Form 940-V Payment Voucher

Form

940 for 2016:

Employer's Annual Federal Unemployment (FUTA) Tax Return
Department of the Treasury — Internal Revenue Service

Employer identification number
(EIN)

—

850113
OMB No. 1545-0028

Type of Return
(Check all that apply.)

Name (not your trade name)

a. Amended

Trade name (if any)

b. Successor employer

Address

c. No payments to employees in
2016
d. Final: Business closed or
stopped paying wages

Number

Street

Suite or room number

Instructions and prior-year forms are
available at www.irs.gov/form940.
City

ZIP code

State

Foreign country name

Foreign postal code

Foreign province/county

Read the separate instructions before you complete this form. Please type or print within the boxes.

Part 1:

Tell us about your return. If any line does NOT apply, leave it blank. See instructions before completing Part 1.

1a
1b

If you had to pay state unemployment tax in one state only, enter the state abbreviation .
1a
If you had to pay state unemployment tax in more than one state, you are a multi-state
employer . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b

2

If you paid wages in a state that is subject to CREDIT REDUCTION .

Part 2:

.

.

.

.

.

.

Check here.
Complete Schedule A (Form 940).

2

Determine your FUTA tax before adjustments. If any line does NOT apply, leave it blank.

3

Total payments to all employees .

.

.

.

.

.

.

4

Payments exempt from FUTA tax .

.

.

.

.

.

.

5

.

.

.

.

.

.

.

.

.

.

.

4

Check all that apply: 4a
Fringe benefits
4c
4b
Group-term life insurance
4d
Total of payments made to each employee in excess of
$7,000 . . . . . . . . . . . . . . . .
5

.

.

.

4e

Retirement/Pension
Dependent care

.

3

Other

.

6

Subtotal (line 4 + line 5 = line 6) .

.

.

.

.

.

.

.

.

.

6

7

Total taxable FUTA wages (line 3 – line 6 = line 7). See instructions .

.

.

.

.

.

.

.

.

7

8

FUTA tax before adjustments (line 7 x 0.006 = line 8) .

.

.

.

.

.

.

.

.

8

Part 3:

.

.

.

.

.

.

.

.

.

.

.

.

.

.

10

11

If credit reduction applies, enter the total from Schedule A (Form 940)

Part 4:

.

.

.

.

.

.

.

.
.
.

11

Determine your FUTA tax and balance due or overpayment. If any line does NOT apply, leave it blank.

12

Total FUTA tax after adjustments (lines 8 + 9 + 10 + 11 = line 12) .

.

.

12

13

FUTA tax deposited for the year, including any overpayment applied from a prior year

.

13

14

Balance due. If line 12 is more than line 13, enter the excess on line 14.
• If line 14 is more than $500, you must deposit your tax.
• If line 14 is $500 or less, you may pay with this return. See instructions

.

14

15

.
.
.

Determine your adjustments. If any line does NOT apply, leave it blank.

If ALL of the taxable FUTA wages you paid were excluded from state unemployment tax,
multiply line 7 by 0.054 (line 7 × 0.054 = line 9). Go to line 12 . . . . . . . . . .
9
If SOME of the taxable FUTA wages you paid were excluded from state unemployment tax,
OR you paid ANY state unemployment tax late (after the due date for filing Form 940),
complete the worksheet in the instructions. Enter the amount from line 7 of the worksheet . .
10

9

Check here.
Complete Schedule A (Form 940).

.

.

.

.

.

.

.

.

.

.

.

.

Overpayment. If line 13 is more than line 12, enter the excess on line 15 and check a box below 15
▶ You MUST complete both pages of this form and SIGN it.
Check one:
Apply to next return.

.
.
.
.
Send a refund.
Next ■▶

For Privacy Act and Paperwork Reduction Act Notice, see the back of Form 940-V, Payment Voucher.

Cat. No. 11234O

Form

940 (2016)

850212
Employer identification number (EIN)

Name (not your trade name)

Part 5:

Report your FUTA tax liability by quarter only if line 12 is more than $500. If not, go to Part 6.

16 Report the amount of your FUTA tax liability for each quarter; do NOT enter the amount you deposited. If you had no liability for
a quarter, leave the line blank.

17

16a 1st quarter (January 1 – March 31) .

.

.

.

.

.

.

.

.

16a

16b 2nd quarter (April 1 – June 30) .

.

.

.

.

.

.

.

.

.

16b

16c 3rd quarter (July 1 – September 30)

.

.

.

.

.

.

.

.

16c

16d 4th quarter (October 1 – December 31)

.

.

.

.

.

.

.

16d

.
.
.
.
.

Total tax liability for the year (lines 16a + 16b + 16c + 16d = line 17) 17

Part 6:

Total must equal line 12.

May we speak with your third-party designee?

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions
for details.
Yes.

Designee's name and phone number
Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS

No.

Part 7:

Sign here. You MUST complete both pages of this form and SIGN it.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the
best of my knowledge and belief, it is true, correct, and complete, and that no part of any payment made to a state unemployment
fund claimed as a credit was, or is to be, deducted from the payments made to employees. Declaration of preparer (other than
taxpayer) is based on all information of which preparer has any knowledge.

✗

Print your
name here

Sign your
name here

Date

Print your
title here
/

Best daytime phone

/

Paid Preparer Use Only

Check if you are self-employed

Preparer's name

PTIN

Preparer's
signature

Date

Firm's name (or yours
if self-employed)

EIN

Address

Phone

City

Page 2

State

/

/

ZIP code

Form 940 (2016)

Form 940-V,
Payment Voucher
Purpose of Form

Specific Instructions

Complete Form 940-V if you're making a payment with
Form 940. 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
don't have an EIN, you may apply for one online. Go to
IRS.gov and type “EIN” in the search box. You may also
apply for an EIN by faxing or mailing Form SS-4 to the
IRS. If you haven't received your EIN by the due date of
Form 940, write “Applied For” and the date you applied in
this entry space.
Box 2—Amount paid. Enter the amount paid with
Form 940.
Box 3—Name and address. Enter your name and
address as shown on Form 940.
• Enclose your check or money order made payable to
“United States Treasury.” Be sure to enter your EIN,
“Form 940,” and “2016” on your check or money order.
Don't send cash. Don't staple Form 940-V or your
payment to Form 940 (or to each other).
• Detach Form 940-V and send it with your payment and
Form 940 to the address provided in the Instructions for
Form 940.
Note: You must also complete the entity information
above Part 1 on Form 940.

To avoid a penalty, make your payment with your 2016
Form 940 only if your FUTA tax for the fourth quarter
(plus any undeposited amounts from earlier quarters) is
$500 or less. If your total FUTA tax after adjustments
(Form 940, line 12) is more than $500, you must make
deposits by electronic funds transfer. See When Must
You Deposit Your FUTA Tax? in the Instructions for Form
940. Also see sections 11 and 14 of Pub. 15 for more
information about deposits.
Use Form 940-V when making any payment with
Form 940. However, if you pay an amount with
Form 940 that should've been deposited, you
CAUTION
may be subject to a penalty. See Deposit
Penalties in section 11 of Pub. 15.

!
▲

Form

✁

▼

Detach Here and Mail With Your Payment and Form 940.

940-V

Department of the Treasury
Internal Revenue Service

1 Enter your employer identification number (EIN).

▼

Payment Voucher
▶ Don't

2

OMB No. 1545-0028

2016

staple or attach this voucher to your payment.

Enter the amount of your payment. ▶

✃

Making Payments With Form 940

Dollars

Cents

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 or your city, foreign country name, foreign province/county, and foreign postal code.

Form 940 (2016)

Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on this form to carry out the
Internal Revenue laws of the United States. We need it
to figure and collect the right amount of tax. Chapter
23, Federal Unemployment Tax Act, of Subtitle C,
Employment Taxes, of the Internal Revenue Code
imposes a tax on employers with respect to employees.
This form is used to determine the amount of the tax that
you owe. Section 6011 requires you to provide the
requested information if you are liable for FUTA tax under
section 3301. Section 6109 requires you to provide your
identification number. If you fail to provide this
information in a timely manner or provide a false or
fraudulent form, you may be subject to penalties.
You aren't required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books and records relating to a form or
instructions must be retained as long as their contents
may become material in the administration of any Internal
Revenue law.
Generally, tax returns and return information are
confidential, as required by section 6103. However,
section 6103 allows or requires the IRS to disclose or
give the information shown on your tax return to others
as described in the Code. For example, we may disclose

your tax information to the Department of Justice for civil
and criminal litigation, and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions to
administer their tax laws. We may also disclose this
information to other countries under a tax treaty, to
federal and state agencies to enforce federal nontax
criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
average time is:
Recordkeeping . . . . . . . . . . 9 hr., 19 min.
Learning about the law or the form . . 1 hr., 23 min.
Preparing, copying, assembling, and
sending the form to the IRS . . . . . 1 hr., 36 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making
Form 940 simpler, we would be happy to hear from
you. You can send us comments from
www.irs.gov/formspubs. Click on More Information and
then click on Give us feedback. Or you can send your
comments to Internal Revenue Service, Tax Forms and
Publications Division, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Don't send Form 940 to
this address. Instead, see Where Do You File? in the
Instructions for Form 940.