Form 943-A Agricultural Employer's Record of Federal Tax Liability

Form

943-A

Agricultural Employer’s Record of
Federal Tax Liability

(Rev. December 2020)
Department of the Treasury
Internal Revenue Service

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Name (as shown on Form 943)

OMB No. 1545-0035

Go to www.irs.gov/Form943A for instructions and the latest information.
▶ File with Form 943 or Form 943-X.
Calendar Year
Employer identification number (EIN)

You must complete this form if you’re a semiweekly schedule depositor or became one because your accumulated tax liability during
any month was $100,000 or more. Show tax liability here, not deposits. (The IRS gets deposit data from electronic funds transfers.)
Don’t change your current year tax liability by adjustments reported on any Forms 943-X.
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January Tax Liability
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A Total liability for month ▶

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April Tax Liability
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D Total liability for month ▶

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February Tax Liability
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B Total liability for month ▶

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May Tax Liability
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E Total liability for month ▶

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

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March Tax Liability
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C Total liability for month ▶

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June Tax Liability
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F Total liability for month ▶
Cat. No. 17030C

Form 943-A (Rev. 12-2020)

Form 943-A (Rev. 12-2020)

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July Tax Liability
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G Total liability for month ▶

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October Tax Liability
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J Total liability for month ▶

Page

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August Tax Liability
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H Total liability for month ▶

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I Total liability for month ▶

November Tax Liability
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K Total liability for month ▶

M Total tax liability for year (add lines A through L). This must equal line 13 on Form 943 .

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September Tax Liability
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December Tax Liability
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L Total liability for month ▶
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Form 943-A (Rev. 12-2020)