1120-F Schedule Q Tax Liability of Qualified Derivatives Dealer (QDD)

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SCHEDULE Q
(Form 1120-F)

Tax Liability of Qualified Derivatives Dealer (QDD)

Department of the Treasury
Internal Revenue Service

▶

OMB No. 1545-0123

2021

▶ Attach to Form 1120-F.
Go to www.irs.gov/Form1120F for the latest information.

Name of corporation

Employer identification number

Name of QDD

QI-EIN

DRAFT AS OF
October 5, 2021
DO NOT FILE

QDD Taxable Year (enter month, day, and year for beginning and ending dates)

Beginning

, 20

, and ending

, 20

Indicate the year or portion of the year to which the schedule relates (enter month, day, and year for beginning and ending dates)

Beginning

, 20

, and ending

4
5
a
b
c
d
6

Total section 871(m) amount . . . . . . . . . . . .
Total dividends received in equity derivatives dealer capacity . .
Total QDD tax liability pursuant to section 3.09(A) of the Qualified
Intermediary Agreement . . . . . . . . . . . . . .
Total QDD tax liability pursuant to section 3.09(B) of the Qualified
Intermediary Agreement . . . . . . . . . . . . . .
Total QDD tax liability pursuant to section 3.09(C) of the Qualified
Intermediary Agreement:
Income Type ▶
Income Type ▶
Income Type ▶
Income Type ▶
Total of line 5 amounts

.

.

.

.

.

.

.

.

.

.

of

, 20

(a)
Gross Amount

Summary of QDD Tax Liability

1
2
3

Schedule

.

Who Must File
If the corporation or any branch of the corporation was a
qualified derivatives dealer (QDD) (defined below) during the tax
year, Schedule Q must be completed and filed for each of those
QDDs. The corporation must file Schedule Q as an attachment
to Form 1120-F even if the QDD has zero tax liability.
Qualified derivatives dealer (QDD). A QDD is a home office or
branch that, in accordance with the qualified intermediary
agreement (QIA) (defined below), qualifies and has been
approved for QDD status and satisfies the requirements of the
QIA. See the QIA for additional information.
Qualified intermediary agreement (QIA). The QIA is section 6
of Rev. Proc. 2017-15.

General Instructions
A separate Schedule Q is required for each QDD. In addition, if
a corporation has a tax year other than the calendar year, the
corporation must provide separate Schedules Q for each QDD
for the portion of the tax year in the first calendar year and the
portion in the second calendar year.

Specific Instructions
Name of QDD. The name of the QDD should follow the naming
protocol used for applying to be a QDD.
Number of schedules filed. A QDD may be required to file
multiple Schedules Q, for example, if it has multiple branches
that are QDDs or if it is a fiscal year taxpayer (as explained in
General Instructions above). Indicate the number of each
Schedule Q filed, as well as the total number of Schedules Q
being filed by the corporation in the entry spaces provided.
Column (c), Amount of Tax Liability. Except as provided in the
Note that immediately follows this paragraph, the amount in
column (c) is determined by multiplying column (a) by column (b).
This column is not reduced by any withholding that has occurred.

.

.

.

(b)
Withholding Tax Rate

(c)
Amount of
Tax Liability
(column (a) x
column (b))

1
2

3
4

5a
5b
5c
5d
6

Note: For calendar years 2018 through 2022, certain information
is not required, as indicated in the line instructions below.
However, if the taxpayer has a tax year that begins in 2022 other
than the calendar year, information is required for any amounts
paid or accrued on or after January 1, 2023.
Line 1, total section 871(m) amount. The gross amount to be
entered in column (a) is the sum of each section 871(m) amount
for the QDD for the relevant period. See section 2.73 of the QIA
for the definition of section 871(m) amount.
Note: For calendar years 2019 through 2022, this information is
not required.
Line 2, total dividends received in equity derivatives dealer
capacity.
Note: For calendar years 2019 through 2022, only the gross
amount (column (a)) and tax rate (column (b)) are required.
Line 3, total QDD tax liability pursuant to section 3.09(A) of
the Qualified Intermediary Agreement. Column (c) is the sum
of each section 3.09(A) amount for the QDD for the relevant
period.
Note: For calendar years 2019 through 2022, this information is
not required.
Line 4, total QDD tax liability pursuant to section 3.09(B) of
the Qualified Intermediary Agreement. Enter the information
requested in columns (a), (b), and (c).
Line 5, total QDD tax liability pursuant to section 3.09(C) of
the Qualified Intermediary Agreement. In addition to
specifying the type of income (for example, dividends or
interest), enter the information requested in columns (a), (b), and
(c) separately for each income type. For dividends, include all
dividends, including dividends separately stated on line 2.
Note: For calendar years 2019 through 2022, do not include
dividends included on line 2.

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-F.

Cat. No. 71803X

Schedule Q (Form 1120-F) 2021