430121
                                                                                                                                               OMB No. 1545-0035
                                      Employer’s Annual Federal Tax Return 
Form  943                                               for Agricultural Employees
Department of the Treasury        ▶ Go to www.irs.gov/Form943 for instructions and the latest information.                                     2021
Internal Revenue Service 
                            Name (as distinguished from trade name)                                   Employer identification number (EIN)

                            Trade name, if any                                                                                               If address is 
      Type                                                                                                                                   different from 
      or                    Address (number and street)                                                                                      prior return, 
      Print                                                                                                                                  check here  ▶
                            City or town, state or province, country, and ZIP or foreign postal code

                            If you don’t have to file returns in the future, check here  .              .  . . . . . . .  .               .  . . .     .   . ▶

1     Number of agricultural employees employed in the pay period that includes March 12, 2021                       . ▶                  1 
                                                                                                                                             *Include taxable qualified 
2     Wages subject to social security tax* .           . . .       . . . . . . .                   .   2                                    sick and family leave wages 
                                                                                                                                             for leave taken after March 
                                                                                                                                             31, 2021, on line 2. Use lines 
a     Qualified sick leave wages*  .           . . .    . . .       . . . . . . .                   .   2a                                   2a and 2b only to report 
                                                                                                                                             wages paid for leave taken 
b     Qualified family leave wages*  .           . .    . . .       . . . . . . .                   .   2b                                   before April 1, 2021.
3     Social security tax (multiply line 2 by 12.4% (0.124))  .         . . . . .                   . . .  . . . . . . .                  3
a     Social security tax on qualified sick leave wages (multiply line 2a by 6.2% (0.062))  .                  . . . . .                  3a
b     Social security tax on qualified family leave wages (multiply line 2b by 6.2% (0.062))  .                  . . . .                  3b
4     Wages subject to Medicare tax              . .    . . .       . . . . . . .                   .   4 
5     Medicare tax (multiply line 4 by 2.9% (0.029))  .             . . . . . . .                   . . .  . . . . . . .                  5 
6     Wages subject to Additional Medicare Tax withholding  .             . . . .                   .   6
7     Additional Medicare Tax withholding (multiply line 6 by 0.9% (0.009))  .                        . .  . . . . . . .                  7
8     Federal income tax withheld              . . .    . . .       . . . . . . .                   . . .  . . . . . . .                  8
9     Total taxes before adjustments. Add lines 3, 3a, 3b, 5, 7, and 8  .       .                   . . .  . . . . . . .                  9
10    Current year’s adjustments  .            . . .    . . .       . . . . . . .                   . . .  . . . . . . .                  10
11    Total taxes after adjustments (line 9 as adjusted by line 10)         . . .                   . . .  . . . . . . .                  11
12a   Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 .               .                  12a
b     Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before 
      April 1, 2021 .       . . . . .          . . .    . . .       . . . . . . .                   . . .  . . . . . . .                  12b
c     Nonrefundable portion of employee retention credit  .             . . . . .                   . . .  . . . . . . .                  12c
d     Nonrefundable  portion  of  credit  for  qualified  sick  and  family  leave  wages  for  leave  taken  after 
      March 31, 2021  .       . . . .          . . .    . . .       . . . . . . .                   . . .  . . . . . . .                  12d
e     Nonrefundable portion of COBRA premium assistance credit .              . .                   . . .  . . . . . . .                  12e
f     Number of individuals provided COBRA premium assistance 
g     Total nonrefundable credits. Add lines 12a, 12b, 12c, 12d, and 12e .                          . . .  . . . . . . .                  12g
13    Total taxes after adjustments and nonrefundable credits. Subtract line 12g from line 11  .                   . . .                  13
                                    You MUST complete all three pages of Form 943 and SIGN it.                                                             Next   ■▶
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.                             Cat. No. 11252K                   Form 943 (2021) 

                                                                                                                            430221
Form 943 (2021)                                                                                                                 Page  2 
14a Total deposits for 2021, including overpayment applied from a prior year and Form 943-X  .        .   .      14a
  b Reserved for future use  . .  .           . .   . . . .    . . . . . . .       . . .     . . . .  .   .      14b
  c Reserved for future use  . .  .           . .   . . . .    . . . . . . .       . . .     . . . .  .   .      14c
  d Refundable  portion  of  credit  for  qualified  sick  and  family  leave  wages  for  leave  taken  before
    April 1, 2021 .   . . . .  .  .           . .   . . . .    . . . . . . .       . . .     . . . .  .   .      14d
  e Refundable portion of employee retention credit  .         . . . . . . .       . . .     . . . .  .   .      14e
  f Refundable  portion  of  credit  for  qualified  sick  and  family  leave  wages  for  leave  taken  after 
    March 31, 2021 .    . . .  .  .           . .   . . . .    . . . . . . .       . . .     . . . .  .   .      14f
  g Refundable portion of COBRA premium assistance credit  .         . . . .       . . .     . . . .  .   .      14g
  h Total deposits and refundable credits. Add lines 14a, 14d, 14e, 14f, and 14g       .     . . . .  .   .      14h
  i Total advances received from filing Form(s) 7200 for the year .    . . .       . . .     . . . .  .   .      14i
  j Total deposits and refundable credits less advances. Subtract line 14i from line 14h  .      . .  .   .      14j
15  Balance due. If line 13 is more than line 14j, enter the difference and see the instructions  .   .   ▶        15
16  Overpayment. If line 14j is more than line 13, enter the difference  . .       . . .     . . . .  .   ▶        16
    Check one:        Apply to next return.           Send a refund.
• All filers: If line 13 is less than $2,500, don’t complete line 17 or Form 943-A.
• Semiweekly schedule depositors: Complete Form 943-A and check here  .            . . .     . . . .  .   .      . .  . . . . . ▶
• Monthly schedule depositors: Complete line 17 and check here  .      . . .       . . .     . . . .  .   .      . .  . . . . . ▶

17  Monthly Summary of Federal Tax Liability. (Don’tcomplete if you were a semiweekly schedule depositor.)
                      Tax liability for month                        Tax liability for month                          Tax liability for month

  A January  .    . .                               F June  .  . . .                           K November  .       .
  B February .    . .                               G July  .  . . .                           L December  .       .

  C March       . . .                               H August  .  . .                           M Total liability 
  D April  .    . . .                               I September  . .                             for year 
                                                                                                 (add lines   A 
  E May  .      . . .                               J October  . . .                             through L)  .     .  

18  Qualified  health  plan  expenses  allocable  to  qualified  sick  leave  wages  for  leave  taken  before 
    April 1, 2021 .   . . . .  .  .           . .   . . . .    . . . . . . .       . . .     . . . .  .   .        18
19  Qualified  health  plan  expenses  allocable  to  qualified  family  leave  wages  for  leave  taken  before 
    April 1, 2021  .  . . . .  .  .           . .   . . . .    . . . . . . .       . . .     . . . .  .   .        19
20  Qualified wages for the employee retention credit          . . . . . . .       . . .     . . . .  .   .        20
21  Qualified health plan expenses for the employee retention credit .   . .       . . .     . . . .  .   .        21
                               You MUST complete all three pages of Form 943 and SIGN it.                                     Next ■▶
                                                                                                                          Form 943 (2021) 

                                                                                                                                                 430321
Form 943 (2021)                                                                                                                                        Page  3 
22   Qualified sick leave wages for leave taken after March 31, 2021  .     . . . . . . . . .                           . .   22
23   Qualified health plan expenses allocable to qualified sick leave wages reported on line 22  .                      . .   23
24   Amounts under certain collectively bargained agreements allocable to qualified sick leave wages 
     reported on line 22 .       . . .     . . . . . . . . . .          . . . . . . . . . . .                           . .   24
25   Qualified family leave wages for leave taken after March 31, 2021  .     . . . . . . . .                           . .   25
26   Qualified health plan expenses allocable to qualified family leave wages reported on line 25                       . .   26
27   Amounts under certain collectively bargained agreements allocable to qualified family leave wages 
     reported on line 25 .       . . .     . . . . . . . . . .          . . . . . . . . . . .                           . .   27
28   If you're eligible for the employee retention credit in the third quarter solely because your business
     is a recovery startup business, enter the total of any amounts included on lines 12c and 14e for 
     the third quarter .    .    . . .     . . . . . . . . . .          . . . . . . . . . . .                           . .   28
29   If  you're  eligible  for  the  employee  retention  credit  in  the  fourth  quarter  solely  because  your 
     business is a recovery startup business, enter the total of any amounts included on lines 12c and 
     14e for the fourth quarter .    .     . . . . . . . . . .          . . . . . . . . . . .                           . .   29
                Do you want to allow another person to discuss this return with the IRS? See the separate instructions.   Yes. Complete the following. No.
Third- 
Party  
Designee        Designee’s                                 Phone                          Personal identification 
                name ▶                                     no. ▶                          number (PIN) ▶
                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.
Sign 
Here            Signature ▶                                                               Date ▶
                Print your name and title ▶
                Print/Type preparer’s name         Preparer’s signature             Date
Paid                                                                                                                      Check          if  PTIN
                                                                                                                          self-employed
Preparer                    ▶                                                                                             Firm’s EIN  ▶
                Firm’s name 
Use Only        Firm’s address ▶                                                                                          Phone no.
                                                                                                                                             Form 943 (2021) 

                                  430621

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Form 943-V,  
Payment Voucher

Purpose of Form                                                          Specific Instructions
Complete Form 943-V if you’re making a payment with                      Box 1—Employer identification number (EIN). If you 
Form 943. 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 943                                            Form 943, write “Applied For” and the date you applied in 
To avoid a penalty, make your payment with your 2021                     this entry space.
Form 943 only if:                                                        Box 2—Amount paid. Enter the amount paid with     
• Your total taxes after adjustments and nonrefundable                   Form 943.
credits for the year (Form 943, line 13) are less than                   Box 3—Name and address. Enter your name and 
$2,500 and you’re paying in full with a timely filed return,             address as shown on Form 943.
or
                                                                         • Enclose your check or money order made payable to 
• You’re a monthly schedule depositor making a payment                   “United States Treasury.” Be sure to enter your EIN, 
in accordance with the Accuracy of Deposits Rule. See                    “Form 943,” and “2021” on your check or money order. 
section 7 of Pub. 51 for details. In this case, the amount               Don’t send cash. Don’t staple Form 943-V or your 
of your payment may be $2,500 or more.                                   payment to Form 943 (or to each other).
   Otherwise, you must make deposits by electronic funds                 • Detach Form 943-V and send it with your payment and 
transfer. See section 7 of Pub. 51 for deposit instructions.             Form 943 to the address provided in the Instructions for 
Don’t use Form 943-V to make federal tax deposits.                       Form 943.
       Use Form 943-V when making any payment with                       Note: You must also complete the entity information 
CAUTION
▲!     Form 943. However, if you pay an amount with                      above line 1 on Form 943.
       Form 943 that should’ve been deposited, you may  
be subject to a penalty. See Deposit Penalties   in section 7 
of Pub. 51.

                                                                                                                                                     ✃
            ▼ Detach Here and Mail With Your Payment and Form 943. ▼
✁

Form  943-V                                           Payment Voucher                                                                     OMB No. 1545-0035
Department of the Treasury       ▶
Internal Revenue Service                              Don’t staple this voucher or your payment to Form 943.                                      2021
1  Enter your employer identification number (EIN).                                                                 ▶                     Dollars    Cents
                                                    2 Enter the amount of your payment  . . .
                                                      Make your check or money order payable to “United States Treasury”

                                                    3 Enter your business name (individual name if sole proprietor).

                                                      Enter your address.

                                                      Enter your city or town, state or province, country, and ZIP or foreign postal code.