Form 944-SS Employer's ANNUAL Federal Tax Return (American Samoa, Gu

Form

944-SS for 2009:

Employer’s ANNUAL Federal Tax Return
American Samoa, Guam, the Commonwealth of the Northern
(77) Mariana Islands, and the U.S. Virgin Islands

OMB No. 1545-2010

Department of the Treasury — Internal Revenue Service

Who Must File Form 944-SS

—
Employer identification number (EIN)

You must file annual
Form 944-SS instead of
filing quarterly Forms
941-SS only if the IRS
notified you in writing.

Name (not your trade name)
Trade name (if any)
Address
Number

City

Street

Suite or room number

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State

ZIP code

Read the separate instructions before you complete Form 944-SS. Type or print within the boxes.
Part 1: Answer these questions for 2008.
1

2

3 If no wages, tips, and other compensation are subject to social security or Medicare tax
4 Taxable social security and Medicare wages and tips:
Column 1

Check and go to line 6.

4d

.

Column 2

4a Taxable social security wages

 .124 =

4b Taxable social security tips

 .124 =

4c Taxable Medicare wages & tips

 .029 =

4d Total social security and Medicare taxes (Column 2, lines 4a + 4b + 4c = line 4d)

5

3

6 Current year’s adjustments (see instructions)

6

7 Total taxes after adjustments. Combine lines 4d and 6

7

.
.

8
9

.
.

10 Total deposits for this year, including overpayment applied from a prior year and
10
overpayment applied from Form 944-X or Form 941-X
11a

11a COBRA premium assistance payments (see instructions)
11b Number of individuals provided COBRA premium assistance
reported on line 11a

11b

12 Add lines 10 and 11a

12

13 Balance due. If line 7 is more than line 12, write the difference here. For information on how
to pay, see the instructions

13

14 Overpayment. If line 12 is more than line 7, write the
difference here

14

.

.
.
Check one

Apply to next return.
Send a refund.

 You MUST complete both pages of Form 944-SS and SIGN it.
Next 
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.

Cat. No. 47935C

Form

944-SS

(2009)

Name (not your trade name)

Employer identification number (EIN)

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Part 2: Tell us about your tax liability for 2009.

Line 7 is less than $2,500. Go to Part 3.

15 Check one:

Line 7 is $2,500 or more. Enter your tax liability for each month. If you are a semiweekly depositor or you accumulate
$100,000 or more of liability on any day during a deposit period, you must complete Form 945-A instead of the boxes below.

Jan.
15a
Feb.
15b
Mar.
15c

Apr.

.
.
.

Jul.

15d

15j

15g

Nov.

Aug.

May

15e

15k

15h

Dec.

Sep.

Jun.

15f

15i

15l

Total liability for year. Add lines 15a through 15l. Total must equal line 7.
16

Oct.

15m

.
.
.
.

Part 3: Tell us about your business. If question 17 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.

/

/

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 IRS.
No.

Part 5: Sign here. You MUST complete both pages of Form 944-SS 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
name here

Sign your
name here

Date

Print your
title here
/

Best daytime phone (

/

Paid preparer’s use only

Preparer’s
SSN/PTIN

Preparer’s signature

Date

Firm’s name (or yours
if self-employed)

EIN

Address

Phone

Page

State

2

–

Check if you are self-employed

Preparer’s name

City

)

/

(

/

)

–

ZIP code

Form

944-SS

(2009)

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Form 944-V(SS),
Payment Voucher

Complete Form 944-V(SS), Payment Voucher, if you
are making a payment with Form 944-SS, Employer’s
ANNUAL Federal Tax Return. We will use the
completed voucher to credit your payment more
promptly and accurately, and to improve our service to
you.
If you have your return prepared by a third party and
make a payment with that return, please provide this
payment voucher to the return preparer.

Otherwise, you must deposit your payment at an
authorized financial institution or by using the
Electronic Federal Tax Payment System (EFTPS). See
section 8 of Pub. 80 (Circular SS) for deposit
instructions. Do not use Form 944-V(SS) to make
federal tax deposits.
Caution. Use Form 944-V(SS) when making any
payment with Form 944-SS. However, if you pay an
amount with Form 944-SS that should have been
deposited, you may be subject to a penalty. See
Deposit Penalties in section 8 of Pub. 80 (Circular SS).

Making Payments With Form 944-SS

Specific Instructions

To avoid a penalty, make your payment with your 2009
Form 944-SS only if one of the following applies.
● Your net taxes for the year (line 7 on Form 944-SS)
are less than $2,500 and you are paying in full with a
timely filed return.
● You already deposited the taxes you owed for the
first, second, and third quarters of 2009, and the tax
you owe for the fourth quarter of 2009 is less than
$2,500, and you are paying, in full, the tax you owe for
the fourth quarter of 2009 with a timely filed return.

Box 1—Employer identification number (EIN). If you
do not have an EIN, apply for one on Form SS-4,
Application for Employer Identification Number, and
write “Applied For” and the date you applied in this
entry space.
Box 2—Amount paid. Enter the amount paid with
Form 944-SS.
Box 3—Name and address. Enter your name and
address as shown on Form 944-SS.
● Enclose your check or money order made payable to
the “United States Treasury” and write your EIN, “Form
944-SS,” and “2009” on your check or money order.
Do not send cash. Do not staple Form 944-V(SS) or
your payment to Form 944-SS (or to each other).
● Detach Form 944-V(SS) and send it with your
payment and Form 944-SS to the address provided in
the Instructions for Form 944-SS.
Note. You must also complete the entity information
above Part 1 on Form 944-SS.

● You are a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Rule. See section 8 of 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, for details. In this case,
the amount of your payment may be $2,500 or more.

Form

✁

✃

Purpose of Form

Detach Here and Mail With Your Payment and Form 944-SS.




944-V(SS)

Department of the Treasury
Internal Revenue Service

1 Enter your employer identification
number (EIN).

OMB No. 1545-2010

Payment Voucher


2009

Do not staple this voucher or your payment to Form 944-SS.
Dollars

2

Enter the amount of your payment.



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

Enter your address.

Enter your city, state, and ZIP code.

Cents

Form 944-SS (2009)

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Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on this form to carry out the
Internal Revenue laws of the United States. We need it
to figure and collect the right amount of tax. Subtitle C,
Employment Taxes, of the Internal Revenue Code
imposes employment taxes on wages. This form is
used to determine the amount of the taxes that you
owe. Section 6011 requires you to provide the
requested information if the tax is applicable to you.
Section 6109 requires filers and paid preparers to
provide their identification numbers. If you fail to
provide this information in a timely manner, you may
be subject to penalties and interest.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books and records relating to a form
or instructions must be retained as long as their
contents may become material in the administration of
any Internal Revenue law.
Generally, tax returns and return information are
confidential, as required by section 6103. However,
section 6103 allows or requires the IRS to disclose or
give the information shown on your tax return to others
as described in the Code. For example, we may
disclose your tax information to the Department of
Justice for civil and criminal litigation, and to cities,

states, the District of Columbia, and U.S.
commonwealths and possessions for use in
administering their tax laws. We may also disclose this
information to other countries under a tax treaty, to
federal and state agencies to enforce federal nontax
criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file this form will
vary depending on individual circumstances. The
estimated average time is:
11 hr., 00 min.
Recordkeeping
12 min.
Learning about the law or the form
Preparing, copying, assembling,
22 min.
and sending the form to the IRS
If you have comments concerning the accuracy of
these time estimates or suggestions for making
Form 944-SS simpler, we would be happy to hear from
you. You can write to: Internal Revenue Service, Tax
Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Do not send Form
944-SS to this address. Instead, see Where Should
You File? on page 4 of the Instructions for
Form 944-SS.

Printed on recycled paper