Forms 941, 941-PR and 941-SS, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands; Schedule B

PAGER/SGML
Page 1 of 6

Userid: ________
DTD INSTR04
Fileid: I941SS.SGM (10-Oct-2006)

Leading adjust: 0%

Instructions for Form 941-SS

❏

Draft
(Init. & date)

❏

Ok to Print

11:47 - 10-OCT-2006

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for
Form 941-SS

Department of the Treasury
Internal Revenue Service

(Rev. October 2006)
For use with Form 941-SS (Rev. October 2006)
Employer’s QUARTERLY Federal Tax Return—American Samoa, Guam, the
Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands
Section references are to the Internal Revenue Code unless
otherwise noted.

What’s New
Change to filing addresses. We changed the addresses
where you should mail Form 941-SS. See Where Should
You File? on page 2.
Change to reporting negative amounts. When reporting a
negative amount as a tax adjustment on line 7, use a “minus
sign” instead of parentheses. Doing so enhances the
accuracy of our scanning software. For example, report
“-10.59” instead of “(10.50). ” However, if your software only
allows for parentheses in reporting negative amounts, you
may use them.

Reminders
Alternative signature method. Effective with returns filed
after June 2005, corporate officers or duly authorized agents
may sign Form 941-SS by rubber stamp, mechanical device,
or computer software program. For details and required
documentation, see Rev. Proc. 2005-39. You can find Rev.
Proc. 2005-39 on page 82 of Internal Revenue Bulletin
2005-28 at www.irs.gov/pub/irs-irbs/irb05-28.pdf.
Annual employment tax filing for small employers. For
calendar year 2006, certain small employers will be qualified
to file Form 944-SS, Employer’s ANNUAL Federal Tax
Return, rather than Form 941-SS, Employer’s QUARTERLY
Federal Tax Return, to report their employment taxes. The
IRS will notify those who will qualify to file the form
beginning in February 2006. For more information, get the
Instructions for Form 944-SS.
Correcting Form 941-SS. If you discover an error on a
previously filed Form 941-SS, make the correction using
Form 941-SS for the quarter in which you discovered the
error and attach Form 941c, Supporting Statement to
Correct Information. For example, in March 2006, you
discover that you underreported $10,000 in social security
and Medicare wages on your fourth quarter 2005 Form
941-SS. Correct the error by showing $1,530 (15.3% ×
$10,000) on line 7e of your 2006 first quarter Form 941-SS
and attaching a completed Form 941c. Be sure to include
the $1,530 in any required deposit.
Credit card payments. Beginning in 2006, employers can
pay the balance due shown on Form 941-SS by credit card.
However, do not use a credit card to make federal tax
deposits. For more information on paying your taxes with a
credit card, visit the IRS website at www.irs.gov and type
“e-pay” in the Search box.
Electronic filing and payment. Now, more than ever
before, businesses can enjoy the benefits of filing and
paying their federal taxes electronically. Whether you rely on
a tax professional or handle your own taxes, IRS offers you

convenient programs to make filing and paying easier.
Spend less time and worry on taxes and more time running
your business. Use e-file and Electronic Federal Tax
Payment System (EFTPS) to your benefit.
• For e-file, visit www.irs.gov for additional information.
• For EFTPS, visit www.eftps.gov or call EFTPS Customer
Service at 1-800-555-4477 (U.S. Virgin Islands only) or
720-332-3780 (toll call).
Social security wage base for 2006. Stop withholding
social security tax after an employee reaches $94,200 in
taxable wages during 2006. (There is no limit on the amount
of wages subject to Medicare tax.)
Where can you get telephone help? You can call the IRS
toll free at 1-800-829-4933 (U.S. Virgin Islands only) or
non-toll free at 215-516-2000 to order tax deposit coupons
(Form 8109) and for answers to your questions about
completing Form 941-SS, tax deposit rules, or obtaining an
employer identification number (EIN). Or visit the IRS
website at www.irs.gov and type “Employment Tax” in the
Search box.

General Instructions:
Understanding Form 941-SS
Purpose of Form 941-SS
Use Form 941-SS, Employer’s QUARTERLY Federal Tax
Return, to report social security and Medicare taxes for
workers in American Samoa, Guam, the Commonwealth of
the Northern Mariana Islands, and the U.S. Virgin Islands.
Pub. 80 (Circular SS), Federal Tax Guide for Employers
in the U.S. Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands, explains
the requirements for withholding, depositing, and paying
social security and Medicare taxes. It explains the forms you
must give your employees, those your employees must give
you, and those you must send to the IRS. See Pub. 15-A,
Employer’s Supplemental Tax Guide, for specialized
employment tax information supplementing the basic
information provided in Pub. 80 (Circular SS).

Who Must File Form 941-SS?
Generally, you must file a return for the first quarter in which
you pay wages subject to social security and Medicare
taxes, and for each quarter thereafter until you file a final
return. Use Form 941-SS if your principal place of business
is in American Samoa, Guam, the Commonwealth of the
Northern Mariana Islands, or the U.S. Virgin Islands, or if
you have employees who are subject to income tax
withholding for these jurisdictions.

Cat. No. 35530F

Page 2 of 6

Instructions for Form 941-SS

11:47 - 10-OCT-2006

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Where Can You Obtain Forms?

Once you have filed a return, a preaddressed Form
941-SS will be sent to you every 3 months. You must file a
return each quarter, even if you have no tax liability to report
unless you file a final return. However, see Seasonal
Employers and Agricultural and Household Employers
below. If the form fails to reach you, request one in time to
file. See Where Can You Obtain Forms? on page 2.

See Pub. 80 (Circular SS) for information on ordering IRS
forms by telephone, mail, or online. You may also be able to
get some IRS forms at the addresses listed below.
American Samoa. Department of Treasury, Income Tax
Division, Government of American Samoa, Executive Office
Bldg., First Floor, Pago Pago, AS 96799.
Guam. Department of Revenue and Taxation,
Government of Guam, Building 13-1 Mariner Avenue, Tiyjan
Barrigada, GU 96913.
Commonwealth of the Northern Mariana Islands.
Administrator, CNMI Social Security System, Saipan,
MP 96960.
U.S. Virgin Islands. V.I. Bureau of Internal Revenue,
9601 Estate Thomas, Charlotte Amalie, St. Thomas, VI
00802.

Seasonal Employers
Seasonal employers are not required to file for quarters
when they regularly have no tax liability because they have
paid no wages. To alert the IRS that you will not have to file
a return for one or more quarters during the year, check the
box in line 17 on Form 941-SS. The IRS will mail you two
Forms 941-SS once a year after March 1. The preprinted
information will not include the date the quarter ended. You
must enter the date the quarter ended when you file the
return. The IRS generally will not inquire about unfiled
returns if at least one taxable return is filed each year.
However, you must check the box in line 17 on every
quarterly return you file. Otherwise, the IRS will expect a
return to be filed for each quarter.

How Should You Complete
Form 941-SS?

Final Return

Preprinted Name and Address Information

If you go out of business or stop paying wages, file a final
return. Be sure to check the box in line 16 and enter the
date that you last paid wages. See Terminating a business
in the Form W-3SS instructions for information on the earlier
due dates for the expedited furnishing and filing of Forms
W-2AS, W-2GU, W-2CM, or Forms W-2VI when a final
Form 941-SS is filed.

If your preprinted name, EIN, or address information on
Form 941-SS is not correct, cross it out and type or print the
correct information. However, do not change any of the
preprinted information on your Form 941-V(SS), Payment
Voucher.

Employer Identification Number (EIN)

Agricultural and Household
Employers

If you are liable for social security and Medicare taxes and
have not applied for an EIN, file Form SS-4, Application for
Employer Identification Number. Do not show your social
security number on forms calling for an EIN. You may also
apply for an EIN by calling 1-800-829-4933 (U.S. Virgin
Islands only) or 215-516-6999 (not toll free).

Agricultural employers. Agricultural wages must be
reported on Form 943, Employer’s Annual Federal Tax
Return for Agricultural Employees, not on Form 941-SS.

If you do not have an EIN by the time a return is due,
write “Applied For” and the date you applied in the space
shown for the number. If you do not have a number by the
time a tax deposit is due, send your payment to the Internal
Revenue Service Center where you file your returns. Make it
payable to the “United States Treasury” and show on it your
name (as shown on Form SS-4), address, kind of tax, period
covered, and date you applied for an EIN. For more
information about EINs, see Pub. 583, Starting a Business
and Keeping Records.

Household employers. Employers who report wages for
household employees should see Pub. 80 (Circular SS) and
Pub. 926, Household Employer’s Tax Guide.

When Must You File?
File Form 941-SS for each quarter of the calendar year, as
follows:
Quarter

Due Date

Jan.-Feb.-Mar.
Apr.-May-June
July-Aug.-Sept.
Oct.-Nov.-Dec.

Always make certain that the EIN on the form you file

April 30
July 31
Oct. 31
Jan. 31

TIP matches the EIN assigned to your business by the
IRS. Filing a Form 941-SS with an incorrect EIN or
using the EIN of another business may result in penalties
and delays in processing your return.

If you made deposits on time in full payment of the taxes
for a quarter, you have 10 more calendar days after the
above due dates to file your return for that quarter. If the due
date for filing a return falls on a Saturday, Sunday, or legal
holiday, you may file the return on the next business day.

Check the Box for the Quarter
Under Report for this Quarter... at the top of the form, check
the appropriate box of the quarter for which you are filing.
Make sure that the quarter checked is the same as shown
on any attached Schedule B (Form 941), Report of Tax
Liability for Semiweekly Schedule Depositors.

Where Should You File?
Mail Form 941-SS to:
Form 941-SS with payment

Internal Revenue Service
P. O. Box 105273
Atlanta, GA 30348-5273

Form 941-SS without payment

Internal Revenue Service
P.O. Box 409101
Ogden, UT 84409

Completing and Filing the Form
Make entries on Form 941-SS as follows to enable accurate
scanning and processing.
• Use 12-point Courier font (if possible) for all entries if you
are typing or using a computer to fill out your form.
• Omit dollar signs and decimal points. Commas are
optional. (Report dollars to the left of the preprinted decimal
point and cents to the right of it.)

-2-

Page 3 of 6

Instructions for Form 941-SS

11:47 - 10-OCT-2006

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

• Leave blank any data field (except lines 1 or 8) with a

See section 8 of Pub. 80 (Circular SS) for information and
rules concerning federal tax deposits and to determine your
status as a monthly or semiweekly depositor.

value of zero.
• Use a minus sign to show negative amounts.
• Enter your name and EIN on all pages and attachments.
(Filers using the IRS-preaddressed Form 941-SS are not
required to enter their name and EIN on page 2.)

Specific Instructions:

Penalties and Interest

Part 1: Answer these questions for
this quarter.

There are penalties for filing a return late and paying or
depositing taxes late, unless reasonable cause is shown for
the delay. If you file or pay late, attach an explanation to
your return.
There are also penalties for failure to (a) furnish Forms
W-2AS, W-2GU, W-2CM, or W-2VI to employees and file
copies with the SSA and (b) deposit taxes when required. In
addition, there are penalties for willful failure to file returns
and pay taxes when due and for filing false returns or
submitting bad checks. See Pub. 80 (Circular SS) for
additional information.
Interest is charged on taxes paid late at the rate set by
law.

1. Number of employees who received
wages, tips, or other compensation for the
pay period including:
Tell us the number of employees on your payroll for the pay
period including March 12, June 12, September 12, or
December 12 for the quarter indicated at the top of the
return. Do not include:
• household employees,
• employees in nonpay status for the pay period,
• pensioners, or
• active members of the Armed Forces.

A trust fund recovery penalty may apply if social
security and Medicare taxes that must be withheld
CAUTION are not withheld or are not paid. Under this penalty,
certain officers or employees of a corporation, employees of
a sole proprietorship, or certain members or employees of a
partnership become personally liable for payment of the
taxes and are penalized an amount equal to the unpaid
taxes. See section 8 of Pub. 80 (Circular SS) for details.

!

If you enter “250” or more on line 1, you must file Forms
W-2 electronically. For details, call the SSA at
1-800-772-6270 or visit SSA’s Employer Reporting
Instructions and Information website at www.socialsecurity.
gov/employer.

4. If no wages, tips, and other
compensation are subject to social security
or Medicare tax . . .

Reconciliation of Forms 941-SS and W-3SS
Certain amounts reported on your four quarterly Forms
941-SS for 2006 should agree with your Form W-2AS,
W-2GU, W-2CM, or W-2VI totals reported on your 2006
Form W-3SS, Transmittal of Wage and Tax Statements, or
with information filed with the SSA on equivalent electronic
reports. The amounts that should agree are: social security
wages, social security tips, and Medicare wages and tips. If
the totals do not agree, the IRS or SSA may require you to
explain any differences and correct any errors.

If no wages, tips, and compensation are subject to social
security or Medicare tax, check the box on line 4. If this
question does not apply to you, leave the box blank. For
more information about exempt wages, see section 12 of
Pub. 80 (Circular SS) and section 4 of Pub. 15-A,
Employer’s Supplemental Tax Guide.
If you are a government employer, wages that you
pay are not automatically exempt from social security
CAUTION and Medicare taxes. Your employees may be
covered by law or by a voluntary Section 218 Agreement
with SSA. For more information, see Pub. 963,
Federal-State Reference Guide.

Adjustment of Tax on Tips

!

If, by the 10th of the month after the month you received an
employee’s report on tips, you do not have enough
employee funds available to withhold the employee’s share
of social security and Medicare taxes, you no longer have to
collect it. Report the entire amount of these tips on lines 5b
(Taxable social security tips) and 5c (Taxable Medicare
wages and tips). Include as an adjustment on line 7c the
total uncollected employee share of the social security and
Medicare taxes.

5. Taxable social security and Medicare
wages and tips
5a. Taxable social security wages. Report the total
wages, sick pay, or fringe benefits subject to social security
taxes that you paid to your employees during the quarter.
For this purpose, sick pay includes payments made by an
insurance company to your employees for which you
received timely notice from the insurance company. See
section 6 in Pub. 15-A for more information about sick pay
reporting.

When and How Must You Deposit
Your Taxes?
You may pay the taxes with Form 941-SS instead of
depositing if your total taxes after adjustments for the
quarter (line 8) are less than $2,500 and you pay in full with
a timely filed return.
If your total taxes after adjustments (line 8) are $2,500 or
more for the quarter, you must deposit your tax liabilities at
an authorized financial institution with Form 8109, Federal
Tax Deposit Coupon, or by using the Electronic Federal Tax
Payment System (EFTPS).
To get more information or to enroll in EFTPS, you may
call 1-800-555-4477 (or 720-332-3780 for territories unable
to use the toll-free numbers) or visit the EFTPS website at
www.eftps.gov.

Enter the amount before deductions. Do not include tips
on this line. For information on types of wages subject to
social security taxes, see section 4 of Pub. 80 (Circular SS).
The rate of social security tax on taxable wages is 6.2
percent (.062) each for the employer and employee or 12.4
percent (.124) for both. Stop paying social security tax on
and reporting an employee’s wages on line 5a when the
employee’s taxable wages (including tips) reach $94,200
during 2006. However, continue to withhold Medicare taxes
for the whole year on wages and tips even when the social
security wage base of $94,200 has been reached.

-3-

Page 4 of 6

Instructions for Form 941-SS

11:47 - 10-OCT-2006

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

x

7b. Current quarter’s sick pay. Enter the adjustment
for the employee share of social security and Medicare
taxes that were withheld by your third-party sick pay payer.
7c. Current quarter’s adjustments for tips and
group-term life insurance. Enter adjustments for:
• any uncollected employee share of social security and
Medicare taxes on tips and
• the uncollected employee share of social security and
Medicare taxes on group-term life insurance premiums paid
for former employees.
Prior period adjustments. Use lines 7e and 7g to adjust
amounts reported on previous returns. If you need to
report both an increase and a decrease for the same line,
show only the difference.
Adjustments you report here change your tax liability and
your tax deposits. You will have to take these adjustments
into account on line 15 as Tax liability: Month 1; Month 2;
Month 3 or on Schedule B (Form 941). You must explain
any prior period adjustments that you make on Form
941c, Supporting Statement to Correct Information, or in an
equivalent statement.
Form 941c is not an amended return but is a statement
providing the necessary information and certifications for
adjustments shown on lines 7e and 7g. Do not file Form
941c separately from Form 941-SS. See also section 9 of
Pub. 80 (Circular SS).
7e. Prior quarters’ social security and Medicare
taxes. Enter adjustments for prior quarters’ social security
and Medicare taxes. For example, if you made a mistake
when reporting social security and Medicare taxes on
previously filed Forms 941-SS, adjust it here. If you need to
report both an underpayment and an overpayment, show
only the net difference.

line 5a (column 1)
.124
line 5a (column 2)

5b. Taxable social security tips. Enter all tips your
employees reported to you during the quarter until the total
of the tips and wages for an employee reach $94,200 in
2006. Do this even if you were unable to withhold the
employee tax of 6.2%.
An employee must report cash tips to you, including tips
you paid the employee for charge customers, totaling $20 or
more in a month by the 10th of the next month. Employees
may use Form 4070, Employee’s Report of Tips to
Employer, or submit a written statement or electronic tip
record.
Do not include allocated tips on this line. Instead, report
them on Form 8027, Employer’s Annual Information Return
of Tip Income and Allocated Tips. Allocated tips are not
reportable on Form 941-SS and are not subject to social
security or Medicare taxes.
x

line 5b (column 1)
.124
line 5b (column 2)

5c. Taxable Medicare wages and tips. Report all
wages, tips, sick pay, and taxable fringe benefits that are
subject to Medicare tax. Unlike social security wages, there
is no limit on the amount of wages subject to Medicare tax.
Include all tips your employees reported during the
quarter, even if you were unable to withhold the employee
tax of 1.45%.
x

line 5c (column 1)
.029
line 5c (column 2)

If you are adjusting an employee’s social security

TIP wages, social security tips, or Medicare wages and

For more information, see section 4 of Pub. 80
(Circular SS).
5d. Total social security and Medicare taxes. Add
social security tax, social security tips tax, and Medicare tax.

tips for a prior year, you must also file Form W-2c,
Corrected Wage and Tax Statement, and Form W-3c,
Transmittal of Corrected Wage and Tax Statements.
7g. Special additions to social security and
Medicare. This line is reserved for employers with special
circumstances. Use this line only if the IRS has sent you a
notice instructing you to do so. You must attach Form 941c
explaining the tax increase.
7h. Total adjustments. Combine all adjustments
shown on lines 7a through 7g and enter the result here.

line 5a(column 2)
line 5b(column 2)
+ line 5c(column 2)
line 5d

7. TAX ADJUSTMENTS
Enter tax amounts on lines 7a – 7g that result from current
or prior period adjustments. Use a minus sign to show an
adjustment that decreases the total taxes shown on line 5d.
Do not enter an amount on line 7g unless the IRS has sent
you a notice instructing you to do so.
Current period adjustments. In certain cases, you must
adjust the amounts you reported as social security and
Medicare taxes in column 2 of lines 5a, 5b, and 5c to figure
your correct tax liability for this quarter’s Form 941-SS. See
section 8 of Pub. 80 (Circular SS). Do not attach Form 941c
or an equivalent statement for current period adjustments.
If you need to adjust any amount previously reported on
lines 7a – 7c, use line 7e to report the adjustment and attach
Form 941c or an equivalent statement with an explanation.
7a. Current quarter’s fractions of cents. Enter
adjustments for fractions of cents (due to rounding) relating
to the employee share of social security and Medicare taxes
withheld. The employee share (one-half) of amounts shown
in column 2 of lines 5a – 5c may differ slightly from amounts
actually withheld from employees’ paychecks due to the
rounding of social security and Medicare taxes based on
statutory rates.

8.

Total taxes after adjustments

Combine the amounts shown on lines 5d and 7h and enter
the result here.
• If line 8 is less than $2,500, you may pay the full amount
with a timely filed return because you were not required to
deposit. See section 8 of Pub. 80 (Circular SS) for
information and rules about federal tax deposits.
• If line 8 is $2,500 or more, you must deposit your tax
liabilities by using the Electronic Federal Tax Payment
System (EFTPS) or at an authorized financial institution with
Form 8109. The amount shown on line 8 must equal the
“Total liability for quarter” shown on Form 941-SS, line 15 or
the “Total liability for the quarter” shown on Schedule B
(Form 941).
If you are a semiweekly depositor, you must
complete Schedule B (Form 941). If you fail to
CAUTION complete and submit Schedule B (Form 941), IRS
will assert deposit penalties based on available information.

!

11. Total deposits for this quarter...
Enter your deposits for this quarter, including any deposits
that you were required to make to cover prior period

-4-

Page 5 of 6

Instructions for Form 941-SS

11:47 - 10-OCT-2006

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

liabilities resulting from adjustments shown on line 7. Also
include in the amount shown any overpayment from a
previous period that you applied to this return.

Note that your total tax liability for the quarter must equal
your total taxes shown on line 8. If it does not, your tax
deposits and payments may not be counted as timely.
You are a monthly schedule depositor for the calendar
year if the amount of your Form 941-SS taxes reported for
the lookback period is $50,000 or less. The lookback
period is the four consecutive quarters ending on June 30
of the prior year. For 2006, the lookback period begins July
1, 2004, and ends June 30, 2005. For details on the deposit
rules, see section 8 of Pub. 80 (Circular SS).

12. Balance Due
If line 8 is more than line 11, write the difference in line 12.
Otherwise, see Overpayment below.
You do not have to pay if line 12 is under $1. Generally,
you should have a balance due only if your total taxes for
the quarter (line 8) are less than $2,500. (However, see
section 8 of Pub. 80 (Circular SS) for information about
payments made under the accuracy of deposits rule.)

13. Overpayment

This is a summary of your monthly tax liability, not a
summary of deposits you made. If you do not
CAUTION properly report your liabilities when required or if you
are a semiweekly schedule depositor and report your
liabilities on line 15 instead of on Schedule B (Form 941),
you may be assessed an “averaged” failure-to-deposit (FTD)
penalty. See Deposit Penalties in section 8 of Pub. 80
(Circular SS) for more information.
• If you reported more than $50,000 of taxes for the
lookback period (see above), you are a semiweekly
schedule depositor. Check the appropriate box on line 15.
You must complete the Schedule B (Form 941) and
submit it with your Form 941-SS. Do not use Schedule B
(Form 941) if you are a monthly schedule depositor.
Reporting adjustments on line 15. If your tax liability for
any month is negative (for example, if you are adjusting an
overreported liability in a prior period), do not enter a
negative amount for the month. Instead, enter zero for the
month and subtract that negative amount from your tax
liability for the next month.

If line 11 is more than line 8, write the amount in line 13.
Never make an entry in both lines 12 and 13.

Here’s an example:

!

You may pay the amount shown on line 12 using EFTPS
or credit card. Do not use a credit card to pay taxes that
were required to be deposited. For more information on
paying your taxes with a credit card, visit the IRS website at
www.irs.gov and type “e-pay” in the Search box.
If you pay by EFTPS or credit card, file your return using
the “Without a payment” address on page 2 under Where
Should You File? and do not file Form 941-V(SS), Payment
Voucher.
If line 8 is $2,500 or more and you have deposited all
taxes when due, line 12 (“Balance due”) should be zero.

!

CAUTION

If you do not deposit as required and, instead, pay
the taxes with Form 941-SS, you may be subject to a
penalty.

If you deposited more than the correct amount for a
quarter, you can choose to have us either refund the
overpayment or apply it to your next return. Check the
appropriate box in line 13. If you do not check either box, we
will automatically refund the overpayment. We may apply
your overpayment to any past due tax account that is shown
in our records under your EIN.

Pine Co. discovered on February 6, 2006, that it
overreported social security tax on a prior quarter return by
$2,500. Its Form 941-SS taxes for the first quarter of 2006
were:
January =
February =
March =

If line 13 is under $1, we will send a refund or apply it to
your next return only if you ask us in writing to do so.

$2,000
$2,000
$2,000

Pine Co. reports liabilities on line 15 as follows:
Month 1 =
Month 2 =
Month 3 =
Total

Fill out both pages.
You must fill out both pages of Form 941-SS and sign it on
the second page. Failure to do so may delay processing of
your return.

$2,000
0
+$1,500
$3,500

The prior period adjustment ($2,500) offsets the $2,000
liability for February and the excess $500 must be used to
offset March liabilities. Since the error was not discovered
until February, it does not affect January liabilities reported
in Month 1 of line 15.

Part 2: Tell us about your deposit
schedule and tax liability for this
quarter.

Using the above example, if the overreported social
security tax on a prior quarter return had been $10,000, Pine
Co. could carry the excess negative adjustment of $6,000
($10,000 − $2,000 − $2,000) to the next quarter. Pine Co.
would only report $4,000 of the adjustment on line 7e
because line 8 must equal the total shown in line 15.
See Form 941c for reporting requirements and information
on the option of filing a claim for refund of overpaid
employment taxes.

15. Check one:
• If line 8 is less than $2,500, check the appropriate box in
line 15 and go to Part 3.

• If you reported $50,000 or less in taxes during the

lookback period (see below), you are a monthly schedule
depositor unless the $100,000 Next-Day Deposit Rule
discussed in section 8 of Pub. 80 (Circular SS) applies.
Check the appropriate box on line 15 and fill out your tax
liability for each month in the quarter.

Part 3: Tell us about your business.

+ Month 1
+ Month 2
+ Month 3
Total tax liability for quarter

In Part 3, answer only those questions that apply to your
business. If a question does not apply, leave it blank and go
to Part 4.

-5-

Page 6 of 6

Instructions for Form 941-SS

11:47 - 10-OCT-2006

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

16. If your business has closed . . .

Part 5: Sign here—
Who Must Sign the Form 941-SS?

If you go out of business or stop paying wages, you must file
a final return. To tell IRS that a particular Form 941-SS is
your final return, check the box on line 16 and enter the date
you last paid wages in the space provided.

Form 941-SS must be signed as follows.
• Sole proprietorship — The individual who owns the
business.
• Corporation (including an LLC treated as a
corporation) — The president, vice president, or other
principal officer.
• Partnership (including an LLC treated as a
partnership) or unincorporated organization — A
responsible and duly authorized member or officer having
knowledge of its affairs.
• Single member limited liability company (LLC) treated
as a disregarded entity — The owner of the limited liability
company (LLC).
• Trust or estate — The fiduciary.
Form 941-SS may also be signed by a duly authorized
agent of the taxpayer if a valid power of attorney has been
filed.

17. If you are a seasonal employer . . .
If you hire employees seasonally — such as for summer or
winter only — check the box on line 17. Checking the box
tells IRS not to expect four Forms 941-SS from you
throughout the year because you have not paid wages
regularly.
IRS will mail you two forms once a year after March 1.
Generally, we will not ask about unfiled returns if you file at
least one return showing tax due each year. However, you
must check the box every time you file a Form 941-SS.
Also, when you fill out Form 941-SS, be sure to check the
box on the top of the form that corresponds to the quarter
reported.

Part 4: May we speak with your
third-party designee?

Part 6: For PAID preparers only
(optional)

If you want to allow an employee, a paid tax preparer, or
another person to discuss your Form 941-SS with the IRS,
check the “Yes” box in Part 4. Then tell us the name, phone
number, and the five-digit personal identification number
(PIN) of the specific person to speak with — not the name of
the firm who prepared your tax return. The designee may
choose any five numbers as his or her PIN.
By checking “Yes,” you authorize the IRS to talk to the
person you named (your designee) about any questions we
may have while we process your return. You also authorize
your designee to:
• give us any information that is missing from your return,
• call us for information about processing your return, and
• respond to certain IRS notices that you have shared with
your designee about math errors and return preparation.
IRS will not send notices to your designee.
You are not authorizing your designee to bind you to
anything (including additional tax liability) or to otherwise
represent you before the IRS. If you want to expand your
designee’s authorization, see Pub. 947, Practice Before the
IRS and Power of Attorney.
The authorization will automatically expire one year from
the due date (without regard to extensions) for filing your
Form 941-SS. If you or your designee want to terminate the
authorization, write to the IRS office for your locality using
the “Without a payment” address under Where Should You
File? on page 2.

You may complete Part 6 if you were paid to prepare Form
941-SS and are not an employee of the filing entity. Sign in
the space provided and give the filer a copy of the return in
addition to the copy to be filed with the IRS. Do not complete
Part 6 if you are filing the return as a reporting agent and
have a valid Form 8655, Reporting Agent Authorization, on
file with the IRS.

How to Order Forms and Publications
from the IRS
Call 1-800-829-3676 (U.S. Virgin Islands only), or
215-516-2000 (toll call).
Visit the IRS website at www.irs.gov.

-6-