Form 941-V (OTC) & Prep 941-V (OTC) & Prep Payment Voucher

Form 941-V,
Payment Voucher
Purpose of Form

Specific Instructions

Complete Form 941-V, Payment Voucher, if you are
making a payment with Form 941, Employer’s
QUARTERLY Federal Tax Return. We will use the
completed voucher to credit your payment more promptly
and accurately, and to improve our service to you.

Box 1—Employer identification number (EIN). If you do
not have an EIN, you may apply for one online. Go to
IRS.gov and click on the Apply for an EIN Online link
under “Tools.” You may also apply for an EIN by calling
1-800-829-4933, or you can fax or mail Form SS-4,
Application for Employer Identification Number, to the
IRS. If you have not received your EIN by the due date of
Form 941, write “Applied For” and the date you applied in
this entry space.
Box 2—Amount paid. Enter the amount paid with
Form 941.
Box 3—Tax period. Darken the circle identifying the
quarter for which the payment is made. Darken only
one circle.
Box 4—Name and address. Enter your name and
address as shown on Form 941.
• Enclose your check or money order made payable to
the "United States Treasury." Be sure to enter your
EIN, "Form 941," and the tax period on your check or
money order. Do not send cash. Do not staple Form
941-V or your payment to Form 941 (or to each other).
• Detach Form 941-V and send it with your payment
and Form 941 to the address in the Instructions for
Form 941.
Note. You must also complete the entity information
above Part 1 on Form 941.

To avoid a penalty, make your payment with Form 941
only if:
• Your total taxes after adjustments for either the current
quarter or the preceding quarter (Form 941, line 10) are
less than $2,500, you did not incur a $100,000 next-day
deposit obligation during the current quarter, and you are
paying in full with a timely filed return, or
• You are a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Rule. See section 11 of Pub. 15 (Circular E), Employer's
Tax Guide, for details. In this case, the amount of your
payment may be $2,500 or more.
Otherwise, you must make deposits by electronic funds
transfer. See section 11 of Pub. 15 (Circular E) for deposit
instructions. Do not use Form 941-V to make federal tax
deposits.
Caution. Use Form 941-V when making any payment with
Form 941. However, if you pay an amount with Form 941
that should have been deposited, you may be subject to a
penalty. See Deposit Penalties in section 11 of Pub. 15
(Circular E).

Form



d

Detach Here and Mail With Your Payment and Form 941.

941-V

Payment Voucher

Department of the Treasury
Internal Revenue Service

1

d

a Do

Enter your employer identification
number (EIN).

Make your check or money order payable to "United States Treasury"
4 Enter your business name (individual name if sole proprietor).

1st
Quarter

3rd
Quarter

2nd
Quarter

4th
Quarter

2013
Dollars

Enter the amount of your payment. a

3 Tax Period

OMB No. 1545-0029

not staple this voucher or your payment to Form 941.
2

Enter your address.

Enter your city, state, and ZIP code.



Making Payments With Form 941

Cents