941 (draft) Employer's Quarterly Federal Tax Return

Version B, Cycle 11
Fillable Fields: Font=10pt Times; Color=Black; Checkmark=Cross

941 for 2020:

Form
(Rev. April 2020)

950120

Employer’s QUARTERLY Federal Tax Return

OMB No. 1545-0029

Department of the Treasury — Internal Revenue Service

Report for this Quarter of 2020

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Employer identification number (EIN)

(Check one.)

1: January, February, March

Name (not your trade name)

2: April, May, June

Trade name (if any)

3: July, August, September
4: October, November, December

Address
Number

Street

Suite or room number

City

State

Foreign country name

Go to www.irs.gov/Form941 for
instructions and the latest information.

ZIP code

Foreign postal code

Foreign province/county

Read the separate instructions before you complete Form 941. Type or print within the boxes.

Part 1:

Answer these questions for this quarter.

Number of employees who received wages, tips, or other compensation for the pay
period including: June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4) . . .

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2

INTERNAL USE ONLY
DRAFT AS OF
June 12, 2020
Wages, tips, and other compensation

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Federal income tax withheld from wages, tips, and other compensation .

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3

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If no wages, tips, and other compensation are subject to social security or Medicare tax
Column 1

5a
5a
5a
5b
5c

Taxable social security wages .

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(i) Qualified sick leave wages .

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(ii) Qualified family leave wages

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Taxable social security tips .

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Taxable Medicare wages & tips .

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Column 2

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× 0.124 =
× 0.062 =
× 0.062 =
× 0.124 =
× 0.029 =

5d

Taxable wages & tips subject to
Additional Medicare Tax withholding

5e

Total social security and Medicare taxes. Add Column 2 from lines 5a, 5a(i), 5a(ii), 5b, 5c, and 5d

5f

Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions)

6

Total taxes before adjustments. Add lines 3, 5e, and 5f .

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Current quarter’s adjustment for fractions of cents .

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Current quarter’s adjustment for sick pay .

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Current quarter’s adjustments for tips and group-term life insurance .

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Total taxes after adjustments. Combine lines 6 through 9

× 0.009 =

Check and go to line 6.

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5e

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5f

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6

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9

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10

11a

Qualified small business payroll tax credit for increasing research activities. Attach Form 8974

11a

11b

Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1

11b

11c

Nonrefundable portion of employee retention credit from Worksheet 1

11c

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Next ■▶

You MUST complete all three pages of Form 941 and SIGN it.

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.

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Cat. No. 17001Z

Form 941 (Rev. 4-2020)

Version B, Cycle 11

950220
Name (not your trade name)

Part 1:

Employer identification number (EIN)

Answer these questions for this quarter. (continued)

11d

Total nonrefundable credits. Add lines 11a, 11b, and 11c

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11d

12

Total taxes after adjustments and nonrefundable credits. Subtract line 11d from line 10

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13a

Total deposits for this quarter, including overpayment applied from a prior quarter and
overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter 13a

13b

Deferred amount of the employer share of social security tax

13c

Refundable portion of credit for qualified sick and family leave wages from Worksheet 1

13d

Refundable portion of employee retention credit from Worksheet 1 .

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13d

13e

Total deposits, deferrals, and refundable credits. Add lines 13a, 13b, 13c, and 13d .

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13e

13f

Total advances received from filing Form(s) 7200 for the quarter .

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13f

13g
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13b
13c

INTERNAL USE ONLY
DRAFT AS OF
June 12, 2020
Total deposits, deferrals, and refundable credits less advances. Subtract line 13f from line 13e .

Balance due. If line 12 is more than line 13g, enter the difference and see instructions .

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Overpayment. If line 13g is more than line 12, enter the difference

Part 2:

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13g
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Check one:

Apply to next return.

Send a refund.

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

If you’re unsure about whether you’re a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15.
16 Check one:

Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500,
and you didn’t incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior
quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your
federal tax liability. If you’re a monthly schedule depositor, complete the deposit schedule below; if you’re a
semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3.
You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total
liability for the quarter, then go to Part 3.
Tax liability:

Month 1
Month 2
Month 3

Total liability for quarter

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Total must equal line 12.

You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941),
Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Go to Part 3.
▶

You MUST complete all three pages of Form 941 and SIGN it.

Page 2

Next ■▶
Form 941 (Rev. 4-2020)

Version B, Cycle 11

950920
Name (not your trade name)

Part 3:
17

Employer identification number (EIN)

Tell us about your business. If a question does NOT apply to your business, leave it blank.

If your business has closed or you stopped paying wages .
enter the final date you paid wages

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Check here, and

; also attach a statement to your return. See instructions.

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If you’re a seasonal employer and you don’t have to file a return for every quarter of the year .

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Qualified health plan expenses allocable to qualified sick leave wages

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Qualified health plan expenses allocable to qualified family leave wages .

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21

Qualified wages for the employee retention credit

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Qualified health plan expenses allocable to wages reported on line 21 .

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Credit from Form 5884-C, line 11, for this quarter

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Qualified wages paid March 13 through March 31, 2020, for the employee retention
credit (use this line only for the second quarter filing of Form 941) . . . . . . . .

24

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Qualified health plan expenses allocable to wages reported on line 24 (use this line only
for the second quarter filing of Form 941) . . . . . . . . . . . . . . . .

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Check here.

INTERNAL USE ONLY
DRAFT AS OF
June 12, 2020

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Part 4:

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 the IRS.

No.

Part 5:

Sign here. You MUST complete all three pages of Form 941 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. 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
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Best daytime phone

Paid Preparer Use Only

Check if you’re self-employed

Preparer’s name

PTIN

Preparer’s signature

Date

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

EIN

Address

Phone

City
Page 3

State

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ZIP code
Form 941 (Rev. 4-2020)

Version B, Cycle 11

951020

INTERNAL USE ONLY
AS left
OFblank
This DRAFT
page intentionally
June 12, 2020

Version B, Cycle 11

Form 941-V,
Payment Voucher
Purpose of Form

Specific Instructions

Complete Form 941-V if you’re making a payment with
Form 941. 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 by
visiting the IRS website at www.irs.gov/EIN. 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 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
“United States Treasury.” Be sure to enter your
EIN, “Form 941,” and the tax period (“1st Quarter 2020,”
“2nd Quarter 2020,” “3rd Quarter 2020,” or “4th Quarter
2020”) on your check or money order. Don’t send cash.
Don’t 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.

Making Payments With Form 941
To avoid a penalty, make your payment with Form 941
only if:
• Your total taxes after adjustments and nonrefundable
credits (Form 941, line 12) for either the current quarter or
the preceding quarter are less than $2,500, you didn’t
incur a $100,000 next-day deposit obligation during the
current quarter, and you’re paying in full with a timely filed
return; or
• You’re a monthly schedule depositor making a
payment in accordance with the Accuracy of Deposits
Rule. See section 11 of Pub. 15 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 for deposit
instructions. Don’t use Form 941-V to make federal tax
deposits.
Use Form 941-V when making any payment with
! Form 941. However, if you pay an amount with
CAUTION
Form 941 that should’ve been deposited, you
may be subject to a penalty. See Deposit Penalties in
section 11 of Pub. 15.

INTERNAL USE ONLY
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DRAFT AS OF
June 12, 2020

Form

▼

Detach Here and Mail With Your Payment and Form 941.

941-V

Payment Voucher

Department of the Treasury
Internal Revenue Service

1

▼

▶ Don’t

OMB No. 1545-0029

2020

staple this voucher or your payment to Form 941.

2

Enter your employer identification
number (EIN).

✃

✁

Dollars

Cents

Enter the amount of your payment. ▶
Make your check or money order payable to “United States Treasury”
4 Enter your business name (individual name if sole proprietor).

3 Tax Period

1st
Quarter

3rd
Quarter

2nd
Quarter

4th
Quarter

Enter your address.
Enter your city, state, and ZIP code; or your city, foreign country name, foreign province/county, and foreign postal code.

Version B, Cycle 11
Form 941 (Rev. 4-2020)

Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on Form 941 to carry out the
Internal Revenue laws of the United States. We need it to
figure and collect the right amount of tax. Subtitle C,
Employment Taxes, of the Internal Revenue Code
imposes employment taxes on wages and provides for
income tax withholding. Form 941 is used to determine
the amount of taxes that you owe. Section 6011 requires
you to provide the requested information if the tax is
applicable to you. Section 6109 requires you to provide
your identification number. If you fail to provide this
information in a timely manner, or provide false or
fraudulent information, you may be subject to penalties.
You’re not 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
its 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 for use in administering 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 Form 941 will
vary depending on individual circumstances. The
estimated average time is:
Recordkeeping . . . . . . . . . . 20 hr., 19 min.
Learning about the law or the form . . . . 53 min.
Preparing, copying, assembling, and
sending the form to the IRS . . . . . 1 hr., 16 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making Form 941
simpler, we would be happy to hear from you. You can
send us comments from www.irs.gov/FormComments. 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 941 to this address. Instead, see Where
Should You File? in the Instructions for Form 941.

INTERNAL USE ONLY
DRAFT AS OF
June 12, 2020