Employer's Quarterly Federal Tax Return

Forms and Documents

Document Name	Status
Form 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	Modified
Form Schedule R (Form 9 Schedule R (Form 941) - Allocation for Aggregate Form 941 Filers Form and Instruction	Modified
Form 941SS-V OTC Form 941SS -V - Payment Voucher (OTC) Form and Instruction	Modified
Form 941-V (SS) Form 941SS -V -(Preprinted) Form and Instruction	Modified
Form 941-V (PR) Form 941-V (PR) (Preprinted) - Payment Voucher Form and Instruction	Modified
Form 941-V (PR) Form 941-V (PR) - Payment voucher (OTC) Form and Instruction	Modified
Form 941-V - Preprinted Form 941-V - Payment voucher (Preprinted) and (OTC) Form	Modified
Form 941-X (PR) Form 941-X (PR) - Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso Form	Modified
Form 941-X Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund Form	Modified
Form Anexo B (Forma 941 Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual Form	Modified
Form 941-PR Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono Form	Modified
Form Schedule D (Form 9 Scedule D (Form 941) - Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations Form	Modified
Form Schedule B (Form 9 Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors Form	Modified
ombat1.doc Supplementary Document	2010-05-17
941, 941-PR, 941-SS-Sup.doc Supporting Statement A	2010-10-25

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	Modified
190971	Schedule R (Form 941) - Allocation for Aggregate Form 941 Filers Form and Instruction	Modified
187195	Form 941SS -V - Payment Voucher (OTC) Form and Instruction	Modified
187193	Form 941SS -V -(Preprinted) Form and Instruction	Modified
187191	Form 941-V (PR) (Preprinted) - Payment Voucher Form and Instruction	Modified
187190	Form 941-V (PR) - Payment voucher (OTC) Form and Instruction	Modified
187189	Form 941-V - Payment voucher (Preprinted) and (OTC) Form	Modified
187188	Form 941-X (PR) - Ajuste a la Declaracion Federal TRIMESTRAL del Patrono o Reclamo de Reembolso Form	Modified
187187	Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund Form	Modified
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 Other-2011 Draft	Modified
187185	Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual Form	Modified
187184	Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono Form	Modified
187183	Scedule D (Form 941) - Report for Discrepancies Caused by Acquisitions, Statutory Mergers, or Consolidations Form	Modified
187174	Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors Form	Modified

ICR Details

OMB Control No: 1545-0029	ICR Reference No: 201010-1545-034
Status: Historical Active	Previous ICR Reference No: 201005-1545-038
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Employer's Quarterly Federal Tax Return
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/27/2011
	Date Received in OIRA: 11/29/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	36 Months From Approved	01/31/2011
Responses	37,810,463	0	37,810,463
Time Burden (Hours)	388,256,964	0	388,256,964
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): US Code: 26 USC 3111(d) Name of Law: Rate of tax
   US Code: 26 USC 3405 Name of Law: Special rules for pensions, annuities, and certain other deferred income
   US Code: 26 USC 3501 Name of Law: Collection and payment of taxes
   US Code: 26 USC 3102 Name of Law: Deduction of tax from wages
   US Code: 26 USC 3504 Name of Law: Acts to be performed by agents
   US Code: 26 USC 3101 Name of Law: Rate of tax
  

Citations for New Statutory Requirements: None

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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:
	75 FR 51531	08/20/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 73162	11/29/2010
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 941-V (PR) (Preprinted) - Payment Voucher	941-V (PR)	Comprobante de Pago
Form 941SS -V -(Preprinted)	941-V (SS)	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 Reclamacion de Reembolso
Form 941SS -V - Payment Voucher (OTC)	941SS-V OTC	Payment Voucher
Form 941-V - Payment voucher (Preprinted) and (OTC)	941-V (OTC), 941-V - Preprinted	payment voucher ,   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
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 941	Employee's Quarterly Federal Tax Return
Form 941-V (PR) - Payment voucher (OTC)	941-V (PR)	Comprobante de Pago
Form 941-PR - Planilla para la Declaracion Federal TRIMESTRAL del Patrono	941-PR	Planilla para la Declaracion Federal TRIMESTRAL del Patrono
Schedule R (Form 941) - Allocation for Aggregate Form 941 Filers	Schedule R (Form 941)	Allocation Schedule for Aggregated Form 941 Filers
Schedule B (Form 941) - Report of Tax Liability for Semiweekly Schedule Depositors	Schedule B (Form 941)	Report of Tax Liability for Semiweekly Schedule Depositors
Anexo B, (Forma 941-PR) - Registro de la Obligacion Contributiva para los Despositantes de Itinerario Bisemanual	Anexo B (Forma 941-PR)	Registro de la Obligacion Contributiva para los Depositantes de Itinerario Bisemanal
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

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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	37,810,463	0	0	0	0
Annual Time Burden (Hours)	388,256,964	388,256,964	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 11/29/2010

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