430421
Schedule R (Form 943):                    Allocation Schedule for Aggregate Form 943 Filers
(Rev. December 2021)                      Department of the Treasury — Internal Revenue Service             OMB No. 1545-0035
Employer identification number (EIN)                         —                                                                                                Report for calendar year:
                                                                                                                                                                   (Same as Form 943):
Name as shown on Form 943
                                                                                                                                                                            2021
Type of filer (check one):        Section 3504 Agent              CPEO               Other Third Party
Read the instructions before you complete Schedule R. Type or print within the boxes. Complete a separate line for the amounts 
allocated to each of your clients. The term “client” as used on this form includes the term “customer.” See the instructions.
      (a) Client’s EIN     (b) Type of wages       (c) Form 943, line 1        (d) Form 943, line 2    (e) Form 943, line 2a  (f) Form 943, line 2b   (g) Form 943, line 4       (h) Form 943, line 6 (i) Form 943, line 8
                                (CPEO     only)                                                                                                                                                                      
1                                                                                          .                          .                      .                         .                    .                  .
2                                                                                          .                          .                      .                         .                    .                  .
3                                                                                          .                          .                      .                         .                    .                  .
4                                                                                          .                          .                      .                         .                    .                  .
5                                                                                          .                          .                      .                         .                    .                  .
6 Subtotals for clients. Add lines 1 through 5                                             .                          .                      .                         .                    .                  .
7 Enter the combined subtotal from line 9 
  of all Continuation Sheets for Schedule R                                                .                          .                      .                         .                    .                  .
8 Enter Form 943 amounts for your employees                                                .                          .                      .                         .                    .                  .
9 Totals. Add lines 6, 7, and 8.                                                           .                          .                      .                         .                    .                  .
    (j) Form 943, line 12a      (k) Form 943, lines 12b      (l) Form 943, lines 12c       (m) Form 943, lines 12d    (n) Form 943, lines 12e    (o) Form 943, line 12f     (p) Form 943, line 13     (q) Form 943, line 14a
                                     and      14d, total          and      14e, total          and     14f, total         and     14g, total                                                                         
1                      .                           .                            .                           .                          .                                                  .                    .
2                      .                           .                            .                           .                          .                                                  .                    .
3                      .                           .                            .                           .                          .                                                  .                    .
4                      .                           .                            .                           .                          .                                                  .                    .
5                      .                           .                            .                           .                          .                                                  .                    .
6                      .                           .                            .                           .                          .                                                  .                    .
7                      .                           .                            .                           .                          .                                                  .                    .
8                      .                           .                            .                           .                          .                                                  .                    .
9                      .                           .                            .                           .                          .                                                  .                    .
    (r) Form 943, line 14i       (s) Form 943, lines 18      (t) Form 943, lines 20        (u) Form 943, lines 22     (v) Form 943, lines 23     (w) Form 943, lines 25     (x) Form 943, line 28     (y) Form 943, line 29
                                     and      19, total           and      21, total           and     24, total          and     26, total           and     27, total                                              
1                      .                           .                            .                           .                          .                           .                      .                    .
2                      .                           .                            .                           .                          .                           .                      .                    .
3                      .                           .                            .                           .                          .                           .                      .                    .
4                      .                           .                            .                           .                          .                           .                      .                    .
5                      .                           .                            .                           .                          .                           .                      .                    .
6                      .                           .                            .                           .                          .                           .                      .                    .
7                      .                           .                            .                           .                          .                           .                      .                    .
8                      .                           .                            .                           .                          .                           .                      .                    .
9                      .                           .                            .                           .                          .                           .                      .                    .
For Paperwork Reduction Act Notice, see the separate instructions.                             www.irs.gov/Form943                                    Cat. No. 69329E                 Schedule R (Form 943) (Rev. 12-2021)

Page       of                                                                                                                                                                                                   430521
Continuation Sheet for Schedule R (Form 943)
(Rev. December 2021)
Employer identification number (EIN)                         —                                                                                                Report for calendar year:
                                                                                                                                                                   (Same as Form 943):
Name as shown on Form 943
                                                                                                                                                                            2021
Type of filer (check one):       Section 3504 Agent               CPEO               Other Third Party

       (a) Client’s EIN    (b) Type of wages        (c) Form 943, line 1       (d) Form 943, line 2    (e) Form 943, line 2a  (f) Form 943, line 2b   (g) Form 943, line 4       (h) Form 943, line 6 (i) Form 943, line 8
                                (CPEO     only)                                                                                                                                                                      
1                                                                                          .                          .                      .                         .                    .                  .
2                                                                                          .                          .                      .                         .                    .                  .
3                                                                                          .                          .                      .                         .                    .                  .
4                                                                                          .                          .                      .                         .                    .                  .
5                                                                                          .                          .                      .                         .                    .                  .
6                                                                                          .                          .                      .                         .                    .                  .
7                                                                                          .                          .                      .                         .                    .                  .
8                                                                                          .                          .                      .                         .                    .                  .
9 Subtotals for clients.   Add lines 1 through 
  8.  Include  the  subtotals  from  this  line  on 
  Schedule R, Page 1, line 7.                                                              .                          .                      .                         .                    .                  .
    (j) Form 943, line 12a      (k) Form 943, lines 12b      (l) Form 943, lines 12c       (m) Form 943, lines 12d    (n) Form 943, lines 12e    (o) Form 943, line 12f     (p) Form 943, line 13     (q) Form 943, line 14a
                                    and      14d, total           and      14e, total          and     14f, total         and     14g, total                                                                         
1                       .                           .                           .                           .                          .                                                  .                    .
2                       .                           .                           .                           .                          .                                                  .                    .
3                       .                           .                           .                           .                          .                                                  .                    .
4                       .                           .                           .                           .                          .                                                  .                    .
5                       .                           .                           .                           .                          .                                                  .                    .
6                       .                           .                           .                           .                          .                                                  .                    .
7                       .                           .                           .                           .                          .                                                  .                    .
8                       .                           .                           .                           .                          .                                                  .                    .
9                       .                           .                           .                           .                          .                                                  .                    .
    (r) Form 943, line 14i      (s) Form 943, lines 18       (t) Form 943, lines 20        (u) Form 943, lines 22     (v) Form 943, lines 23     (w) Form 943, lines 25     (x) Form 943, line 28     (y) Form 943, line 29
                                     and      19, total           and      21, total           and     24, total          and     26, total           and     27, total                                              
1                       .                           .                           .                           .                          .                           .                      .                    .
2                       .                           .                           .                           .                          .                           .                      .                    .
3                       .                           .                           .                           .                          .                           .                      .                    .
4                       .                           .                           .                           .                          .                           .                      .                    .
5                       .                           .                           .                           .                          .                           .                      .                    .
6                       .                           .                           .                           .                          .                           .                      .                    .
7                       .                           .                           .                           .                          .                           .                      .                    .
8                       .                           .                           .                           .                          .                           .                      .                    .
9                       .                           .                           .                           .                          .                           .                      .                    .
                                                                                                                                                                                      Schedule R (Form 943) (Rev. 12-2021)