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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 (only for Q1 2022)

INSTRUCTIONS: No usernames or passwords required. Prepare your form and click the validate button below. ALL PARTS must display Complete. The AutoFill feature is optional. Supplemental worksheets will be prepared automatically.
Taxable year:*
Employer identification number (EIN):*
Employer name:*
Trade name:
If you have a foreign address, click here:
Address:*
City, State and Zip code:*
Foreign province, postal code and country:
Report for this Quarter:*
1st quarter: Jan, Feb, Mar
3rd quarter: Jul, Aug, Sep
2nd quarter: Apr, May, Jun
4th quarter: Oct, Nov, Dec
1. Number of employees who received wages, tips, or other compensation for the pay period:
4. If no wages, tips, and other compensation are subject to social security or Medicare tax, check here:
Supplemental Worksheets filled automatically.
Amount
 
Tax
5a. Taxable social security wages:
x 0.124 =
5a(i). Qualified sick leave wages:
x 0.062 =
5a(j). Qualified sick leave wages excluded from the definition of employment under section 3121(b):
5a(ii). Qualified family leave wages:
x 0.062 =
5a(jj). Qualified family leave wages excluded from the definition of employment under section 3121(b):
5b. Taxable social security tips:
x 0.124 =
5c. Taxable Medicare wages & tips:
x 0.029 =
5c(i). Qualified sick leave wages included on line 5c, but not included on line 5a(i), column 1, because the wages reported on that line were limited by the social security wage base:
5c(ii). Qualified family leave wages included on line 5c, but not included on line 5a(ii), column 1, because the wages reported on that line were limited by the social security wage base:
5d. Taxable wages & tips subject to Additional Medicare Tax withholding:
x 0.009 =
5e. Total social security and Medicare taxes:
5f. Section 3121(q) Notice and Demand - Tax due on unreported tips (see instructions):
5f(i). If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount of the employer share of social security tax from the notice:
5f(ii). If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount of the employer share of medicare tax from the notice:
6. Total taxes before adjustments:
7. Current quarter’s adjustment for fractions of cents:
8. Current quarter’s adjustment for sick pay:
8(i). If you are a third-party payer of sick pay that isn't an agent and you're claiming credits for amounts paid to your employees, enter the employer share of social security tax included in line 8 above (enter as positive number):
8(ii). If you are a third-party payer of sick pay that isn't an agent and you're claiming credits for amounts paid to your employees, enter the employer share of medicare tax included in line 8 above (enter as positive number):
9. Current quarter’s adjustments for tips and group-term life insurance:
10. Total taxes after adjustments:
11a. Qualified small business payroll tax credit for increasing research activities. Attach form 8974: (not supported)
11b. Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021:
11c. Reserved for future use:
11d. Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021:
11e. Nonrefundable portion of COBRA premium assistance credit:
11f. Number of individuals provided COBRA premium assistance:
11g. Total nonrefundable credits:
12. Total taxes after adjustments and nonrefundable credits:
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:
13b. Reserved for future use:
13c. Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021:
13d. Reserved for future use:
13e. Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021:
13f. Refundable portion of COBRA premium assistance credit:
13g. Total deposits and refundable credits:
13h. Reserved for future use:
13i. Reserved for future use:
14. Balance due.
Check here if you want to pay your balance due with this return.
15. Overpayment.
 
Apply to next return.
 
Send a refund.
FEDERAL DEBIT (limited to a maximum amount of $2,500.00)
Your Federal Debit is limited to an amount no greater than $2500.00. If your employment form shows an amount due greater than $2500.00 your are responsible to make any additional payments.

This Electronic Funds Withdrawal (EFW) payment option cannot be used for making federal tax deposits. Deposits can be submitted using the Electronic Federal Tax Payment System (EFTPS). For more information refer to the tax form Instructions for each respective form.

Entities that do not bank in the United States that need to make a payment cannot pay using EFW or EFTPS. However, payments can be made by check or money order payable to “United States Treasury” and mail to the address shown in the specific form’s instruction.

Once your return is accepted, information pertaining to your payment, such as account information, payment date, or amount, cannot be changed. If changes are needed, the only option is to cancel the payment and choose another payment method. In the event your financial institution is unable to process your payment request, you will be responsible for making other payment arrangements, and for any penalties and interest incurred.

To revoke or cancel an EFW payment, the taxpayer should contact the IRS E-file Payment Inquiry and Cancellation Service at 1-888-353-4537. Wait at least ten (10) days from when the IRS e-file return was accepted before calling. The caller should be prepared to provide the EIN, the exact payment amount (dollars and cents), and bank account number entered in the payment record. Cancellations must be made by 11:59 p.m. ET two business days prior to the scheduled payment date.
BANKING INFORMATION (ALL fields required)
 
 
Checking
Savings
 
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 are a monthly schedule depositor, complete the deposit schedule below; if you are a semiweekly schedule depositor, complete Schedule B below.
 
 
You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month, then go to Part 3.
 
 
Month 1:
 
Month 2:
 
Month 3:
 
Total liability for quarter:
 
You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B, Report of Tax Liability for Semiweekly Schedule Depositors, below.
 
17.  
Click here if your business has closed or you stopped paying wages and enter the final date you paid wages.
18.  
Click here if you are a seasonal employer and you don’t have to file a return for every quarter of the year.
19. Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021:
20. Qualified health plan expenses allocable to qualified family leave wages for leave taken before April 1, 2021:
21. Reserved for future use:
22. Reserved for future use:
23. Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021:
23(i). Qualified sick leave wages included on line 23, that were not included as wages reported on Part 1, lines 5a and 5c, because the qualified sick leave wages were excluded from the definition of employment under sections 3121(b)(1)–(22):
23(ii). Qualified sick leave wages included on line 23, that were not included as wages reported on Part 1, line 5a, because the qualified sick leave wages were limited by the social security wage base:
24. Qualified health plan expenses allocable to qualified sick leave wages reported on line 23:
25. Amounts under certain collectively bargained agreement allocable to qualified sick leave wages reported on line 23:
26. Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021:
26(i). Qualified family leave wages included on line 26, that were not included as wages reported on Part 1, lines 5a and 5c, because the qualified family leave wages were excluded from the definition of employment under sections 3121(b)(1)–(22):
26(ii). Qualified family leave wages included on line 26, that were not included as wages reported on Part 1, line 5a, because the qualified family leave wages were limited by the social security wage base:
27. Qualified health plan expenses allocable to qualified family leave wages reported on line 26:
28. Amounts under certain collectively bargained agreement allocable to qualified family leave wages reported on line 26:
Additional Information (used to calculate supplemental worksheets)
Enter the amount to be claimed on Form 5884-C, line 11, for this quarter:
Enter the amount to be claimed on Form 5884-D, line 12, for this quarter:
Enter any credit claimed under section 41 for increasing research activities with respect to any wages taken into account for the credit for qualified sick and family leave wages:
Enter the COBRA premium assistance that you provided this quarter:
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.
Name and phone number
 
Select a 5-digit PIN to use when talking to the IRS.
No.
Check if you are self-employed:
Name:*
Title:*
Date:*
Best daytime phone:*
Enter a 5 digit PIN as your signature:*
What is a 5 digit signature PIN?
Authorized signature:*
 
Your cost: $0.00 
PERJURY STATEMENT: Under penalties of perjury, I declare that I have an approved role (as identified in the instructions for the employment tax return) within the company listed above and that I've examined a copy of the electronic return and accompanying schedules and statements for the period shown above and to the best of my knowledge and belief, they're true, correct, and complete. I further declare that the amounts in Part I of Form 8879-EMP are the amounts shown on the copy of the electronic return. I consent to allow the electronic return originator (ERO), Tax Me, LLC., to send the return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days before the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I've selected a personal identification number (PIN) as the signature for the electronic return and, if applicable, the consent to electronic funds withdrawal.      I Agree