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 . . . . . |
|
x 0.124 = |
|
|
5b |
Taxable social security tips . . . . . . .
. |
|
x 0.124 = |
|
|
5c |
Taxable Medicare wages & tips . . . .
. |
|
x 0.029 = |
|
|
5d |
Taxable wages & tips subject to
Additional Medicare Tax withholding |
|
x 0.009 = |
|
|
|
5e |
Add Column 2 from lines 5a, 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 |
|
11 |
Qualified small business payroll tax credit for
increasing research activities. Attach Form 8974 . . |
11 |
|
12 |
Total taxes after adjustments and credits.
Subtract line 11 from line 10. . |
12 |
|
13 |
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 . . |
13 |
|
14 |
Balance due. If line 12 is more than line 13,
enter the difference and see instructions . . . . . . . . . . . . .
. . . . . . . |
14 |
|
15 |
Overpayment. If line 13 is more
than line 12, enter the difference Check one: ☐
Apply to next return. ☐ Send a refund. |
▶ You MUST complete both pages
of Form 941 and SIGN it. |
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