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Schedule R (Form 940): Allocation Schedule for Aggregate Form 940 Filers                                                               OMB No. 1545-0028
(Rev. December 2014)
Department of the Treasury — Internal Revenue Service
                                                                                                               Report for calendar year:
   Employer identification number                —                                                            (Same as Form 940):
   (EIN)
   Name as shown on 
   Form 940

Read the instructions before you complete Schedule R (Form 940). Type or print within the boxes. Complete a separate line for the 
amounts allocated to each of your clients.

           (a)                    (b)                (c)                 (d)                 (e)                     (f)                      (g) 
        Client Employer          State      Total taxable FUTA    Total adjustments      Credit reduction      Total FUTA tax          Total FUTA tax 
   Identification Number      abbreviation  wages allocated to      to FUTA tax          amount allocated      after adjustments       deposits from 
           (EIN)              from Form     the listed client EIN   allocated to the     to the listed client  allocated to the        Form 940, line 13, 
                              940, line 1a, from Form 940,line 7  listed client EIN from EIN from Form 940,   listed client EIN from   plus any payment 
                              or Schedule                         Form 940, line 9 or        line 11           Form 940,line 12        made with the 
                              A (Form 940)                               line 10                                                       return allocated to 
                                                                                                                                       the listed client EIN   

1                                                         .                         .                  .                        .                 .
2                                                         .                         .                  .                        .                 .
3                                                         .                         .                  .                        .                 .
4                                                         .                         .                  .                        .                 .
5                                                         .                         .                  .                        .                 .
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7                                                         .                         .                  .                        .                 .
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11                                                        .                         .                  .                        .                 .
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13                                                        .                         .                  .                        .                 .
14                                                        .                         .                  .                        .                 .
15                                                        .                         .                  .                        .                 .
16 Subtotals for clients. 
   Add all amounts on lines 1 
   through 15.                                            .                         .                  .                        .                 .
17 Enter the combined 
   subtotal from line 26 of 
   all Continuation Sheets 
   for Schedule R (Form 
   940).                                                  .                         .                  .                        .                 .
18 Enter Form 940 amounts 
   for employees of the 
   agent.                                                 .                         .                  .                        .                 .
19 Totals. Add lines 16, 17, 
   and 18. The column totals 
   must match the related 
   lines on the aggregate 
   Form 940.                                              .                         .                  .                        .                 .
For Paperwork Reduction Act Notice, see the instructions.                             Cat. No. 53082A                Schedule R (Form 940) (Rev. 12-2014)



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Page        of                                                                                                                                      860612

Continuation Sheet for Schedule R (Form 940)                                                                        Report for calendar year:
(Rev. December 2014)
                                                                                                                    (Same as Form 940):

Employer identification number                    —
(EIN)
Name as shown on 
Form 940

Read the instructions before you complete Schedule R (Form 940). Type or print within the boxes. Complete a separate line for the 
amounts allocated to each of your clients.
            (a)                   (b)                 (c)                    (d)                   (e)                     (f)                      (g) 
       Client Employer            State      Total taxable FUTA       Total adjustments        Credit reduction     Total FUTA tax           Total FUTA tax 
   Identification Number       abbreviation     wages allocated to    to FUTA tax              amount allocated     after adjustments        deposits from  
            (EIN)              from Form        the listed client EIN allocated to the         to the listed client allocated to the         Form 940, line 13, 
                               940, line 1a, from Form 940,line 7     listed client EIN from   EIN from Form 940,   listed client EIN from   plus any payment 
                               or Schedule                            Form 940, line 9 or          line 11          Form 940,line 12         made with the 
                               A (Form 940)                                  line 10                                                         return allocated to 
                                                                                                                                             the listed client EIN   

1                                                          .                            .                    .                        .                 .
2                                                          .                            .                    .                        .                 .
3                                                          .                            .                    .                        .                 .
4                                                          .                            .                    .                        .                 .
5                                                          .                            .                    .                        .                 .
6                                                          .                            .                    .                        .                 .
7                                                          .                            .                    .                        .                 .
8                                                          .                            .                    .                        .                 .
9                                                          .                            .                    .                        .                 .
10                                                         .                            .                    .                        .                 .
11                                                         .                            .                    .                        .                 .
12                                                         .                            .                    .                        .                 .
13                                                         .                            .                    .                        .                 .
14                                                         .                            .                    .                        .                 .
15                                                         .                            .                    .                        .                 .
16                                                         .                            .                    .                        .                 .
17                                                         .                            .                    .                        .                 .
18                                                         .                            .                    .                        .                 .
19                                                         .                            .                    .                        .                 .
20                                                         .                            .                    .                        .                 .
21                                                         .                            .                    .                        .                 .
22                                                         .                            .                    .                        .                 .
23                                                         .                            .                    .                        .                 .
24                                                         .                            .                    .                        .                 .
25                                                         .                            .                    .                        .                 .
26 Subtotals for clients. Add 
   lines 1 through 25. Include 
   the subtotals from line 26 
   on Schedule R (Form 940), 
   line 17.                                                .                            .                    .                        .                 .
                                                                                                                           Schedule R (Form 940) (Rev. 12-2014)



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                                                                                                                       860712
Schedule R (Form 940) (Rev. 12-2014)

Section references are to the Internal Revenue Code unless        • Total taxable FUTA wages allocated to the client from Form 
otherwise noted.                                                  940, line 7.
                                                                  • Total adjustments to FUTA tax allocated to the client from 
General Instructions                                              Form 940, line 9 or 10.
                                                                  • Credit reduction amount allocated to the client from Form 
Purpose of Schedule R                                             940, line 11.
Use Schedule R to allocate the aggregate information reported     • Total FUTA tax after adjustments allocated to the client from 
on Form 940, Employer's Annual Federal Unemployment (FUTA)        Form 940, line 12.
Tax Return, to each home care service recipient client. An 
aggregate Form 940 may only be filed by section 3504 Agents       • Total FUTA tax deposits from Form 940, line 13, plus any 
acting on behalf of home care service recipients. If you are an   other payments allocated to the client.
agent for home care service recipients and have more than 15      You must also report the same information for your 
clients, complete continuation sheets as necessary. Attach        employees on Schedule R, line 18.
Schedule R, including any continuation sheets, to your            Compare the total of each column on line 19 (including your 
aggregate Form 940.                                               information from line 18) to the amounts reported on the 
                                                                  aggregate Form 940. For each column total, the relevant line 
Who Must File?                                                    from Form 940 is noted in the column heading.
You must complete Schedule R if you file an aggregate Form        If the totals on Schedule R, line 19, do not match the totals on 
940. Aggregate Forms 940 are filed by agents of home care         Form 940, there is an error that must be corrected before 
service recipients approved by the IRS under section 3504. To     submitting Form 940 and Schedule R.
request approval to act as an agent for a home care service 
recipient, you must file Form 2678, Employer/Payer                Paperwork Reduction Act Notice.  We ask for the 
Appointment of Agent, with the IRS, unless you are a state or     information on Schedule R to carry out the Internal Revenue 
local government agency acting as agent under the special         laws of the United States. You are required to give us this 
procedures provided in Rev. Proc. 2013-39. On Schedule R, we      information. We need it to ensure that you are complying with 
call those home care service recipients your clients.             these laws and to allow us to figure and collect the right amount 
                                                                  of tax.
When Must You File?
                                                                  You are not required to provide the information requested  
If you are an aggregate Form 940 filer, file Schedule R with your on a form that is subject to the Paperwork Reduction Act  
aggregate Form 940 every year when your Form 940 is due.          unless the form displays a valid OMB control number. Books  
Schedule R may be filed electronically or by paper submission.    or records relating to a form or its instructions must be  
However, agents filing for 1,000 or more clients must file a      retained as long as their contents may become material in the 
paper return unless they are e-filing through an approved         administration of any Internal Revenue law. Generally, tax 
transmitter that uses the IRS's Modernized e-File system.         returns and return information are confidential, as required by 
                                                                  section 6103.
Specific Instructions                                             The time needed to complete and file Schedule R will vary 
                                                                  depending on individual circumstances. The estimated average 
Completing Schedule R                                             time is:
Enter Your Business Information                                   Recordkeeping .    .  . .  .   .  .  .   . .   . .   . .    11 hr.
Carefully enter your employer identification number (EIN) and     Learning about the law or the form .     . .   . .   . . 18 min.
the name of your business at the top of the schedule. Make        Preparing, copying, and assembling the form      .   . .  29 min.
sure they exactly match the EIN and name shown on the 
attached Form 940.                                                If you have comments concerning the accuracy of these 
                                                                  time estimates or suggestions for making Schedule R simpler, 
Calendar Year                                                     we would be happy to hear from you. You can send us 
                                                                  comments from www.irs.gov/formspubs. Click on More 
Enter the calendar year for which you are filing your Form 940.   Information and then click on Give us feedback. Or you can 
Make sure that the year entered on the top of Schedule R          send your comments to Internal Revenue Service, Tax Forms 
matches the year on the attached Form 940.                        and Publications Division, 1111 Constitution Ave., NW, IR-6526, 
Client and Employee Information                                   Washington, DC 20224. Do not send Schedule R to this 
                                                                  address. Instead, see Where Do You File? in the Instructions for 
On Schedule R, including any continuation sheets, you must        Form 940.
report the following for each client.
• Your client's EIN.
• The state abbreviation of the client's location.






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