Forms 941, 941-PR , 941-SS and 941-X, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands; Schedule B

Forms and Documents

Document Name	Status
Form 941 Forms 941, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands Form	Unchanged
Form Schedule R (Form 9 Schedule R (Form 941) - Allocation for Aggregate Form 941 Filers Form and Instruction	New
Form 941SS-V OTC Form 941SS -V - Payment Voucher (OTC) Form and Instruction	Unchanged
Form 941-SS-V Form 941SS -V -(Preprinted) Form and Instruction	Unchanged
Form Form 941PR-V Form 941-V (PR) (Preprinted) - Payment Voucher Form and Instruction	Unchanged
Form 941PR-V Form 941-V (PR) - Payment voucher (OTC) Form and Instruction	Unchanged
Form 941-V Form 941-V - Payment voucher (Preprinted) and (OTC) Form and Instruction	Unchanged
Form 941-X (PR) Form 941-X (PR) - Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso Form	Unchanged
Form 941-SS 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 Form	Unchanged
Form Anexo B (Form 940- Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual Form	Unchanged
Form 941-PR Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono Form	Unchanged
Form Schedule D (Form 9 Scedule D (Form 941) - Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations Form	Unchanged
Form Schedule B (Form 9 Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors Form	Unchanged
Justification of need for OMB approval.pdf Justification for No Material/Nonsubstantive Change	2009-10-14

IC Document Collections

IC ID	Document Title	Status
39380	Forms 941, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands Form	Unchanged
190971	Schedule R (Form 941) - Allocation for Aggregate Form 941 Filers Form and Instruction	New
187195	Form 941SS -V - Payment Voucher (OTC) Form and Instruction	Unchanged
187193	Form 941SS -V -(Preprinted) Form and Instruction	Unchanged
187191	Form 941-V (PR) (Preprinted) - Payment Voucher Form and Instruction	Unchanged
187190	Form 941-V (PR) - Payment voucher (OTC) Form and Instruction	Unchanged
187189	Form 941-V - Payment voucher (Preprinted) and (OTC) Form and Instruction	Unchanged
187188	Form 941-X (PR) - Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso Form	Unchanged
187187	Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund Instruction	Unchanged
187186	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 Form	Unchanged
187185	Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual Form	Unchanged
187184	Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono Form	Unchanged
187183	Scedule D (Form 941) - Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations Form	Unchanged
187174	Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors Form	Unchanged

ICR Details

OMB Control No: 1545-0029	ICR Reference No: 200910-1545-022
Status: Historical Active	Previous ICR Reference No: 200811-1545-008
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Forms 941, 941-PR , 941-SS and 941-X, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands; Schedule B
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/23/2009
	Date Received in OIRA: 10/19/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2010	04/30/2010	04/30/2010
Responses	37,810,463	0	37,803,963
Time Burden (Hours)	318,884,262	0	318,799,502
Cost Burden (Dollars)	0	0	0

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Abstract: Form 941 is used by employers to report payments made to employees subject to income and social security/Medicare taxes and the amounts of these taxes. Form 941-PR is used by employers in Puerto Rico to report social security and Medicare taxes only. Form 941-SS is used by employers in the U.S. possessions to report social security and Medicare taxes only. Schedule B is used by employers to record their employment tax liability.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: US Code: 26 USC 3504 Name of Law: Acts to be performed by agents

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 58051	10/02/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 2729	01/22/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

IC Title	Form No.	Form Name
Form 941SS -V - Payment Voucher (OTC)	941SS-V OTC	Payment Voucher
Form 941-V - Payment voucher (Preprinted) and (OTC)	941-V	Payment Voucher
Scedule D (Form 941) - Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations	Schedule D (Form 941)	Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations
Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono	941-PR	Planilla para la Declaracion Federal TRIMESTRAL del Patrono
Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors	Schedule B (Form 941)	Report of Tax Liability for Semiweekly Schedule Depositors
Form 941SS -V -(Preprinted)	941-SS-V	Payment Voucher
Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund	941-X	Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund
Form 941-X (PR) - Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso	941-X (PR)	Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso
Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual	Anexo B (Form 940-PR)	Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual
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	941-SS	Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands
Forms 941, Employer's Quarterly Federal Tax Return; American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands	941	Employer's Quarterly Federal Tax Return
Form 941-V (PR) - Payment voucher (OTC)	941PR-V	Payment Voucher
Form 941-V (PR) (Preprinted) - Payment Voucher	Form 941PR-V	Payment Voucher (preprinted)
Schedule R (Form 941) - Allocation for Aggregate Form 941 Filers	Schedule R (Form 941)	Allocation for Aggregate Form 941 Filers

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	37,810,463	37,803,963	0	6,500	0	0
Annual Time Burden (Hours)	318,884,262	318,799,502	0	84,760	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Form 941 family of forms is used by employers to report payments made to employees that are subject to income and social security/Medicare taxes and the amounts of these taxes. The Service needs Schedule R (Form 941) to indentify the separate employers, their EIN's, and their allocated tax payments reported on an aggregate Form 941, Employer' QUARTERLY Federal Tax Return and ensure income tax withholding and reporting compliance. The respondent is the Agent who files the aggregate Form 941 on behalf of the employers that have completed Form 2678 to provide the Agent with such filing authorization. The creation of this new form increases the estimated number of responses by 6,500 and the estimated burden by 84,760 hours.

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Annual Cost to Federal Government: $12,235,028

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/19/2009

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