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

Instructions for
Form 941-SS

Department of the Treasury
Internal Revenue Service

(Rev. January 2010)
Employer’s QUARTERLY Federal Tax Return—American Samoa, Guam, the
Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands
Section references are to the Internal Revenue Code unless
otherwise noted.

What’s New
COBRA premium assistance credit extended. The credit
for COBRA premium payments has been extended. It now
applies to premiums paid for employees terminated before
March 1, 2010, and to premiums paid for 15 months. See
COBRA premium assistance credit on page 5.
Employers can choose to file Forms 941-SS instead of
Form 944-SS for 2010. Beginning with tax year 2010,
employers that would otherwise be required to file Form
944-SS can notify the IRS if they want to file quarterly Forms
941-SS instead of annual Form 944-SS. See Revenue
Procedure 2009- 51, 2009-45 I.R.B. 625 available at
www.irs.gov/irb/2009-45_IRB.
Social security wage base for 2010. Do not withhold
social security tax after an employee reaches $106,800 in
social security wages, which remains unchanged from 2009.

Reminders
Correcting a previously filed Form 941-SS. If you
discover an error on a previously filed Form 941-SS, make
the correction using Form 941-X, Adjusted Employer’s
QUARTERLY Federal Tax Return or Claim for Refund.
Form 941-X is an adjusted return and is filed separately
from Form 941-SS. For more information, see section 9 of
Pub. 80 or visit the IRS website at www.irs.gov and enter
the keywords Correcting Employment Taxes.
Paid preparers must sign Form 941-SS. Paid preparers
must complete and sign the paid preparer’s section of Form
941-SS.
Electronic filing and payment. Now, more than ever
before, businesses can enjoy the benefits of filing 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 and worry on taxes and more time running
your business. Use e-file and the Electronic Federal Tax
Payment System (EFTPS) to your benefit.
• For e-file, visit www.irs.gov for additional information.
• For EFTPS, visit www.eftps.gov or call EFTPS Customer
Service at 1-800-555-4477 (U.S. Virgin Islands only),
303-967-5916 (toll call), or 1-800-733-4829 (TDD).
Electronic funds withdrawal (EFW). If you file Form
941-SS electronically, you can e-file and e-pay (electronic
funds withdrawal) the balance due in a single step using tax
preparation software or through a tax professional.
However, do not use EFW to make federal tax deposits. For
more information on paying your taxes using EFW, visit the
IRS website at www.irs.gov and type e-pay in the search
box. A fee may be charged to file electronically.

Credit card payments. Employers can pay the balance
due shown on Form 941-SS by credit card. Do not use a
credit card to make federal tax deposits. For more
information on paying your taxes with a credit card, visit the
IRS website at www.irs.gov and type e-pay in the search
box.
Employer’s liability. Employers are responsible to ensure
that tax returns are filed and deposits and payments are
made, even if the employer contracts with a third party. The
employer remains liable if the third party fails to perform a
required action.
Where can you get telephone help? You can call the IRS
toll free at 1-800-829-4933 (U.S. Virgin Islands only) or
215-516-2000 (toll call) on Monday through Friday from 7:00
a.m. to 10:00 p.m. local time (Alaska and Hawaii follow
Pacific time) to order tax deposit coupons (Form 8109) and
for answers to your questions about completing Form
941-SS, tax deposit rules, or obtaining an employer
identification number (EIN).
Photographs of missing children. The Internal Revenue
Service is a proud partner with the National Center for
Missing and Exploited Children. 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.

General Instructions:
Purpose of Form 941-SS
Use Form 941-SS, Employer’s QUARTERLY Federal Tax
Return, to report social security and Medicare taxes for
workers in American Samoa, Guam, the Commonwealth of
the Northern Mariana Islands, and the U.S. Virgin Islands.
Pub. 80 (Circular SS), Federal Tax Guide for Employers
in the U.S. Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands, explains
the requirements for withholding, depositing, and paying
social security and Medicare taxes. It explains the forms you
must give your employees, those your employees must give
you, and those you must send to the IRS. See Pub. 15-A,
Employer’s Supplemental Tax Guide, for specialized
employment tax information supplementing the basic
information provided in Pub. 80 (Circular SS).

Who Must File Form 941-SS?
Generally, you must file a return for the first quarter in which
you pay wages subject to social security and Medicare
taxes, and for each quarter thereafter until you file a final
return. Use Form 941-SS if your principal place of business
is in American Samoa, Guam, the Commonwealth of the
Northern Mariana Islands, or the U.S. Virgin Islands, or if

Cat. No. 35530F

you have employees who are subject to income tax
withholding for these jurisdictions.
Once you have filed a return, a preaddressed Form
941-SS will be sent to you every 3 months. You must file a
return each quarter, even if you have no tax liability to report
unless you file a final return. However, see Seasonal
Employers and Agricultural and Household Employers
below. If the form fails to reach you, request one in time to
file. See Where Can You Obtain Forms? below.

containing Form 941-SS 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 on or before the due
date. If you do not follow these guidelines, we will consider
Form 941-SS filed when it is actually received. See Pub. 80
(Circular SS) for more information on IRS-designated private
delivery services.

Seasonal Employers

Mail Form 941-SS to:

Where Should You File?

Seasonal employers are not required to file for quarters
when they regularly have no tax liability because they have
paid no wages. To alert the IRS that you will not have to file
a return for one or more quarters during the year, check the
box in line 19 on Form 941-SS. The IRS will mail you two
Forms 941-SS once a year after March 1. The preprinted
information will not include the date the quarter ended. You
must enter the date the quarter ended when you file the
return. The IRS generally will not inquire about unfiled
returns if at least one taxable return is filed each year.
However, you must check the box in line 19 on every
quarterly return you file. Otherwise, the IRS will expect a
return to be filed for each quarter.

Internal Revenue Service
P.O. Box 105273
Atlanta, GA 30348-5273

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

See Pub. 80 (Circular SS) for information on ordering IRS
forms by telephone, mail, or online. You may also be able to
get some IRS forms at the addresses listed below.
American Samoa. Department of Treasury, Income Tax
Division, Government of American Samoa, Executive Office
Bldg., First Floor, Pago Pago, AS 96799.
Commonwealth of the Northern Mariana Islands.
Administrator, CNMI Social Security System, Saipan,
MP 96960.
Guam. Department of Revenue and Taxation,
Government of Guam, Building 13-1 Mariner Avenue, Tiyjan
Barrigada, GU 96913.
U.S. Virgin Islands. V.I. Bureau of Internal Revenue,
9601 Estate Thomas, Charlotte Amalie, St. Thomas, VI
00802.

If you go out of business or stop paying wages to your
employees, you must file a final return. To tell the IRS that
Form 941-SS for a particular quarter is your final return,
check the box on line 18 and enter the date you last 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.
See the Instructions for Form W-3SS, Transmittal of
Wage and Tax Statements, for information about earlier
dates for the expedited furnishing and filing of the following
Wage and Tax Statements when a final Form 941-SS is
filed.
• W-2AS, American Samoa;
• W-2CM, Commonwealth of the Northern Mariana Islands;
• W-2GU, Guam; or
• W-2VI, U.S. Virgin Islands.

How Should You Complete
Form 941-SS?
Preprinted Name and Address Information

Agricultural and Household
Employers

If your preprinted name, EIN, or address information on
Form 941-SS is not correct, cross it out and type or print the
correct information. However, do not change any of the
preprinted information on your Form 941-V(SS), Payment
Voucher.

Agricultural employers. Agricultural wages must be
reported on Form 943, Employer’s Annual Federal Tax
Return for Agricultural Employees, not on Form 941-SS.
Household employers. Employers who report wages for
household employees should see Pub. 80 (Circular SS) and
Pub. 926, Household Employer’s Tax Guide.

Employer identification number (EIN)
To make sure that businesses comply with federal tax laws,
the IRS monitors tax filings and payments by using a
numerical system to identify taxpayers. A unique 9-digit
employer identification number (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 are not sure which one to use, write to
the IRS office where you file your returns (using the without
a payment address on page 2) or call the IRS at
1-800-829-4933 (U.S. Virgin Islands only) or 215-516-6999
(toll call). TTY/TDD users in the U.S. Virgin Islands can call
1-800-829-4059.
If you do not have an EIN, you may apply for one online.
Go to the IRS website at www.irs.gov and click on the Apply
for an Employer Identification Number (EIN) Online link. You
may also apply for an EIN by calling 1-800-829-4933 (U.S.
Virgin Islands) or 215-516-6999 (toll call), or you can fax or

When Must You File?
File Form 941-SS for each quarter of the calendar year, as
follows:
Jan.-Feb.-Mar.
Apr.-May-June
July-Aug.-Sept.
Oct.-Nov.-Dec.

without a payment

Where Can You Obtain Forms?

Final Return

Quarter

with a payment

Due Date
April 30
July 31
Oct. 31
Jan. 31

If you made deposits on time in full payment of the taxes
for a quarter, you have 10 more calendar days after the
above due dates to file your return for that quarter. If the due
date for filing a return falls on a Saturday, Sunday, or legal
holiday, you may file the return on the next business day.
If we receive Form 941-SS after the due date, we will
treat Form 941-SS as filed on time if the envelope

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mail Form SS-4 to the IRS. If you have applied for an EIN
but do not have your EIN by the time a return is due, write
“Applied For” and the date you applied in the space shown
for the number.

unpaid taxes. A responsible person can be an officer or
employee of a corporation, a partner or employee of a
partnership, an accountant, a volunteer director/trustee, an
employee of a sole proprietorship, or any other person or
entity that is responsible for collecting, accounting for, and
paying over trust fund taxes. See section 8 of Pub. 80
(Circular SS) for details.

Always be sure the EIN on the form you file exactly

TIP matches the EIN the IRS assigned to your business.
Do not use your social security number on forms that
ask for an EIN. Filing a Form 941-SS with an incorrect EIN
or using another business’s EIN may result in penalties and
delays in processing your return.

Reconciling Forms 941-SS and W-3SS
The IRS matches amounts reported on your four quarterly
Forms 941-SS with Form W-2AS, W-2CM, W-2GU, or
W-2VI amounts totaled on your yearly Form W-3SS,
Transmittal of Wage and Tax Statements. If the amounts do
not agree, you may be contacted by the IRS or SSA. The
following amounts are reconciled.

Changing Your Name or Address
Notify the IRS immediately if you change your business
name or address.
• Write to the IRS office where you file your returns (using
the without a payment address on page 2) to notify the IRS
of any name change. Get Pub. 1635, Understanding Your
Employer Identification Number (EIN), to see if you need to
apply for a new EIN.
• Complete and mail Form 8822, Change of Address, for
any address change.

• Social security wages.
• Social security tips.
• Medicare wages and tips.
Use Schedule D (Form 941), Report of Discrepancies
Caused by Acquisitions, Statutory Mergers, or
Consolidations, to explain certain wage, tax, and payment
discrepancies between Forms 941-SS and Forms W-2AS,
W-2CM, W-2GU, W-2VI, W-3SS, and W-2c that were
caused by acquisitions, statutory mergers, or consolidations.
For more information, get the instructions for Schedule D
(Form 941). Also see Rev. Proc. 2004-53 for more
information. You can find Rev. Proc. 2004-53 on page 320
of Internal Revenue Bulletin 2004-34 at
www.irs.gov/pub/irs-irbs/irb04-34.pdf.

Check the Box for the Quarter
Under Report for this Quarter of 2010 at the top of Form
941-SS, check the appropriate box of the quarter for which
you are filing. Make sure the quarter checked is the same as
shown on any attached Schedule B (Form 941), Report of
Tax Liability for Semiweekly Schedule Depositors.

Completing and Filing Form 941-SS
Make entries on Form 941-SS as follows to enable accurate
processing.
• Use 12-point Courier font (if possible) for all entries if you
are typing or using a computer to fill out your form.
• Omit dollar signs and decimal points. Commas are
optional. Report dollars to the left of the preprinted decimal
point and cents to the right of it.
• Leave blank any data field (except lines 1 or 8) 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 and attachments.
Filers using the IRS-preaddressed Form 941-SS do not
have to enter their name and EIN on page 2.
• Staple multiple sheets in the upper left corner when filing.

Adjustment of Tax on Tips
If, by the 10th of the month after the month you received an
employee’s report on tips, you do not have enough
employee funds available to withhold the employee’s share
of social security and Medicare taxes, you no longer have to
collect it. Report the entire amount of these tips on lines 5b
(Taxable social security tips) and 5c (Taxable Medicare
wages and tips). Include as an adjustment on line 7c the
total uncollected employee share of the social security and
Medicare taxes.

Depositing Your Taxes:
When Must You Deposit Your Taxes?

What About Penalties and Interest?

Determine if you are a monthly or
semiweekly schedule depositor for the
quarter.

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, using
EFTPS if required.
• File your fully completed Form 941-SS on time.
• Report your tax liability accurately.
• Submit valid checks for tax payments.
• Furnish accurate Forms W-2AS, W-2CM, W-2GU, or
W-2VI to employees.
• File Form W-3SS and Copies A of Form W-2AS,
W-2CM,W-2GU, or W-2VI with the Social Security
Administration (SSA) on time and accurately.
Penalties and interest are charged on taxes paid late
and returns filed late at a rate set by law. See section 8 of
Pub. 80 (Circular SS) for details.

The IRS uses two different sets of deposit rules to determine
when businesses must deposit their social security and
Medicare taxes. These schedules tell you when a deposit is
due after you have a payday.
Your deposit schedule is not determined by how often
you pay your employees. Your deposit schedule depends on
the total tax liability you reported on Form 941-SS during the
previous four-quarter lookback period (July 1 of the second
preceding calendar year through June 30 of last year). See
section 8 of Pub. 80 (Circular SS) for details. If you filed
Form 944-SS in either 2008 or 2009, your lookback period is
the 2008 calendar year.
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
are a monthly schedule depositor.
• More than $50,000 of taxes for the lookback period, you
are a semiweekly schedule depositor.

A trust fund recovery penalty may apply if social
security and Medicare taxes that must be withheld
CAUTION are not withheld or are not paid. Under this penalty,
responsible persons become personally liable for payment
of the taxes and are penalized an amount equal to the

!

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See $100,000 Next-Day Deposit Rule in section 8 of

4. If no wages, tips, and other
compensation are subject to social security
or Medicare tax . . .

TIP Pub. 80 (Circular SS) if you have taxes of $100,000
or more accumulated on any day during the deposit
period.

If no wages, tips, and compensation are subject to social
security or Medicare tax, check the box on line 4. If this
question does not apply to you, leave the box blank. For
more information about exempt wages, see section 12 of
Pub. 80 (Circular SS) and section 4 of Pub. 15-A.

How Must You Deposit Your Taxes?
You may have to deposit both the employer and employee
social security taxes and Medicare taxes. If your total taxes
after adjustments (line 8) are:
• Less than $2,500 for the current quarter or the
preceding quarter, and you did not incur a $100,000
next-day deposit obligation during the current quarter.
You do not have to make a deposit. To avoid a penalty, you
must pay the amount in full with a timely filed return or you
must deposit the amount timely. However, if your taxes for
the preceding quarter were less than $2,500, you are unsure
whether you will incur a $100,000 next-day deposit
obligation in the current quarter, and you are unsure your
taxes will be less than $2,500 for current quarter, deposit
your taxes using the appropriate rules (above) to avoid
failure to deposit penalties.
• $2,500 or more for the current quarter and the
preceding quarter. You must deposit your taxes by using
EFTPS or by depositing them at a financial institution that is
authorized to accept federal tax deposits (that is, authorized
depository) with Form 8109, Federal Tax Deposit Coupon.
See section 8 of Pub. 80 (Circular SS).

If you are a government employer, wages you pay
are not 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.

!

5. Taxable social security and Medicare
wages and tips
5a. Taxable social security wages. Report the total
wages, sick pay, and fringe benefits subject to social
security taxes that you paid to your employees during the
quarter. 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 in Pub. 15-A for more information about sick pay
reporting.
Enter the amount before deductions. Do not include tips
on this line. For information on types of wages subject to
social security taxes, see section 4 of Pub. 80 (Circular SS).

You may reduce your deposits during the quarter by the
amount of COBRA premium assistance payments reported
on line 12a. See the instructions for line 12a on page 5.

The rate of social security tax on taxable wages is 6.2
percent (.062) each for the employer and employee or 12.4
percent (.124) for both. Stop paying social security tax on
and reporting an employee’s wages on line 5a when the
employee’s taxable wages (including tips) reach $106,800
during 2010. However, continue to withhold Medicare taxes
for the whole year on wages and tips even when the social
security wage base of $106,800 has been reached.

EFTPS is an easy, safe, and convenient way for all
TIP employers to make their tax deposits. Using EFTPS
helps eliminate errors commonly made on federal tax
deposit (FTD) coupons. Some taxpayers are required to
use EFTPS to deposit their taxes. See section 8 of
Pub. 80 (Circular SS) for details.

x

Specific Instructions:
Part 1: Answer these questions for
this quarter.

line 5a (column 1)
.124
line 5a (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 wages for an employee reach $106,800 in
2010. Do this even if you were unable to withhold the
employee tax of 6.2%.

Employers in American Samoa, Guam, the Commonwealth
of the Northern Mariana Islands, and the U.S. Virgin Islands
are not required to complete lines 2, 3, 6, 9, 10, and 16.

An employee must report cash tips to you, including tips
you paid the employee for charge customers, totaling $20 or
more in a month by the 10th of the next month. Employees
may use Form 4070, Employee’s Report of Tips to Employer
(available only in Pub. 1244, Employee’s Daily Record of
Tips and Report to Employer), or submit a written statement
or electronic tip record.

1. Number of employees who received
wages, tips, or other compensation for the
pay period including:
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 the
return. Do not include:
• Household employees,
• Employees in nonpay status for the pay period,
• Farm employees,
• Pensioners, or
• Active members of the Armed Forces.

Do not include allocated tips on this line. Instead, report
them on Form 8027, Employer’s Annual Information Return
of Tip Income and Allocated Tips. Allocated tips are not
reportable on Form 941-SS and are not subject to social
security or Medicare taxes.
x

line 5b (column 1)
.124
line 5b (column 2)

If you enter “250” or more on line 1, you must file

TIP Forms W-2 electronically. For details, call the SSA at

5c. Taxable Medicare wages and tips. Report all
wages, 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.

1-800-772-6270 or visit SSA’s Employer W-2 Filing
Instructions & Information website at
www.socialsecurity.gov/employer.

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• If line 8 is $2,500 or more and line 8 on the preceding

Include all tips your employees reported during the
quarter, even if you were unable to withhold the employee
tax of 1.45%.
x

return was $2,500 or more, or if you incurred a $100,000
next-day deposit obligation during the current quarter.
You must deposit the amount by using the Electronic
Federal Tax Payment System (EFTPS) or at an authorized
financial institution with Form 8109. The amount shown on
line 8 must equal the “Total liability for quarter” shown on
Form 941-SS, line 17 or the “Total liability for the quarter”
shown on Schedule B (Form 941).

line 5c (column 1)
.029
line 5c (column 2)

For more information, see sections 4, 5, and 7 of Pub. 80
(Circular SS).
5d. Total social security and Medicare taxes. Add
the social security tax (line 5a), social security tips tax (line
5b), and Medicare tax (line 5c) and enter the result on line
5d.

If you are a semiweekly depositor, you must
complete Schedule B (Form 941). If you fail to
CAUTION complete and submit Schedule B (Form 941), the
IRS will assert deposit penalties based on available
information.

7. TAX ADJUSTMENTS

11. Total deposits for this quarter...

Enter tax amounts on lines 7a through 7c that result from
current quarter adjustments. Use a minus sign (if possible)
to show an adjustment that decreases the total taxes shown
on line 5d, instead of parentheses. Doing so enhances the
accuracy of our scanning software. For example, report
‘‘-10.59’’ instead of ‘‘(10.59).’’ However, if your software only
allows for parentheses in reporting negative amounts, you
may use them.

Enter your deposits for this quarter, including any
overpayment that you applied from filing Form 941-X or
Form 944-X in the current quarter. Also include in the
amount shown any overpayment from a previous period that
you applied to this return.

!

12a. COBRA premium assistance payments
Report on this line 65% of the COBRA premiums for
assistance eligible individuals. Take the COBRA premium
assistance credit on this line only after the assistance
eligible individual’s 35% share of the premium has been
paid. For COBRA coverage provided under a self-insured
plan, COBRA premium assistance is treated as having been
made for each assistance eligible individual who pays 35%
of the COBRA premium. Do not include the assistance
eligible individual’s 35% of the premium in the amount
entered on this line. For more information on the COBRA
premium assistance credits, visit the IRS website at www.
irs.gov and enter keyword COBRA.
If you provided premium assistance in a prior quarter of
the current year and did not report the amount of that
premium assistance on Form 941-SS for that quarter, you
may include the amount of that premium assistance in the
amount entered on this line, or file Form 941-X, Adjusted
Employer’s QUARTERLY Federal Tax Return or Claim for
Refund, to report the amount for the prior quarter of the
current year.

Current quarter’s adjustments. In certain cases, you
must adjust the amounts you reported as social security and
Medicare taxes in column 2 of lines 5a, 5b, and 5c to figure
your correct tax liability for this quarter’s Form 941-SS. See
section 8 of Pub. 80 (Circular SS).
Prior quarter’s adjustments. If you need to adjust any
amount reported on lines 7a, 7b, or 7c from a previously
filed Form 941-SS, complete and file Form 941-X. Form
941-X is an adjusted return and is filed separately from
Form 941-SS. See section 9 of Pub. 80 (Circular SS).
7a. Current quarter’s 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 (one-half) of amounts shown
in column 2 of lines 5a – 5c may differ slightly from amounts
actually withheld from employees’ paychecks due to the
rounding of social security and Medicare taxes based on
statutory rates.

12b. Number of individuals provided
COBRA premium assistance on line 12a

7b. Current quarter’s sick pay. Enter the adjustment
for the employee share of social security and Medicare
taxes that were withheld by your third-party sick pay payer.

Enter the total number of assistance eligible individuals
provided COBRA premium assistance reported on line 12a.
Count each assistance eligible individual who paid a
reduced COBRA premium in the quarter as one individual,
whether or not the reduced premium was for insurance that
covered more than one assistance eligible individual. For
example, if the reduced COBRA premium was for coverage
for a former employee, spouse, and two children, you would
include one individual in the number entered on line 12b for
the premium assistance. Further, each individual is reported
only once per quarter. For example, an assistance eligible
individual who made monthly premium payments during the
quarter would only be reported as one individual.

7c. Current quarter’s adjustments for tips and
group-term life insurance. Enter adjustments 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.
7d. TOTAL ADJUSTMENTS. Combine all adjustments
shown on lines 7a through 7c and enter the result here.

8.

Total taxes after adjustments

Combine the amounts shown on lines 5d and 7d and enter
the result here.
• If line 8 is less than $2,500 or line 8 on the preceding
quarterly return was less than $2,500, and you did not
incur a $100,000 next-day deposit obligation during the
current quarter. You may pay the amount with Form
941-SS or you may deposit the amount. To avoid a penalty,
you must pay the amount in full with a timely filed return or
you must deposit the amount timely. See section 8 of Pub.
80 (Circular SS) for information and rules about federal tax
deposits.

13. Total deposits and COBRA credit
Add lines 11 and 12a.

14. Balance due
If line 8 is more than line 13, write the difference in line 14.
Otherwise, see Overpayment below.You do not have to
pay if line 14 is under $1. Generally, you should have a
balance due only if your total taxes for the current quarter or
preceding quarter (line 8) are less than $2,500, and you did
not incur a $100,000 next-day deposit obligation during the

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current quarter. However, see section 8 of Pub. 80 (Circular
SS) for information about payments made under the
Accuracy of Deposits Rule.
You may pay the amount shown on line 14 using EFTPS,
a credit card, a check or money order, or electronic funds
withdrawal (EFW). Do not use a credit card or EFW to pay
taxes that were required to be deposited. For more
information on paying your taxes with a credit card or EFW,
visit the IRS website at www.irs.gov and click on the Online
Services link.
If you pay by EFTPS, credit card, or EFW, file your return
using the without a payment address on page 2 under
Where Should You File? and do not file Form 941-V,
Payment Voucher.
If you pay by check or money order, make it payable to
the United States Treasury. Enter your EIN, Form 941-SS,
and the tax period on your check or money order. Complete
Form 941-V(SS) and enclose with Form 941-SS.
If line 8 is $2,500 or more and you have deposited all
taxes when due, the balance due on line 14 should be zero.

!

CAUTION

You are a monthly schedule depositor for the calendar
year if the amount of your Form 941-SS taxes reported for
the lookback period is $50,000 or less. The lookback
period is the four consecutive quarters ending on June 30
of the prior year. For 2010, the lookback period begins July
1, 2008, and ends June 30, 2009. For details on the deposit
rules, see section 8 of Pub. 80 (Circular SS). If you filed
Form 944-SS in either 2008 or 2009, your lookback period is
the 2008 calendar year.
The amounts reported on line 17 are a summary of
your monthly tax liability, not a summary of deposits
CAUTION you made. If you do not properly report your liabilities
when required or if you are a semiweekly schedule
depositor and report your liabilities on line 17 instead of on
Schedule B (Form 941), you may be assessed an
“averaged” failure-to-deposit (FTD) penalty. See Deposit
Penalties in section 8 of Pub. 80 (Circular SS) for more
information.
• If you reported more than $50,000 of taxes for the
lookback period (see above), you are a semiweekly
schedule depositor. Check the appropriate box on line 17.
You must complete the Schedule B (Form 941) and
submit it with your Form 941-SS. Do not use Schedule B
(Form 941) if you are a monthly schedule depositor.
Do not change your tax liability on Schedule B (Form
941) by adjustments reported on any Forms 941-X.

!

If you do not deposit as required and, instead, pay
the taxes with Form 941-SS, you may be subject to a
penalty.

15. Overpayment
If line 13 is more than line 8, write the difference in line 15.
Never make an entry in 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 in line 15. If you do not check either box or if you check
both boxes, generally we will apply the overpayment to your
account. 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 3: Tell us about your business.
In Part 3, answer only those questions that apply to your
business. If the questions do not apply, leave them blank
and go to Part 4.

18. 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-SS
is your final return, check the box on line 18 and enter the
date you last paid wages in the space provided. For
additional filing requirements, see Final Return on page 2 of
these instructions.

Complete both pages.
You must complete both pages of Form 941-SS and sign on
page 2. Failure to do so may delay processing of your
return.

19. If you are a seasonal employer . . .
If you hire employees seasonally — such as for summer or
winter only — check the box on line 19. Checking the box
tells the IRS not to expect four Forms 941-SS from you
throughout the year because you have not paid wages
regularly.
Generally, we will not ask about unfiled returns if you file
at least one return showing tax due each year. However,
you must check the box every time you file a Form 941-SS.
Also, when you fill out Form 941-SS, be sure to check the
box on the top of the form that corresponds to the quarter
reported.

Part 2: Tell us about your deposit
schedule and tax liability for this
quarter.
17. Check one:
• If line 8 is less than $2,500, or line 8 on the preceding

quarterly return was less than $2,500, and you did not incur
a $100,000 next-day deposit obligation during the current
quarter, check the appropriate box in line 17 and go to Part
3.
• If you reported $50,000 or less in taxes during the
lookback period (see below), you are a monthly schedule
depositor unless the $100,000 Next-Day Deposit Rule
discussed in section 8 of Pub. 80 (Circular SS) applies.
Check the appropriate box on line 17 and enter your tax
liability for each month in the quarter. 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 8. If it does not, your tax
deposits and payments may not be counted as timely. Do
not change your tax liability on line 17 by adjustments
reported on any Forms 941-X.

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-SS with the IRS,
check the “Yes” box in Part 4. Then tell us the name, phone
number, and the five-digit personal identification number
(PIN) of the specific person to speak with — not the name of
the firm who prepared your tax return. The designee may
choose any five numbers as his or her PIN.
By checking “Yes,” you authorize the IRS to talk to the
person you named (your designee) about any questions we

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may have while we process your return. You also authorize
your designee to:
• give us any information that is missing from your return,
• call us for information about processing your return, and
• respond to certain IRS notices that you have shared with
your designee about math errors and return preparation.
The IRS will not send notices to your designee.
You are 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, Practice Before the
IRS and Power of Attorney.
The authorization will automatically expire 1 year from the
due date (without regard to extensions) for filing your Form
941-SS. If you or your designee want to terminate the
authorization, write to the IRS office for your locality using
the without a payment address under Where Should You
File? on page 2.

mechanical device, or computer software program. For
details and required documentation, see Rev. Proc.
2005-39. You can find Rev. Proc. 2005-39 on page 82 of
Internal Revenue Bulletin 2005-28 at
www.irs.gov/pub/irs-irbs/irb05-28.pdf.

Paid Preparer’s Use Only
A paid preparer must sign Form 941-SS and provide the
information in the Paid preparer’s use only section of Part 5
if the preparer was paid to prepare Form 941-SS and is not
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 are a paid preparer, write your SSN or your
Preparer Tax Identification Number (PTIN) in the space
provided. Include your complete address. If you work for a
firm, write the firm’s name and the EIN of the firm. You can
apply for a PTIN using Form W-7P, Application for Preparer
Tax Identification Number. You cannot use your PTIN in
place of the EIN of the tax preparation firm.
Generally, do not complete this section if you are filing
the return as a reporting agent and have a valid Form 8655,
Reporting Agent Authorization, 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.

Part 5: Sign here
Complete all information in Part 5 and sign Form 941-SS as
follows.
• 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 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
other principal officer duly authorized to sign.
• Trust or estate — The fiduciary.
Form 941-SS may also 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-SS by rubber stamp,

How to Order Forms and Publications
from the IRS
Call 1-800-829-3676 (U.S. Virgin Islands only), or
215-516-2000 (toll call).
Visit the IRS website at www.irs.gov.

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