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

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Instructions for Form 941-SS

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Instructions for
Form 941-SS

Department of the Treasury
Internal Revenue Service

(Rev. April 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

.

, Allocation Schedule
for Aggregate Form
941 Filers,

Qualified employer’s social security tax credit. Qualified
employers are allowed a credit in the second quarter of
2010 for their share (6.2%) of social security tax on wages/
tips paid to qualified employees after March 18, 2010, and
before April 1, 2010, that would otherwise have been treated
as the social security tax exemption in the first quarter of
2010. See the instructions for lines 12c through 12e
beginning on page 6.
Qualified employer’s social security tax exemption.
Qualified employers are allowed an exemption for their
share (6.2%) of social security tax on wages/tips paid to
qualified employees after March 31, 2010, and before
January 1, 2011. See the instructions for lines beginning on
6a through 6d on page 5.
filers
Aggregate Form 941-SS. Agents must complete Schedule
R (Form 941), when filing an aggregate Form 941-SS.
Aggregate Forms 941-SS are filed by agents approved by
the IRS under section 3504. To request approval to act as
an agent for an employer, the agent files Form 2678,
Employer/Payer Appointment of Agent, with the IRS.
COBRA premium assistance credit extended. The credit
for COBRA premium assistance payments has been
pp
p y
extended. It now applies
to p
premiums p
paid for employees
involuntarily
y terminated between September 1, 2008, and
May 31, 2010, , and to premiums paid for 15 months.
Congress may take additional legislative action that extends
the credit. To find out if additional legislation is enacted,
up to
monitor the news media or visit the IRS website at
www.irs.gov and enter the keyword COBRA. See COBRA
premium assistance payments on page 6.
,
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.
/ar12.html.
Social security wage base for 2010. Do not withhold or
pay 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. 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
y g yyour taxes using EFW, visit the
more information on p
paying
y A fee may be charged to
IRS website att www.irs.gov/e-pay.
file electronically.
y the
Credit or debit card payments. Employers can p
pay
balance due shown on Form 941-SS by credit or debit card.
Do not use a credit or debit card to make federal tax
deposits. For more information on paying your taxes with a
credit or debit card,, visit the IRS website at
www.irs.gov/e-pay.
y
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.

Cat. No. 35530F

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Instructions for Form 941-SS

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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.

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).

Agricultural and Household
Employers
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.

Who Must File Form 941-SS?

When Must You File?

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
you have employees who are subject to income tax
withholding for these jurisdictions.
Use Form 941-SS to report the following amounts:
• Wages/tips subject to social security and Medicare taxes.
• Both the employer’s and the employee’s share of social
security and Medicare taxes.
• Current quarter’s adjustments to social security and
Medicare taxes for fractions of cents, sick pay, tips, and
group-term life insurance.
• Credit for COBRA premium assistance payments.
• Exemption for qualified employer’s share of social security
tax on wages/tips paid to qualified employees.
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.

File Form 941-SS for each quarter of the calendar year, as
follows:
Quarter

Due Date

Jan.-Feb.-Mar.
Apr.-May-June
July-Aug.-Sept.
Oct.-Nov.-Dec.

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
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.

Where Should You File?

Seasonal Employers

Mail Form 941-SS to:

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 on 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.

with a payment

without a payment

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

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

Where Can You Obtain Forms?
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.

Final Return
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

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Guam. Department of Revenue and Taxation,
Government of Guam, Building 13-1 Mariner Avenue, Tiyjan
Barrigada, GU 96913.

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 and 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.

U.S. Virgin Islands. V.I. Bureau of Internal Revenue,
9601 Estate Thomas, Charlotte Amalie,
St. Thomas, VI 00802.

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

What About Penalties and Interest?

Employer identification number (EIN)

Avoiding penalties and interest

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.

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.

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
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.

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
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. If the
amounts do not agree, you may be contacted by the IRS or
SSA. The following amounts are reconciled.
• 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.

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.

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.

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Employer's exempt
You may reduce your deposits during the quarter by the
amount of:
• COBRA premium assistance payments reported on line
12a,
• Exempt employer social security tax on line 6d, and
• Exempt employer social security tax on line 12e.
.

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.

Employer's exempt

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.

Depositing Your Taxes:
When Must You Deposit Your Taxes?

Specific Instructions:

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

Part 1: Answer these questions for
this quarter.

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.

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, 9, 10, and 16.

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.

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.

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.

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

TIP Forms W-2 electronically. For details, call the SSA at
1-800-772-6270 or visit SSA’s Employer W-2 Filing
Instructions & Information website at
www.socialsecurity.gov/employer.

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

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

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

How Must You Deposit Your Taxes?

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.

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
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.

!

CAUTION

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

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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).
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.
x

6. Employer’s social security tax exemption.
Complete lines 6a – 6d to figure the payroll tax exemption
for the employer’s share (6.2%) of social security tax on
wages/tips paid to one or more qualified employees.
An employer must be a qualified employer to be eligible
for the employer’s social security tax exemption. A qualified
employer is any employer other than Federal, State, and
any related government entities. All public institutions of
higher education and Indian tribal governments are also
qualified employers.
An employer may elect not to apply the social security tax
exemption with respect to a qualified employee. The election
is made by not including that employee or that employee’s
wages on lines 6a – 6d and lines 12c – 12e. An election not to
apply the social security tax exemption to a qualified
employee may allow a qualified employer to claim the Work
Opportunity Credit for that employee. A qualified employer
cannot apply both the social security tax exemption on Form
941-SS and claim the Work Opportunity Credit for the same
employee. For more information, see Form 5884, Work
Opportunity Credit.

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

Do not reduce the amount reported on line 5a by any
amount paid to qualified new employees. Your
CAUTION liability for exempt wages/tips will be reduced
on line 6d.
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%.
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.
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

For more information about the employer’s social security
tax exemption, visit the IRS website at www.irs.gov and
enter the keywords “HIRE Act” in the search box.
6a. Number of qualified employees first paid exempt
wages/tips this quarter. A qualified employee is an
employee who:
• Begins employment with you after February 3, 2010, and
before January 1, 2011;
• Certifies by signed affidavit (Form W-11, Hiring Incentives
to Restore Employment (HIRE) Act Employee Affidavit), or
similar statement under penalties of perjury, that he or she
has not been employed for more than 40 hours during the
60-day period (including 2009) ending on the date the
employee begins employment with you;
• Is not employed by you to replace another employee
unless the other employee separated from employment
voluntarily or for cause (including downsizing); and
• Is not related to you. An employee is related to you if he
or she is your child or a descendant of your child, your
sibling or stepsibling, your parent or ancestor of your parent,
your stepparent, your niece or nephew, your aunt or uncle,
or your in-law. An employee is also related to you if he or
she is related to anyone who owns more than 50% of your
outstanding stock or capital and profits interest or is your
dependent or a dependent of anyone who owns more than
50% of your outstanding stock or capital and profits interest.
If you are an estate or trust, see section 51(i)(1) and section
152(d)(2) for more details.

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

Do not reduce the amount reported on line 5b by
any amount paid to qualified new employees. Your
CAUTION liability for exempt wages/tips will be reduced
on line 6d.
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.
Include all tips your employees reported during the
quarter, even if you were unable to withhold the employee
tax of 1.45%.

!

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

are the wages/tips
paid to
on

For more information, see sections 4, 5, and 7 of Pub. 80
(Circular SS).
Delete "the"

!

CAUTION

Do not reduce the amount reported on line 5c by any
amount paid to qualified new employees. The tax
exemption does not apply to the Medicare tax.

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.
Delete bold from

highlighted text

-5-

Exempt wages/tipsqualified employees for which the
employer is exempt from paying the employer’s 6.2% share
of social security tax. Enter on line 6a the number of
qualified employees first paid wages/tips to which you
applied the social security tax exemption in this quarter. Do
not include in line 6a qualified employees that are included
in line 12c.
on
6b. Number of qualified employees paid exempt
wages/tips this quarter. Enter on line 6b the total number
of qualified employees paid exempt wages/tips to which you
applied the social security tax exemption in this quarter.
Qualified employees included on line 6a will also be
included on line 6b. Qualified employees on line 12c may
also be included on line 6b. See line 6a for the definition of
qualified employee.
6c. Exempt wages/tips paid to qualified employees
this quarter. Enter the amount of exempt wages/tips paid
this quarter to all qualified employees
reported
on line 6b.
y
p
See line 6a for the definition of exempt wages/tips.

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6d. Social security tax exemption. Multiply the amount
of exempt wages/tips reported on line 6c by .062 and enter
the result on line 6d. See the instructions for line 17 for
details about applying this exemption to your tax liability.
6e. Total taxes before adjustments. Subtract the
qualified employer’s social security tax exemption (line 6d)
from the total social security and Medicare taxes before
adjustments (line 5d). Enter the result on line 6e.

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

!

CAUTION

11. Total deposits for this quarter...
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.

7. TAX ADJUSTMENTS
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 6e, 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.
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).
Delete Prior quarter’s adjustments. If you need to adjust any
amount reported on lines 7a, 7b, or 7c from a previously
"and" filed Form 941-SS, complete and file Form 941-X. Form
941-X and is filed separately from Form 941-SS. See
section 9 of Pub. 80 (Circular SS).
7a. Current quarter’s adjustment for 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.
7b. Current quarter’s adjustment for 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.
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. d

8.

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.
The amount reported on line 12a is treated as a
deposit of taxes on the first day of your return period
CAUTION and must not be used to adjust line 17 or Schedule B
(Form 941).
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 to report the
amount for the prior quarter of the current year.

!

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

Total taxes after adjustments

Combine the amounts shown on lines 6e through 7c 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.
• If line 8 is $2,500 or more and line 8 on the preceding
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).

Lines 12c – 12e only apply to the second quarter of
2010. These lines are used to determine the number
CAUTION of qualified employees, amount of exempt wages/
tips, and amount of exemption as if the exemption were
allowed for the first quarter of 2010. An employer is allowed
to treat this exemption as a payment credited against
deposit requirements for employment taxes due for the
second quarter 2010. If any of these lines are completed for
any quarter other than the second quarter of 2010, Form
941-SS may be considered incomplete and subject to
correction and penalties.

!

12c. Number of qualified employees paid
exempt wages/tips March 19–31
Complete this line when filing Form 941 for the 2nd quarter
of 2010 only. Enter on line 12c the number of qualified
employees paid exempt wages/tips from March 19, 2010

-6-

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Instructions for Form 941-SS

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Delete bold from
highlighted text
through March 31, 2010. Include only qualified employees
for which you are claiming
g the social security tax exemption.
For the definition of qualified employee, see
s the
instructions for line 6a on page 5.

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.

12d. Exempt wages/tips paid to qualified
employees March 19–31

Part 2: Tell us about your deposit
schedule and tax liability for this
quarter

Complete this line when filing Form 941 for the 2nd quarter
of 2010 only. Enter the amount of exempt wages/tips paid
March 19, 2010 through March 31, 2010, to all qualified
employees
reported
on line 12c. For the definition of
p y
p
exempt wages/tips, see the instructions for line 6a
on page 5.

17. Tax liability for the quarter
• If line 8 is less than $2,500, or line 8 on the preceding

12e. Social security tax exemption for March
19–31
Insert line break

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.
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.

Multiply the amount of exempt wages/tips reported on line
12d by .062 and enter the result on line 12e.

!

CAUTION

The amount reported on line 12e is treated as a
deposit of taxes on April 1, 2010, and must not be
used to adjust line 17 or Schedule B (Form 941).

13. Total deposits and COBRA credits
Add lines 11, 12a, and 12e.

Delete "COBRA"

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
current quarter. However, see section 8 of Pub. 80 (Circular
SS) for information about payments made under the
Accuracy of Deposits Rule.
p y the amount shown on line 14 using EFTPS,
You mayy pay
a credit or debit card, a check or money order,, or electronic
funds withdrawal (EFW). Do not use a credit or debit card or
EFW to pay taxes that were required to be deposited. For
more information on electronic payment options, visit the
IRS website at www.irs.gov/e-pay
.
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.
or debit
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

The amounts reported on line 17 are a summary of
your monthly tax liability, not a summary of deposits
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.

!

CAUTION

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.

Adjusting tax liability for employer’s social security tax
exemption reported on line 6d. Monthly schedule
depositors and semiweekly schedule depositors must
account for the employer’s social security tax exemption
(line 6d) when reporting their tax liabilities on line 17 or
Schedule B (Form 941). The total liability for the quarter
must equal the amount reported on line 8. Failure to account
for the social security tax exemption on line 17 or Schedule
B (Form 941) may cause line 8 to be less than the total tax
liability reported on line 17 or Schedule B (Form 941). Do

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Instructions for Form 941-SS

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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

not reduce the tax liability reported on line 17 or Schedule B
(Form 941) below zero.

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,
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/
www.irs.gov/pub/irs-irbs/irb05-28.pdf.

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.

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.

irb/2005-28_IRB/ar.16.html.

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 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
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.

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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69
file-metadata-1

file-metadata-2

Instructions for
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
Cat. No. 35530F
(Rev. April 2010)
What's New
Qualified employer's social security tax credit. Qualified employers are allowed a credit in the second quarter of
2010 for their share (6.2%) of social security taxestax on wages/tips paid to qualified employees after March 18, 2010,
and before April 1, 2010, that would otherwise have been treated as the social security tax exemption in the first
quarter of 2010. See the instructions for lines 12c through 12e beginning on page 6.
ta taref="PL 111-147, section 101"

Qualified employer's social security tax exemption. Qualified employers are allowed an exemption for their share
(6.2%) of social security taxestax on wages/tips paid to qualified employees after March 31, 2010, and before January
1, 2011. See the instructions for lines beginning on 6a through 6d on page 5.

ta taref="PL 111-147-sec. 101"

Aggregate Form 941-SS. Agents must complete Schedule R (Form 941), when filing an aggregate Form 941-SS.
Aggregate Forms 941-SS are filed by agents approved by the IRS under section 3504. To request approval to act as
an agent for an employer, the agent files Form 2678, Employer/Payer Appointment of Agent, with the IRS.
COBRA premium assistance credit extended. The credit for COBRA premium assistance payments has been
extended. It now applies to premiums paid for employees involuntarily terminated before Junebetween September 1,
2008, and May 31, 2010, , and to premiums paid for 15 months. Congress may take additional legislative action that
extends the credit. To find out if additional legislation wasis enacted, monitor the news media or visit the IRS website at
www.irs.gov and enter the keyword COBRA. See COBRA premium assistance payments on page 6.
ta taref="PL 111-118, section 1010"

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 or pay social security tax after an employee reaches $106,800
in social security wages, which remains unchangedfrom 2009.
from 2009. ta taref="Annual notice from SSA, about mid-October"
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 return941-X. 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.
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).

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EFTPS Customer Support on 09/29/2008, Business 1-800-555-4477
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.govwww.irs.gov/e-payand type e-pay in the search box.. A fee may be charged to file
electronically. ta taref="COTR/E-payments:SE:W:CAS:SP:ATP:EP"
Credit or debit card payments. Employers can pay the balance due shown on Form 941-SS by credit or debit card.
Do not use a credit or debit card to make federal tax deposits. For more information on paying your taxes with a credit
or debit card, visit the IRS website at
www.irs.govwww.irs.gov/e-payand type e-pay in the search box..
SE:W:CAS:SP:TPM:EP
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. ta taref="Requested by collection policy."
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 you
have employees who are subject to income tax withholding for these jurisdictions.
Use Form 941-SS to report the following amounts:
• Wages/tips subject to social security and Medicare taxes.
• Both the employer's and the employee's share of social security and Medicare taxes.
• Current quarter's adjustments to social security and Medicare taxes for fractions of cents, sick pay, tips, and
group-term life insurance.
• Credit for COBRA premium assistance payments.
• Exemption for qualified employer's share of social security taxestax on wages/tips paid to qualified employees.
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.
Seasonal Employers
Seasonal employers are not required to file for quarters when they regularly have no tax liability because they

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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 on 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.
Final Return
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.

Agricultural and Household Employers
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.

When Must You File?
File Form 941-SS for each quarter of the calendar year, as follows:
Quarter

Due Date

Jan.-Feb.-Mar.

April 30

Apr.-May-June

July 31

July-Aug.-Sept.

Oct. 31

Oct.-Nov.-Dec.

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 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. ta taref="CC:TEGE"

Where Should You File?
Mail Form 941-SS to:
with a payment

without a payment

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

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

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Where Can You Obtain Forms?
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.
St. Thomas, VI 00802.

How Should You Complete
Form 941-SS?
Preprinted Name and Address Information
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.
Payment Voucher.
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 cancall
1-800-829-4059.
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 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. ta taref="Instructions for Form SS-4"

Always be sure the EIN on the form you file exactly 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.
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.
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

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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 and 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.
What About Penalties and Interest?
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.

A trust fund recovery penalty may apply if social security and Medicare taxes that must be withheld 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 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. ta taref="CC:INTL"
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. If the amounts do not agree, you may be contacted by the IRS or
SSA. The following amounts are reconciled.
• 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.
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:

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When Must You Deposit Your Taxes?
Determine if you are a monthly or semiweekly schedule depositor for the quarter.
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.
As recommended by CC:TEGE:EEOG:ET1

See $100,000 Next-Day Deposit Rule in section 8 of Pub. 80 (Circular SS) if you have taxes of $100,000 or
more accumulated on any day during the deposit period.

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).

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You may reduce your deposits during the quarter by the amount of:
• COBRA premium assistance payments reported on line 12a,
• Exempt employer social security taxestax on line 6d, and
• Exempt employer social security taxestax on line 12e.
.

EFTPS is an easy, safe, and convenient way for all 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.

Specific Instructions:
Part 1:

&ensp

Answer these questions for this quarter.

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, 9, 10, and 16.
1. &ensp 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.

If you enter ``250'' or more on line 1, you must file Forms W-2 electronically. For details, call the SSA at
1-800-772-6270 or visit SSA's Employer W-2 Filing Instructions & Information website at
www.socialsecurity.gov/employer.
4. &ensp If no wages, tips, and other compensation are subject to social security or Medicare tax . . .
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.

If you are a government employer, wages you pay are not automatically exempt from social security 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. &ensp Taxable social security and Medicare wages and tips
5a. &ensp 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).
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

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taxes for the whole year on wages and tips even when the social security wage base of $106,800 has been reached.
line 5a
x &numsp

(column 1)

&numsp .124

line 5a

(column 2)

Do not reduce the amount reported on line 5a by any amount paid to qualified new employees. Your
liability for exempt wages/tips will be reduced on line 6d.
on line 6d.
5b. &ensp 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%.
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.
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.
line 5b
x &numsp

(column 1)

&numsp .124

line 5b

(column 2)

Do not reduce the amount reported on line 5b by any amount paid to qualified new employees. Your
liability for exempt wages/tips will be reducedon line 6d.
on line 6d.
5c. &ensp 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.
Include all tips your employees reported during the quarter, even if you were unable to withhold the employee tax of
1.45%.
line 5c
x &numsp

(column 1)

&numsp .029

line 5c

(column 2)

For more information, see sections 4, 5, and 7 of Pub. 80
(Circular SS).

Do not reduce the amount reported on line 5c by any amount paid to qualified new employees. The tax
exemption does not apply to the Medicare tax.

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5d. &ensp 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 resulton line 5d.
on line 5d.
6. Employer's social security tax exemption.
Complete lines 6a–6d to figure the payroll tax exemption for the employer's share (6.2%) of social security tax on
exemptwages/tips paid to aone or more qualified employee. An employer may elect not to claim the social security
tax exemption. The election is made by not completing linesemployees.
6a – 6d and lines 12c – 12e, or as further guidance may be provided by the Secretary of the Treasury. An election
not to claim the social security tax exemption may allow qualified employers to claim the Work Opportunity Credit.
However, a qualified employer cannot claim both the social security tax exemption on Form 941-SS and the Work
Opportunity Credit for the same paid wages. For more information, see Form 5884, Work Opportunity Credit.
An employer must be a qualified employer to qualifybe eligible for the employer's social security tax exemption. A
qualified employer is any employer other than Federal, State, and any related government entities. All public
institutions of higher education and Indian tribal governments are also qualified employers.
An employer may elect not to apply the social security tax exemption with respect to a qualified employee. The
election is made by not including that employee or that employee's wages on lines 6a–6d and lines 12c–12e. An
election not to apply the social security tax exemption to a qualified employee may allow a qualified employer to
claim the Work Opportunity Credit for that employee. A qualified employer cannot apply both the social security tax
exemption on Form 941-SS and claim the Work Opportunity Credit for the same employee. For more information,
see Form 5884, Work Opportunity Credit.
For more information regardingabout the employer's social security tax exemption, visit the IRS website at
www.irs.gov and enter the keywords ``HIRE Act'' in the search box. ta taref="PL 111-147"
CC:TEGE
6a. Number of qualified employees first paid exempt wages/tips this quarter. A qualified employee is an
employee who:
• Begins employment with you after February 3, 2010, and before January 1, 2011;
• Certifies by signed affidavit (Form W-11, Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit),
or similar statement under penalties of perjury, that he or she has not been employed for more than 40 hours during
the 60-day period (including 2009) ending on the date the employee begins employment with you;
• Is not employed by you to replace another employee unless the other employee separated from employment
voluntarily or for cause (including downsizing);and ta taref="JCT" and
• Is not related to you. An employee is related to you if he or she is your child or a descendant of your child, your
sibling or stepsibling, your parent or ancestor of your parent, your stepparent, your niece or nephew, your aunt or
uncle, or your in-law. An employee is also related to you if he or she is related to anyone who owns more than 50% of
your outstanding stock or capital and profits interest or is your dependent or a dependent of anyone who owns more
than 50% of your outstanding stock or capital and profits interest. If you are an estate or trust, see section 51(i)(1)
and section 152(d)(2) for more details.
Exempt wages/tipsare the wages/tips paid toqualified employees that requirefor which the employer is exempt from
paying the employer's 6.2% share of social security tax withholding.tax. Enter on line 6a the number of qualified
employees paid exempt wages/tips for the first time in the quarter for which this Form 941 is being filed.first paid
wages/tips to which you applied the social security tax exemption in this quarter. Do not include in line 6a qualified
employees that are included in line 12c.
6b. Number of qualified employees paid exempt wages/tips this quarter. Enter on line 6b the total number of
qualified employees paid exempt wages/tips to which you applied the social security tax exemption in this quarter
Some qualified. Qualified employees paid exempt wages/tips this quarter may haveincluded on line 6a will also been
paid exempt wages/tips in a prior quarter. Add the amount of these qualifiedbe included on line 6b. Qualified
employees to the amount fromon line 6a and enter the total12c may also be included on line 6b. See line 6a for
definitionsthe definition of qualified employeeemployee. and exempt wages/tips.
6c. Exempt wages/tips paid to qualified employees this quarter. Enter the amount of exempt wages/tips paid this
quarter to all qualified employees reported on line 6b. See line 6a for definitionsthe definition of qualified employee

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and exempt wages/tips.
6d. Social security tax exemption. Multiply the amount of exempt wages/tips reported on line 6c by .062 and enter
the result on line 6d. See the instructions for line 17 for details about applying this exemption to your tax liability.
6e. Total taxes before adjustments. Subtract the qualified employer's social security tax exemption (line 6d) from
the total social security and Medicare taxes before adjustments (line 5d). Enter the result on line 6e.
7. TAX ADJUSTMENTS
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 6e, 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.
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 returnand is filed separately from Form
941-SS. See section 9 of Pub. 80 (Circular SS).
7a. &ensp Current quarter's adjustment for 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.
7b. &ensp Current quarter's adjustment for 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.
7c. &ensp 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.
8. &ensp Total taxes after adjustments
Combine the amounts shown on lines 6e through 7c 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.
• If line 8 is $2,500 or more and line 8 on the preceding 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).

If you are a semiweekly depositor, you must complete Schedule B (Form 941). If you fail to complete and
submit Schedule B (Form 941), the IRS will assert deposit penalties based on available information.
11. &ensp Total deposits for this quarter...
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. &ensp 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

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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.

The amount reported on line 12a is treated as a deposit of taxes on the first day of your return period and
must not be used to adjust line 17 or Schedule B (Form 941). ta taref="SE:S:E:EP: SP: Exam Policy"
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,941-X to report the amount for the prior quarter of the current year.
ta taref="Q&A-20 to Q&A-26 of Notice 2009-27 "

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

Lines 12c–12e only apply to the second quarter of 2010. These lines are used to determine the number of
qualified employees, amount of exempt wages/tips, and amount of exemption as if the exemption were allowed for
the first quarter of 2010. An employer is allowed to treat this exemption as a payment credited against deposit
requirements for employment taxes due for the second quarter 2010. If any of these lines are completed for any
quarter other than the second quarter of 2010, Form 941-SS may be considered incomplete and subject to correction
and penalties.
12c. Number of qualified employees paid exempt wages/tips March 19-3119–31
Complete this line when filing Form 941 for the 2nd quarter of 2010 only. Enter on line 12c the number of qualified
employees paid exempt wages/tips for the first timefrom March 19, 2010 through March 31, 2010. See line 6aInclude
only qualified employees for definitionswhich you are claiming the social security tax exemption. For the definition of
qualified employeeand exempt wages/tips. Complete this line when filing Form 941 for, see the 2nd quarter of 2010
only.instructions for line 6a on page 5.
12d. Exempt wages/tips paid to qualified employees March 19-3119–31
Complete this line when filing Form 941 for the 2nd quarter of 2010 only. Enter the amount of exempt wages/tips paid
March 19, 2010 through March 31, 2010, to all qualified employees reported on line 12c. See line 6a for definitionsFor
the definition of qualified employee and exempt wages/tips. Complete this line when filing Form 941 for, see the 2nd
quarter of 2010 only.instructions for line 6a
on page 5.
12e. Social security tax exemption for March 19-3119–31
Multiply the amount of exempt wages/tips reported on line 12d by .062 and enter the result on line 12e.

The amount reported on line 12e is treated as a deposit of taxes on April 1, 2010, and must not be used to
adjust line 17 or Schedule B (Form 941).
13. &ensp Total deposits and COBRA credits
Add lines 11, 12a, and 12e.
14. &ensp Balance due

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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 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 or debit card, a check or money order, or
electronic funds withdrawal (EFW). Do not use a credit or debit 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,electronic payment options, visit the
IRS website at www.irs.govwww.irs.gov/e-payand 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.

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

Part 2:

&ensp

Tell us about your deposit schedule and tax liability for this quarter

17. &ensp Tax liability for the quarter
• 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.
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
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''

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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.
Adjusting tax liability for employer's social security tax exemption.exemption reported on line 6d. Monthly
schedule depositors and semiweekly schedule depositors must account for the employer's social security tax
exemption (line 6d) when reporting their tax liabilities on line 17 or Schedule B (Form 941). The total liability for the
quarter must equal the amount reported on line 8. Failure to account for the social security tax exemption on line 17
or Schedule B (Form 941) may cause line 8 to be less than the total tax liability reported on line 17 or Schedule B
(Form 941). Do not reduce the tax liability reported on line 17 or Schedule B (Form 941) below zero.

Part 3:

&ensp

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. &ensp 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.
19. &ensp 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 4:

&ensp

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.
NACTP and F. 941 Instructions
By checking ``Yes,'' you authorize the IRS to talk to the person you named (your designee) about any questions we
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.

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Part 5:

&ensp

Sign here

Complete all information in Part 5 and sign Form 941-SS as follows.
• &ensp Sole proprietorship— The individual who owns the business.
• &ensp Corporation (including a limited liability company (LLC) treated as a corporation)— The president, vice
president, or other principal officer duly authorized to sign.
• &ensp Partnership (including an LLC treated as a partnership) or unincorporated organization— A
responsible and duly authorized member or officer having knowledge of its affairs.
• &ensp 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.
• &ensp 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,
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.
CC:TEGE and F. 941 Instructions

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.