Form 941SS -V -(Preprinted)

Version A, Cycle 8

Form 941-V(SS),
Payment Voucher
Purpose of Form

Specific Instructions

Complete Form 941-V(SS), Payment Voucher, if you
are making a payment with Form 941-SS, 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-SS, write “Applied For” and the date you
applied in this entry space.
Box 2—Amount paid. Enter the amount paid with
Form 941-SS.
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-SS.
• Enclose your check or money order payable to the
“United States Treasury.” Be sure to enter your EIN,
“Form 941-SS,” and the tax period on your check or
money order. Do not send cash. Do not staple Form
941-V(SS) or your payment to Form 941-SS (or to each
other).
• Detach Form 941-V(SS) and send it with your
payment and Form 941-SS to the address in the
Instructions for Form 941-SS.
Note. You must also complete the entity information
above Part 1 on Form 941-SS.

Making Payments With Form 941-SS
To avoid a penalty, make your payment with Form
941-SS only if:
• Your total taxes after adjustments for either the current
quarter or the preceding quarter (Form 941-SS, 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 8 of 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, 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 8 of Pub. 80 (Circular SS) for deposit
instructions. Do not use Form 941-V(SS) to make federal
tax deposits.
Caution. Use Form 941-V(SS) when making any
payment with Form 941-SS. However, if you pay an
amount with Form 941-SS that should have been
deposited, you may be subject to a penalty. See
Deposit Penalties in section 8 of Pub. 80 (Circular SS).

Internal Use Only
DRAFT AS OF
May 22, 2013

Form

▼

Detach Here and Mail With Your Payment and Form 941-SS.

941-V(SS)

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Payment Voucher

Department of the Treasury
Internal Revenue Service
1 Enter your employer identification
number (EIN).

▶

2

4

1st
Quarter

3rd
Quarter

2nd
Quarter

4th
Quarter

2014
Dollars

Enter the amount of your payment. ▶

Tax period

OMB No. 1545-0029

Do not staple this voucher or your payment to Form 941-SS.

Make your check or money order payable to “United States Treasury”
3

✃

✁

Enter your business name (individual name if sole proprietor).
Enter your address.
Enter your city, state, and ZIP code.

Cents