Form Schedule R (Form 9 Schedule R (Form 9 Allocation for Aggregate Form 941 Filers

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7
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
Schedule R (FORM 941) PAGE 1 of 4
MARGINS: TOP 13 mm (1⁄ 2 ") CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20
FLAT SIZE: 216 mm (81⁄ 2 ") x 279 mm (11")
PERFORATE: NONE

Action

Date

Signature

O.K. to print

PRINTS: HEAD TO HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Revised proofs
requested

950410

Schedule R (Form 941):

Allocation Schedule for Aggregate Form 941 Filers

(January 2010)

OMB No. 1545-0029

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Report for calendar year:

Department of the Treasury — Internal Revenue Service

Employer identification number
(EIN)

—

Check the quarter (same as Form 941):
1: January, February, March

Name as shown on
Form 941

2: April, May, June
3: July, August, September

Read the separate instructions before you complete Schedule R (Form 941). Type or print within the
boxes. Complete a separate line for the allocated amounts of each client of the agent filing the
aggregate Form 941.
(c)
(a)
(b)
Total income tax
Client’s Employer
Wages, tips, and
Identification
other compensation withheld from wages,
tips, and other
Number (EIN)
allocated to the listed
compensation
client EIN from line 2
allocated to the listed
of Form 941
client EIN from line 3
of Form 941

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16 Subtotals for
clients. Combine
all amounts on
lines 1 through 15

17 Enter the
combined totals
from line 26 of all
Continuation
Sheets for
Schedule R
(Form 941)

18 Enter Form 941
amounts for
employees of
the agent

19 Add lines 16, 17,
and 18. The
column totals
must match the
related lines on
the aggregate
Form 941

(d)
Total social
security and
Medicare taxes
allocated to the
listed client EIN
from line 5d
of Form 941

4: October, November, December

(e)
Total taxes after
adjustments
allocated to the
listed client EIN
from line 8
of Form 941

(f)
Advance earned
income credit
payments
allocated to the
listed client EIN
from line 9
of Form 941

(g)
Total deposits and
COBRA payments,
from line 13 of
Form 941, plus any
other payments
allocated to the
listed client EIN

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For Privacy Act and Paperwork Reduction Act Notice, see the instructions.

.
Cat. No. 49301K

Schedule R (Form 941) (1-2010)

7
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
Schedule R (FORM 941) PAGE 2 of 4
MARGINS: TOP 13 mm (1⁄ 2 ") CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20
FLAT SIZE: 216 mm (81⁄ 2 ") x 279 mm (11")
PERFORATE: NONE

PRINTS: HEAD TO HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Page

950510

of

Continuation Sheet for Schedule R (Form 941)
(January 2010)

Report for calendar year:

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Check the quarter (same as Form 941):

Employer identification number
(EIN)

—

1: January, February, March

Name as shown on
Form 941

2: April, May, June
3: July, August, September
4: October, November, December

(c)
(a)
(b)
Total income tax
Client’s Employer
Wages, tips, and
Identification
other compensation withheld from wages,
tips, and other
Number (EIN)
allocated to the listed
compensation
client EIN from line 2
allocated to the listed
of Form 941
client EIN from line 3
of Form 941

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26 Add lines 1 through 25.
Include the amounts
from line 26 on line 17
of Schedule R
(Form 941)

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(d)
Total social
security and
Medicare taxes
allocated to the
listed client EIN
from line 5d
of Form 941

(e)
Total taxes after
adjustments
allocated to the
listed client EIN
from line 8
of Form 941

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(f)
Advance earned
income credit
payments
allocated to the
listed client EIN
from line 9
of Form 941

(g)
Total deposits and
COBRA payments
from line 13 of
Form 941, plus any
other payments
allocated to the
listed client EIN

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Schedule R (Form 941) (1-2010)

7
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
Schedule R (FORM 941) PAGE 3 of 4 (page 4 is blank)
MARGINS: TOP 13 mm (1⁄ 2 ") CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
1
FLAT SIZE: 216 mm (8 ⁄ 2 ") x 279 mm (11")
PERFORATE: NONE

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

950610
Schedule R (Form 941) (1-2010)

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Instructions for Schedule R

Allocation Schedule for Aggregate
Form 941 Filers

You must complete Schedule R (Form 941), Allocation
Schedule for Aggregate Form 941 Filers, each time you file
an aggregate Form 941. You must have been approved by
the IRS as an agent as defined by section 3504 of the
Internal Revenue Code to file an aggregate Form 941. To
request authorization to act as an agent for an employer, you
must file Form 2678, Employer/Payer Appointment of Agent,
with the Internal Revenue Service. On Schedule R
(Form 941), we call those employers your clients.

What’s the Purpose of Schedule R
(Form 941)?

Use Schedule R (Form 941) to allocate the aggregate
information reported on Form 941 to each client. If you have
more than 12 clients, complete continuation sheets as
necessary. Attach Schedule R (Form 941), including any
continuation sheets, to your aggregate Form 941 and file it
with your return.
On Schedule R (Form 941), including any continuation
sheets, for each client you must report:
● Your client’s employer identification number (EIN),
● Wages, tips, and other compensation (line 2 of Form 941)
allocated to the client EIN listed,

If the amounts, when totaled, on the Schedule R
(Form 941) do not match the totals on Form 941, there is an
error that must be corrected before submitting Form 941 and
Schedule R (Form 941).
Privacy Act and Paperwork Reduction Act Notice. We ask
for the information on this form to carry out the Internal
Revenue laws of the United States. We need it to figure and
collect the right amount of tax.
You are 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 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 this form 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, and the District of Columbia 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.

● Total income tax withheld from wages, tips, and other
compensation (line 3 of Form 941) allocated to the client EIN
listed,

The time needed to complete and file Schedule R (Form
941) will vary depending on individual circumstances. The
estimated average time is:

● Total social security and Medicare taxes (line 5d of
Form 941) allocated to the client EIN listed,

Recordkeeping

● Total taxes after adjustments (line 8 of Form 941) allocated
to the client EIN listed,

Preparing ,the form

● Advance earned income credit (EIC) payments (line 9 of
Form 941) allocated to the client EIN listed,
● Total deposits for this quarter (line 11 of Form 941) and
amount from line 12 of Form 941 paid with this return,
allocated to the client EIN listed.
You must also report the same information for your
employees on line 15 of Schedule R (Form 941).
Compare the total of each column on line 16 (including
your information on line 15) to the amounts reported on the
aggregate Form 941.

Learning about the law or the form

12XX
hrs.,
26XX
mins.
hr.,
min.

min.
12XX
min.
X hr., XX min.

Copying, assembling, and sending the form
24
to the IRS
X mins.
hr., XX min.
If you have comments concerning the accuracy of these
time estimates or suggestions for making Schedule R (Form
941) simpler, we would be happy to hear from you. You can
write to: Internal Revenue Service, Tax Products Coordinating
Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave.
NW, IR-6406, Washington, DC 20224. Do not send Schedule
R (Form 941) to this address. Instead, see Where Should You
File? on page 4 of the Instructions for Form 941.