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pdf941-SS for 2023:
Employer’s QUARTERLY Federal Tax Return
Form
(Rev. March 2023)
Department of the Treasury — Internal Revenue Service
American Samoa, Guam, the Commonwealth of the Northern
Mariana Islands, and the U.S. Virgin Islands
Report for this Quarter of 2023
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Employer identification number (EIN)
OMB No. 1545-0029
(Check one.)
1: January, February, March
Name (not your trade name)
2: April, May, June
Trade name (if any)
3: July, August, September
Address
4: October, November, December
Number
Street
Suite or room number
City
ZIP code
State
Foreign country name
Go to www.irs.gov/Form941SS for
instructions and the latest information.
Foreign postal code
Foreign province/county
Read the separate instructions before you complete Form 941-SS. Type or print within the boxes.
Part 1:
1
Answer these questions for this quarter.
Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)
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2
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4
Check and go to line 6.
If no wages, tips, and other compensation are subject to social security or Medicare tax
Column 1
Column 2
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* Include taxable qualified sick and
family leave wages paid in this
quarter of 2023 for leave taken
after March 31, 2021, and before
October 1, 2021, on line 5a. Use
lines 5a(i) and 5a(ii) only for
taxable qualified sick and family
leave wages paid in this quarter of
2023 for leave taken after March
31, 2020, and before April 1, 2021.
5a
Taxable social security wages*
5a
(i) Qualified sick leave wages*
5a
(ii) Qualified family leave wages*
5b
Taxable social security tips
5c
Taxable Medicare wages & tips
5d
Taxable wages & tips subject to
Additional Medicare Tax withholding
5e
Total social security and Medicare taxes. Add column 2 from lines 5a, 5a(i), 5a(ii), 5b, 5c, and 5d .
5e
5f
Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions)
6
Total taxes before adjustments. Add lines 5e and 5f .
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7
Current quarter’s adjustment for fractions of cents .
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8
Current quarter’s adjustment for sick pay .
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9
Current quarter’s adjustments for tips and group-term life insurance .
10
Total taxes after adjustments. Combine lines 6 through 9
× 0.124 =
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× 0.062 =
× 0.062 =
× 0.124 =
× 0.029 =
× 0.009 =
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5f
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9
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10
11a
Qualified small business payroll tax credit for increasing research activities. Attach Form 8974
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11a
11b
Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . .
11b
Reserved for future use .
11c
11c
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You MUST complete all three pages of Form 941-SS and SIGN it.
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Cat. No. 17016Y
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Form 941-SS (Rev. 3-2023)
Name (not your trade name)
Employer identification number (EIN)
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Part 1:
Answer these questions for this quarter. (continued)
11d
Nonrefundable portion of credit for qualified sick and family leave wages for leave taken
after March 31, 2021, and before October 1, 2021
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11e
Reserved for future use .
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11f
Reserved for future use .
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11g
Total nonrefundable credits. Add lines 11a, 11b, and 11d
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11e
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11g
12
Total taxes after adjustments and nonrefundable credits. Subtract line 11g from line 10
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12
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13a
Total deposits for this quarter, including overpayment applied from a prior quarter and
overpayments applied from Form 941-X, 944-X, or 944-X (SP) filed in the current quarter
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13a
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13b
Reserved for future use .
13b
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13c
Refundable portion of credit for qualified sick and family leave wages for leave taken before
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13c
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13d
Reserved for future use .
13d
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13e
Refundable portion of credit for qualified sick and family leave wages for leave taken after
March 31, 2021, and before October 1, 2021 . . . . . . . . . . . . . . . . 13e
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13f
Reserved for future use .
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13f
13g
Total deposits and refundable credits. Add lines 13a, 13c, and 13e
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13g
13h
Reserved for future use .
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13h
13i
Reserved for future use .
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13i
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Balance due. If line 12 is more than line 13g, enter the difference and see instructions .
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Overpayment. If line 13g is more than line 12, enter the difference
Part 2:
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Check one:
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Apply to next return.
Send a refund.
Tell us about your deposit schedule and tax liability for this quarter.
If you’re unsure about whether you’re a monthly schedule depositor or a semiweekly schedule depositor, see section 8 of Pub. 80.
16
Check one:
Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500,
and you didn’t incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior
quarter was less than $2,500 but line 12 on this return is $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 below; if you’re a
semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3.
You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total
liability for the quarter, then go to Part 3.
Tax liability:
Month 1
Month 2
Month 3
Total liability for quarter
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Total must equal line 12.
You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941),
Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941-SS. Go to Part 3.
Page 2
You MUST complete all three pages of Form 941-SS and SIGN it.
Form 941-SS (Rev. 3-2023)
Name (not your trade name)
Employer identification number (EIN)
–
Part 3:
17
Tell us about your business. If a question does NOT apply to your business, leave it blank.
If your business has closed or you stopped paying wages .
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enter the final date you paid wages
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Check here, and
; also attach a statement to your return. See instructions.
18
If you’re a seasonal employer and you don’t have to file a return for every quarter of the year .
19
Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021 19
20
Qualified health plan expenses allocable to qualified family leave wages for leave taken before April 1, 2021 20
21
Reserved for future use .
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Reserved for future use .
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Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021
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Qualified health plan expenses allocable to qualified sick leave wages reported on line 23
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Amounts under certain collectively bargained agreements allocable to qualified sick leave
wages reported on line 23 . . . . . . . . . . . . . . . . . . . . . . 25
26
Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021 26
27
Qualified health plan expenses allocable to qualified family leave wages reported on line 26
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Amounts under certain collectively bargained agreements allocable to qualified family leave
wages reported on line 26 . . . . . . . . . . . . . . . . . . . . . . 28
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Part 4:
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Check here.
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May we speak with your third-party designee?
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the
instructions for details.
Yes.
Designee’s name and phone number
Select a 5-digit personal identification number (PIN) to use when talking to the IRS.
No.
Part 5:
Sign here. You MUST complete all three pages of Form 941-SS and SIGN it.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Print your
name here
Sign your
name here
Date
Print your
title here
/
/
Best daytime phone
Paid Preparer Use Only
Check if you’re self-employed .
Preparer’s name
PTIN
Preparer’s signature
Date
Firm’s name (or yours
if self-employed)
EIN
Address
Phone
City
Page 3
State
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ZIP code
Form 941-SS (Rev. 3-2023)
This page intentionally left blank
Form 941-V(SS),
Payment Voucher
Purpose of Form
Specific Instructions
Complete Form 941-V(SS) if you’re making a payment
with Form 941-SS. We will use the completed voucher to
credit your payment more promptly and accurately, and
to improve our service to you.
Box 1—Employer identification number (EIN). If you
don’t have an EIN, you may apply for one online by
visiting the IRS website at www.irs.gov/EIN. You may also
apply for an EIN by faxing or mailing Form SS-4 to the
IRS. If you haven’t received your EIN by the due date of
Form 941-SS, write “Applied For” and the date you
applied in this entry space.
Box 2—Amount paid. Enter the amount paid with
Form 941-SS.
Box 3—Tax period. Darken the circle identifying the
quarter for which the payment is made. Darken only
one circle.
Box 4—Name and address. Enter your name and
address as shown on Form 941-SS.
• Enclose your check or money order made payable to
“United States Treasury.” Be sure to enter your EIN,
“Form 941-SS,” and the tax period (“1st Quarter 2023,”
“2nd Quarter 2023,” “3rd Quarter 2023,” or “4th Quarter
2023”) on your check or money order. Don’t send cash.
Don’t staple Form 941-V(SS) or your payment to Form
941-SS (or to each other).
• Detach Form 941-V(SS) and send it with your payment
and Form 941-SS to the address in the Instructions for
Form 941-SS.
Note: You must also complete the entity information
above Part 1 on Form 941-SS.
Making Payments With Form 941-SS
To avoid a penalty, make your payment with Form
941-SS only if:
• Your total taxes after adjustments and nonrefundable
credits (Form 941-SS, line 12) for either the current
quarter or the preceding quarter are less than $2,500, you
didn’t incur a $100,000 next-day deposit obligation during
the current quarter, and you’re paying in full with a timely
filed return; or
• You’re a monthly schedule depositor making a payment
in accordance with the Accuracy of Deposits Rule. See
section 8 of Pub. 80 for details. In this case, the amount
of your payment may be $2,500 or more.
Otherwise, you must make deposits by electronic funds
transfer. See section 8 of Pub. 80 for deposit instructions.
Don’t use Form 941-V(SS) to make federal tax deposits.
Use Form 941-V(SS) when making any
payment with Form 941-SS. However, if you pay
an amount with Form 941-SS that should’ve
CAUTION
been deposited, you may be subject to a
penalty. See Deposit Penalties in section 8 of Pub. 80.
!
▲
Form
Detach Here and Mail With Your Payment and Form 941-SS.
941-V(SS)
Payment Voucher
Department of the Treasury
Internal Revenue Service
1 Enter your employer identification
number (EIN).
2023
Don’t staple this voucher or your payment to Form 941-SS.
2
Dollars
Cents
Enter the amount of your payment.
–
3
OMB No. 1545-0029
Make your check or money order payable to “United States Treasury.”
4 Enter your business name (individual name if sole proprietor).
Tax Period
1st
Quarter
3rd
Quarter
2nd
Quarter
4th
Quarter
Enter your address.
Enter your city, state, and ZIP code; or your city, foreign country name, foreign province/county, and foreign postal code.
Form 941-SS (Rev. 3-2023)
Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on Form 941-SS to carry out
the Internal Revenue laws of the United States. We
need it to figure and collect the right amount of tax.
Subtitle C, Employment Taxes, of the Internal Revenue
Code imposes employment taxes on wages and provides
for income tax withholding. Form 941-SS is used to
determine the amount of the taxes that you owe. Section
6011 requires you to provide the requested information if
the tax is applicable to you. Section 6109 requires you to
provide your identification number. If you fail to provide
this information in a timely manner or provide false or
fraudulent information, you may be subject to penalties.
You’re not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books and records relating to a form or
its instructions must be retained as long as their
contents may become material in the administration of
any Internal Revenue law.
Generally, tax returns and return information are
confidential, as required by section 6103. However,
section 6103 allows or requires the IRS to disclose or
give the information shown on your tax return to others
as described in the Code. For example, we may
disclose your tax information to the Department of
Justice for civil and criminal litigation, and to cities,
states, the District of Columbia, and U.S. commonwealths
and possessions for use in administering their tax laws.
We may also disclose this information to other countries
under a tax treaty, to federal and state agencies to
enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat
terrorism.
The time needed to complete and file Form 941-SS
will vary depending on individual circumstances. The
estimated average time is:
Recordkeeping . . . . . . . . . . 17 hr., 42 min.
Learning about the law or the form . . . . 24 min.
Preparing, copying, assembling, and
sending the form to the IRS . . . . . . . 42 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making Form
941-SS simpler, we would be happy to hear from you.
You can send us comments from www.irs.gov/
FormComments. Or you can send your comments to
Internal Revenue Service, Tax Forms and Publications
Division, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Don’t send Form 941-SS to this
address. Instead, see Where Should You File? in the
Instructions for Form 941-SS.
| File Type | application/pdf |
| File Title | Form 941-SS (Rev. March 2023) |
| Subject | Fillable |
| Author | SE:W:CAR:MP |
| File Modified | 2023-02-23 |
| File Created | 2023-02-23 |