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Publication 4436 begins on the next page of this file. Before viewing it, please see the 
important update below. 
 
New Mailing Address 
The mailing address provided in Section 1.1.03 and Section 1.12.03 has changed since the publication 
was last published. The new mailing address is shown below. 

Internal Revenue Service 
Attn: Substitute Forms Program 
SE:W:CAR:MP:P:TP:TP 
ATSC  
4800 Buford Highway 
Mail Stop: 061-N 
Chamblee, GA 30341 
  
This update supplements this publication. You may rely on this update for the changes described, which 
will be incorporated into the next revision of this publication (Revenue Procedure).

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Revenue 

Procedure 

2023-13

Reprinted from IR Bulletin 2023-13
Dated March 27, 2023

Publication 4436

General Rules and 

Specifications for Substitute 

Form 941, Schedule B (Form 

941), Schedule D (Form 941), 

Schedule R (Form 941), and 

Form 8974

IRS
Department of the Treasury
Internal Revenue Service
Publication 4436 (Rev. 03-2023)
Catalog Number 39499P
www.irs.gov

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NOTE. This revenue procedure will be reproduced as the next revision of IRS 
Publication 4436, General Rules and Specifications for Substitute Form 941, 
Schedule B (Form 941), Schedule D (Form 941), Schedule R (Form 941), and Form 
8974.

Rev. Proc. 2023-13
TABLE OF CONTENTS

Part 1 – 
             Section 1.1 – Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
             Section 1.2 – What’s New  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
             Section 1.3 – Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   3
             Section 1.4 – General Requirements for Reproducing IRS Official Form 941, 
             Schedule B, Schedule D, Schedule R, and Form 8974 . . . . . . . . . . . . . . . 3
             Section 1.5 – Reproducing Form 941, Schedule B, Schedule D, Schedule R, and 
             Form 8974 for Software-Generated Paper Forms . . . . . . . . . . . . . . . . . .                                5
             Section 1.6 – Specific Instructions for Schedule D        . . . . . . . . . . . . . . . . . . . . . . . . . .   7
             Section 1.7 – Specific Instructions for Schedule R      . . . . . . . . . . . . . . . . . . . . . . . . . . .   7
             Section 1.8 – Specific Instructions for Form 8974 . . . . . . . . . . . . . . . . . . . . . . . . . . .         8
             Section 1.9 – Office of Management and Budget (OMB) Requirements for 
             Substitute Forms                . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
             Section 1.10 – Order Forms and Instructions       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   9
             Section 1.11 – Effect on Other Documents        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   9
             Section 1.12 – Helpful Information    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   9
             Section 1.13 – Exhibits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

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Part 1

Section 1.1 – Purpose

.01 The purpose of Revenue Procedure 2023-13, 2023-13 I.R.B. 581, available
at IRS.gov/irb/2023-13_IRB#RP-2023-13, is to provide general rules and
specifications from the IRS for paper and computer-generated substitutes for
Form 941, Employer's QUARTERLY Federal Tax Return; Schedule B (Form
941), Report of Tax Liability for Semiweekly Schedule Depositors (referred to
in this revenue procedure as “Schedule B”); Schedule D (Form 941), Report of
Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations
(referred to in this revenue procedure as “Schedule D”); Schedule R (Form 941),
Allocation Schedule for Aggregate Form 941 Filers (referred to in this revenue
procedure as “Schedule R”); and Form 8974, Qualified Small Business Payroll
Tax Credit for Increasing Research Activities.

Caution. Before creating a substitute Form 941, see Pub. 1167, General Rules
and Specifications for Substitute Forms and Schedules, for additional rules and
specifications for payment vouchers (Vouchers), printing in margins (Marginal
Printing), and additional instructions (Additional Instructions for All Forms).

Note. Substitute territorial forms (941-PR, Planilla para la Declaración Federal
TRIMESTRAL del Patrono; 941-SS, Employer's QUARTERLY Federal Tax
Return (American Samoa, Guam, the Commonwealth of the Northern Mariana
Islands, and the U.S. Virgin Islands); and Anexo B (Formulario 941-PR),
Registro de la Obligación Contributiva para los Despositantes de Itinerario
Bisemanal), should also generally conform to the specifications outlined in this
revenue procedure. However, some of the measurements provided in the
exhibits, later, may need to be adjusted for substitute territorial forms.

.02 This revenue procedure provides information for substitute Form 941,
Schedule B, Schedule D, Schedule R, and Form 8974. If you need more
in-depth information on who must complete these forms and how to complete
them, see the Instructions for Form 941, the Instructions for Schedule B, the
Instructions for Schedule D, the Instructions for Schedule R, the Instructions for
Form 8974, and Pub. 15, Employer's Tax Guide, or go to IRS.gov.

Note. Failure to produce acceptable substitutes of the forms and schedules listed
in this revenue procedure may result in delays in processing. This may result in
penalties.

.03 Forms that completely follow the guidelines in this revenue procedure and
are exact replicas of the official IRS forms do not need to be submitted to the
IRS for specific approval. Substitute forms and schedules need to be scanned
using IRS scanning equipment.

If you are uncertain of any specification and want clarification, do the following.

1. Submit a letter citing the specification.

2. State your understanding of the specification.

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3. Enclose an example (if appropriate) of how the form would appear if
produced using your understanding.

4. Be sure to include your name, complete address, phone number, and, if
applicable, your email address with your correspondence. Send your request
to SCRIPS@IRS.gov or SubstituteForms@IRS.gov, or use the following
address.

Internal Revenue Service
Attn: Substitute Forms Program
SE:W:CAR:MP:P:TP:TP
5000 Ellin Road, Mail Stop C6-110
Lanham, MD 20706

Note. Allow at least 30 days for the IRS to respond.

.04 However, software developers and form producers should send a blank copy
of their substitute Form 941, Schedule B, and Schedule R in Portable Document
Format (PDF) to SCRIPS@IRS.gov. The purpose is not specifically for approval
but to assist the IRS in preparing to scan these forms. Submitters will only
receive comments if a significant problem is discovered through this process.
Submitters are not expected to delay marketing their forms in order to receive
feedback. Submitters must not include any “live” taxpayer data on any substitute
form submitted for review.

.05 Form 941, Schedule B, Schedule R, and Form 8974 have a six-digit form ID
code in the upper right-hand corner. The first two digits of the form ID code
represent whether the form is an official paper form or a substitute 6x10 grid.
The third and fourth digits of the form ID code are a unique identifier that is
subject to change each quarter when changes are made to a page of the form.
The fifth and six digits of the form ID code generally represent the year in
which the IRS made major formatting changes to the layout of a page of the
form. The following six-digit form ID codes, some of which have been updated
for the first quarter of 2023, are currently used on Form 941, Schedule B,
Schedule R, and Form 8974.

• Official paper forms: 950122 (Form 941, page 1); 951222 (Form 941,
page 2); 950922 (Form 941, page 3); 951020 (Form 941, page 4);
960311 (Schedule B); 951422 (Schedule R, page 1); 951522
(Schedule R, page 2); and 950823 (Form 8974).
• Substitute 6x10 grids: 970122 (Form 941, page 1); 971222 (Form
941, page 2); 970922 (Form 941, page 3); 971020 (Form 941, page 4);
970311 (Schedule B); 971422 (Schedule R, page 1); 971522
(Schedule R, page 2); and 970823 (Form 8974).

You must always use the form ID code provided on the current form for the
applicable quarter for which you are creating a substitute form, even if this
revenue procedure is not superseded to reflect a change to a form ID code.

Note. Page 4 of Form 941 (page intentionally left blank) is not required to be
filed with the IRS as part of a substitute Form 941. However, if page 4 of the
substitute Form 941 is filed, it must include the form ID code.

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.06 This revenue procedure will be updated only if there are major formatting
changes to the layout of the forms (that is, changes to the measurements
provided in the exhibits at the end of this revenue procedure) or there are other
changes that impact the processing of substitute forms. This revenue procedure
won’t be updated solely because a line is changed to “Reserved for future use”
or solely because a form ID code changes without major formatting changes.

Section 1.2 – What’s New

.01 Some measurements shown in the exhibits for Form 941 have changed due
to minor design changes.

.02 Some column headings on Schedule R were revised to make use of columns
that were previously “Reserved for future use.”
.03 Form 8974 was revised due to the Inflation Reduction Act of 2022. See the
instructions for this form at IRS.gov/Form8974.
.04 Form 941-SS and Form 941-PR will no longer be available after the fourth
quarter of 2023. Instead, employers in the U.S. territories will file Form 941, or,
if you prefer your form and instructions in Spanish, you can file new Form 941
(sp), Declaración del Impuesto Federal TRIMESTRAL del Empleador.

Section 1.3 – Reminders

.01 Draft forms. Draft forms can be found atIRS.gov/DraftForms.

Section 1.4 – General Requirements for Reproducing IRS Official Form 941,
Schedule B, Schedule D, Schedule R, and Form 8974

.01 Submit substitute Form 941, Schedule B, Schedule D, Schedule R, and Form
8974 to the IRS for specifications review. Substitute Form 941, Schedule B,
Schedule D, Schedule R, and Form 8974 that completely conform to the
specifications contained in this revenue procedure do not require prior approval
from the IRS, but should be submitted to SCRIPS@IRS.gov to ensure that they
conform to IRS format and scanning specifications.
.02 Print the form on standard 8.5-inch wide by 11-inch paper.
.03 Use white paper that meets generally accepted weight, color, and quality
standards (minimum 20 lb. white bond paper).

Note. Reclaimed fiber in any percentage is permitted provided that the
requirements of this standard are met.

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.04 The IRS prefers printing Form 941 on both sides of a single sheet of paper,
but it is acceptable to print on one side of each of two separate sheets of paper.

.05 Make the substitute paper form as identical to the official form as possible.

.06 Print the substitute form using nonreflective black (not blue or
other-colored) ink. Printing in an ink color other than black may reduce
readability in the scanning process. This may result in figures being too faint to
be recognizable.

.07 Use typefaces that are substantially identical in size and shape to the official
form and use rules and shading (if used) that are substantially identical to those
on the official form. Use font size as large as possible within the fields.

.08 In the same location as shown on the official IRS forms, print the six-digit
form ID code (if one exists on the official form) on each form using
nonreflective black, carbon-based, 12-point font. The use of non-OCR-A font
may reduce readability for scanning. Use the official form to develop your
substitute form.

Note. Maintain as much white space as possible around the form ID code. Do
not allow character strings to print adjacent to the code.

The following six-digit form ID codes are used on Form 941, Schedule B,
Schedule R, and Form 8974 for the first quarter of 2023. Print “950122” on
Form 941, page 1; “951222” on Form 941, page 2; “950922” on Form 941,
page 3; “951020” on Form 941, page 4; “960311” on Schedule B; “951422” on
Schedule R, page 1; “951522” on Schedule R, page 2; and “950823” on Form
8974. You must always use the form ID code provided on the current form for
the applicable quarter for which you are creating a substitute form, even if this
revenue procedure is not superseded to reflect a change to a form ID code. See
Section 1.5 for information on form ID codes for software-generated forms.

.09 Print the OMB number in the same location as on the official form. Be sure
to include the OMB number on Form 941, Schedule B, Schedule D, Schedule R,
and Form 8974.

.10 Print all entry boxes and checkboxes exactly as shown (location and size)
on the official forms.

Note. Instead of a four-sided checkbox for the entry, just the bottom line of the
box can be used as long as the location and size remain the same.

.11 Print “For Privacy Act and Paperwork Reduction Act Notice, see the back of
the Payment Voucher.” at the bottom of page 1 of Form 941.

.12 Print “For Paperwork Reduction Act Notice, see separate instructions.” at
the bottom of Schedule B and Schedule D.

.13 Print “For Paperwork Reduction Act Notice, see the separate instructions.”
at the bottom of Schedule R.

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.14 Print “For Paperwork Reduction Act Notice, see the separate instructions.”
at the bottom of Form 8974.

.15 Do not print the form catalog number (“Cat. No.”) at the bottom of the
forms or instructions. Instead, print your IRS-issued three-letter substitute form
source code in place of the catalog number on the left at the bottom of page 1 of
Form 941, Schedule B, Schedule D, Schedule R, and Form 8974.

Note. You can obtain a three-letter substitute form source code by requesting it
by email at SubstituteForms@IRS.gov. Enter "Substitute Forms" on the subject
line.

.16 Do not print the Government Publishing Office (GPO) symbol at the bottom
of the forms or instructions.

Section 1.5 – Reproducing Form 941, Schedule B, Schedule D, Schedule R, and
Form 8974 for Software-Generated Paper Forms

.01 You may use the PDF files to develop the layout for your forms. Draft forms
found at IRS.gov/DraftForms can be used to develop interim formats until the
forms are finalized. When forms become finalized, they are posted and can be
found at IRS.gov/Forms. You may use 6x10 grid formats to develop software
versions of Form 941, Schedule B, Schedule D, Schedule R, and Form 8974.
Please follow the specifications exactly to develop the fields.

.02 If you are developing software using the 6x10 grid, the following six-digit
form ID codes are used on Form 941, Schedule B, Schedule R, and Form 8974
for the first quarter of 2023.

• “970122” for Form 941, page 1; “971222” for Form 941, page 2;
“970922” for Form 941, page 3; “971020” for Form 941, page 4;
“970311” for Schedule B; “971422” for Schedule R, page 1; “971522”
for Schedule R, page 2; and “970823” for Form 8974.
You must always use the form ID code provided on the current form,
with the first two digits changed to “97” when using a 6x10 grid, for the
applicable quarter for which you are creating a substitute form, even if this
revenue procedure is not superseded to reflect a change to a form ID code.

Note. Maintain as much white space as possible around the form ID code.
Do not allow character strings to print adjacent to the code.

• Place all 6x10 grid boxes and entry spaces in the same field locations
as indicated on the official forms.
• Use single lines for “Employer Identification Number (EIN)” and other
entry areas in the entity section of Form 941, pages 1, 2, and 3;
Schedule B; Schedule R, pages 1 and 2; and Form 8974.

• Reverse type is not needed as shown on the official form.
• Do not pre-print decimal points in the data boxes. However, where the
amounts are required, the amounts should be printed with decimal
points and place holders for cents.

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• Delete the pre-printed formatting in any “date” boxes.
• Use a single box for “Personal Identification Number (PIN)” on Form
941.
• You may delete all shading when using the 6x10 grid format.

.03 If producing both the form and the data or the form only, print your
three-letter source code at the bottom of Form 941, page 1; Schedule B;
Schedule D; Schedule R, page 1; or Form 8974. See Section 1.4.15.

.04 If producing only the data on the form, print your four-digit software
industry vendor code on Form 941. The four-digit vendor code preceded by four
zeros and a slash (0000/9876) must be pre-printed. If you have a valid vendor
code issued to you through the National Association of Computerized Tax
Processors (NACTP), you should use that code. If you do not have a valid
vendor code, contact the NACTP via email at president@nactp.org for
information on these codes.

.05 Print “For Privacy Act and Paperwork Reduction Act Notice, see the back of
the Payment Voucher.” at the bottom of Form 941, page 1.

.06 Print “For Paperwork Reduction Act Notice, see separate instructions.” at
the bottom of Schedule B and Schedule D.

.07 Print “For Paperwork Reduction Act Notice, see the separate instructions.”
at the bottom of Schedule R, page 1.

.08 Print “For Paperwork Reduction Act Notice, see the separate instructions.”
at the bottom of Form 8974.

.09 Be sure to print the OMB number in the same location as on the official
forms on substitute Form 941, Schedule B, Schedule D, Schedule R, and Form
8974.

.10 Do not print the form catalog number (“Cat. No.”) at the bottom of the
forms or instructions.

.11 Do not print the Government Publishing Office (GPO) symbol at the bottom
of the forms or instructions.

.12 To ensure accurate scanning and processing, enter data on Form 941,
Schedule B, Schedule D, Schedule R, and Form 8974 as follows.

• Display/print the name and EIN on all pages and attachments in the
proper associated fields.
• Use 12-point (minimum 10-point) Courier font (where possible).
• Omit dollar signs. Commas are optional.
• Except for Form 941, lines 1, 2, and 12, leave blank any data field with
a value of zero.
• Enter negative amounts with a minus sign. For example, report
“-10.59” instead of “(10.59).”

Note. The IRS prefers that you use a minus sign for negative amounts
instead of parentheses or some other means. However, if your software

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only allows for parentheses in reporting negative amounts, you may use
them.

Section 1.6 – Specific Instructions for Schedule D

.01 To properly file and to reduce delays and contact from the IRS, Schedule D
must be produced as close as possible to the official form.

.02 Use Schedule D to explain why you have certain discrepancies. See the
Instructions for Schedule D for more information. In many cases, the
information on Schedule D helps the IRS resolve discrepancies without
contacting you.
.03 If a substitute Schedule D is not submitted in similar format to the official
IRS schedule, the substitutes may be returned, you may be contacted by the IRS,
delays in processing may occur, and you may be subject to penalties.

Section 1.7 – Specific Instructions for Schedule R

.01 To properly file and to reduce delays and contact from the IRS, Schedule R
and Continuation Sheets for Schedule R must be produced as close as possible
to the official form.

Note. Do not present the information in spreadsheet or similar format. We may
not be able to properly process nonconforming documents with an excessive
number of entries. Complete as many Continuation Sheets for Schedule R
(Schedule R, page 2) as necessary. If Continuation Sheets are not used or they
vary in form from the official form, processing may be delayed and you may be
subject to penalties.
.02 Use Schedule R to allocate the aggregate information reported on Form 941
to each client. If you have more than 5 clients, complete as many Continuation
Sheets for Schedule R as necessary. Attach Schedule R, including any
Continuation Sheets, to your aggregate Form 941 and file it with your return.
Enter your business information carefully.
Make sure all information exactly matches the information shown on the
aggregate Form 941. Compare the total of each column on Schedule R, line 9
(including your information on line 8), to the amounts reported on the aggregate
Form 941. For each column total of Schedule R, the relevant line from Form
941 is noted in the column heading. If the totals on Schedule R, line 9, do not
match the totals on Form 941, there is an error that must be corrected before
submitting Form 941 and Schedule R.

.03 Do:

• Develop and submit only conforming Schedules R;

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• Follow the format and fields exactly as on the official Schedule R, even
if this revenue procedure is not superseded to reflect a change in a
column heading on Schedule R; and
• Maintain the same number of entry lines on the substitute Schedule R
as on the official form.
.04 Do not:
• Add or delete entry lines;
• Submit spreadsheets, database printouts, or similar formatted
documents instead of using the Schedule R format to report data; and
• Reduce or expand font size to add or delete extra data or lines.
.05 If substitute Schedules R and Continuation Sheets for Schedule R are not
submitted in similar format to the official schedule, the substitutes may be
returned, you may be contacted by the IRS, delays in processing may occur, and
you may be subject to penalties.

Section 1.8 – Specific Instructions for Form 8974

.01 To properly file and to reduce delays and contact from the IRS, Form 8974
must be produced as close as possible to the official form.

.02 Use Form 8974 only if you are claiming the qualified small business payroll
tax credit for increasing research activities.
.03 If a substitute Form 8974 is not submitted in similar format to the official
IRS form, the substitutes may be returned, you may be contacted by the IRS,
delays in processing may occur, and you may be subject to penalties.

Section 1.9 – Office of Management and Budget (OMB) Requirements for
Substitute Forms

.01 The Paperwork Reduction Act (the Act) of 1995 (P.L. 104-13) requires the
following.

• OMB approves all IRS tax forms that are subject to the Act.
• Each IRS form contains the OMB approval number, if assigned. The
official OMB numbers may be found on the official IRS-printed forms.
• Each IRS form (or its instructions) states:

1. Why the IRS needs the information,

2. How it will be used, and

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3. Whether or not the information is required to be furnished to the
IRS.

.02 This information must be provided to any users of official or substitute IRS
forms or instructions.
.03 The OMB requirements for substitute IRS forms are the following.

• Any substitute form or substitute statement to a recipient must show the
OMB number as it appears on the official form.
• For Form 941, Schedule B, Schedule D, Schedule R, and Form 8974,
the OMB number (1545-0029) must appear exactly as shown on the
official form.
• For Form 941, Schedule B, Schedule D, Schedule R, and Form 8974,
the OMB number must use one of the following formats.

1. OMB No. 1545-0029 (preferred).

2. OMB # 1545-0029 (acceptable).
.04 If no instructions are provided to users of your forms, you must furnish to
them the exact text of the Privacy Act and Paperwork Reduction Act Notice.

Section 1.10 – Order Forms and Instructions

.01 You can order forms and instructions at IRS.gov/OrderForms.

Section 1.11 – Effect on Other Documents

.01 Revenue Procedure 2022-15, 2022-13 I.R.B. 908, dated March 28, 2022, is
superseded.

Section 1.12 – Helpful Information

.01 Please follow the specifications and guidelines to produce substitute Form
941, Schedule B, Schedule D, Schedule R, and Form 8974.

.02 These forms are subject to review and possible changes, as required.
Therefore, employers are cautioned against overstocking supplies of privately
printed substitutes.
.03 Here is a review of references that were listed throughout this document.

• Form 941, Employer’s QUARTERLY Federal Tax Return.

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              • Schedule B (Form 941), Report of Tax Liability for Semiweekly 
                Schedule Depositors (referred to in this revenue procedure as 
                “Schedule B”).
              • Schedule D (Form 941), Report of Discrepancies Caused by 
                Acquisitions, Statutory Mergers, or Consolidations (referred to in this 
                revenue procedure as “Schedule D”).
              • Schedule R (Form 941), Allocation Schedule for Aggregate Form 941 
                Filers (referred to in this revenue procedure as “Schedule R”).
              • Form 8974, Qualified Small Business Payroll Tax Credit for Increasing 
                Research Activities.
              • Substitute territorial forms (941-PR, 941-SS, and Anexo B (Formulario 
                941-PR)).
              • Instructions for Form 941.
              • Instructions for Schedule B (Form 941).
              • Instructions for Schedule D (Form 941).
              • Instructions for Schedule R (Form 941).
              • Instructions for Form 8974.
              • Pub. 15, Employer’s Tax Guide.
              • SCRIPS@IRS.gov for submissions.
              • SubstituteForms@IRS.gov for questions.
              • For questions:

                Internal Revenue Service
                Attn: Substitute Forms Program
                SE:W:CAR:MP:P:TP:TP
                5000 Ellin Road, Mail Stop C6-110
                Lanham, MD 20706

              • IRS.gov/DraftForms for draft forms.
              • IRS.gov/Forms for final forms.

                                              10

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Section 1.13 – Exhibits

Exhibit A                                                                                                                                                                                       Form 941 Page 1
        .50 in
                                              Employer’s QUARTERLY Federal Tax Return                                                                                                                           950122
        Form   (Rev. March 2023)941 for 2023: Department of the Treasury — Internal Revenue Service                                                                                                    OMB No. 1545-0029
        Employer identiﬁcation number (EIN)           —     .27 in                                                                                                                  Report for this Quarter of 2023 
                                                                                                                                                                                    (Check one.)
                5.00 in                                       3.50 in
        Name (not your trade name)                                                                                                                                                  1: January, February, March
                                                                                                                                                                                                                                 2.40 in
2.33 in Trade name (if any)                                                                                                                                                         2: April, May, June
                                                            3.80 in
                                                                                                                                                                                    3: July, August, September
                                                                                                                                                                                                                                 1.86 in
        Address                                         4.30 in                                                                                                                     4: October, November, December
                Number                                Street                                                                                          Suite or room number
                                                                                                                                                                                   Go to www.irs.gov/Form941 for 
                                            2.60 in                   .50 in          1.00 in                                                                                      instructions and the latest information.
                City                                                    State         ZIP code
                                                                                                                                                                                                2.10 in
                                        2.00 in                   1.20 in                           .90 in
                Foreign country name                      Foreign province/county   Foreign postal code
        Read the separate instructions before you complete Form 941. Type or print within the boxes.
        Part 1: Answer these questions for this quarter.
        1      Number of employees who received wages, tips, or other compensation for the pay period 
               including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)                                                                    1                  .20 in
                                                                                                                                                                                                       .13 in                    .50 in
        2      Wages, tips, and other compensation        . .   .   . . .   .     . . .             . .   .                                                               . . .   . 2                               .
        3      Federal income tax withheld from wages, tips, and other compensation                   .   .                                                               . . .   . 3                               .
        4      If no wages, tips, and other compensation are subject to social security or Medicare tax                                                                                  Check and go to line 6.
                                2.50 in                     Column 1                                        Column 2
        5a     Taxable social security wages* .       .                 .         × 0.124 =                                                                                       .      *Include taxable qualiﬁed sick and 
.50 in                                                                                                                                                                                   family leave wages paid in this 
        5a     (i) Qualiﬁed sick leave wages*         .                 .         × 0.062 =                                                                                       .      quarter of 2023 for leave taken 
                                                                                                                                                                                         after March 31, 2021, and before 
                                                                                                                                                                                         October 1, 2021, on line 5a. Use 
7.81 in 5a     (ii) Qualiﬁed family leave wages*      .                 .         × 0.062 =                                                                                       .      lines 5a(i) and 5a(ii) only for taxable 
                                                                                                                                                                                         qualiﬁed sick and family leave 
        5b     Taxable social security tips       . . .                 .         × 0.124 =                                                                               1.30 in .      wages paid in this quarter of 2023 
                                                                                                                                                                                         for leave taken after March 31, 
        5c     Taxable Medicare wages & tips        . .                 .         × 0.029 =                                                                                       .      2020, and before April 1, 2021.
        5d     Taxable wages & tips subject to                                                                                                                                                         2.20 in
               Additional Medicare Tax withholding                      .         × 0.009 =                                                                                       .
        5e     Total social security and Medicare taxes. Add Column 2 from lines 5a, 5a(i), 5a(ii), 5b, 5c, and 5d                                                                  5e          1.80 in             .
        5f     Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions)                                                                                .   . 5f                              .
        6      Total taxes before adjustments. Add lines 3, 5e, and 5f .    .     . . .             . .   .                                                               . . .   . 6                               .
        7      Current quarter’s adjustment for fractions of cents    . .   .     . . .             . .   .                                                               . . .   . 7                               .
        8      Current quarter’s adjustment for sick pay    .   .   . . .   .     . . .             . .   .                                                               . . .   . 8                               .
        9      Current quarter’s adjustments for tips and group-term life insurance                 . .   .                                                               . . .   . 9                               .
        10     Total taxes after adjustments. Combine lines 6 through 9     .     . . .             . .   .                                                               . . .   . 10                              .
        11a    Qualiﬁed small business payroll tax credit for increasing research activities. Attach Form 8974                                                                      11a                             .
                                                                                                                                                                                                .21 in
        11b    Nonrefundable portion of credit for qualiﬁed sick and family leave wages for leave taken 
               before April 1, 2021         .   . . . . . . .   .   . . .   .     . . .             . .   .                                                               . . .   . 11b                             .
                                                                                                                                                                                                .17 in
        11c    Reserved for future use          . . . . . . .   .   . . .   .     . . .             . .   .                                                               . . .   . 11c                             .
        You MUST complete all three pages of Form 941 and SIGN it.                                                                                                                              .83 in
        For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.                                                                              Cat. No. 17001Z   Form 941 (Rev. 3-2023)

                                                                                  11

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Exhibit B                                                                                                                        Form 941 Page 2

                                                                                                                          .66 in
                                                                                                                                             951222
        Name (not your trade name)                                                                    Employer identiﬁcation number (EIN)
                                                                                                                                                                   .33 in
                                                    5.00 in                                               .50 in   –          1.90 in 
        Part 1: Answer these questions for this quarter. (continued)
        11d    Nonrefundable portion of credit for qualiﬁed sick and family leave wages for leave taken                                                            1.80 in
               after March 31, 2021, and before October 1, 2021   .             .  . . . . . .   .  . .   .  .     11d                       .

        11e    Reserved for future use . .        . . .   . . . . .             .  . . . . . .   .  . .   .  .     11e                       .
                                                                                             1.20 in
        11f    Reserved for future use . .        . . .   . . . . .             .  . .                                    2.30 in
        11g    Total nonrefundable credits. Add lines 11a, 11b, and 11d            . . . . . .   .  . .   .  .     11g                       .
                                                                                                                                       .13 in
        12     Total taxes after adjustments and nonrefundable credits. Subtract line 11g from line 10       .     12                        .
        13a    Total  deposits  for  this  quarter,  including  overpayment  applied  from  a  prior  quarter  and 
               overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) ﬁled in the current quarter  13a                       .

6.08 in 13b    Reserved for future use . .        . . .   . . . . .             .  . . . . . .   .  . .   .  .     13b                       .
        13c    Refundable  portion  of  credit  for  qualiﬁed sick  and  family  leave  wages  for  leave  taken 
               before April 1, 2021 .  . .        . . .   . . . . .             .  . . . . . .   .  . .   .  .     13c                       .
        13d    Reserved for future use . .        . . .   . . . . .             .  . . . . . .   .  . .   .  .     13d                       .
                                                                                                                                       .21 in
        13e    Refundable  portion  of  credit  for  qualiﬁed sick  and  family  leave  wages  for  leave  taken 
               after March 31, 2021, and before October 1, 2021 . .             .  . . . . . .   .  . .   .  .     13e                       .

        13f    Reserved for future use . .        . . .   . . . . .             .  . . . . . .   .  . .   .  .     13f                       .
        13g    Total deposits and refundable credits. Add lines 13a, 13c, and 13e        . . .   .  . .   .  .     13g                       .
        13h    Reserved for future use . .        . . .   . . . . .             .  . . . . . .   .  . .   .  .     13h                       .
        13i    Reserved for future use . .        . . .   . . . . .             .  . . . . . .   .  . .   .  .     13i                       .
        14     Balance due. If line 12 is more than line 13g, enter the difference and see instructions . .  .     14                        .
                                    3.70 in                                                                               0.86 in
        15     Overpayment. If line 13g is more than line 12, enter the difference       1.30 in .    Check one:       Apply to next return. Send a refund.
        Part 2: Tell us about your deposit schedule and tax liability for this quarter.
        If you’re unsure about whether you’re a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15.
        16 Check one:              Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500, 
                                   and you didn’t incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior 
                                   quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your 
                .53 in             federal  tax  liability.  If  you’re  a  monthly  schedule  depositor,  complete  the  deposit  schedule  below;  if  you’re  a 
                                   semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3.
3.33 in                            You were a monthly schedule depositor for the entire quarter.    Enter your tax liability for each month and total 
             1.02 in               liability for the quarter, then go to Part 3.

                                   Tax liability: Month 1                                .                             3.00 in
                1.44 in                           Month 2                                .
                                                  Month 3                                .
                            Total liability for quarter                                  .       Total must equal line 12.
                                   You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941), 
                                   Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Go to Part 3.
                                                                                           .64 in
        You MUST complete all three pages of Form 941 and SIGN it.
        Page 2                                                                                                                  Form 941 (Rev. 3-2023)

                                                                                     12

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Exhibit C                                                                                                                                        Form 941 Page 3

                                                                                                                                                        .50 in
                                                                                                                                                               950922
              Name (not your trade name)                                                            Employer identiﬁcation number (EIN)
                                                                                                                                 –
              Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank.
              17     If your business has closed or you stopped paying wages .    . . . . .     . . . .      .                   . . . .      Check here, and
                                                                           1.10 in
                     enter the nal date you paid wages        /       /                 ; also attach a statement to your return. See instructions.
                                  2.40 in                                                                                                                      1.65 in
              18     If you’re a seasonal employer and you don’t have to ﬁle a return for every quarter of the year                . . .      Check here.
              19     Qualiﬁed health plan expenses allocable to qualiﬁed sick leave wages for leave taken before April 1, 2021   19                             .
              20     Qualiﬁed health plan expenses allocable to qualiﬁed family leave wages for leave taken before April 1, 2021 20                             .          1.80 in

              21     Reserved for future use       . . . . .   . . . .   . . .    . . . . .     . . . .      .                   21                             .          .04 in
       3.92 in
              22     Reserved for future use       . . . . .   . . . .   . . .    . . . . .     . . . .      .                   22                             .
              23     Qualiﬁed sick leave wages for leave taken after March 31, 2021, and before October 1, 2021                  23                             .
              24     Qualiﬁed health plan expenses allocable to qualiﬁed sick leave wages reported on line 23                    24                             .
              25     Amounts  under  certain  collectively  bargained  agreements  allocable  to  qualiﬁed  sick 
                     leave wages reported on line 23     . .   . . . .   . . .    . . . . .     . . . .      .                   25                             .
                                                                                                                                                        .13 in
              26     Qualiﬁed family leave wages for leave taken after March 31, 2021, and before October 1, 2021                26                             .
              27     Qualiﬁed health plan expenses allocable to qualiﬁed family leave wages reported on line 26                  27                             .
              28     Amounts  under  certain  collectively  bargained  agreements  allocable  to  qualiﬁed family 
                     leave wages reported on line 26     . .   . . . .   . . .    . . . . .     . . . .      .                   28                             .
              Part 4: May we speak with your third-party designee?
                     Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions
                     for details.                                                                                                .40 in
                      Yes. Designee’s name and phone number                           2.40 in                                                           1.50 in
                                         3.10 in                                                                                                                                  1.33 in
                         Select a 5-digit personal identication number (PIN) to use when talking to the IRS.
                      No.
              Part 5: Sign here. You MUST complete all three pages of Form 941 and SIGN it.
              Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge 
              and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
1.66 in                                                                               Print your 
              Sign your                                                               name here                                        2.50 in
              name here                                  3.00 in                      Print your 
                                                                                      title here
                                         1.10 in
                      Date               /       /                                    Best daytime phone                                 2.00 in

              Paid Preparer Use Only                                                              Check if you’re self-employed                         . .    .
              Preparer’s name                                    3.60 in                              PTIN                                    1.70 in
              Preparer’s signature                                                                    Date                             /        /1.20 in
              Firm’s name (or yours                                                                                                                                        2.00 in
              if self-employed)                                                                       EIN
              Address                                                                                 Phone
              City                                     2.50 in                    State               ZIP code
.50 in                                                                                  .50 in
              Page 3                                                                                                                          Form 941 (Rev. 3-2023)

                                                                           1.08 in

                                                                               13

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Exhibit D                                                     Form 941 Page 4

                                                              951020

              This page intentionally left blank

              14

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Exhibit E                                                                                                                                           Form 941-V
                                                                                                                                     .50 in

       Form 941-V, 
       Payment Voucher

                                          Detach Here and Mail With Your Payment and Form 941.
                                                                       Payment Voucher                                                              OMB No. 1545-0029
       DepartmentForm941-Vof the Treasury                 Don’t staple this voucher or your payment to Form 941.                                    2023
       Internal Revenue Service       
       1 Enter your employer identication                      2                                                                           Dollars   Cents
         number (EIN).                                            Enter the amount of your payment.
         .63 in         –                 1.80 in                 Make your check or money order payable to “United States Treasury.”
       3 Tax Period                                             4 Enter your business name (individual name if sole proprietor).
                        1st                       3rd 
                     Quarter                      Quarter         Enter your address.                                                2.33 in
                        2nd                       4th             Enter your city, state, and ZIP code; or your city, foreign country name, foreign province/county, and foreign postal code.
                     Quarter                      Quarter

.50 in                                                                                7.50 in                                                                                                .50 in
                                                                                                                                     .73 in

                                                                                       15

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Exhibit F                                                                                                               Schedule B (Form 941)
                                                                                                                                                        .50 in
                                                                                                                                         3.50 in
                                                                                                                        1.00 in
                                                                                                                                                 960311
      Schedule B (Form 941):
      Report of Tax Liability for Semiweekly Schedule Depositors                                                                         OMB No. 1545-0029
      (Rev. January 2017)           Department of the Treasury — Internal Revenue Service
                                               3.27 in                                         Report for this Quarter... 
      Employer identiﬁcation number        —                                                   (Check one.)
      (EIN)                                                                                                                                             2.20 in
                                               3.50 in                                                                1: January, February, March
      Name (not your trade name)                                                                                      2: April, May, June
      Calendar year                                                     (Also check quarter)                          3: July, August, September        2.50 in
                                    1.33 in
                                                                                                                      4: October, November, December
      Use this schedule to show your TAX LIABILITY for the quarter; don't use it to show your deposits. When you ﬁle this form with Form 941 or 
      Form 941-SS, don't change your tax liability by adjustments reported on any Forms 941-X or 944-X. You must ﬁll out this form and attach it to 
      Form 941 or Form 941-SS if you're a semiweekly schedule depositor or became one because your accumulated tax liability on any day was 
      $100,000 or more. Write your daily tax liability on the numbered space that corresponds to the date wages were paid. See Section 11 in 
      Pub. 15 for details.
      Month 1                       1.20 in
      1      .20 in       .      9           . 17                      . 25                  .                          Tax liability for Month 1
                                                                                                                                                 .60 in
                                                                                                                               1.80 in
      2                   .      10          . 18                      . 26                  .                                                         .
      3                   .      11          . 19                      . 27                  .
      4                   .      12          . 20                      . 28                  .
      5                   .      13          . 21                      . 29                  .
      6                   .      14          . 22                      . 30                  .                                           1.57 in
      7                   .      15          . 23                      . 31                  .
      8                   .      16          . 24                      .
      Month 2 .20 in.20 in                                      6.30 in
      1                   .      9           . 17                      . 25                  .                          Tax liability for Month 2

      2                   .      10          . 18                      . 26                  .                                                         .
      3                   .      11          . 19                      . 27                  .
      4                   .      12          . 20                      . 28                  .
      5                   .      13          . 21                      . 29                  .
      6                   .      14          . 22                      . 30                  .                                           1.58 in
      7                   .      15          . 23                      . 31                  .
      8                   .      16          . 24                      .
      Month 3
      1                   .      9           . 17                      . 25                  .                          Tax liability for Month 3

      2                   .      10          . 18                      . 26                  .                                                         .
      3                   .      11          . 19                      . 27                  .
      4                   .      12          . 20                      . 28                  .
.50 in
      5                   .      13          . 21                      . 29                  .                                           1.41 in
      6                   .      14          . 22                      . 30                  .
      7                   .      15          . 23                      . 31                  .
      8                   .      16          . 24                      .
                                                                                                                        Total liability for the quarter
                                    .55 in Fill in your total liability for the quarter (Month 1 + Month 2 + Month 3)                   .50 in
                                               Total must equal line 12 on Form 941 or Form 941-SS.                                                    .
      For Paperwork Reduction Act Notice, see separate instruc-        IRS.gov/form941       Cat. No. 11967Q            Schedule B (Form 941) (Rev. 1-2017)
                                                                1.20 in

                                                                       16

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Exhibit G Form 941 Schedule D Page 1
.50 in
.50 in
Schedule D (Form 941):
Report of Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations
(Rev. June 2011) Department of the Treasury—Internal Revenue Service
OMB No. 1545-0029
Employer Identiﬁcation Number (EIN) — Tax Year of Discrepancies (Fill in)
2.85 in .75 in
Name (not your trade name) 3.40 in Format: YYYY
Trade name (if any) 3.70 in
4.20 in Type of Submission (Check one)
Address
Number Street Suite or room number
1.08 in
2.60 in .50 in .90 in Original 2.20 in
City State ZIP code Corrected
Phone number 2.29 in

About this schedule
Each year the Internal Revenue Service (IRS) and the Social Security Administration (SSA) compare the totals on your Forms 941,
Employer’s QUARTERLY Federal Tax Return, with the totals on Forms W-2, Wage and Tax Statement, to verify that:
• The wages you reported on Forms 941 match those you reported on Forms W-2 (Copy A) so that your
employees’ social security earnings records are complete for benet purposes; and
• You have paid the appropriate taxes.
Generally, the totals on your Forms W-2 (Copy A) should equal the totals you reported on Forms 941. Use this schedule if discrepancies
exist between the totals you reported on those forms ONLY as a result of an acquisition, statutory merger, or consolidation. In many cases,
the information on this schedule should help the IRS resolve discrepancies without contacting you. If you are an eligible employer
who elects to use the alternate procedure set forth in Rev. Proc. 2004-53, explained in the instructions, you should le this schedule.
Read the separate instructions before you ﬁll out this schedule.
Part 1: Answer these background questions.

1. Are you ﬁling this schedule —
After a statutory merger or consolidation? (See Rev. Rul. 62-60, 1962-1 C.B. 186 and Rev. Proc. 2004-53, 2004-2 C.B. 320.)
You are either: An acquired corporation or
OR A surviving corporation.
After an acquisition and you are using the alternate procedure under Rev. Proc. 2004-53, 2004-2 C.B. 320?
You are either: A predecessor or
A successor. 4.91 in
1.70 in
2. The effective date of the statutory merger/consolidation or acquisition is .........................
MM / DD / YYYY
3. The OTHER PARTY in this transaction is . . .
Other party’s EIN —

Other party’s name 6.00 in
Trade name (if any)
Address
Number Street Suite or room number

City State ZIP code
Phone number 2.30 in Next
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 38791Y Schedule D (Form 941) (Rev. 6-2011)
.50 in

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Exhibit H                                                                                      Form 941 Schedule D Page 2

                                                                                                                                   .50 in

Your EIN                   —                                          2.86 in                           Tax Year of Discrepancies (Fill in)     .50 in
                                                                                                                       .80 in
Name (not your trade name)                                3.60 in                                                      Format: YYYY
                                                                                                                                                2.20 in
Other party’s EIN                —

Part 2: Tell us about the discrepancies with your returns.
                                  Column A                                        Column B                             Column C
                                 Amount you reported to IRS         – Amount you reported to SSA          = The difference
                                 for the tax year                     for the tax year
                                 Totals from Forms 941 as corrected   Totals from Forms W-2 (Copy A) as 
                                 by any Forms 941-X                   corrected by any Forms W-2c (Copy A)
                                                              .20 in
4. Social security wages          1.80 in                           –                                     =
5. Medicare wages and tips                                          –                                     =
6. Social security tips                                             –                                     =
7. Federal income tax                                               –                                     =
   withheld
8. Advance earned income credit                                     –                                     =
   (EIC) payments (for tax years 
   ending before January 1, 2011)
If you are ling for one transaction only, STOP here. If you are ling for more than one transaction, go to Part 3.

Part 3: Fill this part out ONLY if you are ﬁling more than one Schedule D (Form 941) for any calendar year.

9. File one Schedule D (Form 941) for each separate transaction. This is schedule .70 in  of               . (Example: This is schedule 1 of 3.)

7.09 in                           Column A                                        Column B                             Column C
                                 Amount you reported to IRS         – Amount you reported to SSA          = The difference
                                 for the tax year for the             for the tax year for the 
                                 employees affected by the            employees affected by the 
                                 transaction reported on this         transaction reported on this 
                                 Schedule D (Form 941)                Schedule D (Form 941)
                                 Totals from Forms 941 as corrected   Totals from Forms W-2 (Copy A) as 
                                 by any Forms 941-X                   corrected by any Forms W-2c (Copy A)

10. Social security wages                                           –             5.80 in                 =
11. Medicare wages and tips                                         –                                     =
12. Social security tips                                            –                                     =
13. Federal income tax                                              –                                     =
   withheld
14. Advance earned income credit                                    –                                     =
   (EIC) payments (for tax years 
   ending before January 1, 2011)
Page 2                                                                                                       Schedule D (Form 941) (Rev. 6-2011)

1.51 in

.50 in

                                                                      18

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Exhibit I Must Be in Landscape                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Form 941 Schedule R Page 1

       .50 in                                                                                                                                                                                                      2.90 in
       951422
.50 in
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            . .              . . .                                             .                                                                                         .                                      .                                         .                                                                   .       .      . . . . . . .                       . . . . . . . .   .

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Form 941, line 5e
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (i)                                                                                                                                                                                                                                                                                                                                                   Form 941, line 13e                                              Form 941, line 28
                                                                                                                                                                                                                                                                                                                2.10 in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      (q)                                                             (y) 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            . .              . . .                                             .                                                                                         .                                      .                                         .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              .       .      . . . . . . .                       . . . . . . . .   .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Schedule R (Form 941) (Rev. 3-2023)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            column 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Form 941, line 5c, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (h)                                                                                                                                                                                                                                                                                                                                                   Form 941, line 13c                                              Form 941, line 27
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             (p)                                                             (x) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            . .              . . .                                             .                                                                                         .                                      .                                         .
                                                                                                                      2023                                                        January, February, March                       April, May, June                                       July, August, September          October, November, December                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          .       .      . . . . . . .                       . . . . . . . .   .
                                                                                                                                                                                 1:                                             2:                                                     3:                                                                                                                                                              4:
       Report for calendar year:                                                                                                   Check the quarter (same as Form 941):                                                                                                                                                                                                                                                                                                                                                                                                                                                       Form 941, lines 5a 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (g)                            and 5b, column 2, total                                                                                                                                                                                                                                                                                                                                                                Form 941, line 26                                                                                           Cat. No. 49301K
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Form 941, line 13a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             (o)                                                             (w) 
                                                                                                                                                                                                           1.66 in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          . .              . . .                                             .                                                                                         .                                      .                                         .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              .       .      . . . . . . .                       . . . . . . . .   .
                                                                                                                           5.70 in                                                                                                                                                                                                                                                                                                                                                                                                                                                     Form 941, lines 5a(i) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             (f)                                                         and 5a(ii), column 1, total
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Form 941, line 12                                               Form 941, line 25
                                                                                                                                                                         3.25 in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            . .              . . .                                             .                                                                                         .                                      .                                         .                                                  (n)                                                             (v) 

                                                                OMB No. 1545-0029                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Form 941, line 3                                                                                                                                                                                                                                                                                                                                                                                            .       .      . . . . . . .                       . . . . . . . .   .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (e)                                                                      .40 in                                                                                                                                                                                                                                                                                                                                                                                                                                                   www.irs.gov/Form941
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Form 941, line 11d                                              Form 941, line 24
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            . .              . . .                                             .                                                                                         .                                      .                                         .                                                  (m)                                                             (u) 
                                                                                                                                                                                                                                                         Other Third Party
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Form 941, line 2                                                                            .70 in                                                                                                                                                                                                                                                                                                          .       .      . . . . . . .                       . . . . . . . .  .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (d) 
                                                                                                                                                                                                                                3.90 in
                                                                                                                                                                                                                                                         CPEO                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Form 941, line 11b                                              Form 941, line 23
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             (l)                      .40 in                                 (t) 
                                                                                                                                   —                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             1.10 in
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Form 941, line 1
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (c)                                                                                                                                                                                                                                                                                                                                                                                      .       .      . . . . . . .                       . . . . . . . .   .

       Allocation Schedule for Aggregate Form 941 Filers        Department of the Treasury — Internal Revenue Service                                                                                                                             1.26 in
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                .90 in
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Form 941, line 11a                                               Form 941, line 20
                                                                                                                                                                                                                                                          Section 3504 Agent                                                                                                                                                                                                                                                                                                                                     Type of wages                                                                      (CPEO only)                               .90 in                                                                                                                                                                                                                                                                                         (k)                                                             (s)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     (b) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Add lines 1 through 5
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              .       .      . . . . . . .                       . . . . . . . .   .

                                                                                                                                                                                                                                                                          (check one):                                                                                                                                                                                                                                                                                                                                                                                                                                              1.40 in                                                                                                                                                                                                                                                                                                            1.50 in
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Client’s EIN                                                                                                                                                                                                                                                                                                                             Add lines 6, 7, and 8.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Form 941, line 5f                                               Form 941, line 19
                                                                                                                                                                                                           as shown on Form 941                                                                                                                                                                                                                                                                                                                                                                                                                                      (a)                                                                                                                                                                                                                                                                                                                                                                     (j)                                                             (r) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Subtotals for clients.                                             Enter the combined subtotal from line 9 of    all Continuation Sheets for Schedule R Enter Form 941 amounts for your employees                        Totals. 
                                                                                                                                   Employer identiﬁcation number (EIN)                                     Name                                                           Type of ﬁler                                                                                                                                                                                                                                                                                                                                                                                                                                                      1 2              3 4 5                                             6                                                                                       7                                        8                                                                        9                                    1       2      3 4 5 6 7 8 9                       1 2 3 4 5 6 7 8    9
.50 in Schedule R (Form 941):                                   (Rev. March 2023)                                                                                                                                                                                                                                       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.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               For Paperwork Reduction Act Notice, see the separate instructions.

                                                         .50 in                                                                                                                                                 1.00 in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              1.16 in                                                     .16 in                                                                                                                                                                                                                          .33 in

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           19

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Page 22 of 23                                                                               Fileid: … ns/p4436/202303/a/xml/cycle04/source                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               15:05 - 27-Mar-2023

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

Exhibit J Must Be in Landscape                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Form 941 Schedule R Page 2

            951522
                                                                                                                                                                                                                                                                                                                                                                                                                                . . . . . . . .                                                                                                                                                                                     .                       . . . . . . . .  .                       . . . . . . . .   .

                                                                                                                                                                                                                                                                                                                                                      Form 941, line 5e
                                                                                                                                                                                                                                                                                                                                                                         (i)                                                                                                                                                                                                                                                          Form 941, line 13e                        Form 941, line 28
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        (q)                                      (y) 

                                                                                                                                                                                                                                                                                                                                                                                                                                . . . . . . . .                                                                                                                                                                                     .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            . . . . . . . .  .                       . . . . . . . .   .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Schedule R (Form 941) (Rev. 3-2023)
                                                                                                                                                                                                                                                                                                                                                                                                        column 2
                                                                                                                                                                                                                                                                                                                                                      Form 941, line 5c, 
                                                                                                                                                                                                                                                                                                                                                                         (h)                                                                                                                                                                                                                                                          Form 941, line 13c                        Form 941, line 27
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        (p)                                      (x) 
                                                                                                                                                                                                                                                                                                                                                                                                                                . . . . . . . .                                                                                                                                                                                     .
                                                                                           2023                                        January, February, March                       April, May, June                                July, August, September  October, November, December                                                                                                                                                                                                                                                                                                                                                                  . . . . . . . .  .                       . . . . . . . .   .
                                                                                                                                      1:                                             2:                                              3:                       4:
            Report for calendar year:                                                           Check the quarter (same as Form 941):                                                                                                                                                                                              Form 941, lines 5a 
                                                                                                                                                                                                                                                                                                                                                                         (g)                            and 5b, column 2, total                                                                                                                                                                                                                                                 Form 941, line 26
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Form 941, line 13a
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        (o)                                      (w) 
                                                                                                                                                                                                                                                                                                                                                                                                                                . . . . . . . .                                                                                                                                                                                     .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            . . . . . . . .  .                       . . . . . . . .   .
                                                                                                                                                                                                                                                                                           Form 941, lines 5a(i) 
                                                                                                                                                                                                                                                                                                                 (f)                                                         and 5a(ii), column 1, total
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Form 941, line 12                         Form 941, line 25
                                                                                                                                                                                                                                                                                                                                                                                                                                . . . . . . . .                                                                                                                                                                                     .                   (n)                                      (v) 

                                                                                                                                                                                                                                                                                                                                                      Form 941, line 3                                                                                                                                                                                                                                                                                      . . . . . . . .  .                       . . . . . . . .   .
                                                                                                                                                                                                                                                                                                                                                                         (e) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Form 941, line 11d                        Form 941, line 24
                                                                                                                                                                                                                                                                                                                                                                                                                                . . . . . . . .                                                                                                                                                                                     .                   (m)                                      (u) 
                                                                                                                                                                                                       Other Third Party
                                                                                                                                                                                                                                                                                                                                                      Form 941, line 2                                                                                                                                                                                                                                                                                      . . . . . . . .  .                       . . . . . . . .  .
                                                                                                                                                                                                                                                                                                                                                                         (d) 

                                                                                                                                                                                                       CPEO                                                                                                                                                                                                                                                                                                                                                                                                                           Form 941, line 11b                        Form 941, line 23
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        (l)                                      (t) 
                                                                                                —
                                                                                                                                                                                                                                                                                                                                                      Form 941, line 1
                                                                                                                                                                                                                                                                                                                                                                         (c)                                                                                                                                                                                                                                                                                . . . . . . . .  .                       . . . . . . . .   .

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Form 941, line 11a                        Form 941, line 20
                                                                                                                                                                                                        Section 3504 Agent                                                                                           Type of wages                                                                      (CPEO only)                                                                                                                                                                                                                                     (k)                                      (s) 
                                                                                                                                                                                                                                                                                                                                                                         (b) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            . . . . . . . .  .
.50 in                                                                                                                                                                                                                                                                                                                                                                                                                                          Add lines 1 through 8.                                                                                                                                                                                                                               . . . . . . . .   .

       of                                                                                                                                                                                              (check one):
                                                                                                                                                                                                                                                                                                                                                      Client’s EIN                                                                                                                                                                                                                                                                    Form 941, line 5f                         Form 941, line 19
                                                                                                                                                                as shown on Form 941                                                                                                                                                                                     (a)                                                                                                                                                                                                                                                                            (j)                                      (r) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Subtotals for clients.                                         Include the subtotals from this line on                            Schedule R, Page 1, line 7.
                                                                                                 Employer identification number (EIN)                           Name                                                    Type of ﬁler                                                                                                                                                                                            1 2 3 4 5 6 7 8                                               9                                                                                                                                                             1 2 3 4 5 6 7 8   9                      1 2 3 4 5 6 7 8    9
       Page Continuation Sheet for Schedule R (Form 941)                  (Rev. March 2023)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              20

- 24 -

Page 23 of 23    Fileid: … ns/p4436/202303/a/xml/cycle04/source                                                                         15:05 - 27-Mar-2023

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

Exhibit K                                                                                                                                         Form 8974
           .50 in
        Form  8974:       Qualiﬁed Small Business Payroll Tax Credit for Increasing Research Activities                                           950823
           .42 in                                                                                                                                              .50 in
.50 in  (Rev. March 2023) Department of the Treasury — Internal Revenue Service                                                              OMB No. 1545-0029

        Employer identiﬁcation               —                 3.27 in                                                  Report for this quarter...
        number (EIN)
                                                                                                                    Check only one box.
        Name              5.00 in                                                                                                                              1.50 in
        (not your trade name)                                    3.60 in                                                1: January, February, March
        The credit from Part 2, line 12 or, if applicable,     .18 in                                                   2: April, May, June
        line 17, will be reported on (check only one box):     Form 941, 941-PR, or 941-SS
                                  .83 in                       Form 943 or 943-PR                                       3: July, August, September
               1.83 in                                         Form 944 or 944(SP)                                      4: October, November, December

        Calendar year          .90 in        You must select a quarter if you le Form 941, 941-PR, or 941-SS.                      2.10 in
        Part 1:     Tell us about your income tax return.                                       7.58 in
                    (a)                  (b)                   (c)                 (d)            (e)                     (f)                     (g) 
        .30 in  Ending date of        Income               Date income tax      EIN used on     Amount from           Amount of credit     Remaining credit 
               income tax period    tax return             return was led      Form 6765     Form 6765, line 44,     from column (e)   (subtract column (f) 
                          .75 in      led that                                               or if applicable, the     taken on a         from column (e))  
                                      included                                                amount that was       previous period(s)  
                                  Form 6765                                                 allocated to your EIN 
                  1.20 in             .70 in                   1.20 in            .80 in        1.10 in                 1.10 in              1.10 in
2.42 in 1         /       /                                  /     /                                   .                      .                       .
        2         /       /         .25 in                   /     /                                   .                      .                       .
        3         /       /                                  /     /                                   .                      .                       .
        4         /       /                                  /     /                                   .                      .                       .
        5         /       /                                  /     /                                   .                      .                       .
        6      Add lines 1(g) through 5(g) and enter the total here        .    . . .  .    . . . . .          . .  . . .   . .     .   6.10 in       .
        Part 2:     Determine the credit that you can use this period.
5.70 in 7      Enter the amount from Part 1, line 6(g)         . .    . .  .    . . .  .    . . . . .          . .  . 7                               .        1.80 in
        8      Enter the amount from Form 941 (941-PR or 941-SS), 
               line 5a, column 2; Form 943 (943-PR), line 3; or Form 
3.70 in        944 (944(SP)), line 4a, column 2 .          . . . .    . .  .    8                                .
        9      Enter the amount from Form 941 (941-PR or 941-SS), line                            .17 in
               5b, column 2; or Form 944 (944(SP)), line 4b, column 2           9                                .                         1.53 in
                                                                                                                      .04 in
        10     Add lines 8 and 9  .   .  .   .  .          . . . .    . .  .    10                               .
                                  2.85 in
        11     Multiply line 10 by 50% (0.50). Check this box         if you’re a third-party payer of sick pay or
1.23 in        check this box     if you received a Section 3121(q) Notice and Demand. See the instructions
               before completing line 11  .  .  .          . . . .    . .  .    . . .  .    . . . . .          . .  . 11                     .20 in   .
                                                                                                  1.46 in
        12  Credit against the employer share of social security tax. Enter the smaller of line 7 or 
               11, but not more than $250,000. See the instructions before entering an amount if you le                                   .62 in
               Form 943 or Form 944. If you entered the amount from line 7, stop here and also enter this
               amount on Form 941 (941-PR or 941-SS), line 11a; Form 943 (943-PR), line 12a; or Form
               944 (944(SP)), line 8a  . .   .  .          . . . .    . .  .    . . .  .    . . . . .          . .  . 12                              .
                               3.06 in                                3.23 in
        13     Subtract line 12 from line 7  .  .          . . . .    . .  .    13                               .
        14     Enter the amount from Form 941 (941-PR or 941-SS),                                   .34 in
               line 5c, column 2; Form 943 (943-PR), line 5; or Form                                                                       1.38 in
               944 (944(SP)), line 4c, column 2 .          . . . .    . .  .    14                               .
        15     Multiply line 14 by 50% (0.50). If you’re a third-party payer 
               of sick pay or you received a Section 3121(q) Notice and
               Demand, see the instructions before completing line 15           15                               .
        16     Credit against the employer share of Medicare tax. Enter the smaller of line 13 or 15  .               16                              .
                                                                                                                                           .20 in
        17     Total credit. Add lines 12 and 16. Also, enter this amount on Form 941 (941-PR or 941-SS), 
               line 11a; Form 943 (943-PR), line 12a; or Form 944 (944(SP)), line 8a  .       . . . .          . .  . 17                              .
        For Paperwork Reduction Act Notice, see the separate instructions.             www.irs.gov/Form8974         Cat. No. 37797C     Form 8974 (Rev. 3-2023)

                                                                                    21

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