Employer's Quarterly Federal Tax Return

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Instructions for Form 941

Department of the Treasury
Internal Revenue Service

(Rev. March 2023)

Employer's QUARTERLY Federal Tax Return
Section references are to the Internal Revenue Code
unless otherwise noted.

The Medicare tax rate is 1.45% each for the employee
and employer, unchanged from 2022. There is no wage
base limit for Medicare tax.
Social security and Medicare taxes apply to the wages
of household workers you pay $2,600 or more in cash
wages in 2023. Social security and Medicare taxes apply
to election workers who are paid $2,200 or more in cash
or an equivalent form of compensation in 2023.

DRAFT AS OF
January 12, 2023

Contents
Future Developments . . . . . . . . . . . . . . . . . . . . .
What's New . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
General Instructions: . . . . . . . . . . . . . . . . . . . . . .
Purpose of Form 941 . . . . . . . . . . . . . . . . . .
Who Must File Form 941? . . . . . . . . . . . . . . .
When Must You File? . . . . . . . . . . . . . . . . . .
How Should You Complete Form 941? . . . . . .
Where Should You File? . . . . . . . . . . . . . . . .
Depositing Your Taxes . . . . . . . . . . . . . . . . .
What About Penalties and Interest? . . . . . . . .
Adjustment of Tax on Tips . . . . . . . . . . . . . . .
Specific Instructions: . . . . . . . . . . . . . . . . . . . . . .
Part 1: Answer These Questions for This
Quarter . . . . . . . . . . . . . . . . . . . . . . . . . .
Part 2: Tell Us About Your Deposit Schedule
and Tax Liability for This Quarter . . . . . . . .
Part 3: Tell Us About Your Business . . . . . . . .
Part 4: May We Speak With Your Third-Party
Designee? . . . . . . . . . . . . . . . . . . . . . . . .
Part 5: Sign Here (Approved Roles) . . . . . . . .
How To Get Forms, Instructions, and Publications .
Worksheet 1. Credit for Qualified Sick and Family
Leave Wages Paid This Quarter of 2023 for
Leave Taken After March 31, 2020, and Before
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . .
Worksheet 2. Credit for Qualified Sick and Family
Leave Wages Paid This Quarter of 2023 for
Leave Taken After March 31, 2021, and Before
October 1, 2021 . . . . . . . . . . . . . . . . . . . . . .

Future Developments

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For the latest information about developments related to
Form 941 and its instructions, such as legislation enacted
after they were published, go to IRS.gov/Form941.

What's New
Social security and Medicare tax for 2023. The rate of
social security tax on taxable wages, including qualified
sick leave wages and qualified family leave wages paid in
2023 for leave taken after March 31, 2021, and before
October 1, 2021, is 6.2% each for the employer and
employee or 12.4% for both. Qualified sick leave wages
and qualified family leave wages paid in 2023 for leave
taken after March 31, 2020, and before April 1, 2021,
aren't subject to the employer share of social security tax;
therefore, the tax rate on these wages is 6.2%. The social
security wage base limit is $160,200.

Jan 6, 2023

Qualified small business payroll tax credit for increasing research activities. For tax years beginning
before January 1, 2023, a qualified small business may
elect to claim up to $250,000 of its credit for increasing
research activities as a payroll tax credit. The Inflation
Reduction Act of 2022 (the IRA) increases the election
amount to $500,000 for tax years beginning after
December 31, 2022. The payroll tax credit election must
be made on or before the due date of the originally filed
income tax return (including extensions). The portion of
the credit used against payroll taxes is allowed in the first
calendar quarter beginning after the date that the qualified
small business filed its income tax return. The election
and determination of the credit amount that will be used
against the employer’s payroll taxes are made on Form
6765, Credit for Increasing Research Activities. The
amount from Form 6765, line 44, must then be reported
on Form 8974, Qualified Small Business Payroll Tax
Credit for Increasing Research Activities.
Starting in the first quarter of 2023, the payroll tax credit
is first used to reduce the employer share of social
security tax up to $250,000 per quarter and any remaining
credit reduces the employer share of Medicare tax for the
quarter. Any remaining credit, after reducing the employer
share of social security tax and the employer share of
Medicare tax, is then carried forward to the next quarter.
Form 8974 is used to determine the amount of the credit
that can be used in the current quarter. The amount from
Form 8974, line 12, or, if applicable, line 17, is reported on
line 11a. For more information about the payroll tax credit,
see IRS.gov/ResearchPayrollTC. Also see Adjusting tax
liability for nonrefundable credits claimed on lines 11a,
11b, and 11d, later.
Forms 941-SS and 941-PR discontinued after 2023.
Form 941-SS, Employer’s QUARTERLY Federal Tax
Return—American Samoa, Guam, the Commonwealth of
the Northern Mariana Islands, and the U.S. Virgin Islands;
and Form 941-PR, Planilla para la Declaración Federal
TRIMESTRAL del Patrono, will no longer be available
after the fourth quarter of 2023. Instead, employers in the
U.S. territories will file Form 941, or, if you prefer your form
and instructions in Spanish, you can file new Form 941
(sp), Declaración del Impuesto Federal TRIMESTRAL del
Empleador.
Pubs. 51, 80, and 179 discontinued after 2023. Pub.
51, Agricultural Employer’s Tax Guide; Pub. 80, Federal

Cat. No. 14625L

5884-D (not on Form 941). Form 5884-D is filed after the
Form 941 for the quarter for which the credit is being
claimed has been filed. If you will claim this credit on Form
5884-D and you're also claiming a credit for qualified sick
and family leave wages for leave taken before April 1,
2021, you must include any credit that will be claimed on
Form 5884-D on Worksheet 1 for that quarter. For more
information about this credit, go to IRS.gov/Form5884D.

Tax Guide for Employers in the U.S. Virgin Islands, Guam,
American Samoa, and the Commonwealth of the Northern
Mariana Islands; and Pub. 179, Guía Contributiva Federal
para Patronos Puertorriqueños, will no longer be available
after 2023. Instead, information specific to agricultural
employers and employers in the U.S. territories will be
included in Pub. 15, Employer's Tax Guide, beginning with
the Pub. 15 for use in 2024 (published December 2023).
Beginning in 2024, there will be a new Pub. 15 (sp) that is
a Spanish-language version of Pub. 15.

DRAFT AS OF
January 12, 2023
2023 withholding tables. The federal income tax
withholding tables are included in Pub. 15-T, Federal
Income Tax Withholding Methods.

Reminders

Certification program for professional employer organizations (PEOs). The Stephen Beck, Jr., ABLE Act
of 2014 required the IRS to establish a voluntary
certification program for PEOs. PEOs handle various
payroll administration and tax reporting responsibilities for
their business clients and are typically paid a fee based on
payroll costs. To become and remain certified under the
certification program, certified professional employer
organizations (CPEOs) must meet various requirements
described in sections 3511 and 7705 and related
published guidance. Certification as a CPEO may affect
the employment tax liabilities of both the CPEO and its
customers. A CPEO is generally treated for employment
tax purposes as the employer of any individual who
performs services for a customer of the CPEO and is
covered by a contract described in section 7705(e)(2)
between the CPEO and the customer (CPEO contract),
but only for wages and other compensation paid to the
individual by the CPEO. To become a CPEO, the
organization must apply through the IRS Online
Registration System. For more information or to apply to
become a CPEO, go to IRS.gov/CPEO.
CPEOs must generally file Form 941 and Schedule R
(Form 941), Allocation Schedule for Aggregate Form 941
Filers, electronically. For more information about a
CPEO’s requirement to file electronically, see Rev. Proc.
2017-14, 2017-3 I.R.B. 426, available at IRS.gov/irb/
2017-03_IRB#RP-2017-14.

Use the March 2023 revision of Form 941 to
report taxes for the first quarter of 2023; don't use
CAUTION an earlier revision to report taxes for 2023. At this
time, the IRS expects the March 2023 revision of Form
941 and these instructions to also be used for the second,
third, and fourth quarters of 2023. If changes in law
require additional changes to Form 941, the form and/or
these instructions may be revised. Prior revisions of Form
941 are available at IRS.gov/Form941 (select the link for
“All Form 941 Revisions” under “Other Items You May
Find Useful”).

!

The COVID-19 related credit for qualified sick and
family leave wages is limited to leave taken after
March 31, 2020, and before October 1, 2021.
Generally, the credit for qualified sick and family leave
wages, as enacted under the Families First Coronavirus
Response Act (FFCRA) and amended and extended by
the COVID-related Tax Relief Act of 2020, for leave taken
after March 31, 2020, and before April 1, 2021, and the
credit for qualified sick and family leave wages under
sections 3131, 3132, and 3133 of the Internal Revenue
Code, as enacted under the American Rescue Plan Act of
2021 (the ARP) for leave taken after March 31, 2021, and
before October 1, 2021, have expired. However,
employers that pay qualified sick and family leave wages
in 2023 for leave taken after March 31, 2020, and before
October 1, 2021, are eligible to claim a credit for qualified
sick and family leave wages in the quarter of 2023 in
which the qualified wages were paid. For more
information, see the instructions for line 11b, line 11d,
line 13c, and line 13e, later.
Use Worksheet 1 to figure the credit for leave taken
after March 31, 2020, and before April 1, 2021. Use
Worksheet 2 to figure the credit for leave taken after
March 31, 2021, and before October 1, 2021. For more
information about the credit for qualified sick and family
leave wages, go to IRS.gov/PLC.

Outsourcing payroll duties. Generally, as an employer,
you're responsible to ensure that tax returns are filed and
deposits and payments are made, even if you contract
with a third party to perform these acts. You remain
responsible if the third party fails to perform any required
action. Before you choose to outsource any of your payroll
and related tax duties (that is, withholding, reporting, and
paying over social security, Medicare, FUTA, and income
taxes) to a third-party payer, such as a payroll service
provider or reporting agent, go to IRS.gov/
OutsourcingPayrollDuties for helpful information on this
topic. If a CPEO pays wages and other compensation to
an individual performing services for you, and the services
are covered by a CPEO contract, then the CPEO is
generally treated for employment tax purposes as the
employer, but only for wages and other compensation
paid to the individual by the CPEO. However, with respect
to certain employees covered by a CPEO contract, you
may also be treated as an employer of the employees
and, consequently, may also be liable for federal
employment taxes imposed on wages and other
compensation paid by the CPEO to such employees. For

Advance payment of COVID-19 credits ended.
Although you may pay qualified sick and family leave
wages in 2023 for leave taken after March 31, 2020, and
before October 1, 2021, you may no longer request an
advance payment of any credit on Form 7200, Advance
Payment of Employer Credits Due to COVID-19.
Payroll tax credit for certain tax-exempt organizations affected by qualified disasters. Section 303(d) of
the Taxpayer Certainty and Disaster Tax Relief Act of
2020 allows for a payroll tax credit for certain tax-exempt
organizations affected by certain qualified disasters not
related to COVID-19. This credit is claimed on Form
-2-

Instructions for Form 941 (Rev. 3-2023)

includes the qualified sick leave wages on the third party's
aggregate Form 941, claims the sick leave credit on
behalf of the employer on the aggregate Form 941, and
separately reports the credit allocable to the employers on
Schedule R (Form 941). See section 6 of Pub. 15-A,
Employer's Supplemental Tax Guide, for more information
about sick pay reporting.

more information on the different types of third-party payer
arrangements, see section 16 of Pub. 15.
COVID-19 employment tax credits when return filed
by a third-party payer. If you're the common-law
employer of the individuals that are paid qualified sick or
family leave wages, you're entitled to the credit for the sick
and family leave wages regardless of whether you use a
third-party payer (such as a PEO, CPEO, or section 3504
agent) to report and pay your federal employment taxes.
The third-party payer isn't entitled to the credits with
respect to the wages and taxes it remits on your behalf
(regardless of whether the third party is considered an
"employer" for other purposes).

Work opportunity tax credit for qualified tax-exempt
organizations hiring qualified veterans. Qualified
tax-exempt organizations that hire eligible unemployed
veterans may be able to claim the work opportunity tax
credit against their payroll tax liability using Form 5884-C.
For more information, go to IRS.gov/WOTC.

DRAFT AS OF
January 12, 2023

Correcting a previously filed Form 941. If you
discover an error on a previously filed Form 941, or if you
otherwise need to amend a previously filed Form 941,
make the correction using Form 941-X. Form 941-X is
filed separately from Form 941. For more information, see
the Instructions for Form 941-X, section 13 of Pub. 15, or
go to IRS.gov/CorrectingEmploymentTaxes.

Aggregate Form 941 filers. Approved section 3504
agents and CPEOs must complete and file Schedule R
(Form 941) when filing an aggregate Form 941. Aggregate
Forms 941 are filed by agents approved by the IRS under
section 3504. To request approval to act as an agent for
an employer, the agent files Form 2678 with the IRS
unless you're a state or local government agency acting
as an agent under the special procedures provided in
Rev. Proc. 2013-39, 2013-52 I.R.B. 830, available at
IRS.gov/irb/2013-52_IRB#RP-2013-39. Aggregate Forms
941 are also filed by CPEOs approved by the IRS under
section 7705. To become a CPEO, the organization must
apply through the IRS Online Registration System at
IRS.gov/CPEO. CPEOs file Form 8973, Certified
Professional Employer Organization/Customer Reporting
Agreement, to notify the IRS that they started or ended a
service contract with a customer. CPEOs must generally
file Form 941 and Schedule R (Form 941) electronically.
For more information about a CPEO’s requirement to file
electronically, see Rev. Proc. 2017-14, 2017-3 I.R.B. 426,
available at IRS.gov/irb/2017-03_IRB#RP-2017-14.
Other third-party payers that file aggregate Forms 941,
such as non-certified PEOs, must complete and file
Schedule R (Form 941) if they have clients that are
claiming the qualified small business payroll tax credit for
increasing research activities, and/or the credit for
qualified sick and family leave wages.

Federal tax deposits must be made by electronic
funds transfer (EFT). You must use EFT to make all
federal tax deposits. Generally, an EFT is made using the
Electronic Federal Tax Payment System (EFTPS). If you
don't want to use EFTPS, you can arrange for your tax
professional, financial institution, payroll service, or other
trusted third party to make electronic deposits on your
behalf. Also, you may arrange for your financial institution
to initiate a same-day wire payment on your behalf.
EFTPS is a free service provided by the Department of the
Treasury. Services provided by your tax professional,
financial institution, payroll service, or other third party
may have a fee.
For more information on making federal tax deposits,
see section 11 of Pub. 15. To get more information about
EFTPS or to enroll in EFTPS, go to EFTPS.gov or call
800-555-4477. To contact EFTPS using
Telecommunications Relay Services (TRS) for people
who are deaf, hard of hearing, or have a speech disability,
dial 711 and then provide the TRS assistant the
800-555-4477 number above or 800-733-4829. Additional
information about EFTPS is also available in Pub. 966.

If both an employer and a section 3504 authorized

TIP agent (or CPEO or other third-party payer) paid

wages to an employee during a quarter, both the
employer and the section 3504 authorized agent (or
CPEO or other third-party payer, if applicable) should file
Form 941 reporting the wages each entity paid to the
employee during the applicable quarter and issue Forms
W-2 reporting the wages each entity paid to the employee
during the year.

!

CAUTION

Same-day wire payment option. If you fail to submit a
deposit transaction on EFTPS by 8 p.m. Eastern time the
day before the date a deposit is due, you can still make
your deposit on time by using the Federal Tax Collection
Service (FTCS) to make a same-day wire payment. To
use the same-day wire payment method, you will need to
make arrangements with your financial institution ahead of
time. Please check with your financial institution regarding
availability, deadlines, and costs. Your financial institution
may charge you a fee for payments made this way. To
learn more about the information you will need to give
your financial institution to make a same-day wire
payment, go to IRS.gov/SameDayWire.
Timeliness of federal tax deposits. If a deposit is
required to be made on a day that isn't a business day, the
deposit is considered timely if it is made by the close of

If a third-party payer of sick pay is also paying qualified
sick leave wages on behalf of an employer, the third party
would be making the payments as an agent of the
employer. The employer is required to do the reporting
and payment of employment taxes with respect to the
qualified sick leave wages and claim the credit for the
qualified sick leave wages, unless the employer has an
agency agreement with the third-party payer that requires
the third-party payer to do the collecting, reporting, and/or
paying or depositing employment taxes on the qualified
sick leave wages. If the employer has an agency
agreement with the third-party payer, the third-party payer
Instructions for Form 941 (Rev. 3-2023)

For an EFTPS deposit to be on time, you must
submit the deposit by 8 p.m. Eastern time the day
before the date the deposit is due.

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the next business day. A business day is any day other
than a Saturday, Sunday, or legal holiday. The term “legal
holiday” for deposit purposes includes only those legal
holidays in the District of Columbia. Legal holidays in the
District of Columbia are provided in section 11 of Pub. 15.

Photographs of missing children. The IRS is a proud
partner with the National Center for Missing & Exploited
Children® (NCMEC). Photographs of missing children
selected by the Center may appear in instructions on
pages that would otherwise be blank. You can help bring
these children home by looking at the photographs and
calling 1-800-THE-LOST (1-800-843-5678) if you
recognize a child.

Electronic filing and payment. Businesses can enjoy
the benefits of filing tax returns and paying their federal
taxes electronically. Whether you rely on a tax
professional or handle your own taxes, the IRS offers you
convenient programs to make filing and paying easier.
Spend less time worrying about taxes and more time
running your business. Use e-file and EFTPS to your
benefit.
• For e-file, go to IRS.gov/EmploymentEfile for additional
information. A fee may be charged to file electronically.
• For EFTPS, go to EFTPS.gov or call 800-555-4477. To
contact EFTPS using TRS for people who are deaf, hard
of hearing, or have a speech disability, dial 711 and then
provide the TRS assistant the 800-555-4477 number
above or 800-733-4829.
• For electronic filing of Forms W-2, Wage and Tax
Statement, go to SSA.gov/employer. You may be required
to file Forms W-2 electronically. For details, see the
General Instructions for Forms W-2 and W-3.

DRAFT AS OF
January 12, 2023
General Instructions:
Purpose of Form 941

These instructions give you some background information
about Form 941. They tell you who must file Form 941,
how to complete it line by line, and when and where to file
it.
If you want more in-depth information about payroll tax
topics relating to Form 941, see Pub. 15 or go to IRS.gov/
EmploymentTaxes.
Federal law requires you, as an employer, to withhold
certain taxes from your employees' pay. Each time you
pay wages, you must withhold—or take out of your
employees' pay—certain amounts for federal income tax,
social security tax, and Medicare tax. You must also
withhold Additional Medicare Tax from wages you pay to
an employee in excess of $200,000 in a calendar year.
Under the withholding system, taxes withheld from your
employees are credited to your employees in payment of
their tax liabilities.

If you’re filing your tax return or paying your
federal taxes electronically, a valid employer
CAUTION identification number (EIN) is required at the time
the return is filed or the payment is made. If a valid EIN
isn't provided, the return or payment won't be processed.
This may result in penalties. See Employer identification
number (EIN), later, for information about applying for an
EIN.

!

Federal law also requires you to pay any liability for the
employer share of social security and Medicare taxes.
This share of social security and Medicare taxes isn't
withheld from employees.

Electronic funds withdrawal (EFW). If you file Form
941 electronically, you can e-file and use EFW to pay the
balance due in a single step using tax preparation
software or through a tax professional. However, don't use
EFW to make federal tax deposits. For more information
on paying your taxes using EFW, go to IRS.gov/EFW.

Who Must File Form 941?
If you pay wages subject to federal income tax withholding
or social security and Medicare taxes, you must file Form
941 quarterly to report the following amounts.
• Wages you’ve paid.
• Tips your employees reported to you.
• Federal income tax you withheld.
• Both the employer and the employee share of social
security and Medicare taxes.
• Additional Medicare Tax withheld from employees.
• Current quarter's adjustments to social security and
Medicare taxes for fractions of cents, sick pay, tips, and
group-term life insurance.
• Qualified small business payroll tax credit for increasing
research activities.
• Credit for qualified sick and family leave wages paid
this quarter of 2023 for leave taken after March 31, 2020,
and before October 1, 2021.

Credit or debit card payments. You can pay the
balance due shown on Form 941 by credit or debit card.
Your payment will be processed by a payment processor
who will charge a processing fee. Don't use a credit or
debit card to make federal tax deposits. For more
information on paying your taxes with a credit or debit
card, go to IRS.gov/PayByCard.
Online payment agreement. You may be eligible to
apply for an installment agreement online if you can't pay
the full amount of tax you owe when you file your return.
For more information, see What if you can't pay in full,
later.
Paid preparers. If you use a paid preparer to complete
Form 941, the paid preparer must complete and sign the
paid preparer's section of the form.

Don't use Form 941 to report backup withholding or
income tax withholding on nonpayroll payments such as
pensions, annuities, and gambling winnings. Report these
types of withholding on Form 945, Annual Return of
Withheld Federal Income Tax. Also, don't use Form 941 to
report unemployment taxes. Report unemployment taxes
on Form 940, Employer's Annual Federal Unemployment
(FUTA) Tax Return.

Where can you get telephone help? For answers to
your questions about completing Form 941 or tax deposit
rules, you can call the IRS at 800-829-4933 or
800-829-4059 (TDD/TTY for persons who are deaf, hard
of hearing, or have a speech disability), Monday–Friday
from 7:00 a.m. to 7:00 p.m. local time (Alaska and Hawaii
follow Pacific time).
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Instructions for Form 941 (Rev. 3-2023)

After you file your first Form 941, you must file a return
for each quarter, even if you have no taxes to report,
unless you filed a final return or one of the exceptions
listed next applies.

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0038

Exceptions

or

Department of the Treasury
Internal Revenue Service
Cincinnati, OH 45999-0038

If you would mail your return filed without a payment to
Ogden, as shown under Where Should You File, later,
send your request to the Ogden address shown above. If
you would mail your return filed without a payment to
Kansas City, send your request to the address for
Cincinnati shown above. For more information about
these procedures, see Rev. Proc. 2009-51, 2009-45
I.R.B. 625, available at IRS.gov/irb/
2009-45_IRB#RP-2009-51.

Special rules apply to some employers.
• If you received notification to file Form 944, Employer's
ANNUAL Federal Tax Return, you must file Form 944
annually; don't file Form 941 quarterly.
• Seasonal employers don't have to file a Form 941 for
quarters in which they have no tax liability because they
have paid no wages. To tell the IRS that you won't file a
return for one or more quarters during the year, check the
box on line 18 every quarter you file Form 941. See
section 12 of Pub. 15 for more information.
• Employers of household employees don't usually file
Form 941. See Pub. 926 and Schedule H (Form 1040) for
more information.
• Employers of farm employees don't file Form 941 for
wages paid for agricultural labor. See Form 943 and Pub.
51 for more information.

DRAFT AS OF
January 12, 2023
What if You Reorganize or Close Your
Business?
If You Sell or Transfer Your Business . . .

If you sell or transfer your business during the quarter, you
and the new owner must each file a Form 941 for the
quarter in which the transfer occurred. Report only the
wages you paid.

If none of these exceptions apply and you haven't

TIP filed a final return, you must file Form 941 each

When two businesses merge, the continuing firm must
file a return for the quarter in which the change took place
and the other firm should file a final return.

quarter even if you didn't pay wages during the
quarter. Use IRS e-file, if possible.

Requesting To File Forms 941 Instead of Form
944, or Requesting To File Form 944 Instead of
Forms 941

Changing from one form of business to another—such
as from a sole proprietorship to a partnership or
corporation—is considered a transfer. If a transfer occurs,
you may need a new EIN. See Pub. 1635 and section 1 of
Pub. 15 for more information.

Requesting to file Forms 941 instead of Form 944.
Employers that would otherwise be required to file Form
944 may contact the IRS to request to file quarterly Forms
941 instead of annual Form 944. To request to file
quarterly Forms 941 to report your social security and
Medicare taxes for the 2023 calendar year, you must
either call the IRS at 800-829-4933 between January 1,
2023, and April 3, 2023, or send a written request
postmarked between January 1, 2023, and March 15,
2023. After you contact the IRS, the IRS will send you a
written notice that your filing requirement has been
changed to Forms 941. You must receive written notice
from the IRS to file Forms 941 instead of Form 944 before
you may file these forms. If you don't receive this notice,
you must file Form 944 for calendar year 2023.

Attach a statement to your return with:

• The new owner's name (or the new name of the

business);
• Whether the business is now a sole proprietorship,
partnership, or corporation;
• The kind of change that occurred (a sale or transfer);
• The date of the change; and
• The name of the person keeping the payroll records
and the address where those records will be kept.

If Your Business Has Closed . . .
If you permanently go out of business or stop paying
wages to your employees, you must file a final return. To
tell the IRS that Form 941 for a particular quarter is your
final return, check the box on line 17 and enter the final
date you paid wages. Also attach a statement to your
return showing the name of the person keeping the payroll
records and the address where those records will be kept.

Requesting to file Form 944 instead of Forms 941. If
you’re required to file Forms 941 but believe your
employment taxes for calendar year 2023 will be $1,000
or less, you may request to file Form 944 instead of Forms
941 by calling the IRS at 800-829-4933 between January
1, 2023, and April 3, 2023, or sending a written request
postmarked between January 1, 2023, and March 15,
2023. After you contact the IRS, the IRS will send you a
written notice that your filing requirement has been
changed to Form 944. You must receive written notice
from the IRS to file Form 944 instead of Forms 941 before
you may file this form. If you don't receive this notice, you
must file Forms 941 for calendar year 2023.

See Terminating a business in the General Instructions
for Forms W-2 and W-3 for information about earlier dates
for the expedited furnishing and filing of Forms W-2 when
a final Form 941 is filed.
If you participated in a statutory merger or
consolidation, or qualify for predecessor-successor status
due to an acquisition, you should generally file
Schedule D (Form 941), Report of Discrepancies Caused
by Acquisitions, Statutory Mergers, or Consolidations.

Where to send written requests. Written requests
should be sent to:
Instructions for Form 941 (Rev. 3-2023)

-5-

“Haleigh's Cycles” on the “Trade name” line. Leave the
“Trade name” line blank if it is the same as your “Name.”

See the Instructions for Schedule D (Form 941) to
determine whether you should file Schedule D (Form 941)
and when you should file it.

If you use a tax preparer to fill out Form 941, make sure
the preparer shows your business name exactly as it
appeared when you applied for your EIN.

When Must You File?
File your initial Form 941 for the quarter in which you first
paid wages that are subject to social security and
Medicare taxes or subject to federal income tax
withholding. See the table titled When To File Form 941,
later.

Employer identification number (EIN). To make sure
businesses comply with federal tax laws, the IRS monitors
tax filings and payments by using a numerical system to
identify taxpayers. A unique nine-digit EIN is assigned to
all corporations, partnerships, and some sole proprietors.
Businesses needing an EIN must apply for a number and
use it throughout the life of the business on all tax returns,
payments, and reports.
Your business should have only one EIN. If you have
more than one and aren't sure which one to use, write to
the IRS office where you file your returns (using the
Without a payment address under Where Should You
File, later) or call the IRS at 800-829-4933.
If you don't have an EIN, you may apply for one online
by going to IRS.gov/EIN. You may also apply for an EIN
by faxing or mailing Form SS-4 to the IRS. If the principal
business was created or organized outside of the United
States or U.S. territories, you may also apply for an EIN by
calling 267-941-1099 (toll call). If you haven't received
your EIN by the due date of Form 941, file a paper return
and write “Applied For” and the date you applied in this
entry space.

DRAFT AS OF
January 12, 2023

Then, you must file for every quarter after that—every 3
months—even if you have no taxes to report, unless
you’re a seasonal employer or are filing your final return.
See Seasonal employers and If Your Business Has
Closed, earlier.
File Form 941 only once for each quarter. If you filed
electronically, don't file a paper Form 941. For more
information about filing Form 941 electronically, see
Electronic filing and payment, earlier.

When To File Form 941
Your Form 941 is due by the last day of the month that follows the end of the
quarter.
The Quarter Includes . . .

Quarter Ends

Form 941
Is Due

1. January, February, March

March 31

April 30

2. April, May, June

June 30

July 31

3. July, August, September

September 30

October 31

4. October, November, December

December 31

January 31

If you’re filing your tax return electronically, a valid
EIN is required at the time the return is filed. If a
CAUTION valid EIN isn't provided, the return won't be
accepted. This may result in penalties.

!

For example, you must generally report wages you pay
during the 1st quarter—which is January through
March—by April 30. If you made timely deposits in full
payment of your taxes for the quarter, you may file by the
10th day of the 2nd month that follows the end of the
quarter. For example, you may file Form 941 by May 10 if
you made timely deposits in full payment of your taxes for
the 1st quarter.

Always be sure the EIN on the form you file

TIP exactly matches the EIN the IRS assigned to your

business. Don't use your SSN or ITIN on forms
that ask for an EIN. If you used an EIN (including a prior
owner's EIN) on Form 941 that is different from the EIN
reported on Form W-3, see Box h—Other EIN used this
year in the General Instructions for Forms W-2 and W-3.
Filing a Form 941 with an incorrect EIN or using another
business's EIN may result in penalties and delays in
processing your return.

If we receive Form 941 after the due date, we will treat
Form 941 as filed on time if the envelope containing Form
941 is properly addressed, contains sufficient postage,
and is postmarked by the U.S. Postal Service on or before
the due date, or sent by an IRS-designated private
delivery service (PDS) on or before the due date. If you
don't follow these guidelines, we will generally consider
Form 941 filed when it is actually received. For more
information about PDSs, see Where Should You File,
later.

If you change your business name, business address, or responsible party... Notify the IRS
immediately if you change your business name, business
address, or responsible party.
• Write to the IRS office where you file your returns (using
the Without a payment address under Where Should You
File, later) to notify the IRS of any business name change.
See Pub.1635 to see if you need to apply for a new EIN.
• Complete and mail Form 8822-B to notify the IRS of a
business address or responsible party change. Don't mail
Form 8822-B with your Form 941. For a definition of
“responsible party,” see the Instructions for Form SS-4.

If any due date for filing falls on a Saturday, Sunday, or
legal holiday, you may file your return on the next
business day.

How Should You Complete Form 941?
Type or print your EIN, name, and address in the spaces
provided. Also enter your name and EIN on the top of
pages 2 and 3. Don't use your social security number
(SSN) or individual taxpayer identification number (ITIN).
Generally, enter the business (legal) name you used when
you applied for your EIN. For example, if you’re a sole
proprietor, enter “Haleigh Smith” on the “Name” line and

Check the Box for the Quarter

Under “Report for this Quarter of 2023” at the top of Form
941, check the appropriate box of the quarter for which
you’re filing. Make sure the quarter checked is the same
as shown on any attached Schedule B (Form 941), Report

-6-

Instructions for Form 941 (Rev. 3-2023)

depends on whether you include a payment with Form
941. Mail your return to the address listed for your location
in the table that follows.

of Tax Liability for Semiweekly Schedule Depositors, and,
if applicable, Schedule R (Form 941).

Completing and Filing Form 941

PDSs can't deliver to P.O. boxes. You must use the
U.S. Postal Service to mail an item to a P.O. box address.
Go to IRS.gov/PDS for the current list of PDSs. For the
IRS mailing address to use if you’re using a PDS, go to
IRS.gov/PDSstreetAddresses. Select the mailing address
listed on the webpage that is in the same state as the
address to which you would mail returns filed without a
payment, as shown next.

Make entries on Form 941 as follows to enable accurate
scanning and processing.
• Use 10-point Courier font (if possible) for all entries if
you’re typing or using a computer to complete your form.
Portable Document Format (PDF) forms on IRS.gov have
fillable fields with acceptable font specifications.
• Don't enter dollar signs and decimal points. Commas
are optional. Enter dollars to the left of the preprinted
decimal point and cents to the right of it. Don’t round
entries to whole dollars. Always show an amount for
cents, even if it is zero.
• Leave blank any data field (except lines 1, 2, and 12)
with a value of zero.
• Enter negative amounts using a minus sign (if possible).
Otherwise, use parentheses.
• Enter your name and EIN on all pages.
• Enter your name, EIN, “Form 941,” and the tax year and
quarter on all attachments.
• Staple multiple sheets in the upper left corner when
filing.

DRAFT AS OF
January 12, 2023
Mailing Addresses for Form 941

Complete all three pages. You must complete all three
pages of Form 941 and sign on page 3. Failure to do so
may delay processing of your return.

Required Notice to Employees About the
Earned Income Credit (EIC)

To notify employees about the EIC, you must give the
employees one of the following items.
• Form W-2 which has the required information about the
EIC on the back of Copy B.
• A substitute Form W-2 with the same EIC information
on the back of the employee's copy that is on Copy B of
the IRS Form W-2.
• Notice 797, Possible Federal Tax Refund Due to the
Earned Income Credit (EIC).
• Your written statement with the same wording as
Notice 797.
For more information, see section 10 of Pub. 15, Pub.
596, and IRS.gov/EIC.

Reconciling Forms 941 With Form W-3

The IRS matches amounts reported on your four quarterly
Forms 941 with Form W-2 amounts totaled on your yearly
Form W-3, Transmittal of Wage and Tax Statements. If
the amounts don't agree, you may be contacted by the
IRS or the Social Security Administration (SSA). The
following amounts are reconciled.
• Federal income tax withholding.
• Social security wages.
• Social security tips.
• Medicare wages and tips.
For more information, see section 12 of Pub. 15 and
the Instructions for Schedule D (Form 941).

Without a
payment . . .

With a
payment . . .

Connecticut, Delaware, District of
Columbia, Georgia, Illinois,
Indiana, Kentucky, Maine,
Maryland, Massachusetts,
Michigan, New Hampshire, New
Jersey, New York, North Carolina,
Ohio, Pennsylvania, Rhode
Island, South Carolina,
Tennessee, Vermont, Virginia,
West Virginia, Wisconsin

Department of
the Treasury
Internal
Revenue
Service
Kansas City,
MO 64999-0005

Internal
Revenue
Service
P.O. Box
806532
Cincinnati, OH
45280-6532

Alabama, Alaska, Arizona,
Arkansas, California, Colorado,
Florida, Hawaii, Idaho, Iowa,
Kansas, Louisiana, Minnesota,
Mississippi, Missouri, Montana,
Nebraska, Nevada, New Mexico,
North Dakota, Oklahoma,
Oregon, South Dakota, Texas,
Utah, Washington, Wyoming

Department of
the Treasury
Internal
Revenue
Service
Ogden, UT
84201-0005

Internal
Revenue
Service
P.O. Box
932100
Louisville, KY
40293-2100

No legal residence or principal
place of business in any state

Internal
Revenue
Service
P.O. Box
409101
Ogden, UT
84409

Internal
Revenue
Service
P.O. Box
932100
Louisville, KY
40293-2100

Special filing address for
exempt organizations; federal,
state, and local governmental
entities; and Indian tribal
governmental entities, regardless
of location

Department of
the Treasury
Internal
Revenue
Service
Ogden, UT
84201-0005

Internal
Revenue
Service
P.O. Box
932100
Louisville, KY
40293-2100

Your filing address may have changed from that
used to file your employment tax return in prior
CAUTION years. Don't send Form 941 or any payments to
the SSA.

!

Depositing Your Taxes
You must deposit all depository taxes
electronically by EFT. For more information, see
CAUTION Federal tax deposits must be made by electronic
funds transfer (EFT) under Reminders, earlier.

!

Where Should You File?
You’re encouraged to file Form 941 electronically. Go to
IRS.gov/EmploymentEfile for more information on
electronic filing. If you file a paper return, where you file
Instructions for Form 941 (Rev. 3-2023)

If you’re in . . .

-7-

Must You Deposit Your Taxes?

Before the beginning of each calendar year, determine
which type of deposit schedule you must use.
• If you reported $50,000 or less in taxes during the
lookback period, you’re a monthly schedule depositor.
• If you reported more than $50,000 of taxes during the
lookback period, you’re a semiweekly schedule
depositor.

You may have to deposit the federal income taxes you
withheld and both the employer and employee social
security taxes and Medicare taxes.
• If your total taxes after adjustments and
nonrefundable credits (line 12) are less than $2,500
for the current quarter or the prior quarter, and you
didn't incur a $100,000 next-day deposit obligation
during the current quarter. You don't have to make a
deposit. To avoid a penalty, you must pay any amount
due in full with a timely filed return or you must deposit any
amount you owe by the due date of the return. For more
information on paying with a timely filed return, see the
instructions for line 14, later. If you’re not sure your total
tax liability for the current quarter will be less than $2,500
(and your liability for the prior quarter wasn't less than
$2,500), make deposits using the semiweekly or monthly
rules so you won't be subject to failure-to-deposit (FTD)
penalties.
• If your total taxes after adjustments and
nonrefundable credits (line 12) are $2,500 or more
for the current quarter and the prior quarter. You
must make deposits according to your deposit schedule.
See section 11 of Pub. 15 for information about payments
made under the accuracy of deposits rule and for rules
about federal tax deposits.

If you’re a monthly schedule depositor and
accumulate a $100,000 tax liability on any day
CAUTION during the deposit period, you become a
semiweekly schedule depositor on the next day and
remain so for at least the rest of the calendar year and for
the following calendar year. See $100,000 Next-Day
Deposit Rule in section 11 of Pub. 15 for more
information. The $100,000 tax liability threshold requiring
a next-day deposit is determined before you consider any
reduction of your liability for nonrefundable credits. For
more information, including an example, see frequently
asked question 17 at IRS.gov/ETD.

DRAFT AS OF
January 12, 2023
!

What About Penalties and Interest?
Avoiding Penalties and Interest

You can avoid paying penalties and interest if you do all of
the following.
• Deposit or pay your taxes when they are due, unless
you meet the requirements discussed in Notice 2020-22
and Notice 2021-24.
• File your fully completed Form 941 on time.
• Report your tax liability accurately.
• Submit valid checks for tax payments.
• Furnish accurate Forms W-2 to employees.
• File Form W-3 and Copy A of Forms W-2 with the SSA
on time and accurately.

Reducing your deposits for the credit for qualified
sick and family leave wages. Employers eligible to
claim the credit for qualified sick and family leave wages
paid this quarter of 2023 for leave taken after March 31,
2020, and before October 1, 2021, can reduce their
deposits by the amount of their anticipated credit.
Employers won’t be subject to an FTD penalty for
reducing their deposits if certain conditions are met. See
the instructions for line 11b and line 11d, later, for more
information on these credits. For more information on
reducing deposits, see Notice 2020-22, 2020-17 I.R.B.
664, available at IRS.gov/irb/2020-17_IRB#NOT-2020-22;
and Notice 2021-24, 2021-18 I.R.B. 1122, available at
IRS.gov/irb/2021-18_IRB#NOT-2021-24. See the
instructions for line 16, later, for information on adjusting
tax liabilities reported on line 16 or Schedule B (Form 941)
for nonrefundable credits.

Penalties and interest are charged on taxes paid late
and returns filed late at a rate set by law. See sections 11
and 12 of Pub. 15 for details.
Use Form 843 to request abatement of assessed
penalties or interest. Don't request abatement of
assessed penalties or interest on Form 941 or Form
941-X.
If you receive a notice about a penalty after you file this
return, reply to the notice with an explanation and we will
determine if you meet reasonable-cause criteria. Don't
attach an explanation when you file your return.

When Must You Deposit Your Taxes?
Determine if You’re a Monthly or Semiweekly
Schedule Depositor for the Quarter

If federal income, social security, and Medicare
taxes that must be withheld (that is, trust fund
CAUTION taxes) aren't withheld or aren't deposited or paid
to the United States Treasury, the trust fund recovery
penalty may apply. The penalty is 100% of the unpaid
trust fund tax. If these unpaid taxes can't be immediately
collected from the employer or business, the trust fund
recovery penalty may be imposed on all persons who are
determined by the IRS to be responsible for collecting,
accounting for, or paying over these taxes, and who acted
willfully in not doing so. For more information, see section
11 of Pub. 15. The trust fund recovery penalty won't apply
to any amount of trust fund taxes an employer holds back
in anticipation of any credits they are entitled to.

The IRS uses two different sets of deposit rules to
determine when businesses must deposit their social
security, Medicare, and withheld federal income taxes.
These schedules tell you when a deposit is due after you
have a payday.

!

Your deposit schedule isn't determined by how often
you pay your employees. Your deposit schedule depends
on the total tax liability you reported on Form 941 during
the previous 4-quarter lookback period (July 1 of the
second preceding calendar year through June 30 of the
preceding calendar year). See section 11 of Pub. 15 for
details. If you filed Form 944 in either 2021 or 2022, your
lookback period is the 2021 calendar year.
-8-

Instructions for Form 941 (Rev. 3-2023)

Adjustment of Tax on Tips

this quarter of 2023 for leave taken after March 31, 2020,
and before October 1, 2021, and qualified family leave
wages paid this quarter of 2023 for leave taken after
March 31, 2020, and before October 1, 2021; tips; taxable
fringe benefits; and supplemental unemployment
compensation benefits. Don't include any income tax
withheld by a third-party payer of sick pay even if you
reported it on Forms W-2. You will reconcile this
difference on Form W-3. Also include here any excise
taxes you were required to withhold on golden parachute
payments (section 4999). For information on the
employment tax treatment of fringe benefits, see Pub.
15-B, Employer's Tax Guide to Fringe Benefits. For
information about supplemental unemployment
compensation benefits and golden parachute payments,
see section 5 of Pub. 15-A.

If, by the 10th of the month after the month you received
an employee's report on tips, you don't have enough
employee funds available to withhold the employee share
of social security and Medicare taxes, you no longer have
to collect it. Report the entire amount of these tips on
line 5b (Taxable social security tips), line 5c (Taxable
Medicare wages and tips), and, if the withholding
threshold is met, line 5d (Taxable wages and tips subject
to Additional Medicare Tax withholding). Include as a
negative adjustment on line 9 the total uncollected
employee share of the social security and Medicare taxes.

DRAFT AS OF
January 12, 2023

Specific Instructions:

Part 1: Answer These Questions for
This Quarter

If you’re a third-party payer of sick pay, enter the
federal income tax you withheld (or were required to
withhold) on third-party sick pay here.

1. Number of Employees Who Received Wages,
Tips, or Other Compensation

4. If No Wages, Tips, and Other Compensation
Are Subject to Social Security or Medicare
Tax . . .

Enter the number of employees on your payroll for the pay
period including March 12, June 12, September 12, or
December 12, for the quarter indicated at the top of Form
941. Don't include:
• Household employees,
• Employees in nonpay status for the pay period,
• Farm employees,
• Pensioners, or
• Active members of the U.S. Armed Forces.

If no wages, tips, and other compensation on line 2 are
subject to social security or Medicare tax, check the box
on line 4. If this question doesn't apply to you, leave the
box blank. For more information about exempt wages, see
section 15 of Pub. 15. For religious exemptions, see
section 4 of Pub. 15-A.
If you’re a governmental employer, wages you pay
aren't automatically exempt from social security
CAUTION and Medicare taxes. Your employees may be
covered by law or by a voluntary Section 218 Agreement
with the SSA. For more information, see Pub. 963,
Federal-State Reference Guide.

!

For purposes of these instructions, all references

TIP to “sick pay” mean ordinary sick pay, not “qualified

sick leave wages” that are reported on line 5a(i)
for leave taken after March 31, 2020, and before April 1,
2021, or reported on line 5a for leave taken after March
31, 2021, and before October 1, 2021.

5a–5e. Taxable Social Security and Medicare
Wages and Tips

2. Wages, Tips, and Other Compensation

Qualified sick leave wages and qualified family
leave wages paid this quarter of 2023 for leave
CAUTION taken after March 31, 2020, and before April 1,
2021, are reported on lines 5a(i) and 5a(ii), respectively.
Qualified sick leave wages and qualified family leave
wages paid this quarter of 2023 for leave taken after
March 31, 2021, and before October 1, 2021, are reported
on line 5a.

Enter amounts on line 2 that would also be included in
box 1 of your employees' Forms W-2. See Box
1—Wages, tips, other compensation in the General
Instructions for Forms W-2 and W-3 for details. Include
sick pay paid by your agent. Also include sick pay paid by
a third party that isn't your agent (for example, an
insurance company) if you were given timely notice of the
payments and the third party transferred liability for the
employer's taxes to you.

!

5a. Taxable social security wages. Enter the total
wages, including qualified sick leave wages and qualified
family leave wages paid this quarter of 2023 for leave
taken after March 31, 2021, and before October 1, 2021;
sick pay; and taxable fringe benefits subject to social
security taxes you paid to your employees during the
quarter. Don't include the qualified sick leave wages paid
this quarter of 2023 that are reported on line 5a(i) or
qualified family leave wages paid this quarter of 2023 that
are reported on line 5a(ii) for leave taken after March 31,
2020, and before April 1, 2021. For this purpose, sick pay
includes payments made by an insurance company to
your employees for which you received timely notice from
the insurance company. See section 6 of Pub. 15-A for

If you’re a third-party payer of sick pay and not an agent
of the employer, don't include sick pay that you paid to
policyholders' employees here if you gave the
policyholders timely notice of the payments. See section 6
of Pub. 15-A for more information about sick pay reporting
and the procedures for transferring the liability to the
employer.

3. Federal Income Tax Withheld From Wages,
Tips, and Other Compensation

Enter the federal income tax you withheld (or were
required to withhold) from your employees on this
quarter's wages, including qualified sick leave wages paid

Instructions for Form 941 (Rev. 3-2023)

-9-

more information about sick pay reporting. See the
instructions for line 8 for an adjustment that you may need
to make on Form 941 for sick pay.
Enter the amount before payroll deductions. Don't
include tips on this line. For information on types of wages
subject to social security taxes, see section 5 of Pub. 15.
For 2023, the rate of social security tax on taxable
wages, except for qualified sick leave wages and qualified
family leave wages paid in 2023 for leave taken after
March 31, 2020, and before April 1, 2021, is 6.2% (0.062)
each for the employer and employee or 12.4% (0.124) for
both. Stop paying social security tax on and entering an
employee's wages on line 5a when the employee's
taxable wages, including qualified sick leave wages paid
in 2023 that are reported on line 5a(i), qualified family
leave wages paid in 2023 that are reported on line 5a(ii),
and tips, reach $160,200 for the year. However, continue
to withhold income and Medicare taxes for the whole year
on all wages, including qualified sick leave wages paid in
2023, qualified family leave wages paid in 2023, and tips,
even when the social security wage base of $160,200 has
been reached.
For purposes of the credit for qualified sick and family
leave wages, qualified sick leave and family leave wages
are wages for social security and Medicare tax purposes,
determined without regard to the exclusions from the
definition of employment under sections 3121(b)(1)–(22),
that an employer pays that otherwise meet the
requirements of the Emergency Paid Sick Leave Act
(EPSLA) or the Emergency Family and Medical Leave
Expansion Act (Expanded FMLA), as enacted under the
FFCRA and amended for purposes of the ARP. However,
don't include any wages otherwise excluded under
section 3121(b) when reporting qualified sick and family
leave wages on lines 5a, 5a(i), 5a(ii), 5c, and, if
applicable, 5d. See the instructions for line 11d for
information about the credit for qualified sick and family
leave wages for leave taken after March 31, 2021, and
before October 1, 2021.

3. Is experiencing symptoms of COVID-19 and
seeking a medical diagnosis; or, for leave taken after
March 31, 2021, and before October 1, 2021, is seeking
or awaiting the results of a diagnostic test for, or a medical
diagnosis of, COVID-19 (and the employee has been
exposed to COVID-19 or the employee's employer has
requested such test or diagnosis), or the employee is
obtaining immunizations related to COVID-19 or
recovering from an injury, disability, illness, or condition
related to such immunization;
4. Is caring for an individual subject to an order
described in (1) or who has been advised as described in
(2);
5. Is caring for a son or daughter because the school
or place of care for that child has been closed, or the
childcare provider for that child is unavailable, due to
COVID-19 precautions; or
6. Is experiencing any other substantially similar
condition specified by the U.S. Department of Health and
Human Services, which for leave taken after March 31,
2021, and before October 1, 2021, includes to
accompany an individual to obtain immunization related to
COVID-19, or to care for an individual who is recovering
from any injury, disability, illness, or condition related to
the immunization.

DRAFT AS OF
January 12, 2023

line 5a (column 1)
x    0.124
line 5a (column 2)

EPSLA. Employers with fewer than 500 employees
and, for leave taken after March 31, 2021, and before
October 1, 2021, certain governmental employers without
regard to number of employees (except for the federal
government and its agencies and instrumentalities unless
described in section 501(c)(1)) are entitled to a credit if
they provide paid sick leave to employees that otherwise
meets the requirements of the EPSLA. Under the EPSLA,
as amended for purposes of the ARP, wages are qualified
sick leave wages if paid to employees that are unable to
work or telework before October 1, 2021, because the
employee:
1. Is subject to a federal, state, or local quarantine or
isolation order related to COVID-19;
2. Has been advised by a health care provider to
self-quarantine due to concerns related to COVID-19;

Son or daughter. A son or daughter must generally
have been under 18 years of age or incapable of self-care
because of a mental or physical disability. A son or
daughter includes a biological child, adopted child,
stepchild, foster child, legal ward, or a child for whom the
employee assumes parental status and carries out the
obligations of a parent.
Limits on qualified sick leave wages. The EPSLA,
as amended for purposes of the ARP, provides different
limitations for different circumstances under which
qualified sick leave wages are paid. For paid sick leave
qualifying under (1), (2), or (3) above, the amount of
qualified sick leave wages is determined at the
employee's regular rate of pay, but the wages may not
exceed $511 for any day (or portion of a day) for which the
individual is paid sick leave. For paid sick leave qualifying
under (4), (5), or (6) above, the amount of qualified sick
leave wages is determined at two-thirds the employee's
regular rate of pay, but the wages may not exceed $200
for any day (or portion of a day) for which the individual is
paid sick leave. The EPSLA also limits each individual to a
maximum of up to 80 hours of paid sick leave in total for
leave taken after March 31, 2020, and before April 1,
2021. The ARP resets this limit at 80 hours of paid sick
leave for leave taken after March 31, 2021, and before
October 1, 2021. Therefore, for leave taken after March
31, 2020, and before April 1, 2021, the maximum amount
of paid sick leave wages can't exceed $5,110 for an
employee for leave under (1), (2), or (3), and it can't
exceed $2,000 for an employee for leave under (4), (5), or
(6). These maximum amounts also reset and apply to
leave taken after March 31, 2021, and before October 1,
2021.
For more information about qualified sick leave wages,
go to IRS.gov/PLC.
Expanded FMLA. Employers with fewer than 500
employees and, for leave taken after March 31, 2021, and
-10-

Instructions for Form 941 (Rev. 3-2023)

before October 1, 2021, certain governmental employers
without regard to number of employees (except for the
federal government and its agencies and instrumentalities
unless described in section 501(c)(1)) are entitled to a
credit under the FFCRA, as amended for purposes of the
ARP, if they provide paid family leave to employees that
otherwise meets the requirements of the Expanded
FMLA. For leave taken after March 31, 2020, and before
April 1, 2021, wages are qualified family leave wages if
paid to an employee who has been employed for at least
30 calendar days when an employee is unable to work or
telework due to the need to care for a son or daughter
under 18 years of age or incapable of self-care because of
a mental or physical disability because the school or place
of care for that child has been closed, or the childcare
provider for that child is unavailable, due to a public health
emergency. See Son or daughter, earlier, for more
information. For leave taken after March 31, 2021, and
before October 1, 2021, the leave can be granted for any
other reason provided by the EPSLA, as amended for
purposes of the ARP.
For leave taken after March 31, 2020, and before April
1, 2021, the first 10 days for which an employee takes
leave may be unpaid. During this period, employees may
use other forms of paid leave, such as qualified sick leave,
accrued sick leave, annual leave, or other paid time off.
After an employee takes leave for 10 days, the employer
must provide the employee paid leave (that is, qualified
family leave wages) for up to 10 weeks. For leave taken
after March 31, 2021, and before October 1, 2021, the
10-day rule discussed above doesn't apply and the paid
leave can be provided for up to 12 weeks.
Rate of pay and limit on wages. The rate of pay must
be at least two-thirds of the employee’s regular rate of pay
(as determined under the Fair Labor Standards Act of
1938), multiplied by the number of hours the employee
otherwise would have been scheduled to work. For leave
taken after March 31, 2020, and before April 1, 2021, the
total qualified family leave wages can’t exceed $200 per
day or $10,000 in the aggregate per employee. For leave
taken after March 31, 2021, and before October 1, 2021,
the limit resets and the total qualified family leave wages
can't exceed $200 per day or $12,000 in the aggregate
per employee.
For more information about qualified family leave
wages, go to IRS.gov/PLC.

For purposes of the credit for qualified sick and family
leave wages, qualified sick leave wages are wages for
social security and Medicare tax purposes, determined
without regard to the exclusions from the definition of
employment under sections 3121(b)(1)–(22), that an
employer pays that otherwise meet the requirements of
the EPSLA, as enacted under the FFCRA and amended
by the COVID-related Tax Relief Act of 2020. However,
don't include any wages otherwise excluded under
section 3121(b) when reporting qualified sick leave wages
on lines 5a(i), 5c, and, if applicable, 5d. See the
instructions for line 11b for information about the credit for
qualified sick and family leave wages for leave taken after
March 31, 2020, and before April 1, 2021.

DRAFT AS OF
January 12, 2023

5a(i). Qualified sick leave wages. Enter the qualified
taxable (subject to social security tax) sick leave wages
you paid this quarter of 2023 to your employees for leave
taken after March 31, 2020, and before April 1, 2021.
Qualified sick leave wages for leave taken after March 31,
2020, and before April 1, 2021, aren't subject to the
employer share of social security tax; therefore, the tax
rate on these wages is 6.2% (0.062). Stop paying social
security tax on and entering an employee's wages on
line 5a(i) when the employee's taxable wages, including
wages reported on line 5a, qualified sick leave wages
reported on line 5a(i), qualified family leave wages
reported on line 5a(ii), and tips, reach $160,200 for the
year. See the instructions for line 5c for reporting
Medicare tax on qualified sick leave wages, including the
portion above the social security wage base.
Instructions for Form 941 (Rev. 3-2023)

line 5a(i) (column 1)
x    0.062
line 5a(i) (column 2)

5a(ii). Qualified family leave wages. Enter the qualified
taxable (subject to social security tax) family leave wages
you paid this quarter of 2023 to your employees for leave
taken after March 31, 2020, and before April 1, 2021.
Qualified family leave wages for leave taken after March
31, 2020, and before April 1, 2021, aren't subject to the
employer share of social security tax; therefore, the tax
rate on these wages is 6.2% (0.062). Stop paying social
security tax on and entering an employee's wages on
line 5a(ii) when the employee's taxable wages, including
wages reported on line 5a, qualified sick leave wages
reported on line 5a(i), qualified family leave wages
reported on line 5a(ii), and tips, reach $160,200 for the
year. See the instructions for line 5c for reporting
Medicare tax on qualified family leave wages, including
the portion above the social security wage base.
For purposes of the credit for qualified sick and family
leave wages, qualified family leave wages are wages for
social security and Medicare tax purposes, determined
without regard to the exclusions from the definition of
employment under sections 3121(b)(1)–(22), that an
employer pays that otherwise meet the requirements of
the Expanded FMLA, as enacted under the FFCRA and
amended by the COVID-related Tax Relief Act of 2020.
However, don't include any wages otherwise excluded
under section 3121(b) when reporting qualified family
leave wages on lines 5a(ii), 5c, and, if applicable, 5d. See
the instructions for line 11b for information about the credit
for qualified sick and family leave wages for leave taken
after March 31, 2020, and before April 1, 2021.
line 5a(ii) (column 1)
x    0.062
line 5a(ii) (column 2)

5b. Taxable social security tips. Enter all tips your
employees reported to you during the quarter until the
total of the tips and taxable wages, including wages
reported on line 5a, qualified sick leave wages reported
on line 5a(i), and qualified family leave wages reported on
line 5a(ii), for an employee reach $160,200 for the year.
Include all tips your employee reported to you even if you
-11-

were unable to withhold the employee tax of 6.2%. You
will reduce your total taxes by the amount of any
uncollected employee share of social security and
Medicare taxes on tips later on line 9; see Current
quarter's adjustments for tips and group-term life
insurance, later. Don’t include service charges on line 5b.
For details about the difference between tips and service
charges, see Rev. Rul. 2012-18, 2012-26 I.R.B. 1032,
available at IRS.gov/irb/2012-26_IRB#RR-2012-18.
Your employee must report cash tips to you by the 10th
day of the month after the month the tips are received.
Cash tips include tips paid by cash, check, debit card, and
credit card. The report should include charged tips (for
example, credit and debit card charges) you paid over to
the employee for charge customers, tips the employee
received directly from customers, and tips received from
other employees under any tip-sharing arrangement. Both
directly and indirectly tipped employees must report tips to
you. No report is required for months when tips are less
than $20. Employees may use Form 4070 (available only
in Pub. 1244), or submit a written statement or electronic
tip record.
Don't include allocated tips (described in section 6 of
Pub. 15) on this line. Instead, report them on Form 8027.
Allocated tips aren't reportable on Form 941 and aren't
subject to withholding of federal income, social security,
or Medicare taxes.

until the end of the calendar year. Additional Medicare
Tax is only imposed on the employee. There is no
employer share of Additional Medicare Tax. All wages that
are subject to Medicare tax are subject to Additional
Medicare Tax withholding if paid in excess of the
$200,000 withholding threshold.
For more information on what wages are subject to
Medicare tax, see the chart, Special Rules for Various
Types of Services and Payments, in section 15 of Pub. 15.
For more information on Additional Medicare Tax, go to
IRS.gov/ADMTfaqs. See the instructions for line 8 for an
adjustment that you may need to make on Form 941 for
sick pay.
Once wages and tips exceed the $200,000 withholding
threshold, include all tips your employees reported during
the quarter, even if you were unable to withhold the
employee tax of 0.9%.

DRAFT AS OF
January 12, 2023
line 5b (column 1)
x     0.124
line 5b (column 2)

5c. Taxable Medicare wages & tips. Enter all wages,
including qualified sick leave wages paid this quarter of
2023 and qualified family leave wages paid this quarter of
2023; tips; sick pay; and taxable fringe benefits that are
subject to Medicare tax. Unlike social security wages,
there is no limit on the amount of wages subject to
Medicare tax.
The rate of Medicare tax is 1.45% (0.0145) each for the
employer and employee or 2.9% (0.029) for both. Include
all tips your employees reported during the quarter, even if
you were unable to withhold the employee tax of 1.45%.
line 5c (column 1)
x     0.029
line 5c (column 2)

For more information on tips, see section 6 of Pub. 15.
See the instructions for line 8 for an adjustment that you
may need to make on Form 941 for sick pay.
5d. Taxable wages & tips subject to Additional Medicare Tax withholding. Enter all wages, including
qualified sick leave wages paid this quarter of 2023 and
qualified family leave wages paid this quarter of 2023;
tips; sick pay; and taxable fringe benefits that are subject
to Additional Medicare Tax withholding. You’re required to
begin withholding Additional Medicare Tax in the pay
period in which you pay wages in excess of $200,000 to
an employee and continue to withhold it each pay period

line 5d (column 1)
x     0.009
line 5d (column 2)

5e. Total social security and Medicare taxes. Add the
column 2 amounts on lines 5a–5d. Enter the result on
line 5e.

5f. Section 3121(q) Notice and Demand—Tax
Due on Unreported Tips

Enter the tax due from your Section 3121(q) Notice and
Demand on line 5f. The IRS issues a Section 3121(q)
Notice and Demand to advise an employer of the amount
of tips received by employees who failed to report or
underreported tips to the employer. An employer isn't
liable for the employer share of the social security and
Medicare taxes on unreported tips until notice and
demand for the taxes is made to the employer by the IRS
in a Section 3121(q) Notice and Demand. The tax due
may have been determined from tips reported to the IRS
on employees' Forms 4137, Social Security and Medicare
Tax on Unreported Tip Income, or other tips that weren't
reported to their employer as determined by the IRS
during an examination. For additional information, see
Rev. Rul. 2012-18.
Deposit the tax within the time period required under
your deposit schedule to avoid any possible deposit
penalty. The tax is treated as accumulated by the
employer on the “Date of Notice and Demand” as printed
on the Section 3121(q) Notice and Demand. The
employer must include this amount on the appropriate line
of the record of federal tax liability (Part 2 of Form 941 for
a monthly schedule depositor or Schedule B (Form 941)
for a semiweekly schedule depositor).

6. Total Taxes Before Adjustments

Add the total federal income tax withheld from wages,
tips, and other compensation (line 3); the total social
security and Medicare taxes before adjustments (line 5e);
and any tax due under a Section 3121(q) Notice and
Demand (line 5f). Enter the result on line 6.

-12-

Instructions for Form 941 (Rev. 3-2023)

7–9. Tax Adjustments

Enter tax amounts on lines 7–9 that result from current
quarter adjustments. Use a minus sign (if possible) to
show an adjustment that decreases the total taxes shown
on line 6 instead of parentheses. Doing so enhances the
accuracy of our scanning software. For example, enter
“-10.59” instead of “(10.59).” However, if your software
only allows for parentheses in entering negative amounts,
you may use them.

Prior quarter's adjustments. If you need to correct any
adjustment reported on a previously filed Form 941,
complete and file Form 941-X. Form 941-X is an adjusted
return or claim for refund and is filed separately from Form
941. See section 13 of Pub. 15.

10. Total Taxes After Adjustments

Combine the amounts shown on lines 6–9 and enter the
result on line 10.

DRAFT AS OF
January 12, 2023

Current quarter's adjustments. In certain cases, you
must adjust the amounts you entered as social security
and Medicare taxes in column 2 of lines 5a–5d to figure
your correct tax liability for this quarter's Form 941. See
section 13 of Pub. 15.
7. Current quarter's adjustment for fractions of
cents. Enter adjustments for fractions of cents (due to
rounding) relating to the employee share of social security
and Medicare taxes withheld. The employee share of
amounts shown in column 2 of lines 5a–5d may differ
slightly from amounts actually withheld from employees'
pay due to the rounding of social security and Medicare
taxes based on statutory rates. This adjustment may be a
positive or a negative adjustment.
8. Current quarter's adjustment for sick pay. If your
third-party payer of sick pay that isn't your agent (for
example, an insurance company) transfers the liability for
the employer share of the social security and Medicare
taxes to you, enter a negative adjustment on line 8 for the
employee share of social security and Medicare taxes that
were withheld and deposited by your third-party sick pay
payer on the sick pay. If you’re the third-party sick pay
payer and you transferred the liability for the employer
share of the social security and Medicare taxes to the
employer, enter a negative adjustment on line 8 for any
employer share of these taxes required to be paid by the
employer. The sick pay should be included on line 5a,
line 5c, and, if the withholding threshold is met, line 5d.
No adjustment is reported on line 8 for sick pay that is
paid through a third party as an employer’s agent. An
employer’s agent bears no insurance risk and is
reimbursed on a cost-plus-fee basis for payment of sick
pay and similar amounts. If an employer uses an agent to
pay sick pay, the employer reports the wages on line 5a,
line 5c, and, if the withholding threshold is met, line 5d,
unless the employer has an agency agreement with the
third-party payer that requires the third-party payer to do
the collecting, reporting, and/or paying or depositing
employment taxes on the sick pay. See section 6 of Pub.
15-A for more information about sick pay reporting.
9. Current quarter's adjustments for tips and
group-term life insurance. Enter a negative adjustment
for:
• Any uncollected employee share of social security and
Medicare taxes on tips, and
• The uncollected employee share of social security and
Medicare taxes on group-term life insurance premiums
paid for former employees.
See the General Instructions for Forms W-2 and W-3
for information on how to report the uncollected employee
share of social security and Medicare taxes on tips and
group-term life insurance on Form W-2.
Instructions for Form 941 (Rev. 3-2023)

11a. Qualified Small Business Payroll Tax Credit
for Increasing Research Activities

Enter the amount of the credit from Form 8974, line 12 or,
if applicable, line 17.

!

If you enter an amount on line 11a, you must
attach Form 8974.

CAUTION

Form 941 and these instructions use the terms

TIP “nonrefundable” and “refundable” when

discussing credits. The term “nonrefundable”
means the portion of the credit which is limited by law to
the amount of certain taxes. The term “refundable” means
the portion of the credit which is in excess of those taxes.

11b. Nonrefundable Portion of Credit for
Qualified Sick and Family Leave Wages for
Leave Taken After March 31, 2020, and Before
April 1, 2021
Complete line 11b only if qualified sick leave
wages and/or qualified family leave wages were
CAUTION paid this quarter of 2023 for leave taken after
March 31, 2020, and before April 1, 2021.

!

Certain private employers with fewer than 500
employees that provide paid sick leave under the EPSLA
and/or provide paid family leave under the Expanded
FMLA are eligible to claim the credit for qualified sick and
family leave wages for leave taken after March 31, 2020,
and before April 1, 2021. For purposes of this credit,
qualified sick leave wages and qualified family leave
wages are wages for social security and Medicare tax
purposes, determined without regard to the exclusions
from the definition of employment under sections 3121(b)
(1)–(22), that an employer pays that otherwise meet the
requirements of the EPSLA or Expanded FMLA. Enter the
nonrefundable portion of the credit for qualified sick and
family leave wages from Worksheet 1, Step 2, line 2j. The
credit for qualified sick and family leave wages consists of
the qualified sick leave wages, the qualified family leave
wages, the qualified health plan expenses allocable to
those wages, and the employer share of Medicare tax
allocable to those wages. The nonrefundable portion of
the credit is limited to the employer share of social
security tax reported on Form 941, lines 5a and 5b, after
that share is first reduced by any credit claimed against
the employer share of social security tax on Form 8974 for
the qualified small business payroll tax credit for
increasing research activities, any credit to be claimed on
Form 5884-C for the work opportunity credit for qualified
tax-exempt organizations hiring qualified veterans, and/or

-13-

any credit to be claimed on Form 5884-D for the disaster
credit for qualified tax-exempt organizations.
If you're a third-party payer of sick pay that isn't an
agent (for example, an insurance company) and
CAUTION you're claiming the credit for qualified sick and
family leave wages for amounts paid to your own
employees, the amount of the employer share of social
security tax reported on line 5a must be reduced by any
adjustment you make on line 8 for the employer share of
social security tax transferred to your client. If you
received a Section 3121(q) Notice and Demand for tax
due on unreported tips (Letter 3263 or Letter 4520) during
the quarter, you report the amount for the employer share
of social security tax and Medicare tax on Form 941,
line 5f. Letter 3263 or Letter 4520 includes an attachment
that shows the employer share of social security tax. This
amount of the employer share of social security tax can
also be reduced by the nonrefundable portion of the
credit. See Worksheet 1 to figure your credit.

!

paid sick leave to employees that otherwise meets the
requirements of the EPSLA, as amended for purposes of
the ARP, and/or provide paid family leave to employees
that otherwise meets the requirements under the
Expanded FMLA, as amended for purposes of the ARP,
for qualified sick and family leave wages for leave taken
after March 31, 2021, and before October 1, 2021. For
purposes of this credit, qualified sick leave wages and
qualified family leave wages are wages for social security
and Medicare tax purposes, determined without regard to
the exclusions from the definition of employment under
sections 3121(b)(1)–(22), that an employer pays that
otherwise meet the requirements of the EPSLA or
Expanded FMLA, as enacted under the FFCRA and
amended for purposes of the ARP. Enter the
nonrefundable portion of the credit for qualified sick and
family leave wages from Worksheet 2, Step 2, line 2p.

DRAFT AS OF
January 12, 2023

Any credit in excess of the remaining amount of the
employer share of social security tax is refundable and
reported on Form 941, line 13c. For more information on
the credit for qualified sick and family leave wages, go to
IRS.gov/PLC.
Qualified health plan expenses allocable to qualified
sick leave and family leave wages. The credit for
qualified sick leave wages and qualified family leave
wages is increased to cover the qualified health plan
expenses that are properly allocable to the qualified leave
wages for which the credit is allowed. These qualified
health plan expenses are amounts paid or incurred by the
employer to provide and maintain a group health plan but
only to the extent such amounts are excluded from the
employees’ income as coverage under an accident or
health plan. The amount of qualified health plan expenses
generally includes both the portion of the cost paid by the
employer and the portion of the cost paid by the employee
with pre-tax salary reduction contributions. However,
qualified health plan expenses don’t include amounts that
the employee paid for with after-tax contributions. For
more information, go to IRS.gov/PLC.
You must include the full amount (both the

TIP nonrefundable and refundable portions) of the

credit for qualified sick and family leave wages in
your gross income for the tax year that includes the last
day of any calendar quarter in which a credit is allowed.

11d. Nonrefundable Portion of Credit for
Qualified Sick and Family Leave Wages for
Leave Taken After March 31, 2021, and Before
October 1, 2021
Complete line 11d only if qualified sick leave
wages and/or qualified family leave wages were
CAUTION paid this quarter of 2023 for leave taken after
March 31, 2021, and before October 1, 2021.

!

Employers with fewer than 500 employees and certain
governmental employers without regard to number of
employees (except for the federal government and its
agencies and instrumentalities unless described in
section 501(c)(1)) are entitled to a credit if they provide

The credit for qualified sick and family leave wages
consists of the:
• Qualified sick leave wages and/or qualified family leave
wages;
• Qualified health plan expenses allocable to qualified
sick leave and family leave wages;
• Collectively bargained defined benefit pension plan
contributions, subject to the qualified leave wage
limitations, allocable to the qualified sick and family leave
wages;
• Collectively bargained apprenticeship program
contributions, subject to the qualified leave wage
limitations, allocable to the qualified sick and family leave
wages; and
• Employer share of social security and Medicare tax
allocable to the qualified sick and family leave wages.
The nonrefundable portion of the credit is limited to the
employer share of Medicare tax reported on Form 941,
line 5c, after that share is first reduced by any credit
claimed against the employer share of Medicare tax on
Form 8974 for the qualified small business payroll tax
credit for increasing research activities. You can’t claim
the credit for leave taken after March 31, 2021, and before
October 1, 2021, if, during the applicable quarter in which
the qualified sick or family leave wages were paid, you
made qualified sick or family leave wages available in a
manner that discriminates in favor of highly compensated
employees, full-time employees, or employees on the
basis of employment tenure. See Highly compensated
employee, later, for the definition.
For leave taken after March 31, 2021, and before
October 1, 2021, the credit for qualified sick and family
leave wages is reduced by the amount of the credit
allowed under section 41 (for the credit for increasing
research activities) with respect to wages taken into
account for determining the credit for qualified sick and
family leave wages; and any wages taken into account in
determining the credit for qualified sick and family leave
wages can't be taken into account as wages for purposes
of the credits under sections 45A, 45P, 45S, and 51. For
leave taken after March 31, 2021, and before October 1,
2021, qualified wages also don't include wages that were
used as payroll costs in connection with a Shuttered
Venue Operator Grant under section 324 of the Economic
Aid to Hard-Hit Small Businesses, Nonprofits, and Venues

-14-

Instructions for Form 941 (Rev. 3-2023)

Act; or a restaurant revitalization grant under section 5003
of the ARP. Employers can receive both a Small Business
Interruption Loan under the Paycheck Protection Program
(PPP) and the credit for qualified sick and family leave
wages; however, employers can't receive both loan
forgiveness and a credit for the same wages. The same
wages can’t be treated as both qualified sick leave wages
and qualified family leave wages.

DRAFT AS OF
January 12, 2023

If you're a third-party payer of sick pay that isn't an
agent (for example, an insurance company) and
CAUTION you're claiming the credit for qualified sick and
family leave wages for amounts paid to your own
employees, the amount of the employer share of
Medicare tax reported on line 5c must be reduced by any
adjustment you make on line 8 for the employer share of
Medicare tax transferred to your client. If you received a
Section 3121(q) Notice and Demand for tax due on
unreported tips (Letter 3263 or Letter 4520) during the
quarter, you report the amount for the employer share of
social security tax and Medicare tax on Form 941, line 5f.
Letter 3263 or Letter 4520 includes an attachment that
shows the employer share of Medicare tax. This amount
of the employer share of Medicare tax can also be
reduced by the nonrefundable portion of the credit. See
Worksheet 2 to figure your credit.

!

agreement to a defined benefit plan, as the rate is applied
to contribution base units, as defined by section 4001(a)
(11) of the Employee Retirement Income Security Act of
1974 (ERISA).
Allocation rules. The amount of collectively bargained
defined benefit pension plan contributions allocated to
qualified sick leave wages and/or qualified family leave
wages in a quarter is the pension contribution rate
(expressed as an hourly rate) multiplied by the number of
hours qualified sick leave wages and/or qualified family
leave wages were provided to employees covered under
the collective bargaining agreement during the quarter.

Any credit in excess of the remaining amount of the
employer share of Medicare tax is refundable and
reported on Form 941, line 13e. For more information on
the credit for qualified sick and family leave wages, go to
IRS.gov/PLC.
Qualified health plan expenses allocable to qualified
sick leave and family leave wages. The credit for
qualified sick leave wages and qualified family leave
wages is increased to cover the qualified health plan
expenses that are properly allocable to the qualified leave
wages for which the credit is allowed. These qualified
health plan expenses are amounts paid or incurred by the
employer to provide and maintain a group health plan but
only to the extent such amounts are excluded from the
employees' income as coverage under an accident or
health plan. The amount of qualified health plan expenses
generally includes both the portion of the cost paid by the
employer and the portion of the cost paid by the employee
with pre-tax salary reduction contributions. However,
qualified health plan expenses don't include amounts that
the employee paid for with after-tax contributions. For
more information, go to IRS.gov/PLC.
Collectively bargained defined benefit pension plan
contributions. For purposes of qualified sick and family
leave wages, collectively bargained defined benefit
pension plan contributions are contributions for a calendar
quarter that are:
• Paid or incurred by an employer on behalf of its
employees to a defined benefit plan, as defined in section
414(j), which meets the requirements of section 401(a);
• Made based on a pension contribution rate; and
• Required to be made under the terms of a collective
bargaining agreement in effect for the quarter.
Pension contribution rate. The pension contribution
rate is the contribution rate that the employer is obligated
to pay under the terms of a collective bargaining
Instructions for Form 941 (Rev. 3-2023)

Collectively bargained apprenticeship program contributions. For purposes of qualified sick and family
leave wages, collectively bargained apprenticeship
program contributions are contributions for a calendar
quarter that are:
• Paid or incurred by an employer on behalf of its
employees to a registered apprenticeship program, which
is an apprenticeship registered under the National
Apprenticeship Act of August 16, 1937, and meets the
standards of Federal Regulations under subpart A of Part
29 and Part 30 of title 29;
• Made based on an apprenticeship program contribution
rate; and
• Required to be made under the terms of a collective
bargaining agreement in effect for the quarter.
Apprenticeship program contribution rate. The
apprenticeship program contribution rate is the
contribution rate that the employer is obligated to pay
under the terms of a collective bargaining agreement for
benefits under a registered apprenticeship program, as
the rate is applied to contribution base units, as defined by
section 4001(a)(11) of ERISA.
Allocation rules. The amount of collectively bargained
apprenticeship program contributions allocated to
qualified sick leave wages and/or qualified family leave
wages in a quarter is the apprenticeship program
contribution rate (expressed as an hourly rate) multiplied
by the number of hours qualified sick leave wages and/or
qualified family leave wages were provided to employees
covered under the collective bargaining agreement during
the quarter.
Highly compensated employee. A highly compensated
employee is an employee who meets either of the
following tests.
1. The employee was a 5% owner at any time during
the year or the preceding year.
2. The employee received more than $135,000 in pay
for the preceding year.
You can choose to ignore test (2) if the employee
wasn’t also in the top 20% of employees when ranked by
pay for the preceding year.

11g. Total Nonrefundable Credits

Add lines 11a, 11b, and 11d. Enter the total on line 11g.

-15-

12. Total Taxes After Adjustments and
Nonrefundable Credits

Subtract line 11g from line 10 and enter the result on
line 12. The amount entered on line 12 can’t be less than
zero.

• If line 12 is less than $2,500 or line 12 on the prior
quarterly return was less than $2,500, and you didn't
incur a $100,000 next-day deposit obligation during
the current quarter. You may pay the amount with Form
941 or you may deposit the amount. To avoid a penalty,
you must pay any amount you owe in full with a timely filed
return or you must deposit any amount you owe before the
due date of the return. For more information on paying
with a timely filed return, see the instructions for line 14,
later.
• If line 12 is $2,500 or more and line 12 on the prior
quarterly return was $2,500 or more, or if you
incurred a $100,000 next-day deposit obligation
during the current quarter. You must make required
deposits according to your deposit schedule. See Notice
2020-22 and Notice 2021-24 for information on reducing
deposits for certain credits. The amount shown on line 12
must equal the “Total liability for quarter” shown on line 16
or the “Total liability for the quarter” shown on Schedule B
(Form 941). For more information, see the line 16
instructions, later.

and family leave wages consists of the qualified sick leave
wages, the qualified family leave wages, the qualified
health plan expenses allocable to those wages, and the
employer share of Medicare tax allocable to those wages.
The refundable portion of the credit is allowed after the
employer share of social security tax is reduced to zero by
nonrefundable credits that are applied against the
employer share of social security tax.

DRAFT AS OF
January 12, 2023

For more information and rules about federal tax
deposits, see Depositing Your Taxes, earlier, and section
11 of Pub. 15.
If you’re a semiweekly schedule depositor, you
must complete Schedule B (Form 941). If you fail
CAUTION to complete and submit Schedule B (Form 941),
the IRS may assess deposit penalties based on available
information.

!

13a. Total Deposits for This Quarter

Enter your deposits for this quarter, including any
overpayment from a prior quarter that you applied to this
return. Also include in the amount shown any
overpayment that you applied from filing Form 941-X,
941-X (PR), 944-X, or 944-X (SP) in the current quarter.
Don't include any amount that you didn't deposit because
you reduced your deposits in anticipation of the credit for
qualified sick and family leave wages, as discussed in
Notice 2020-22 and Notice 2021-24.

13c. Refundable Portion of Credit for Qualified
Sick and Family Leave Wages for Leave Taken
After March 31, 2020, and Before April 1, 2021
Complete line 13c only if qualified sick leave
wages and/or qualified family leave wages were
CAUTION paid this quarter of 2023 for leave taken after
March 31, 2020, and before April 1, 2021.

!

Certain private employers with fewer than 500
employees that provide paid sick leave under the EPSLA
and/or provide paid family leave under the Expanded
FMLA are eligible to claim the credit for qualified sick and
family leave wages. Enter the refundable portion of the
credit for qualified sick and family leave wages from
Worksheet 1, Step 2, line 2k. The credit for qualified sick

13e. Refundable Portion of Credit for Qualified
Sick and Family Leave Wages for Leave Taken
After March 31, 2021, and Before October 1,
2021
Complete line 13e only if qualified sick leave
wages and/or qualified family leave wages were
CAUTION paid this quarter of 2023 for leave taken after
March 31, 2021, and before October 1, 2021.

!

Employers with fewer than 500 employees and certain
governmental employers without regard to number of
employees (except for the federal government and its
agencies and instrumentalities unless described in
section 501(c)(1)) are entitled to a credit if they provide
paid sick leave to employees that otherwise meets the
requirements of the EPSLA, as amended for purposes of
the ARP, and/or provide paid family leave to employees
that otherwise meets the requirements under the
Expanded FMLA, as amended for purposes of the ARP,
for leave taken after March 31, 2021, and before October
1, 2021. Enter the refundable portion of the credit for
qualified sick and family leave wages from Worksheet 2,
Step 2, line 2q. The refundable portion of the credit is
allowed after the employer share of Medicare tax is
reduced to zero by nonrefundable credits that are applied
against the employer share of Medicare tax.

13g. Total Deposits and Refundable Credits

Add lines 13a, 13c, and 13e. Enter the total on line 13g.

14. Balance Due

If line 12 is more than line 13g, enter the difference on
line 14. Otherwise, see the instructions for line 15, later.
Never make an entry on both lines 14 and 15.

You don't have to pay if line 14 is under $1. Generally,
you should have a balance due only if your total taxes
after adjustments and nonrefundable credits (line 12) for
the current quarter or prior quarter are less than $2,500,
and you didn't incur a $100,000 next-day deposit
obligation during the current quarter. However, see
section 11 of Pub. 15 for information about payments
made under the accuracy of deposits rule.
If you were required to make federal tax deposits, pay
the amount shown on line 14 by EFT. If you weren't
required to make federal tax deposits (see Must You
Deposit Your Taxes, earlier) or you're a monthly schedule
depositor making a payment under the accuracy of
deposits rule, you may pay the amount shown on line 14
by EFT, credit card, debit card, check, money order, or
EFW. For more information on electronic payment
options, go to IRS.gov/Payments.
If you pay by EFT, credit card, or debit card, file your
return using the Without a payment address under Where
-16-

Instructions for Form 941 (Rev. 3-2023)

Should You File, earlier, and don't file Form 941-V,
Payment Voucher.

monthly tax liability on Form 941 or your daily tax liability
on Schedule B (Form 941).

If you pay by check or money order, make it payable to
“United States Treasury.” Enter your EIN, “Form 941,” and
the tax period (“1st Quarter 2023,” “2nd Quarter 2023,”
“3rd Quarter 2023,” or “4th Quarter 2023”) on your check
or money order. Complete Form 941-V and enclose it with
Form 941.

De minimis exception. If line 12 is less than $2,500 or
line 12 on the prior quarterly return was less than $2,500,
and you didn't incur a $100,000 next-day deposit
obligation during the current quarter, check the first box
on line 16 and go to Part 3.

DRAFT AS OF
January 12, 2023

If line 12 is $2,500 or more on both your prior and
current quarter Form 941, and you’ve deposited all taxes
when due, the balance due on line 14 should be zero.

!

CAUTION

earlier.

If you’re required to make deposits and instead
pay the taxes with Form 941, you may be subject
to a penalty. See Must You Deposit Your Taxes,

What if you can't pay in full? If you can't pay the full
amount of tax you owe, you can apply for an installment
agreement online. You can apply for an installment
agreement online if:
• You can't pay the full amount shown on line 14,
• The total amount you owe is $25,000 or less, and
• You can pay the liability in full in 24 months.
To apply using the Online Payment Agreement
Application, go to IRS.gov/OPA.
Under an installment agreement, you can pay what you
owe in monthly installments. There are certain conditions
you must meet to enter into and maintain an installment
agreement, such as paying the liability within 24 months,
and making all required deposits and timely filing tax
returns during the length of the agreement.
If your installment agreement is accepted, you will be
charged a fee and you will be subject to penalties and
interest on the amount of tax not paid by the due date of
the return.

15. Overpayment

If line 13g is more than line 12, enter the difference on
line 15.
Never make an entry on both lines 14 and 15.

If you deposited more than the correct amount for the
quarter, you can choose to have the IRS either refund the
overpayment or apply it to your next return. Check only
one box on line 15. If you don't check either box or if you
check both boxes, we will generally apply the
overpayment to your next return. Regardless of any boxes
you check or don't check on line 15, we may apply your
overpayment to any past due tax account that is shown in
our records under your EIN.
If line 15 is under $1, we will send a refund or apply it to
your next return only if you ask us in writing to do so.

Part 2: Tell Us About Your Deposit
Schedule and Tax Liability for This
Quarter
16. Tax Liability for the Quarter

Check one of the boxes on line 16. Follow the instructions
for each box to determine if you need to enter your
Instructions for Form 941 (Rev. 3-2023)

If you meet the de minimis exception based on the
prior quarter and line 12 for the current quarter is
CAUTION $100,000 or more, you must provide a record of
your federal tax liability. If you’re a monthly schedule
depositor, complete the deposit schedule on line 16. If
you’re a semiweekly schedule depositor, attach
Schedule B (Form 941).

!

Monthly schedule depositor. If you reported $50,000 or
less in taxes during the lookback period, you’re a monthly
schedule depositor unless the $100,000 Next-Day
Deposit Rule discussed in section 11 of Pub. 15 applies.
Check the second box on line 16 and enter your tax
liability for each month in the quarter. Enter your tax
liabilities in the month that corresponds to the dates you
paid wages to your employees, not the date payroll
liabilities were accrued or deposits were made. Add the
amounts for each month. Enter the result in the “Total
liability for quarter” box.
Note that your total tax liability for the quarter must
equal your total taxes shown on line 12. If it doesn't, your
tax deposits and payments may not be counted as timely.
Don't reduce your total liability reported on line 16 by the
refundable portion of the credit for qualified sick and
family leave wages. Don't change your tax liability on
line 16 by adjustments reported on any Forms 941-X.
You’re a monthly schedule depositor for the calendar
year if the amount of your Form 941 taxes reported for the
lookback period is $50,000 or less. The lookback period is
the 4 consecutive quarters ending on June 30 of the prior
year. For 2023, the lookback period begins July 1, 2021,
and ends June 30, 2022. For details on the deposit rules,
see section 11 of Pub. 15. If you filed Form 944 in either
2021 or 2022, your lookback period is the 2021 calendar
year.

The amounts entered on line 16 are a summary of
your monthly tax liability, not a summary of
CAUTION deposits you made. If you don't properly report
your liabilities when required or if you’re a semiweekly
schedule depositor and enter your liabilities on line 16
instead of on Schedule B (Form 941), you may be
assessed an “averaged” FTD penalty. See Deposit
Penalties in section 11 of Pub. 15 for more information.

!

Reporting adjustments from lines 7–9 on line 16. If
your net adjustment during a month is negative and it
exceeds your total tax liability for the month, don't enter a
negative amount for the month. Instead, enter "-0-" for the
month and carry over the unused portion of the
adjustment to the next month.
Semiweekly schedule depositor. If you reported more
than $50,000 of taxes for the lookback period, you’re a
semiweekly schedule depositor. Check the third box on
line 16.
-17-

You must complete Schedule B (Form 941) and submit
it with your Form 941. Don't file Schedule B (Form 941)
with your Form 941 if you’re a monthly schedule
depositor.
Don't change your tax liability on Schedule B (Form
941) by adjustments reported on any Forms 941-X.
Adjusting tax liability for nonrefundable credits
claimed on lines 11a, 11b, and 11d. Monthly schedule
depositors and semiweekly schedule depositors must
account for nonrefundable credits claimed on lines 11a,
11b, and 11d when reporting their tax liabilities on line 16
or Schedule B (Form 941). The total tax liability for the
quarter must equal the amount reported on line 12. Failure
to account for the nonrefundable credits on line 16 or
Schedule B (Form 941) may cause line 16 or Schedule B
(Form 941) to report more than the total tax liability
reported on line 12. Don't reduce your monthly tax liability
reported on line 16 or your daily tax liability reported on
Schedule B (Form 941) below zero.
Qualified small business payroll tax credit for
increasing research activities (line 11a). Beginning
with the first quarter of 2023, the qualified small business
payroll tax credit for increasing research activities is first
used to reduce the employer share of social security tax
(up to $250,000) for the quarter and any remaining credit
is then used to reduce the employer share of Medicare tax
for the quarter until it reaches zero. In completing line 16
or Schedule B (Form 941), you take into account the
payroll tax credit against the liability for the employer
share of social security tax starting with the first payroll
payment of the quarter that includes payments of wages
subject to social security tax to your employees until you
use up to $250,000 of credit against the employer share of
social security tax and you then take into account any
remaining payroll tax credit against the liability for the
employer share of Medicare tax starting with the first
payroll payment of the quarter that includes payments of
wages subject to Medicare tax to employees. Consistent
with the entries on line 16 or Schedule B (Form 941), the
payroll tax credit should be taken into account in making
deposits of employment tax. If any payroll tax credit is
remaining at the end of the quarter that hasn’t been used
completely because it exceeds $250,000 of the employer
share of social security tax and the employer share of
Medicare tax for the quarter, the excess credit may be
carried forward to the succeeding quarter and allowed as
a payroll tax credit for the succeeding quarter. The payroll
tax credit may not be taken as a credit against income tax
withholding, the employee share of social security tax, or
the employee share of Medicare tax. Also, the remaining
payroll tax credit may not be carried back and taken as a
credit against wages paid from preceding quarters.

Rose Co. is a semiweekly schedule depositor. Rose Co.
completes Schedule B (Form 941) by reducing the
amount of liability entered for the first payroll payment in
the third quarter of 2023 that includes wages subject to
social security tax by the lesser of (1) its share of social
security tax (up to $250,000) on the wages, or (2) the
available payroll tax credit. If the payroll tax credit elected
is more than Rose Co.'s share of social security tax on the
first payroll payment of the quarter, the excess payroll tax
credit would be carried forward to succeeding payroll
payments in the third quarter until it is used against up to
$250,000 of Rose Co.'s share of social security tax for the
quarter. If the amount of the payroll tax credit exceeds
Rose Co.'s share of social security tax (up to $250,000)
on wages paid to its employees in the third quarter, any
remaining credit is used against Rose Co.'s share of
Medicare tax on the first payroll payment of the quarter
and then the excess payroll tax credit would be carried
forward to succeeding payroll payments in the third
quarter until it is used against Rose Co.'s share of
Medicare tax for the quarter. If Rose Co. still has credit
remaining after reducing its share of social security tax (up
to $250,000) and Medicare tax for the third quarter, the
remainder would be treated as a payroll tax credit against
its share of social security tax (up to $250,000) and
Medicare tax on wages paid in the fourth quarter. If the
amount of the payroll tax credit remaining exceeded Rose
Co.'s share of social security tax (up to $250,000) and
Medicare tax on wages paid in the fourth quarter, it could
be carried forward and treated as a payroll tax credit for
the first quarter of 2024.
Nonrefundable portion of credit for qualified sick
and family leave wages for leave taken after March
31, 2020, and before April 1, 2021 (line 11b). The
nonrefundable portion of the credit for qualified sick and
family leave wages paid this quarter of 2023 for leave
taken after March 31, 2020, and before April 1, 2021, is
limited to the employer share of social security tax on
wages paid in the quarter that is remaining after that share
is first reduced by any credit claimed against the employer
share of social security tax on Form 8974, line 12, for the
qualified small business payroll tax credit for increasing
research activities; any credit to be claimed on Form
5884-C, line 11, for the work opportunity credit for
qualified tax-exempt organizations hiring qualified
veterans; and/or any credit to be claimed on Form 5884-D
for the disaster credit for qualified tax-exempt
organizations. In completing line 16 or Schedule B (Form
941), you take into account the entire quarter's
nonrefundable portion of the credit for qualified sick and
family leave wages against the liability for the first payroll
payment of the quarter, but not below zero. Then reduce
the liability for each successive payroll payment in the
quarter until the nonrefundable portion of the credit is
used. Any credit for qualified sick and family leave wages
paid this quarter of 2023 for leave taken after March 31,
2020, and before April 1, 2021, that is remaining at the
end of the quarter because it exceeds the employer share
of social security tax for the quarter is claimed on line 13c
as a refundable credit. The refundable portion of the credit
doesn’t reduce the liability reported on line 16 or
Schedule B (Form 941).

DRAFT AS OF
January 12, 2023

Example. Rose Co. is an employer with a calendar tax
year that filed its timely 2022 income tax return on April
18, 2023. Rose Co. elected to take the qualified small
business payroll tax credit for increasing research
activities on Form 6765. The third quarter of 2023 is the
first quarter that begins after Rose Co. filed the income tax
return making the payroll tax credit election. Therefore,
the payroll tax credit applies against Rose Co.'s share of
social security tax (up to $250,000) and Medicare tax on
wages paid to employees in the third quarter of 2023.

-18-

Instructions for Form 941 (Rev. 3-2023)

Example. Maple Co. is a semiweekly schedule
depositor that pays employees every other Friday. In the
first quarter of 2023, Maple Co. had pay dates of January
6, January 20, February 3, February 17, March 3, March
17, and March 31. Maple Co. paid qualified sick and
family leave wages on January 6 and January 20 for leave
taken after March 31, 2020, and before April 1, 2021. The
nonrefundable portion of the credit for qualified sick and
family leave wages for the quarter is $10,000. On
Schedule B (Form 941), Maple Co. will use the $10,000 to
reduce the liability for the January 6 pay date, but not
below zero. If any nonrefundable portion of the credit
remains, Maple Co. applies it to the liability for the
January 20 pay date, then the February 3 pay date, and
so forth until the entire $10,000 is used.
Nonrefundable portion of credit for qualified sick
and family leave wages for leave taken after March
31, 2021, and before October 1, 2021 (line 11d). The
nonrefundable portion of the credit for qualified sick and
family leave wages paid this quarter of 2023 for leave
taken after March 31, 2021, and before October 1, 2021,
is limited to the employer share of Medicare tax on wages
paid in the quarter that is remaining after that share is first
reduced by any credit claimed against the employer share
of Medicare tax on Form 8974, line 16, for the qualified
small business payroll tax credit for increasing research
activities. In completing line 16 or Schedule B (Form 941),
you take into account the entire quarter's nonrefundable
portion of the credit for qualified sick and family leave
wages paid this quarter of 2023 against the liability for the
first payroll payment of the quarter, but not below zero.
Then reduce the liability for each successive payroll
payment in the quarter until the nonrefundable portion of
the credit is used. Any credit for qualified sick and family
leave wages paid this quarter of 2023 for leave taken after
March 31, 2021, and before October 1, 2021, that is
remaining at the end of the quarter because it exceeds the
employer share of Medicare tax for the quarter is claimed
on line 13e as a refundable credit. The refundable portion
of the credit doesn’t reduce the liability reported on line 16
or Schedule B (Form 941).

18. If You’re a Seasonal Employer . . .

If you hire employees seasonally—such as for summer or
winter only—check the box on line 18. Checking the box
tells the IRS not to expect four Forms 941 from you
throughout the year because you haven't paid wages
regularly.
Generally, we won't ask about unfiled returns if at least
one taxable return is filed each year. However, you must
check the box on line 18 on every Form 941 you file.
Otherwise, the IRS will expect a return to be filed for each
quarter.

DRAFT AS OF
January 12, 2023

You may reduce your deposits by the amount of
TIP the nonrefundable and refundable portions of the
credit for qualified sick and family leave wages, as
discussed earlier under Reducing your deposits for the
credit for qualified sick and family leave wages.

Part 3: Tell Us About Your Business
In Part 3, answer only those questions that apply to your
business. If the questions don't apply, leave them blank
and go to Part 4.

17. If Your Business Has Closed . . .

If you go out of business or stop paying wages, you must
file a final return. To tell the IRS that a particular Form 941
is your final return, check the box on line 17 and enter the
final date you paid wages in the space provided. For
additional filing requirements, including information about
attaching a statement to your final return, see If Your
Business Has Closed, earlier.

Instructions for Form 941 (Rev. 3-2023)

Also, when you complete Form 941, be sure to check
the box on the top of the form that corresponds to the
quarter reported.
The amounts entered on lines 19 through 28 are

TIP amounts that you use on the worksheets at the

end of these instructions to figure certain credits.
If you’re claiming these credits, you must enter the
applicable amounts.
Complete lines 19 and 20 only if qualified health
plan expenses allocable to qualified sick leave
CAUTION wages and/or qualified family leave wages were
paid this quarter of 2023 for leave taken after March 31,
2020, and before April 1, 2021.

!

19. Qualified Health Plan Expenses Allocable to
Qualified Sick Leave Wages for Leave Taken
After March 31, 2020, and Before April 1, 2021
Enter the qualified health plan expenses allocable to
qualified sick leave wages paid this quarter of 2023 for
leave taken after March 31, 2020, and before April 1,
2021. This amount is also entered on Worksheet 1, Step
2, line 2b.

20. Qualified Health Plan Expenses Allocable to
Qualified Family Leave Wages for Leave Taken
After March 31, 2020, and Before April 1, 2021

Enter the qualified health plan expenses allocable to
qualified family leave wages paid this quarter of 2023 for
leave taken after March 31, 2020, and before April 1,
2021. This amount is also entered on Worksheet 1, Step
2, line 2f.
Complete lines 23, 24, and 25 only if qualified
sick leave wages were paid this quarter of 2023
CAUTION for leave taken after March 31, 2021, and before
October 1, 2021.

!

23. Qualified Sick Leave Wages for Leave Taken
After March 31, 2021, and Before October 1,
2021

Enter the qualified sick leave wages you paid this quarter
of 2023 to your employees for leave taken after March 31,
2021, and before October 1, 2021, including any qualified
sick leave wages that were above the social security wage
base and any qualified sick leave wages excluded from
the definition of employment under sections 3121(b)(1)–
(22). See the instructions for line 11d, earlier, for more
information about qualified sick leave wages for leave
taken after March 31, 2021, and before October 1, 2021.

-19-

This amount is also entered on Worksheet 2, Step 2,
line 2a.

24. Qualified Health Plan Expenses Allocable to
Qualified Sick Leave Wages Reported on
Line 23
Enter the qualified health plan expenses allocable to
qualified sick leave wages paid this quarter of 2023 for
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step
2, line 2b.

Part 4: May We Speak With Your
Third-Party Designee?
If you want to allow an employee, a paid tax preparer, or
another person to discuss your Form 941 with the IRS,
check the “Yes” box in Part 4. Enter the name, phone
number, and five-digit personal identification number
(PIN) of the specific person to speak with—not the name
of the firm that prepared your tax return. The designee
may choose any five numbers as their PIN.

DRAFT AS OF
January 12, 2023

25. Amounts Under Certain Collectively
Bargained Agreements Allocable to Qualified
Sick Leave Wages Reported on Line 23

Enter the collectively bargained defined benefit pension
plan contributions and collectively bargained
apprenticeship program contributions allocable to
qualified sick leave wages paid this quarter of 2023 for
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step
2, line 2c.

Complete lines 26, 27, and 28 only if qualified
family leave wages were paid this quarter of 2023
CAUTION for leave taken after March 31, 2021, and before
October 1, 2021.

!

26. Qualified Family Leave Wages for Leave
Taken After March 31, 2021, and Before October
1, 2021

Enter the qualified family leave wages you paid this
quarter of 2023 to your employees for leave taken after
March 31, 2021, and before October 1, 2021, including
any qualified family leave wages that were above the
social security wage base and any qualified family leave
wages excluded from the definition of employment under
sections 3121(b)(1)–(22). See the instructions for line 11d,
earlier, for more information about qualified family leave
wages for leave taken after March 31, 2021, and before
October 1, 2021. This amount is also entered on
Worksheet 2, Step 2, line 2g.

27. Qualified Health Plan Expenses Allocable to
Qualified Family Leave Wages Reported on
Line 26

Enter the qualified health plan expenses allocable to
qualified family leave wages paid this quarter of 2023 for
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step
2, line 2h.

28. Amounts Under Certain Collectively
Bargained Agreements Allocable to Qualified
Family Leave Wages Reported on Line 26

Enter the collectively bargained defined benefit pension
plan contributions and collectively bargained
apprenticeship program contributions allocable to
qualified family leave wages paid this quarter of 2023 for
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step
2, line 2i.

By checking “Yes,” you authorize the IRS to talk to the
person you named (your designee) about any questions
we may have while we process your return. You also
authorize your designee to do all of the following.
• Give us any information that is missing from your return.
• Call us for information about processing your return.
• Respond to certain IRS notices that you’ve shared with
your designee about math errors and return preparation.
The IRS won't send notices to your designee.
You’re not authorizing your designee to bind you to
anything (including additional tax liability) or to otherwise
represent you before the IRS. If you want to expand your
designee's authorization, see Pub. 947.
The authorization will automatically expire 1 year from
the due date (without regard to extensions) for filing your
Form 941. If you or your designee wants to terminate the
authorization, write to the IRS office for your location using
the Without a payment address under Where Should You
File, earlier.

Part 5: Sign Here (Approved Roles)
Complete all information and sign Form 941. The
following persons are authorized to sign the return for
each type of business entity.
• Sole proprietorship—The individual who owns the
business.
• Corporation (including a limited liability company
(LLC) treated as a corporation)—The president, vice
president, or other principal officer duly authorized to sign.
• Partnership (including an LLC treated as a
partnership) or unincorporated organization—A
responsible and duly authorized partner, member, or
officer having knowledge of its affairs.
• Single-member LLC treated as a disregarded entity
for federal income tax purposes—The owner of the
LLC or a principal officer duly authorized to sign.
• Trust or estate—The fiduciary.
Form 941 may be signed by a duly authorized agent of
the taxpayer if a valid power of attorney has been filed.
Alternative signature method. Corporate officers or
duly authorized agents may sign Form 941 by rubber
stamp, mechanical device, or computer software
program. For details and required documentation, see
Rev. Proc. 2005-39, 2005-28 I.R.B. 82, available at
IRS.gov/irb/2005-28_IRB#RP-2005-39.

Paid Preparer Use Only

A paid preparer must sign Form 941 and provide the
information in the Paid Preparer Use Only section of Part
5 if the preparer was paid to prepare Form 941 and isn't
-20-

Instructions for Form 941 (Rev. 3-2023)

an employee of the filing entity. Paid preparers must sign
paper returns with a manual signature. The preparer must
give you a copy of the return in addition to the copy to be
filed with the IRS.
If you’re a paid preparer, enter your Preparer Tax
Identification Number (PTIN) in the space provided.
Include your complete address. If you work for a firm,
enter the firm's name and the EIN of the firm. You can
apply for a PTIN online or by filing Form W-12. For more
information about applying for a PTIN online, go to
IRS.gov/PTIN. You can't use your PTIN in place of the EIN
of the tax preparation firm.
Generally, don't complete this section if you’re filing the
return as a reporting agent and have a valid Form 8655 on
file with the IRS. However, a reporting agent must
complete this section if the reporting agent offered legal

advice, for example, advising the client on determining
whether its workers are employees or independent
contractors for federal tax purposes.

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DRAFT AS OF
January 12, 2023

Instructions for Form 941 (Rev. 3-2023)

-21-

Worksheet 1. Credit for Qualified Sick and Family Leave Wages
Paid This Quarter of 2023 for Leave Taken After March 31, 2020,
and Before April 1, 2021

Keep for Your Records

Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which
it is applicable, on a client-by-client basis.)
If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2020, and before April 1,
2021, complete Step 1 and Step 2. Caution: Use Worksheet 2 to figure the credit for qualified sick and family leave wages paid this quarter of 2023 for
leave taken after March 31, 2021, and before October 1, 2021.

DRAFT AS OF
January 12, 2023

Step 1.

1a
1b
1c
1d
1e
1f
1g

1h
1i
1j
1j(i)
1k
1l

Step 2.

2a
2a(i)
2a(ii)
2a(iii)
2b
2c
2d
2e
2e(i)
2e(ii)
2e(iii)
2f
2g
2h
2i
2j
2k

Determine the employer share of social security tax this quarter after it is reduced by any credit claimed on Form 8974
and any credit to be claimed on Form 5884-C and/or Form 5884-D
Enter the amount of social security tax from Form 941, Part 1, line 5a, column 2 . . . . . . . 1a
Enter the amount of social security tax from Form 941, Part 1, line 5b, column 2 . . . . . . . 1b
Add lines 1a and 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c
Multiply line 1c by 50% (0.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1d
If you’re a third-party payer of sick pay that isn't an agent and you're claiming credits for
amounts paid to your employees, enter the employer share of social security tax included
on Form 941, Part 1, line 8 (enter as a positive number) . . . . . . . . . . . . . . . . . . . . . . . . . 1e
Subtract line 1e from line 1d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1f
If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount
of the employer share of social security tax from the notice . . . . . . . . . . . . . . . . . . . . . . 1g
Employer share of social security tax. Add lines 1f and 1g . . . . . . . . . . . . . . . . . . . .
1h
Enter the amount from Form 8974, line 12, for this quarter . . . . . . . . . . . . . . . . . . . . . . . 1i
Enter the amount to be claimed on Form 5884-C, line 11, for this quarter . . . . . . . . . . . . . 1j
Enter the amount to be claimed on Form 5884-D, line 12, for this quarter . . . . . . . . . . . . . 1j(i)
Total nonrefundable credits already used against the employer share of social
security tax. Add lines 1i, 1j, and 1j(i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Employer share of social security tax remaining. Subtract line 1k from line 1h . . . . . .
1l

Figure the sick and family leave credit
Qualified sick leave wages reported on Form 941, Part 1, line 5a(i), column 1 . . . . . . . . .
Qualified sick leave wages included on Form 941, Part 1, line 5c, but not included on Form
941, Part 1, line 5a(i), column 1, because the wages reported on that line were limited by
the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total qualified sick leave wages. Add lines 2a and 2a(i) . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified sick leave wages excluded from the definition of employment under sections
3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified health plan expenses allocable to qualified sick leave wages (Form 941, Part 3,
line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45%
(0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Credit for qualified sick leave wages. Add lines 2a(ii), 2a(iii), 2b, and 2c . . . . . . . . . . .
Qualified family leave wages reported on Form 941, Part 1, line 5a(ii), column 1 . . . . . . .
Qualified family leave wages included on Form 941, Part 1, line 5c, but not included on
Form 941, Part 1, line 5a(ii), column 1, because the wages reported on that line were
limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total qualified family leave wages. Add lines 2e and 2e(i) . . . . . . . . . . . . . . . . . . . . . . .
Qualified family leave wages excluded from the definition of employment under sections
3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified health plan expenses allocable to qualified family leave wages (Form 941, Part 3,
line 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Employer share of Medicare tax on qualified family leave wages. Multiply line 2e(ii) by
1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Credit for qualified family leave wages. Add lines 2e(ii), 2e(iii), 2f, and 2g . . . . . . . . .
Credit for qualified sick and family leave wages. Add lines 2d and 2h . . . . . . . . . . . .
Nonrefundable portion of credit for qualified sick and family leave wages for leave
taken after March 31, 2020, and before April 1, 2021. Enter the smaller of line 1l or
line 2i. Enter this amount on Form 941, Part 1, line 11b . . . . . . . . . . . . . . . . . . . . . . . . .
Refundable portion of credit for qualified sick and family leave wages for leave
taken after March 31, 2020, and before April 1, 2021. Subtract line 2j from line 2i and
enter this amount on Form 941, Part 1, line 13c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

-22-

2a
2a(i)
2a(ii)
2a(iii)
2b
2c
2e

2d

2e(i)
2e(ii)
2e(iii)
2f
2g

2h
2i
2j
2k

Instructions for Form 941 (Rev. 3-2023)

Worksheet 2. Credit for Qualified Sick and Family Leave Wages
Paid This Quarter of 2023 for Leave Taken After March 31, 2021,
and Before October 1, 2021

Keep for Your Records

Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which
it is applicable, on a client-by-client basis.)
If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2021, and before October
1, 2021, complete Step 1 and Step 2. Caution: Use Worksheet 1 to figure the credit for qualified sick and family leave wages paid this quarter of 2023
for leave taken after March 31, 2020, and before April 1, 2021.

DRAFT AS OF
January 12, 2023

Step 1.

1a
1b
1c

1d
1e

1f
1g
1h

Step 2.

2a
2a(i)

2a(ii)
2a(iii)
2a(iv)
2b
2c
2d
2e
2f
2g
2g(i)

2g(ii)
2g(iii)
2g(iv)
2h
2i
2j
2k
2l
2m
2n
2o
2p
2q

Determine the employer share of Medicare tax this quarter after it is reduced by any credit claimed on Form 8974
Enter the amount of Medicare tax from Form 941, Part 1, line 5c, column 2 . . . . . . . . . . . 1a
Multiply line 1a by 50% (0.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b
If you’re a third-party payer of sick pay that isn't an agent and you're claiming credits for
amounts paid to your employees, enter the employer share of Medicare tax included on
Form 941, Part 1, line 8 (enter as a positive number) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c
Subtract line 1c from line 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1d
If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount
of the employer share of Medicare tax from the notice . . . . . . . . . . . . . . . . . . . . . . . . . . 1e
Employer share of Medicare tax. Add lines 1d and 1e . . . . . . . . . . . . . . . . . . . . . . . .
1f
Enter the amount from Form 8974, line 16, for this quarter . . . . . . . . . . . . . . . . . . . . . . . 1g
Employer share of Medicare tax remaining. Subtract line 1g from line 1f . . . . . . . . . .
1h

Figure the sick and family leave credit
Qualified sick leave wages for leave taken after March 31, 2021, and before October 1,
2021 (Form 941, Part 3, line 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified sick leave wages included on Form 941, Part 3, line 23, that were not included as
wages reported on Form 941, Part 1, lines 5a and 5c, because the qualified sick leave
wages were excluded from the definition of employment under sections 3121(b)(1)–
(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 2a(i) from line 2a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified sick leave wages included on Form 941, Part 3, line 23, that were not included as
wages reported on Form 941, Part 1, line 5a, because the qualified sick leave wages were
limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 2a(iii) from line 2a(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified health plan expenses allocable to qualified sick leave wages for leave taken after
March 31, 2021, and before October 1, 2021 (Form 941, Part 3, line 24) . . . . . . . . . . . . .
Amounts under certain collectively bargained agreements allocable to qualified sick leave
wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941, Part 3,
line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Employer share of social security tax on qualified sick leave wages. Multiply line 2a(iv) by
6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45%
(0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Credit for qualified sick leave wages. Add lines 2a, 2b, 2c, 2d, and 2e . . . . . . . . . . . .
Qualified family leave wages for leave taken after March 31, 2021, and before October 1,
2021 (Form 941, Part 3, line 26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified family leave wages included on Form 941, Part 3, line 26, that were not included
as wages reported on Form 941, Part 1, lines 5a and 5c, because the qualified family leave
wages were excluded from the definition of employment under sections 3121(b)(1)–
(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 2g(i) from line 2g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified family leave wages included on Form 941, Part 3, line 26, that were not included
as wages reported on Form 941, Part 1, line 5a, because the qualified family leave wages
were limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 2g(iii) from line 2g(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualified health plan expenses allocable to qualified family leave wages for leave taken
after March 31, 2021, and before October 1, 2021 (Form 941, Part 3, line 27) . . . . . . . . .
Amounts under certain collectively bargained agreements allocable to qualified family
leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941,
Part 3, line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Employer share of social security tax on qualified family leave wages. Multiply line 2g(iv) by
6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Employer share of Medicare tax on qualified family leave wages. Multiply line 2g(ii) by
1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Credit for qualified family leave wages. Add lines 2g, 2h, 2i, 2j, and 2k . . . . . . . . . . . .
Credit for qualified sick and family leave wages. Add lines 2f and 2l . . . . . . . . . . . . .
Enter any credit claimed under section 41 for increasing research activities with respect to
any wages taken into account for the credit for qualified sick and family leave
wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Credit for qualified sick and family leave wages after adjusting for other credits.
Subtract line 2n from line 2m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nonrefundable portion of credit for qualified sick and family leave wages for leave
taken after March 31, 2021, and before October 1, 2021. Enter the smaller of line 1h or
line 2o. Enter this amount on Form 941, Part 1, line 11d . . . . . . . . . . . . . . . . . . . . . . . . .
Refundable portion of credit for qualified sick and family leave wages for leave
taken after March 31, 2021, and before October 1, 2021. Subtract line 2p from line 2o
and enter this amount on Form 941, Part 1, line 13e . . . . . . . . . . . . . . . . . . . . . . . . . . .

Instructions for Form 941 (Rev. 3-2023)

-23-

2a

2a(i)
2a(ii)
2a(iii)
2a(iv)
2b
2c
2d
2e

2f

2g

2g(i)
2g(ii)
2g(iii)
2g(iv)
2h
2i
2j
2k

2l
2m

2n
2o
2p
2q