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pdfForm
430121
943
Department of the Treasury
Internal Revenue Service
Employer’s Annual Federal Tax Return
for Agricultural Employees
a Go
OMB No. 1545-0035
2021
to www.irs.gov/Form943 for instructions and the latest information.
Name (as distinguished from trade name)
Employer identification number (EIN)
Trade name, if any
If address is
different from
prior return,
check here a
DRAFT AS OF
August 25, 2021
DO NOT FILE
Type
or
Print
Address (number and street)
City or town, state or province, country, and ZIP or foreign postal code
If you don’t have to file returns in the future, check here
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1
Number of agricultural employees employed in the pay period that includes March 12, 2021
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2
Wages subject to social security tax* .
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2
Qualified sick leave wages* .
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2a
b Qualified family leave wages*
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2b
Social security tax (multiply line 2 by 12.4% (0.124)) .
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3
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3
Social security tax on qualified sick leave wages (multiply line 2a by 6.2% (0.062)) .
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3a
b Social security tax on qualified family leave wages (multiply line 2b by 6.2% (0.062)) .
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3b
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Medicare tax (multiply line 4 by 2.9% (0.029)) .
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6
Wages subject to Additional Medicare Tax withholding .
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Additional Medicare Tax withholding (multiply line 6 by 0.9% (0.009)) .
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8
Federal income tax withheld
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9
Total taxes before adjustments. Add lines 3, 3a, 3b, 5, 7, and 8 .
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10
Current year’s adjustments .
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11
Total taxes after adjustments (line 9 as adjusted by line 10)
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5
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7
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8
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9
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10
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11
12a Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 . .
b Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12a
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e
Nonrefundable portion of COBRA premium assistance credit .
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12c
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Number of individuals provided COBRA premium assistance
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12e
g Total nonrefundable credits. Add lines 12a, 12b, 12c, 12d, and 12e .
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12g
Total taxes after adjustments and nonrefundable credits. Subtract line 12g from line 11 .
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Next Na
You MUST complete all three pages of Form 943 and SIGN it.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
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12b
12d
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c Nonrefundable portion of employee retention credit . . . . . . . . . . . . . . . .
d Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after
March 31, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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*Include taxable qualified
sick and family leave wages
for leave taken after March
31, 2021, on line 2. Use lines
2a and 2b only to report
wages paid for leave taken
before April 1, 2021.
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Wages subject to Medicare tax
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Cat. No. 11252K
Form
943 (2021)
430221
Page 2
Form 943 (2021)
14a
Total deposits for 2021, including overpayment applied from a prior year and Form 943-X
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14a
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14b
c Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . .
d Refundable portion of credit for qualified sick and family leave wages for leave taken before
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14c
b Reserved for future use
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DRAFT AS OF
August 25, 2021
DO NOT FILE
14d
Refundable portion of employee retention credit . . . . . . . . . . . . . . . . .
Refundable portion of credit for qualified sick and family leave wages for leave taken after
March 31, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
g Refundable portion of COBRA premium assistance credit .
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14e
14f
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14g
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14h
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Total deposits and refundable credits. Add lines 14a, 14d, 14e, 14f, and 14g
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Total advances received from filing Form(s) 7200 for the year .
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14i
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Total deposits and refundable credits less advances. Subtract line 14i from line 14h .
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14j
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Balance due. If line 13 is more than line 14j, enter the difference and see the instructions
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Overpayment. If line 14j is more than line 13, enter the difference .
Check one:
Apply to next return.
Send a refund.
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• Semiweekly schedule depositors: Complete Form 943-A and check here .
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• Monthly schedule depositors: Complete line 17 and check here .
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• All filers: If line 13 is less than $2,500, don’t complete line 17 or Form 943-A.
17
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Monthly Summary of Federal Tax Liability. (Don’t complete if you were a semiweekly schedule depositor.)
Tax liability for month
Tax liability for month
Tax liability for month
A January .
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F June .
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K November .
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B February .
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G July
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L December .
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C March
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H August
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D April .
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September .
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E May
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J October .
M Total liability
for year
(add lines A
through L) .
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18
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Qualified health plan expenses allocable to qualified sick leave wages for leave
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . .
Qualified health plan expenses allocable to qualified family leave wages for leave
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . .
taken before
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taken before
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Qualified wages for the employee retention credit
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Qualified health plan expenses for the employee retention credit .
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Next Na
You MUST complete all three pages of Form 943 and SIGN it.
Form
943 (2021)
430321
Page 3
Form 943 (2021)
22
Qualified sick leave wages for leave taken after March 31, 2021 .
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Qualified health plan expenses allocable to qualified sick leave wages reported on line 22 . . .
Amounts under certain collectively bargained agreements allocable to qualified sick leave wages
reported on line 22 . . . . . . . . . . . . . . . . . . . . . . . . . . .
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24
DRAFT AS OF
August 25, 2021
DO NOT FILE
25
Qualified family leave wages for leave taken after March 31, 2021
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Qualified health plan expenses allocable to qualified family leave wages reported on line 25
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Amounts under certain collectively bargained agreements allocable to qualified family leave wages
reported on line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . .
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If you're eligible for the employee retention credit in the third quarter solely because your business
is a recovery startup business, enter the total of any amounts included on lines 12c and 14e for
the third quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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If you're eligible for the employee retention credit in the fourth quarter solely because your
business is a recovery startup business, enter the total of any amounts included on lines 12c and
14e for the fourth quarter . . . . . . . . . . . . . . . . . . . . . . . . .
29
ThirdParty
Designee
Sign
Here
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Do you want to allow another person to discuss this return with the IRS? See the separate instructions.
Designee’s
name a
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Yes. Complete the following.
No.
Personal identification
number (PIN) a
Phone
no. a
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.
Date a
Signature a
Print your name and title a
Paid
Preparer
Use Only
Print/Type preparer’s name
Preparer’s signature
Date
Check
if
self-employed
Firm’s name a
Firm’s EIN
Firm’s address a
Phone no.
PTIN
a
Form
943 (2021)
Form 943-V,
Payment Voucher
Purpose of Form
Specific Instructions
Complete Form 943-V if you’re making a payment with
Form 943. We will use the completed voucher to credit
your payment more promptly and accurately, and to
improve our service to you.
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 943, write “Applied For” and the date you applied in
this entry space.
Box 2—Amount paid. Enter the amount paid with
Form 943.
Box 3—Name and address. Enter your name and
address as shown on Form 943.
• Enclose your check or money order made payable to
“United States Treasury.” Be sure to enter your EIN,
“Form 943,” and “2021” on your check or money order.
Don’t send cash. Don’t staple Form 943-V or your
payment to Form 943 (or to each other).
• Detach Form 943-V and send it with your payment and
Form 943 to the address provided in the Instructions for
Form 943.
Note: You must also complete the entity information
above line 1 on Form 943.
DRAFT AS OF
August 25, 2021
DO NOT FILE
To avoid a penalty, make your payment with your 2021
Form 943 only if:
• Your total taxes after adjustments and nonrefundable
credits for the year (Form 943, line 13) are less than
$2,500 and you’re paying in full with a timely filed return,
or
• You’re a monthly schedule depositor making a payment
in accordance with the Accuracy of Deposits Rule. See
section 7 of Pub. 51 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 7 of Pub. 51 for deposit instructions.
Don’t use Form 943-V to make federal tax deposits.
Use Form 943-V when making any payment with
! Form 943. However, if you pay an amount with
CAUTION
Form 943 that should’ve been deposited, you may
be subject to a penalty. See Deposit Penalties in section 7
of Pub. 51.
F
d
Detach Here and Mail With Your Payment and Form 943. d
943-V
Form
Department of the Treasury
Internal Revenue Service
1 Enter your employer identification number (EIN).
Payment Voucher
a
OMB No. 1545-0035
2021
Don’t staple this voucher or your payment to Form 943.
2
Enter the amount of your payment
Making Payments With Form 943
. . .
a
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 or town, state or province, country, and ZIP or foreign postal code.
Dollars
Cents
| File Type | application/pdf |
| File Title | 2021 Form 943 |
| Subject | Fillable |
| Author | SE:W:CAR:MP |
| File Modified | 2021-11-02 |
| File Created | 2021-11-02 |