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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 941 Employer's Quarterly Federal Tax Return	Form	Modified	Available
Form 941SS-V OTC Payment Voucher	Form and Instruction	New	Available
Form 941-SS-V Payment Voucher	Form and Instruction	New	Available
Form Form 941PR-V Payment Voucher (preprinted)	Form and Instruction	New	Available
Form 941PR-V Payment Voucher	Form and Instruction	New	Available
Form 941-V Payment Voucher	Form and Instruction	New	Repair queued
Form 941-X (PR) Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso	Form	New	Available
Form 941-X Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund	Form	New	Available
Form 941-SS Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands	Form	New	Available
Form Anexo B (Form 940- Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual	Form	New	Available
Form 941-PR Planilla para la Declaracion Federal TRIMESTRAL del Patrono	Form	New	Available
Form Schedule D (Form 9 Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations	Form	New	Available
Form Schedule B (Form 9 Report of Tax Liability for Semiweekly Schedule Depositors	Form	New	Available
Summary of changes 941.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2008-11-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
39380	Forms 941, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands	Instruction	Modified
39380	Forms 941, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands	Form	Modified	Employer's Quarterly Federal Tax Return
187195	Form 941SS -V - Payment Voucher (OTC)	Form and Instruction	New	Payment Voucher
187193	Form 941SS -V -(Preprinted)	Form and Instruction	New	Payment Voucher
187191	Form 941-V (PR) (Preprinted) - Payment Voucher	Form and Instruction	New	Payment Voucher (preprinted)
187190	Form 941-V (PR) - Payment voucher (OTC)	Form and Instruction	New	Payment Voucher
187189	Form 941-V - Payment voucher (Preprinted) and (OTC)	Form and Instruction	New	Payment Voucher
187188	Form 941-X (PR) - Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso	Instruction	New
187188	Form 941-X (PR) - Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso	Form	New	Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso
187187	Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund	Instruction	New
187187	Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund	Form	New	Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund
187186	Form 941-SS - Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands	Instruction	New
187186	Form 941-SS - Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands	Form	New	Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands
187185	Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual	Instruction	New
187185	Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual	Form	New	Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual
187184	Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono	Instruction	New
187184	Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono	Form	New	Planilla para la Declaracion Federal TRIMESTRAL del Patrono
187183	Scedule D (Form 941) - Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations	Instruction	New
187183	Scedule D (Form 941) - Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations	Form	New	Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations
187174	Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors	Instruction	New
187174	Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors	Form	New	Report of Tax Liability for Semiweekly Schedule Depositors

ICR Details

OMB Control No: 1545-0029	ICR Reference No: 200811-1545-008
Status: Historical Active	Previous ICR Reference No: 200612-1545-018
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Forms 941, 941-PR , 941-SS and 941-X, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands; Schedule B
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/20/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/23/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2010	04/30/2010	04/30/2010
Responses	37,803,963	0	53,907,392
Time Burden (Hours)	318,799,502	0	361,369,544
Cost Burden (Dollars)	0	0	0

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Abstract: Form 941 is used by employers to report payments made to employees subject to income and social security/Medicare taxes and the amounts of these taxes. Form 941-PR is used by employers in Puerto Rico to report social security and Medicare taxes only. Form 941-SS is used by employers in the U.S. possessions to report social security and Medicare taxes only. Schedule B is used by employers to record their employment tax liability.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 58051	10/02/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 2729	01/22/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual	Anexo B (Form 940-PR)	Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual
Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono	941-PR	Planilla para la Declaracion Federal TRIMESTRAL del Patrono
Form 941-SS - Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands	941-SS	Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands
Form 941-V (PR) (Preprinted) - Payment Voucher	Form 941PR-V	Payment Voucher (preprinted)
Form 941-V (PR) - Payment voucher (OTC)	941PR-V	Payment Voucher
Form 941-V - Payment voucher (Preprinted) and (OTC)	941-V	Payment Voucher
Form 941-X (PR) - Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso	941-X (PR)	Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso
Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund	941-X	Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund
Form 941SS -V - Payment Voucher (OTC)	941SS-V OTC	Payment Voucher
Form 941SS -V -(Preprinted)	941-SS-V	Payment Voucher
Forms 941, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands	941	Employer's Quarterly Federal Tax Return
Scedule D (Form 941) - Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations	Schedule D (Form 941)	Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations
Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors	Schedule B (Form 941)	Report of Tax Liability for Semiweekly Schedule Depositors

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	37,803,963	53,907,392	0	175,000	-16,278,429	0
Annual Time Burden (Hours)	318,799,502	361,369,544	0	-18,853,648	-23,716,394	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The Form 941 family of forms is used by employers to report payments made to employees that are subject to income and social security/Medicare taxes and the amounts of these taxes. Pursuant to Internal Revenue Code changes (IRC sections 6011, 6205(a) 6413(a), 6302, 6402, and 6414), new Forms 941-X and 941-X(PR) were created so that taxpayers may be able to report adjustments to employment taxes. The addition of these two new forms resulted in an increase of 175,000 responses. Instead of filling out Form 941 when reporting adjustment to taxes as they do currently, taxpayers will now be able to report adjustments more accurately on a separate form dedicated to adjustments. The creation of these two forms will increase burden hours by 2,814,500. To account for forms 941-X and 941-X(PR) and to accommodate new regulations, changes were made to other information collections (ICs) under this control number. This resulted in a burden decrease by 21,668,148 hours. The net result of these changes was an overall burden reduction by 18,853,648 hours. We also adjusted the previously approved burden to differentiate the burden estimates between the various ICs approved under this control number. This eliminated double counting that had occurred previously. This resulted in a decrease of 16,278,429 responses. This correction also decreased the burden by 23,716,394 hours. The result of these various changes is a total burden decrease of over 42,000,000 hours.

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Annual Cost to Federal Government: $12,235,028

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/23/2008

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