Form 944 Form 944 Employer's ANNUAL Federal Tax Return

Form

944 for 2012:

Employer’s ANNUAL Federal Tax Return
Department of the Treasury — Internal Revenue Service

OMB No. 1545-2007

Who Must File Form 944

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Employer identification number (EIN)

You must file annual Form 944
instead of filing quarterly Forms 941
only if the IRS notified you in
writing. You also must file Form 944
(or Form 944 (SP)) for 2012 if you
filed Form 944-SS or Form 944-PR
in 2011 and you did not request to
file Forms 941-SS or Forms 941-PR
for 2012.
Instructions and prior-year forms are
available at www.irs.gov/form944.

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

Address
Number

Street

Suite or room number

City

ZIP code

State

Read the separate instructions before you complete Form 944. Type or print within the boxes.
Part 1:

Answer these questions for this year. Employers in American Samoa, Guam, the Commonwealth of the Northern
Mariana Islands, the U.S. Virgin Islands, and Puerto Rico can skip lines 1 and 2.

1

Wages, tips, and other compensation

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1

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2

FEDERAL income tax withheld from wages, tips, and other compensation

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2

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3

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

3

Check and go to line 5.

4

Taxable social security and Medicare wages and tips:
Column 1

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Column 2

4a Taxable social security wages

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×.

104 =

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4b Taxable social security tips

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×

.104 =

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4c Taxable Medicare wages & tips

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×

.029 =

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For 2012, the employee social
security tax rate is 4.2% and the
Medicare tax rate is 1.45%. The
employer social security tax rate is
6.2% and the Medicare tax rate is
1.45%.

4d Add Column 2 line 4a, Column 2 line 4b, and Column 2 line 4c

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4d

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5

Total taxes before adjustments (add lines 2 and 4d) .

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5

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6

Current year’s adjustments (see instructions)

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6

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7

Total taxes after adjustments. Combine lines 5 and 6 .

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7

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8

Total deposits for this year, including overpayment applied from a prior year and
overpayment applied from Form 944-X, 944-X (PR), 944-X (SP), 941-X, or 941-X (PR) . .

8

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9a

COBRA premium assistance payments (see instructions)

9b

Number of individuals provided COBRA premium assistance

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9a

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10

Add lines 8 and 9a .

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10

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11

Balance due. If line 7 is more than line 10, enter the difference and see instructions .

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11

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12

Overpayment. If line 10 is more than line 7, enter the difference
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Check one:

Apply to next return.

You MUST complete both pages of Form 944 and SIGN it.

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.

Send a refund.

Next ■▶
Cat. No. 39316N

Form 944 (2012)

Name (not your trade name)

Employer identification number (EIN)

Part 2: Tell us about your deposit schedule and tax liability for this year.
13 Check one:

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

Jan.

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13a

13c

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13f

Nov.

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13h

Jun.

Dec.

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13i

Total liability for year. Add lines 13a through 13l. Total must equal line 7.

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13k

Sep.

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13j

Aug.

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13e

Mar.

Oct.

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13g

May

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13b

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13d

Feb.

Jul.

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13l

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13m

Part 3: Tell us about your business. If question 14 does NOT apply to your business, leave it blank.
14 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 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

Print your
title here

Date

Best daytime phone

Paid Preparer Use Only

Check if you are self-employed

Preparer’s name

PTIN

Preparer’s signature

Date

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

EIN

Address

Phone

City
Page 2

State

ZIP code
Form 944 (2012)

Form 944-V,
Payment Voucher
Purpose of Form
Complete Form 944-V, Payment Voucher, if you are
making a payment with Form 944, 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.

Making Payments With Form 944
To avoid a penalty, make your payment with your 2012
Form 944 only if one of the following applies.
• Your net taxes for the year (Form 944, line 7) 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 2012, and the tax you owe
for the fourth quarter of 2012 is less than $2,500, and you
are paying, in full, the tax you owe for the fourth quarter
of 2012 with a timely filed return.
• Your net taxes for the third quarter are $2,500 or more,
net taxes for the fourth quarter are less than $2,500, and
you did not incur a $100,000 next-day deposit obligation
during the fourth quarter.
• You are a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Rule. See section 11 of Pub. 15 (Circular E), Employer’s
Tax Guide, for details. In this case, the amount of your
payment may be $2,500 or more.
Otherwise, you must make deposits by electronic funds
transfer. See section 11 of Pub. 15 (Circular E) for deposit

instructions. Do not use Form 944-V to make federal tax
deposits.
Caution. Use Form 944-V when making any payment with
Form 944. However, if you pay an amount with Form 944
that should have been deposited, you may be subject to a
penalty. See Deposit Penalties in section 11 of Pub. 15
(Circular E).

Specific Instructions
Box 1—Employer identification number (EIN). If you do
not have an EIN, you may apply for one online. Go to
IRS.gov and click on the Apply for an EIN Online link
under Tools. You may also apply for an EIN by calling
1-800-829-4933, or you can fax or mail Form SS-4,
Application for Employer Identification Number. If you
have not received your EIN by the due date of Form 944,
write “Applied For” and the date you applied in this entry
space.
Box 2—Amount paid. Enter the amount paid with Form
944.
Box 3—Name and address. Enter your name and
address as shown on Form 944.
• Enclose your check or money order made payable to
the “United States Treasury” and write your EIN, “Form
944,” and “2012” on your check or money order. Do not
send cash. Do not staple Form 944-V or your payment to
Form 944 (or to each other).
• Detach Form 944-V and send it with your payment and
Form 944 to the address provided in the Instructions for
Form 944. Do not send a photocopy of Form 944-V
because your payment may be misapplied or delayed.
Note. You must also complete the entity information
above Part 1 on Form 944.

Detach Here and Mail With Your Payment and Form 944.

Form

944-V

Department of the Treasury
Internal Revenue Service

1

Enter your employer identification
number (EIN).

▼

✃

✁

▼

Payment Voucher
▶ Do

OMB No. 1545-2007

2012

not staple this voucher or your payment to Form 944.
2

Dollars

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, state, and ZIP code.

Cents

Form 944 (2012)

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, including income
tax withholding. 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 you to provide
your identification number. If you fail to provide this
information in a timely manner, or provide false or
fraudulent information, 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 Form 944 will
vary depending on individual circumstances. The
estimated average time is:
Recordkeeping . . . . . . . . . 10 hrs., 45 min.
Learning about the law or the form . . . . 24 min.
Preparing, copying, assembling, and sending
the form to the IRS . . . . . . . . . . 35 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making Form 944
simpler, we would be happy to hear from you. You can
email us at [email protected]. Enter “Form 944” on the
subject line. Or write to: Internal Revenue Service, Tax
Products Coordinating Committee, SE:W:CAR:MP:T:M:S,
1111 Constitution Ave. NW, IR-6526, Washington, DC
20224. Do not send Form 944 to this address. Instead,
see Where Should You File? in the Instructions for
Form 944.