line 9 or line 10                         Form 940,line 12        to the listed client EIN
                                    (Form 940)  
1                                                                                            .                       .                         .                       .                          .
2                                                                                            .                       .                         .                       .                          .
3                                                                                            .                       .                         .                       .                          .
4                                                                                            .                       .                         .                       .                          .
5                                                                                            .                       .                         .                       .                          .
6                                                                                            .                       .                         .                       .                          .
7                                                                                            .                       .                         .                       .                          .
8                                                                                            .                       .                         .                       .                          .
9                                                                                            .                       .                         .                       .                          .
10                                                                                           .                       .                         .                       .                          .
11                                                                                           .                       .                         .                       .                          .
12                                                                                           .                       .                         .                       .                          .
13                                                                                           .                       .                         .                       .                          .
14                                                                                           .                       .                         .                       .                          .
15                                                                                           .                       .                         .                       .                          .
16                                                                                           .                       .                         .                       .                          .
17                                                                                           .                       .                         .                       .                          .
18                                                                                           .                       .                         .                       .                          .
19                                                                                           .                       .                         .                       .                          .
20                                                                                           .                       .                         .                       .                          .
21                                                                                           .                       .                         .                       .                          .
22                                                                                           .                       .                         .                       .                          .
23 Subtotals for clients. Add lines 
   1 through 22. Include the 
   subtotals from line 23 on 
   Schedule R (Form 940), line 17.                                                           .                       .                         .                       .                          .
                                                                                                                                                                   Schedule R (Form 940) (Rev. 12-2024)

                                                                                                                         860717
Schedule R (Form 940) (Rev. 12-2024)

Section references are to the Internal Revenue Code unless        Client and Employee Information
otherwise noted.
                                                                  On Schedule R, including any Continuation Sheets, you must 
Future Developments                                               report the following for each client.
For the latest information about developments related to          Note: When entering amounts over 999.99 on Schedule R, don’t 
                                                                  enter commas.    
Schedule R and its instructions, such as legislation enacted 
after they were published, go to www.irs.gov/Form940.             Column a. Your client’s EIN. 
                                                                  Column b. The state abbreviation of the client’s location. 
General Instructions                                              Column c (CPEO use only). Type of wages, tips, and other 
                                                                  compensation. Enter a code to report the type of wages, tips, 
Purpose of Schedule R                                             and other compensation paid to the individual(s) performing 
Use Schedule R to allocate the aggregate information reported     services for the client. If you paid more than one type of wages, 
on Form 940 to each client. For purposes of Schedule R, the       tips, or other compensation, you must use more than one line to 
term “client” means (a) a home care service recipient identified  report for that client and enter the applicable code for each line. 
on the Form 2678, Employer/Payer Appointment of Agent; (b) a      The following four codes are the only entries that can be made 
customer who enters into a contract that meets the                in column c. 
requirements under section 7705(e)(2); or (c) a client who enters • A: Wages, tips, and other compensation paid under section 
into a service agreement described under Regulations section      3511(a).
31.3504-2(b)(2) with a certified professional employer 
organization (CPEO). If you have more than 15 clients, complete   • B: Wages, tips, and other compensation paid under section 
as many Continuation Sheets as necessary. Attach Schedule R,      3511(c).
including any Continuation Sheets, to your aggregate Form 940.    • C: Wages, tips, and other compensation not reported under 
                                                                  code A or code B paid as a payor under a service 
Who Must File?                                                    agreement described in Regulations section 31.3504-2(b)(2).
You must complete Schedule R if you file an aggregate Form        • D: Wages, tips, and other compensation paid as an agent 
940. Aggregate Forms 940 are filed by agents of home care         under Regulations section 31.3504-1.
service recipients approved by the IRS under section 3504 and     Column d. Total taxable FUTA wages allocated to the listed 
by CPEOs. To request approval to act as an agent for a home       client EIN from Form 940, line 7.
care service recipient, you must file Form 2678 with the IRS, 
unless you are a state or local government agency acting as       Column e. Total adjustments to FUTA tax allocated to the listed 
agent under the special procedures provided in Rev. Proc.         client EIN from Form 940, line 9 or line 10. 
2013-39. Form 2678 must be previously filed and approved by       Column f. Credit reduction amount allocated to the listed client 
the IRS before filing Schedule R. To become a CPEO, you must      EIN from Form 940, line 11. 
apply through the IRS Online Registration System. Go to 
www.irs.gov/CPEO for more information.                            Column g. Total FUTA tax after adjustments allocated to the 
                                                                  listed client EIN from Form 940, line 12. 
When Must You File?                                               Column h. Total FUTA tax deposits from Form 940, line 13, plus 
If you’re an aggregate Form 940 filer, file Schedule R with your  any other payments allocated to the listed client EIN. 
aggregate Form 940 every year when your Form 940 is due.          You must also report the same information for your 
Agents may file Form 940 and Schedule R electronically or by      employees on Schedule R, line 18.
paper submission. CPEOs must generally file Form 940 and          Compare the total of each column on Schedule R, line 19, 
Schedule R electronically. For more information about a CPEO’s    including your information from Schedule R, line 18, to the 
requirement to file electronically, see Rev. Proc. 2023-18,       amounts reported on the aggregate Form 940. For each column 
2023-13 I.R.B. 605, available at www.irs.gov/                     total, the relevant line from Form 940 is noted in the column 
irb/2023-13_IRB#REV-PROC-2023-18.                                 heading.
Specific Instructions                                             If the totals on Schedule R, line 19, don’t match the totals on 
                                                                  Form 940, there is an error that must be corrected before 
Completing Schedule R                                             submitting Form 940 and Schedule R.

Enter Your Business Information                                   Paperwork Reduction Act Notice. We ask for the information 
Carefully enter your employer identification number (EIN) and     on Schedule R to carry out the Internal Revenue laws of the 
the name of your business at the top of the schedule. Make sure   United States. You’re required to give us the information. We 
they exactly match the EIN and name shown on the attached         need it to ensure that you are complying with these laws and to 
Form 940. Check one of the “Type of filer” boxes to tell us if    allow us to figure and collect the right amount of tax. You’re not 
you’re a section 3504 agent or a CPEO.                            required to provide the information requested on a form that is 
                                                                  subject to the Paperwork Reduction Act unless the form 
Calendar Year                                                     displays a valid OMB control number. Books or records relating 
                                                                  to a form or its instructions must be retained as long as their 
Enter the calendar year for which you are filing your Form 940.   contents may become material in the administration of any 
Make sure that the year entered on the top of Schedule R          Internal Revenue law. Generally, tax returns and return 
matches the year on the attached Form 940.                        information are confidential, as required by section 6103. The 
                                                                  time needed to complete and file Schedule R will vary 
                                                                  depending on individual circumstances. The estimated burden 
                                                                  for employers filing Schedule R is approved under OMB control 
                                                                  number 1545-0029 and is included in the estimates shown in 
                                                                  the instructions for their employment tax return.