Form 941 V 941 V Payment Voucher

Form 941-V,
Payment Voucher
Specific Instructions

Complete Form 941-V if you're making a payment with
Form 941. 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 941
To avoid a penalty, make your payment with Form 941
only if:
• Your total taxes for either the current quarter (Form 941,
line 12) or the preceding quarter (Form 941, line 12 (line
10 if the preceding quarter was the fourth quarter of
2016)) are less than $2,500, you didn't incur a $100,000
next-day deposit obligation during the current quarter,
and you're paying in full with a timely filed return; or
• You are a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Rule. See section 11 of Pub. 15 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 for deposit
instructions. Don't use Form 941-V to make federal tax
deposits.
Use Form 941-V when making any payment with
! Form 941. However, if you pay an amount with
CAUTION
Form 941 that should've been deposited, you
may be subject to a penalty. See Deposit Penalties in
section 11 of Pub. 15.

▲

Form

✁

▼

Detach Here and Mail With Your Payment and Form 941.

941-V

▼

Payment Voucher

Department of the Treasury
Internal Revenue Service

1

Box 1—Employer identification number (EIN). If you
don't have an EIN, you may apply for one online by
visiting the IRS website at www.irs.gov/ein. You may also
apply for an EIN by faxing or mailing Form SS-4 to the
IRS. If you haven't received your EIN by the due date of
Form 941, write “Applied For” and the date you applied in
this entry space.
Box 2—Amount paid. Enter the amount paid with
Form 941.
Box 3—Tax period. Darken the circle identifying the
quarter for which the payment is made. Darken only
one circle.
Box 4—Name and address. Enter your name and
address as shown on Form 941.
• Enclose your check or money order made payable to
“United States Treasury.” Be sure to enter your
EIN, “Form 941,” and the tax period (“1st Quarter 2017,”
“2nd Quarter 2017,” “3rd Quarter 2017,” or “4th Quarter
2017”) on your check or money order. Don't send cash.
Don't staple Form 941-V or your payment to Form 941 (or
to each other).
• Detach Form 941-V and send it with your payment
and Form 941 to the address in the Instructions for
Form 941.
Note: You must also complete the entity information
above Part 1 on Form 941.

▶ Don't

OMB No. 1545-0029

2017

staple this voucher or your payment to Form 941.

2

Enter your employer identification
number (EIN).

✃

Purpose of Form

Dollars

Cents

Enter the amount of your payment. ▶
Make your check or money order payable to “United States Treasury”
4 Enter your business name (individual name if sole proprietor).

3 Tax Period

1st
Quarter

3rd
Quarter

2nd
Quarter

4th
Quarter

Enter your address.
Enter your city, state, and ZIP code or your city, foreign country name, foreign province/county, and foreign postal code.

Form 941 (Rev. 1-2017)

Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on Form 941 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 and provides for
income tax withholding. Form 941 is used to determine
the amount of 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.
You're 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
its 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 941 will
vary depending on individual circumstances. The
estimated average time is:
Recordkeeping . . . . . . . . . . 13 hr., 52 min.
Learning about the law or the form . . . . 47 min.
Preparing, copying, assembling, and
sending the form to the IRS . . . . .
1 hr., 3 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making Form 941
simpler, we would be happy to hear from you. You can
send us comments from www.irs.gov/formcomment. Or
you can send your comments to Internal Revenue
Service, Tax Forms and Publications Division, 1111
Constitution Ave. NW, IR-6526, Washington, DC 20224.
Don't send Form 941 to this address. Instead, see Where
Should You File? in the Instructions for Form 941.