951422
Schedule R (Form 941):                     Allocation Schedule for Aggregate Form 941 Filers                                                                  Report for calendar year:
(Rev. March 2023)                          Department of the Treasury — Internal Revenue Service     OMB No. 1545-0029
                                                                                                                                                                     2023
Employer identification number (EIN)                    —                                                                                                Check the quarter (same as Form 941):
                                                                                                                                                                1: January, February, March
Name as shown on Form 941                                                                                                                                       2: April, May, June
Type of filer (check one):         Section 3504 Agent           CPEO      Other Third Party                                                                     3: July, August, September
Read the instructions before you complete Schedule R. Type or print within the boxes. Complete a separate line for the amounts                                  4: October, November, December
allocated to each of your clients. The term “client” as used on this form includes the term “customer.” See the instructions.
      (a) Client’s EIN        (b) Type of wages (c) Form 941, line 1  (d) Form 941, line 2       (e) Form 941, line 3 (f) Form 941, lines 5a(i)     (g) Form 941, lines 5a               (h) Form 941, line 5c, (i) Form 941, line 5e
                                 (CPEO     only)                                                                      and 5a(ii),     column 1,     totaland 5b,     column 2,     total     column     2                      
1                                                                                 .                         .                         .                                .                                .                .
2                                                                                 .                         .                         .                                .                                .                .
3                                                                                 .                         .                         .                                .                                .                .
4                                                                                 .                         .                         .                                .                                .                .
5                                                                                 .                         .                         .                                .                                .                .
6 Subtotals for clients. Add lines 1 through 5                                    .                         .                         .                                .                                .                .
7 Enter the combined subtotal from line 9 of  
  all Continuation Sheets for Schedule R                                          .                         .                         .                                .                                .                .
8 Enter Form 941 amounts for your employees                                       .                         .                         .                                .                                .                .
9 Totals. Add lines 6, 7, and 8.                                                  .                         .                         .                                .                                .                .
    (j) Form 941, line 5f         (k) Form 941, line 11a   (l) Form 941, line 11b (m) Form 941, line 11d      (n) Form 941, line 12          (o) Form 941, line 13a           (p) Form 941, line 13c            (q) Form 941, line 13e
                                                                                                                                                                                                                               
1                      .                        .                     .                              .                     .                                         .                        .                          .
2                      .                        .                     .                              .                     .                                         .                        .                          .
3                      .                        .                     .                              .                     .                                         .                        .                          .
4                      .                        .                     .                              .                     .                                         .                        .                          .
5                      .                        .                     .                              .                     .                                         .                        .                          .
6                      .                        .                     .                              .                     .                                         .                        .                          .
7                      .                        .                     .                              .                     .                                         .                        .                          .
8                      .                        .                     .                              .                     .                                         .                        .                          .
9                      .                        .                     .                              .                     .                                         .                        .                          .
    (r) Form 941, line 19         (s) Form 941, line 20    (t) Form 941, line 23  (u) Form 941, line 24       (v) Form 941, line 25          (w) Form 941, line 26            (x) Form 941, line 27             (y) Form 941, line 28
                                                                                                                                                                                                                               
1                      .                        .                     .                              .                     .                                         .                        .                          .
2                      .                        .                     .                              .                     .                                         .                        .                          .
3                      .                        .                     .                              .                     .                                         .                        .                          .
4                      .                        .                     .                              .                     .                                         .                        .                          .
5                      .                        .                     .                              .                     .                                         .                        .                          .
6                      .                        .                     .                              .                     .                                         .                        .                          .
7                      .                        .                     .                              .                     .                                         .                        .                          .
8                      .                        .                     .                              .                     .                                         .                        .                          .
9                      .                        .                     .                              .                     .                                         .                        .                          .
For Paperwork Reduction Act Notice, see the separate instructions.                         www.irs.gov/Form941                                      Cat. No. 49301K                           Schedule R (Form 941) (Rev. 3-2023)

Page         of                                                                                                                                                                                                     951522
Continuation Sheet for Schedule R (Form 941)                                                                                                             Report for calendar year:
(Rev. March 2023)
                                                                                                                                                                2023
Employer identification number (EIN)                    —                                                                                           Check the quarter (same as Form 941):
                                                                                                                                                           1: January, February, March
Name as shown on Form 941                                                                                                                                  2: April, May, June
Type of filer (check one):         Section 3504 Agent           CPEO      Other Third Party                                                                3: July, August, September
                                                                                                                                                           4: October, November, December

         (a) Client’s EIN    (b) Type of wages   (c) Form 941, line 1 (d) Form 941, line 2 (e) Form 941, line 3  (f) Form 941, lines 5a(i)     (g) Form 941, lines 5a              (h) Form 941, line 5c, (i) Form 941, line 5e
                                  (CPEO     only)                                                                and 5a(ii),     column 1,     totaland 5b,     column 2,     total    column     2                      
1                                                                                 .                      .                       .                                .                               .                .
2                                                                                 .                      .                       .                                .                               .                .
3                                                                                 .                      .                       .                                .                               .                .
4                                                                                 .                      .                       .                                .                               .                .
5                                                                                 .                      .                       .                                .                               .                .
6                                                                                 .                      .                       .                                .                               .                .
7                                                                                 .                      .                       .                                .                               .                .
8                                                                                 .                      .                       .                                .                               .                .
9 Subtotals for clients. Add lines 1 through 8. 
  Include the subtotals from this line on 
  Schedule R, Page 1, line 7.                                                     .                      .                       .                                .                               .                .
       (j) Form 941, line 5f      (k) Form 941, line 11a   (l) Form 941, line 11b (m) Form 941, line 11d   (n) Form 941, line 12        (o) Form 941, line 13a           (p) Form 941, line 13c           (q) Form 941, line 13e
                                                                                                                                                                                                                         
1                         .                      .                    .                        .                      .                                         .                       .                          .
2                         .                      .                    .                        .                      .                                         .                       .                          .
3                         .                      .                    .                        .                      .                                         .                       .                          .
4                         .                      .                    .                        .                      .                                         .                       .                          .
5                         .                      .                    .                        .                      .                                         .                       .                          .
6                         .                      .                    .                        .                      .                                         .                       .                          .
7                         .                      .                    .                        .                      .                                         .                       .                          .
8                         .                      .                    .                        .                      .                                         .                       .                          .
9                         .                      .                    .                        .                      .                                         .                       .                          .
       (r) Form 941, line 19      (s) Form 941, line 20    (t) Form 941, line 23  (u) Form 941, line 24    (v) Form 941, line 25        (w) Form 941, line 26            (x) Form 941, line 27            (y) Form 941, line 28
                                                                                                                                                                                                                         
1                         .                      .                    .                        .                      .                                         .                       .                          .
2                         .                      .                    .                        .                      .                                         .                       .                          .
3                         .                      .                    .                        .                      .                                         .                       .                          .
4                         .                      .                    .                        .                      .                                         .                       .                          .
5                         .                      .                    .                        .                      .                                         .                       .                          .
6                         .                      .                    .                        .                      .                                         .                       .                          .
7                         .                      .                    .                        .                      .                                         .                       .                          .
8                         .                      .                    .                        .                      .                                         .                       .                          .
9                         .                      .                    .                        .                      .                                         .                       .                          .
                                                                                                                                                                                        Schedule R (Form 941) (Rev. 3-2023)