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                                                                                                                                                                                                      950122
Form   941 for 2023:                   Employer’s QUARTERLY Federal Tax Return
(Rev. March 2023)                      Department of the Treasury — Internal Revenue Service                                                                                                 OMB No. 1545-0029

Employer identification number (EIN)         —                                                                                                                            Report for this Quarter of 2023 
                                                                                                                                                                          (Check one.)

Name (not your trade name)                                                                                                                                                1: January, February, March
                                                                                                                                                                          2: April, May, June
Trade name (if any)
                                                                                                                                                                          3: July, August, September
Address                                                                                                                                                                   4: October, November, December
        Number                                Street                                                                                          Suite or room number
                                                                                                                                                                         Go to www.irs.gov/Form941 for 
                                                                                                                                                                         instructions and the latest information.
        City                                                    State          ZIP code

        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

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.
                                                    Column 1                                       Column 2
5a     Taxable social security wages* .      .                  .          × 0.124 =                                                                                    .      *Include taxable qualified sick and 
                                                                                                                                                                               family leave wages paid in this 
                                                                                                                                                                               quarter of 2023 for leave taken 
5a     (i) Qualified sick leave wages*       .                  .          × 0.062 =                                                                                    .      after March 31, 2021, and before 
                                                                                                                                                                               October 1, 2021, on line 5a. Use 
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 =                                                                                    .      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 
       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                              .

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                             .
11b    Nonrefundable portion of credit for qualified sick and family leave wages for leave taken 
       before April 1, 2021          . . . . . . . .   .    . . .   .      . . .             . . .                                                                . . . . 11b                             .

11c    Reserved for future use         . . . . . . .   .    . . .   .      . . .             . . .                                                                . . . . 11c                             .

You MUST complete all three pages of Form 941 and SIGN it.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.                                                                                Cat. No. 17001Z Form 941 (Rev. 3-2023)

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

11e    Reserved for future use  .     .   . . .   . . . . .             .  . . . . . . . . .      .  .     11e                       .

11f    Reserved for future use  .     .   . . .   . . . . .             .  . .

11g    Total nonrefundable credits. Add lines 11a, 11b, and 11d            . . . . . . . . .      .  .     11g                       .

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              .

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                       .
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                        .

15     Overpayment. If line 13g is more than line 12, enter the difference             .   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 
                           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.
                           You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total 
                           liability for the quarter, then go to Part 3.

                           Tax liability: Month 1                                .

                                          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.
You MUST complete all three pages of Form 941 and SIGN it.
Page 2                                                                                                                 Form 941 (Rev. 3-2023)

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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

enter the final date you paid wages / / ; also attach a statement to your return. See instructions.

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 .
21 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . 21 .
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 .

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.
Yes. Designee’s name and phone number

Select a 5-digit personal identification 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.
Print your
Sign your name here
name here Print your
title here

Date / / Best daytime phone

Paid Preparer Use Only Check if you’re self-employed . . .

Preparer’s name PTIN

Preparer’s signature Date / /
Firm’s name (or yours
if self-employed) EIN

Address Phone

City State ZIP code

Page 3 Form 941 (Rev. 3-2023)

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                                  951020

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Form 941-V,
Payment Voucher

Purpose of Form Specific Instructions
Complete Form 941-V if you’re making a payment with Box 1—Employer identification number (EIN). If you
Form 941. We will use the completed voucher to credit don’t have an EIN, you may apply for one online by
your payment more promptly and accurately, and to visiting the IRS website at www.irs.gov/EIN. You may also
improve our service to you. apply for an EIN by faxing or mailing Form SS-4 to the
IRS. If you haven’t received your EIN by the due date of
Making Payments With Form 941 Form 941, write “Applied For” and the date you applied in
To avoid a penalty, make your payment with Form 941 this entry space.
only if: Box 2—Amount paid. Enter the amount paid with
• Your total taxes after adjustments and nonrefundable Form 941.
credits (Form 941, line 12) for either the current quarter or Box 3—Tax period. Darken the circle identifying the
the preceding quarter are less than $2,500, you didn’t quarter for which the payment is made. Darken only
incur a $100,000 next-day deposit obligation during the one circle.
current quarter, and you’re paying in full with a timely filed
return; or Box 4—Name and address. Enter your name and
address as shown on Form 941.
• You’re a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits • Enclose your check or money order made payable to
Rule. See section 11 of Pub. 15 for details. In this case, “United States Treasury.” Be sure to enter your
the amount of your payment may be $2,500 or more. EIN, “Form 941,” and the tax period (“1st Quarter 2023,”
“2nd Quarter 2023,” “3rd Quarter 2023,” or “4th Quarter
Otherwise, you must make deposits by electronic funds 2023”) on your check or money order. Don’t send cash.
transfer. See section 11 of Pub. 15 for deposit Don’t staple Form 941-V or your payment to Form 941 (or
instructions. Don’t use Form 941-V to make federal tax to each other).
deposits.
• Detach Form 941-V and send it with your payment
Use Form 941-V when making any payment with and Form 941 to the address in the Instructions for
▲! Form 941. However, if you pay an amount with Form 941.
CAUTION
Form 941 that should’ve been deposited, you
may be subject to a penalty. See Deposit Penalties in Note: You must also complete the entity information
section 11 of Pub. 15. above Part 1 on Form 941.

Detach Here and Mail With Your Payment and Form 941.

OMB No. 1545-0029
Form Payment Voucher
Department941-Vof the Treasury Don’t staple this voucher or your payment to Form 941. 2023
Internal Revenue Service
1 Enter your employer identification 2 Dollars Cents
number (EIN).
Enter the amount of your payment.
– 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.

2nd 4th Enter your city, state, and ZIP code; or your city, foreign country name, foreign province/county, and foreign postal code.
Quarter Quarter

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Form 941 (Rev. 3-2023)

Privacy Act and Paperwork Reduction Act Notice. Justice for civil and criminal litigation, and to cities,
We ask for the information on Form 941 to carry out the states, the District of Columbia, and U.S. commonwealths
Internal Revenue laws of the United States. We need it to and possessions for use in administering their tax laws.
figure and collect the right amount of tax. Subtitle C, We may also disclose this information to other countries
Employment Taxes, of the Internal Revenue Code under a tax treaty, to federal and state agencies to
imposes employment taxes on wages and provides for enforce federal nontax criminal laws, or to federal law
income tax withholding. Form 941 is used to determine enforcement and intelligence agencies to combat
the amount of taxes that you owe. Section 6011 requires terrorism.
you to provide the requested information if the tax is The time needed to complete and file Form 941 will
applicable to you. Section 6109 requires you to provide vary depending on individual circumstances. The
your identification number. If you fail to provide this estimated average time is:
information in a timely manner, or provide false or
fraudulent information, you may be subject to penalties. Recordkeeping . . . . . . . . . . 22 hr., 28 min.
You’re not required to provide the information Learning about the law or the form . . . . 53 min.
requested on a form that is subject to the Paperwork Preparing, copying, assembling, and
Reduction Act unless the form displays a valid OMB sending the form to the IRS . . . . . 1 hr., 18 min.
control number. Books and records relating to a form or
If you have comments concerning the accuracy of
its instructions must be retained as long as their contents
these time estimates or suggestions for making Form 941
may become material in the administration of any Internal
simpler, we would be happy to hear from you. You can
Revenue law.
send us comments from www.irs.gov/FormComments . Or
Generally, tax returns and return information are you can send your comments to Internal Revenue
confidential, as required by section 6103. However, Service, Tax Forms and Publications Division, 1111
section 6103 allows or requires the IRS to disclose or Constitution Ave. NW, IR-6526, Washington, DC 20224.
give the information shown on your tax return to others Don’t send Form 941 to this address. Instead, see Where
as described in the Code. For example, we may Should You File? in the Instructions for Form 941.
disclose your tax information to the Department of

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