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Formulaire 941-SS Instructions

Instructions pour le formulaire 941-SS, Quarterly de l'employeur Déclaration fédérale d'impôts des Samoa américaines, de Guam, du Commonwealth des îles Mariannes septentrionales et des îles Vierges américaines

Rév. mars 2023

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  • Formulaire 941-SS - Déclaration fiscale fédérale trimestrielle de l'employeur Samoa américaines, Guam, le Commonwealth des îles Mariannes du Nord et les îles Vierges américaines
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Department of the Treasury  
Internal Revenue Service  
Instructions for Form 941-SS  
(Rev. March 2023)  
Employer's QUARTERLY Federal Tax Return—American Samoa, Guam, the  
Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands  
Section references are to the Internal Revenue Code  
unless otherwise noted.  
Contents  
therefore, the tax rate on these wages is 6.2%. The social  
security wage base limit is $160,200.  
The Medicare tax rate is 1.45% each for the employee  
and employer, unchanged from 2022 There is no wage  
base limit for Medicare tax.  
Social security and Medicare taxes apply to the wages  
of household workers you pay $2,600 or more in cash  
wages in 2023. Social security and Medicare taxes apply  
to election workers who are paid $2,200 or more in cash  
or an equivalent form of compensation in 2023.  
Qualified small business payroll tax credit for in-  
creasing research activities. For tax years beginning  
before January 1, 2023, a qualified small business may  
elect to claim up to $250,000 of its credit for increasing  
research activities as a payroll tax credit. The Inflation  
Reduction Act of 2022 (the IRA) increases the election  
amount to $500,000 for tax years beginning after  
Page  
Future Developments . . . . . . . . . . . . . . . . . . . . . . . . 1  
What's New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1  
Reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2  
General Instructions: . . . . . . . . . . . . . . . . . . . . . . . . . 4  
Purpose of Form 941-SS . . . . . . . . . . . . . . . . . . . 4  
Who Must File Form 941-SS? . . . . . . . . . . . . . . . 4  
When Must You File? . . . . . . . . . . . . . . . . . . . . . 6  
How Should You Complete Form 941-SS? . . . . . . 6  
Where Should You File? . . . . . . . . . . . . . . . . . . . 7  
Depositing Your Taxes . . . . . . . . . . . . . . . . . . . . 7  
What About Penalties and Interest? . . . . . . . . . . . 8  
Where Can You Obtain Forms? . . . . . . . . . . . . . . 9  
Specific Instructions: . . . . . . . . . . . . . . . . . . . . . . . . . 9  
December 31, 2022. The payroll tax credit election must  
be made on or before the due date of the originally filed  
income tax return (including extensions). The portion of  
the credit used against payroll taxes is allowed in the first  
calendar quarter beginning after the date that the qualified  
small business filed its income tax return. The election  
and determination of the credit amount that will be used  
against the employer’s payroll taxes are made on Form  
6765, Credit for Increasing Research Activities. The  
amount from Form 6765, line 44, must then be reported  
on Form 8974, Qualified Small Business Payroll Tax  
Credit for Increasing Research Activities.  
Starting in the first quarter of 2023, the payroll tax credit  
is first used to reduce the employer share of social  
security tax up to $250,000 per quarter and any remaining  
credit reduces the employer share of Medicare tax for the  
quarter. Any remaining credit, after reducing the employer  
share of social security tax and the employer share of  
Medicare tax, is then carried forward to the next quarter.  
Form 8974 is used to determine the amount of the credit  
that can be used in the current quarter. The amount from  
Form 8974, line 12 or, if applicable, line 17, is reported on  
line 11a. For more information about the payroll tax credit,  
11b, and 11d, later.  
Part 1: Answer These Questions for This  
Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9  
Part 2: Tell Us About Your Deposit Schedule  
and Tax Liability for This Quarter . . . . . . . . . . 17  
Part 3: Tell Us About Your Business . . . . . . . . . . 19  
Part 4: May We Speak With Your Third-Party  
Designee? . . . . . . . . . . . . . . . . . . . . . . . . . . 20  
Part 5: Sign Here (Approved Roles) . . . . . . . . . . 20  
How To Get Forms, Instructions, and Publications  
From the IRS . . . . . . . . . . . . . . . . . . . . . . . . . . 21  
Worksheet 1. Credit for Qualified Sick and Family  
Leave Wages Paid This Quarter of 2023 for  
Leave Taken After March 31, 2020, and Before  
April 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . 22  
Worksheet 2. Credit for Qualified Sick and Family  
Leave Wages Paid This Quarter of 2023 for  
Leave Taken After March 31, 2021, and Before  
October 1, 2021 . . . . . . . . . . . . . . . . . . . . . . . . 23  
Future Developments  
For the latest information about developments related to  
Form 941-SS and its instructions, such as legislation  
enacted after they were published, go to IRS.gov/  
What's New  
Forms 941-SS and 941-PR discontinued after 2023.  
Form 941-SS and Form 941-PR, Planilla para la  
Declaración Federal TRIMESTRAL del Patrono, will no  
longer be available after the fourth quarter of 2023.  
Instead, employers in the U.S. territories will file Form 941,  
Employer’s QUARTERLY Federal Tax Return, or, if you  
prefer your form and instructions in Spanish, you can file  
new Form 941 (sp), Declaración del Impuesto Federal  
TRIMESTRAL del Empleador.  
Social security and Medicare tax for 2023. The rate of  
social security tax on taxable wages, including qualified  
sick leave wages and qualified family leave wages paid in  
2023 for leave taken after March 31, 2021, and before  
October 1, 2021, is 6.2% each for the employer and  
employee or 12.4% for both. Qualified sick leave wages  
and qualified family leave wages paid in 2023 for leave  
taken after March 31, 2020, and before April 1, 2021,  
aren't subject to the employer share of social security tax;  
Jan 10, 2023  
Cat. No. 35530F  
   
2020 allows for a payroll tax credit for certain tax-exempt  
organizations affected by certain qualified disasters not  
related to COVID-19. This credit is claimed on Form  
5884-D (not on Form 941-SS). Form 5884-D is filed after  
the Form 941-SS for the quarter for which the credit is  
being claimed has been filed. If you will claim this credit  
on Form 5884-D and you're also claiming a credit for  
qualified sick and family leave wages for leave taken  
before April 1, 2021, you must include any credit that will  
be claimed on Form 5884-D on Worksheet 1 for that  
quarter. For more information about this credit, go to  
Pubs. 80, 51, and 179 discontinued after 2023. Pub.  
80, Federal Tax Guide for Employers in the U.S. Virgin  
Islands, Guam, American Samoa, and the Commonwealth  
of the Northern Mariana Islands; Pub. 51, Agricultural  
Employer's Tax Guide; and Pub. 179, Guía Contributiva  
Federal para Patronos Puertorriqueños, will no longer be  
available after 2023. Instead, information specific to  
employers in the U.S. territories and agricultural  
employers will be included in Pub. 15, Employer's Tax  
Guide, beginning with the Pub. 15 for use in 2024  
(published December 2023). Beginning in 2024, there will  
be a new Pub. 15 (sp) that is a Spanish-language version  
of Pub. 15.  
Certification program for professional employer or-  
ganizations (PEOs). The Stephen Beck, Jr., ABLE Act  
of 2014 required the IRS to establish a voluntary  
Reminders  
certification program for PEOs. PEOs handle various  
payroll administration and tax reporting responsibilities for  
their business clients and are typically paid a fee based on  
payroll costs. To become and remain certified under the  
certification program, certified professional employer  
organizations (CPEOs) must meet various requirements  
described in sections 3511 and 7705 and related  
published guidance. Certification as a CPEO may affect  
the employment tax liabilities of both the CPEO and its  
customers. A CPEO is generally treated for employment  
tax purposes as the employer of any individual who  
performs services for a customer of the CPEO and is  
covered by a contract described in section 7705(e)(2)  
between the CPEO and the customer (CPEO contract),  
but only for wages and other compensation paid to the  
individual by the CPEO. To become a CPEO, the  
organization must apply through the IRS Online  
Use the March 2023 revision of Form 941-SS to  
report taxes for the first quarter of 2023; don't use  
!
CAUTION  
an earlier revision to report taxes for 2023. At this  
time, the IRS expects the March 2023 revision of Form  
941-SS and these instructions to also be used for the  
second, third, and fourth quarters of 2023. If changes in  
law require additional changes to Form 941-SS, the form  
and/or these instructions may be revised. Prior revisions  
of Form 941-SS are available at IRS.gov/Form941SS  
(select the link for "All Form 941-SS Revisions" under  
"Other Items You May Find Useful").  
The COVID-19 related credit for qualified sick and  
family leave wages is limited to leave taken after  
March 31, 2020, and before October 1, 2021.  
Generally, the credit for qualified sick and family leave  
wages, as enacted under the Families First Coronavirus  
Response Act (FFCRA) and amended and extended by  
the COVID-related Tax Relief Act of 2020, for leave taken  
after March 31, 2020, and before April 1, 2021, and the  
credit for qualified sick and family leave wages under  
sections 3131, 3132, and 3133 of the Internal Revenue  
Code, as enacted under American Rescue Plan Act of  
2021 (the ARP), for leave taken after March 31, 2021, and  
before October 1, 2021, have expired. However,  
employers that pay qualified sick and family leave wages  
in 2023 for leave taken after March 31, 2020, and before  
October 1, 2021, are eligible to claim a credit for qualified  
sick and family leave wages in the quarter of 2023 in  
which the qualified wages were paid. For more  
Registration System. For more information or to apply to  
become a CPEO, go to IRS.gov/CPEO.  
CPEOs must generally file Form 941-SS and  
Schedule R (Form 941), Allocation Schedule for  
Aggregate Form 941 Filers, electronically. For more  
information about a CPEO’s requirement to file  
electronically, see Rev. Proc. 2017-14, 2017-3 I.R.B. 426,  
Outsourcing payroll duties. Generally, as an employer,  
you're responsible to ensure that tax returns are filed and  
deposits and payments are made, even if you contract  
with a third party to perform these acts. You remain  
responsible if the third party fails to perform any required  
action. Before you choose to outsource any of your payroll  
and related tax duties (that is, withholding, reporting, and  
paying over social security, Medicare, FUTA, and income  
taxes) to a third-party payer, such as a payroll service  
provider or reporting agent, go to IRS.gov/  
information, see the instructions for line 11b, line 11d,  
line 13c, and line 13e, later.  
Use Worksheet 1 to figure the credit for leave taken  
after March 31, 2020, and before April 1, 2021. Use  
Worksheet 2 to figure the credit for leave taken after  
March 31, 2021, and before October 1, 2021. For more  
information about the credit for qualified sick and family  
leave wages, go to IRS.gov/PLC.  
Advance payment of COVID-19 credits ended.  
Although you may pay qualified sick and family leave  
wages in 2023 for leave taken after March 31, 2020, and  
before October 1, 2021, you may no longer request an  
advance payment of any credit on Form 7200, Advance  
Payment of Employer Credits Due to COVID-19.  
OutsourcingPayrollDuties for helpful information on this  
topic. If a CPEO pays wages and other compensation to  
an individual performing services for you, and the services  
are covered by a CPEO contract, then the CPEO is  
generally treated for employment tax purposes as the  
employer, but only for wages and other compensation  
paid to the individual by the CPEO. However, with respect  
to certain employees covered by a CPEO contract, you  
may also be treated as an employer of the employees  
and, consequently, may also be liable for federal  
Payroll tax credit for certain tax-exempt organiza-  
tions affected by qualified disasters. Section 303(d) of  
the Taxpayer Certainty and Disaster Tax Relief Act of  
employment taxes imposed on wages and other  
compensation paid by the CPEO to such employees. For  
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Instructions for Form 941-SS (Rev. 3-2023)  
 
more information on the different types of third-party payer  
arrangements, see section 16 of Pub. 15.  
agreement with the third-party payer, the third-party payer  
includes the qualified sick leave wages on the third party's  
aggregate Form 941-SS, claims the sick leave credit on  
behalf of the employer on the aggregate Form 941-SS,  
and separately reports the credit allocable to the  
employers on Schedule R (Form 941). See section 6 of  
Pub. 15-A, Employer's Supplemental Tax Guide, for more  
information about sick pay reporting.  
Work opportunity tax credit for qualified tax-exempt  
organizations hiring qualified veterans. Qualified  
tax-exempt organizations that hire eligible unemployed  
veterans may be able to claim the work opportunity tax  
credit against their payroll tax liability using Form 5884-C.  
For more information, go to IRS.gov/WOTC.  
Correcting a previously filed Form 941-SS. If you  
discover an error on a previously filed Form 941-SS or if  
you otherwise need to amend a previously filed Form  
941-SS, make the correction using Form 941-X. Form  
941-X is filed separately from Form 941-SS. For more  
information, see the Instructions for Form 941-X, section 9  
of Pub. 80, or go to IRS.gov/CorrectingEmploymentTaxes.  
Federal tax deposits must be made by electronic  
funds transfer (EFT). You must use EFT to make all  
federal tax deposits. Generally, an EFT is made using the  
Electronic Federal Tax Payment System (EFTPS). If you  
don't want to use EFTPS, you can arrange for your tax  
professional, financial institution, payroll service, or other  
trusted third party to make electronic deposits on your  
behalf. Also, you may arrange for your financial institution  
to initiate a same-day wire payment on your behalf.  
EFTPS is a free service provided by the Department of the  
Treasury. Services provided by your tax professional,  
financial institution, payroll service, or other third party  
may have a fee.  
COVID-19 employment tax credits when return filed  
by a third-party payer. If you're the common-law  
employer of the individuals that are paid qualified sick or  
family leave wages, you're entitled to the credit for the sick  
and family leave wages, regardless of whether you use a  
third-party payer (such as a PEO, CPEO, or section 3504  
agent) to report and pay your federal employment taxes.  
The third-party payer isn't entitled to the credits with  
respect to the wages and taxes it remits on your behalf  
(regardless of whether the third party is considered an  
"employer" for other purposes).  
Aggregate Form 941-SS filers. Approved section 3504  
agents and CPEOs must complete and file Schedule R  
(Form 941) when filing an aggregate Form 941-SS.  
Aggregate Forms 941-SS are filed by agents approved by  
the IRS under section 3504. To request approval to act as  
an agent for an employer, the agent files Form 2678 with  
the IRS unless you’re a state or local government agency  
acting as an agent under the special procedures provided  
in Rev. Proc. 2013-39, 2013-52 I.R.B. 830, available at  
941-SS are also filed by CPEOs approved by the IRS  
under section 7705. To become a CPEO, the organization  
must apply through the IRS Online Registration System at  
IRS.gov/CPEO. CPEOs file Form 8973, Certified  
Professional Employer Organization/Customer Reporting  
Agreement, to notify the IRS that they started or ended a  
service contract with a customer. CPEOs must generally  
file Form 941-SS and Schedule R (Form 941)  
electronically. For more information about a CPEO’s  
requirement to file electronically, see Rev. Proc. 2017-14,  
2017-3 I.R.B. 426, available at IRS.gov/irb/  
For more information on making federal tax deposits,  
see section 8 of Pub. 80. To get more information about  
EFTPS or to enroll in EFTPS, go to EFTPS.gov or call one  
of the following numbers.  
Other third-party payers that file aggregate Forms  
941-SS, such as non-certified PEOs, must complete and  
file Schedule R (Form 941) if they have clients that are  
claiming the qualified small business payroll tax credit for  
increasing research activities, and/or the credit for  
qualified sick and family leave wages.  
800-555-4477 (toll free; for use by U.S. Virgin Islands  
only).  
800-244-4829 (Spanish).  
If both an employer and a section 3504 authorized  
303-967-5916 (toll call).  
agent (or a CPEO or other third-party payer) paid  
wages to an employee during a quarter, both the  
To contact EFTPS using Telecommunications Relay  
Services (TRS) for people who are deaf, hard of hearing,  
or have a speech disability, dial 711 and then provide the  
TRS assistant the 800-555-4477 number above or  
800-733-4829.  
TIP  
employer and the section 3504 authorized agent (or  
CPEO or other third-party payer, if applicable) should file  
Form 941-SS reporting the wages each entity paid to the  
employee during the applicable quarter and issue Forms  
W-2 reporting the wages each entity paid to the employee  
during the year.  
Additional information about EFTPS is also available in  
Pub. 966.  
For an EFTPS deposit to be on time, you must  
If a third-party payer of sick pay is also paying qualified  
sick leave wages on behalf of an employer, the third party  
would be making the payments as an agent of the  
employer. The employer is required to do the reporting  
and payment of employment taxes with respect to the  
qualified sick leave wages and claim the credit for the  
qualified sick leave wages, unless the employer has an  
agency agreement with the third-party payer that requires  
the third-party payer to do the collecting, reporting, and/or  
paying or depositing employment taxes on the qualified  
sick leave wages. If the employer has an agency  
submit the deposit by 8 p.m. Eastern time the day  
!
CAUTION  
before the date the deposit is due.  
Same-day wire payment option. If you fail to submit a  
deposit transaction on EFTPS by 8 p.m. Eastern time the  
day before the date a deposit is due, you can still make  
your deposit on time by using the Federal Tax Collection  
Service (FTCS) to make a same-day wire payment. To  
use the same-day wire payment method, you will need to  
make arrangements with your financial institution ahead of  
time. Please check with your financial institution regarding  
Instructions for Form 941-SS (Rev. 3-2023)  
-3-  
 
availability, deadlines, and costs. Your financial institution  
may charge you a fee for payments made this way. To  
learn more about the information you will need to give  
your financial institution to make a same-day wire  
payment, go to IRS.gov/SameDayWire.  
Timeliness of federal tax deposits. If a deposit is  
required to be made on a day that isn't a business day, the  
deposit is considered timely if it is made by the close of  
the next business day. A business day is any day other  
than a Saturday, Sunday, or legal holiday. The term “legal  
holiday” for deposit purposes includes only those legal  
holidays in the District of Columbia. Legal holidays in the  
District of Columbia are provided in section 8 of Pub. 80.  
Electronic filing and payment. Businesses can enjoy  
the benefits of filing tax returns and paying their federal  
taxes electronically. Whether you rely on a tax  
professional or handle your own taxes, the IRS offers you  
convenient programs to make filing and paying easier.  
Spend less time worrying about taxes and more time  
running your business. Use e-file and EFTPS to your  
benefit.  
Where can you get telephone help? For answers to  
your questions about completing Form 941-SS or tax  
deposit rules, call the IRS at one of the numbers listed  
below.  
800-829-4933 (toll free; for use by U.S. Virgin Islands  
only) or 800-829-4059 (TDD/TTY for persons who are  
deaf, hard of hearing, or have a speech disability),  
Monday–Friday from 7:00 a.m. to 7:00 p.m. local time.  
267-941-1000 (toll call), Monday–Friday from 6:00 a.m.  
to 11:00 p.m. Eastern time.  
Photographs of missing children. The IRS is a proud  
Children® (NCMEC). Photographs of missing children  
selected by the Center may appear in instructions on  
pages that would otherwise be blank. You can help bring  
these children home by looking at the photographs and  
calling 1-800-THE-LOST (1-800-843-5678) if you  
recognize a child.  
General Instructions:  
Purpose of Form 941-SS  
Use Form 941-SS to report social security and Medicare  
taxes for workers in American Samoa, Guam, the  
Commonwealth of the Northern Mariana Islands (CNMI),  
and the U.S. Virgin Islands.  
For e-file, go to IRS.gov/EmploymentEfile for additional  
information. A fee may be charged to file electronically.  
For EFTPS, go to EFTPS.gov or call one of the  
numbers provided under Federal tax deposits must be  
For electronic filing of Forms W-2AS, W-2CM, W-2GU,  
and W-2VI, go to SSA.gov/employer. You may be  
required to file Forms W-2 electronically. For details, see  
the General Instructions for Forms W-2 and W-3.  
Pub. 80 explains the requirements for withholding,  
depositing, and paying social security and Medicare  
taxes. It explains the forms you must give your  
employees, those your employees must give you, and  
those you must send to the IRS. See Pub. 15-A for  
specialized employment tax information supplementing  
the basic information provided in Pub. 80.  
If you’re filing your tax return or paying your  
federal taxes electronically, a valid employer  
!
CAUTION  
identification number (EIN) is required at the time  
the return is filed or the payment is made. If a valid EIN  
isn't provided, the return or payment won't be processed.  
This may result in penalties. See Employer identification  
number (EIN), later, for information about applying for an  
EIN.  
Federal law requires you, as an employer, to withhold  
certain taxes from your employees' pay. Each time you  
pay wages, you must withhold—or take out of your  
employees' pay—certain amounts for social security tax  
and Medicare tax. You must also withhold Additional  
Medicare Tax from wages you pay to an employee in  
excess of $200,000 in a calendar year. Under the  
withholding system, taxes withheld from your employees  
are credited to your employees in payment of their tax  
liabilities.  
Electronic funds withdrawal (EFW). If you file Form  
941-SS electronically, you can e-file and use EFW to pay  
the balance due in a single step using tax preparation  
software or through a tax professional. However, don't use  
EFW to make federal tax deposits. For more information  
on paying your taxes using EFW, go to IRS.gov/EFW.  
Credit or debit card payments. You can pay the  
balance due shown on Form 941-SS by credit or debit  
card. Your payment will be processed by a payment  
processor who will charge a processing fee. Don't use a  
credit or debit card to make federal tax deposits. For more  
information on paying your taxes with a credit or debit  
card, go to IRS.gov/PayByCard.  
Online payment agreement. You may be eligible to  
apply for an installment agreement online if you can’t pay  
the full amount of tax you owe when you file your return.  
For more information, see What if you can't pay in full,  
later.  
Paid preparers. If you use a paid preparer to complete  
Form 941-SS, the paid preparer must complete and sign  
the paid preparer's section of the form.  
Federal law also requires you to pay any liability for the  
employer share of social security and Medicare taxes.  
This share of social security and Medicare taxes isn't  
withheld from employees.  
Who Must File Form 941-SS?  
Generally, you must file a return for the first quarter in  
which you pay wages subject to social security and  
Medicare taxes, and for each quarter thereafter until you  
file a final return. Use Form 941-SS if your principal place  
of business is in American Samoa, Guam, the CNMI, or  
the U.S. Virgin Islands, or if you have employees who are  
subject to income tax withholding for these jurisdictions.  
Use Form 941-SS to report the following amounts.  
Wages you’ve paid.  
Tips your employees reported to you.  
-4-  
Instructions for Form 941-SS (Rev. 3-2023)  
       
Both the employer and the employee share of social  
and the U.S. Virgin Islands that would otherwise be  
required to file Form 944 may contact the IRS to request  
to file quarterly Forms 941-SS instead of annual Form  
944. To request to file quarterly Forms 941-SS to report  
your social security and Medicare taxes for the 2023  
calendar year, you must either call the IRS at  
security and Medicare taxes.  
Additional Medicare Tax withheld from employees.  
Current quarter's adjustments to social security and  
Medicare taxes for fractions of cents, sick pay, tips, and  
group-term life insurance.  
Qualified small business payroll tax credit for increasing  
800-829-4933 toll free (U.S. Virgin Islands only) or  
267-941-1000 (toll call) between January 1, 2023, and  
April 3, 2023, or send a written request postmarked  
between January 1, 2023, and March 15, 2023. After you  
contact the IRS, the IRS will send you a written notice that  
your filing requirement has been changed to Forms  
941-SS. You must receive written notice from the IRS to  
file Forms 941-SS instead of Form 944 before you may file  
these forms. If you don't receive this notice, you must file  
Form 944 for calendar year 2023.  
Requesting to file Form 944 instead of Forms  
941-SS. If you’re required to file Forms 941-SS but  
believe your employment taxes for 2023 will be $1,000 or  
less, you may request to file Form 944 instead of Forms  
941-SS by calling the IRS at 800-829-4933 toll free (U.S.  
Virgin Islands only) or 267-941-1000 (toll call) between  
January 1, 2023, and April 3, 2023, or sending a written  
request postmarked between January 1, 2023, and March  
15, 2023. After you contact the IRS, the IRS will send you  
a written notice that your filing requirement has been  
changed to Form 944. You must receive written notice  
from the IRS to file Form 944 instead of Forms 941-SS  
before you may file this form. If you don't receive this  
notice, you must file Forms 941-SS for calendar year  
2023.  
research activities.  
Credit for qualified sick and family leave wages paid  
this quarter of 2023 for leave taken after March 31, 2020,  
and before October 1, 2021.  
Don't use Form 941-SS if you have both employees  
who are subject to U.S. income tax withholding and  
employees who aren't subject to U.S. income tax  
withholding. Instead, you must file only Form 941 (or Form  
944, Employer's ANNUAL Federal Tax Return) and  
include all of your employees' wages on that form.  
Don't use Form 941-SS to report backup withholding or  
income tax withholding on nonpayroll payments such as  
pensions, annuities, and gambling winnings. Report these  
types of withholding on Form 945, Annual Return of  
Withheld Federal Income Tax. Also, don't use Form  
941-SS to report unemployment taxes. Report  
unemployment taxes (U.S. Virgin Islands employers only)  
on Form 940, Employer's Annual Federal Unemployment  
(FUTA) Tax Return.  
After you file your first Form 941-SS, you must file a  
return each quarter, even if you have no taxes to report,  
unless you filed a final return or one of the exceptions  
listed next applies.  
Where to send written requests. Written requests  
Exceptions  
should be sent to:  
Special rules apply to some employers.  
If you received notification to file Form 944, you must  
Department of the Treasury  
Internal Revenue Service  
Ogden, UT 84201-0038  
file Form 944 annually; don't file Form 941-SS quarterly.  
Seasonal employers don't have to file a Form 941-SS  
for quarters in which they have no tax liability because  
they have paid no wages. To tell the IRS that you won't file  
a return for one or more quarters during the year, check  
the box on line 18 every quarter you file Form 941-SS.  
The IRS generally won't inquire about unfiled returns if at  
least one taxable return is filed each year. However, you  
must check the box on line 18 on every quarterly return  
you file. Otherwise, the IRS will expect a return to be filed  
for each quarter.  
For more information about these procedures, see Rev.  
Proc. 2009-51, 2009-45 I.R.B. 625, available at  
What if You Reorganize or Close Your  
Business?  
If You Sell or Transfer Your Business . . .  
Employers of household employees don't usually file  
Form 941-SS. See Pub. 80, Pub. 926, and Schedule H  
(Form 1040) for more information.  
If you sell or transfer your business during the quarter, you  
and the new owner must each file a Form 941-SS for the  
quarter in which the transfer occurred. Report only the  
wages you paid.  
Employers of farm employees don't file Form 941-SS  
for wages paid for agricultural labor. See Form 943 and  
Pub. 51 for more information.  
When two businesses merge, the continuing firm must  
file a return for the quarter in which the change took place  
and the other firm should file a final return.  
If none of these exceptions apply and you haven't  
filed a final return, you must file Form 941-SS  
each quarter even if you didn't pay wages during  
TIP  
the quarter. Use IRS e-file, if possible.  
Changing from one form of business to another—such  
as from a sole proprietorship to a partnership or  
corporation—is considered a transfer. If a transfer occurs,  
you may need a new EIN. See Pub. 1635 and section 1 of  
Pub. 80 for more information.  
Requesting To File Forms 941-SS Instead of  
Form 944, or Requesting To File Form 944  
Instead of Forms 941-SS  
Requesting to file Forms 941-SS instead of Form  
Attach a statement to your return with:  
944. Employers in American Samoa, Guam, the CNMI,  
Instructions for Form 941-SS (Rev. 3-2023)  
-5-  
 
The new owner's name (or the new name of the  
For example, you must generally report wages you pay  
during the 1st quarter—which is January through  
March—by April 30. If you made timely deposits in full  
payment of your taxes for the quarter, you may file by the  
10th day of the 2nd month that follows the end of the  
quarter. For example, you may file Form 941-SS by May  
10 if you made timely deposits in full payment of your  
taxes for the 1st quarter.  
business);  
Whether the business is now a sole proprietorship,  
partnership, or corporation;  
The kind of change that occurred (a sale or transfer);  
The date of the change; and  
The name of the person keeping the payroll records  
and the address where those records will be kept.  
If we receive Form 941-SS after the due date, we will  
treat Form 941-SS as filed on time if the envelope  
containing Form 941-SS is properly addressed, contains  
sufficient postage, and is postmarked by the U.S. Postal  
Service on or before the due date, or sent by an  
IRS-designated private delivery service (PDS) on or  
before the due date. If you don't follow these guidelines,  
we will generally consider Form 941-SS filed when it is  
actually received. For more information about PDSs, see  
If Your Business Has Closed . . .  
If you permanently go out of business or stop paying  
wages to your employees, you must file a final return. To  
tell the IRS that Form 941-SS for a particular quarter is  
your final return, check the box on line 17 and enter the  
final date you paid wages. Also attach a statement to your  
return showing the name of the person keeping the payroll  
records and the address where those records will be kept.  
See Terminating a business in the General Instructions  
for Forms W-2 and W-3 for information about earlier dates  
for the expedited furnishing and filing of the following  
Wage and Tax Statements when a final Form 941-SS is  
filed.  
If any due date for filing falls on a Saturday, Sunday, or  
legal holiday, you may file your return on the next  
business day.  
How Should You Complete Form  
941-SS?  
W-2AS, American Samoa.  
W-2CM, CNMI.  
W-2GU, Guam.  
Type or print your EIN, name, and address in the spaces  
provided. Also enter your name and EIN on the top of  
pages 2 and 3. Don't use your social security number  
(SSN) or individual taxpayer identification number (ITIN).  
Generally, enter the business (legal) name you used when  
you applied for your EIN. For example, if you’re a sole  
proprietor, enter “Haleigh Smith” on the “Name” line and  
“Haleigh's Cycles” on the “Trade name” line. Leave the  
“Trade name” line blank if it is the same as your “Name.”  
W-2VI, U.S. Virgin Islands.  
If you participated in a statutory merger or  
consolidation, or qualify for predecessor-successor status  
due to an acquisition, you should generally file  
Schedule D (Form 941), Report of Discrepancies Caused  
by Acquisitions, Statutory Mergers, or Consolidations.  
See the Instructions for Schedule D (Form 941) to  
determine whether you should file Schedule D (Form 941)  
and when you should file it.  
If you use a tax preparer to fill out Form 941-SS, make  
sure the preparer shows your business name exactly as it  
appeared when you applied for your EIN.  
When Must You File?  
File your initial Form 941-SS for the quarter in which you  
first paid wages that are subject to social security and  
Medicare taxes. See the table titled When To File Form  
941-SS, later.  
Employer identification number (EIN). To make sure  
that businesses comply with federal tax laws, the IRS  
monitors tax filings and payments by using a numerical  
system to identify taxpayers. A unique nine-digit EIN is  
assigned to all corporations, partnerships, and some sole  
proprietors. Businesses needing an EIN must apply for a  
number and use it throughout the life of the business on all  
tax returns, payments, and reports.  
Your business should have only one EIN. If you have  
more than one and aren't sure which one to use, write to  
the IRS office where you file your returns (using the  
Without a payment address under Where Should You  
File, later) or call the IRS at 800-829-4933 (toll free; for  
use by U.S. Virgin Islands only) or 267-941-1099 (toll call).  
Then, you must file for every quarter after that—every 3  
months—even if you have no taxes to report, unless  
you’re a seasonal employer or are filing your final return.  
Closed, earlier.  
File Form 941-SS only once for each quarter. If you  
filed electronically, don't file a paper Form 941-SS. For  
more information about filing Form 941-SS electronically,  
When To File Form 941-SS  
If you don't have an EIN, you may apply for one online  
by going to IRS.gov/EIN. You may also apply for an EIN  
by faxing or mailing Form SS-4 to the IRS. If the principal  
business was created outside of the United States or U.S.  
territories, you may also apply for an EIN by calling  
267-941-1099 (toll call). If you haven't received your EIN  
by the due date of Form 941-SS, write “Applied For” and  
the date you applied in this entry space.  
Your Form 941-SS is due by the last day of the month that follows the end of the  
quarter.  
Form 941-SS  
The Quarter Includes . . .  
Quarter Ends  
Is Due  
1. January, February, March  
2. April, May, June  
March 31  
April 30  
June 30  
July 31  
3. July, August, September  
4. October, November, December  
September 30  
December 31  
October 31  
January 31  
-6-  
Instructions for Form 941-SS (Rev. 3-2023)  
         
If you’re filing your tax return electronically, a valid  
EIN is required at the time the return is filed. If a  
valid EIN isn't provided, the return won't be  
Reconciling Forms 941-SS With Form W-3SS  
!
The IRS matches amounts reported on your four quarterly  
Forms 941-SS with Form W-2AS, W-2CM, W-2GU, or  
W-2VI amounts totaled on your yearly Form W-3SS,  
Transmittal of Wage and Tax Statements. If the amounts  
don't agree, you may be contacted by the IRS or the  
Social Security Administration (SSA). The following  
amounts are reconciled.  
CAUTION  
accepted. This may result in penalties.  
Always be sure the EIN on the form you file  
exactly matches the EIN the IRS assigned to your  
business. Don't use your SSN or ITIN on forms  
TIP  
that ask for an EIN. If you used an EIN (including a prior  
owner's EIN) on Form 941-SS that is different from the  
EIN reported on Form W-3SS, see Box h—Other EIN  
used this year in the General Instructions for Forms W-2  
and W-3. Filing a Form 941-SS with an incorrect EIN or  
using another business's EIN may result in penalties and  
delays in processing your return.  
Social security wages.  
Social security tips.  
Medicare wages and tips.  
Use Schedule D (Form 941) to explain certain wage,  
tax, and payment discrepancies between Forms 941-SS  
and Forms W-2AS, W-2CM, W-2GU, W-2VI, W-3SS, and  
W-2c, Corrected Wage and Tax Statement, that were  
caused by acquisitions, statutory mergers, or  
If you change your business name, business ad-  
dress, or responsible party . . . Notify the IRS  
immediately if you change your business name, business  
address, or responsible party.  
consolidations. For more information, see the Instructions  
for Schedule D (Form 941). Also see Rev. Proc. 2004-53  
for more information. You can find Rev. Proc. 2004-53 on  
page 320 of I.R.B. 2004-34 at IRS.gov/irb/  
Write to the IRS office where you file your returns (using  
the Without a payment address under Where Should You  
File, later) to notify the IRS of any business name change.  
See Pub. 1635 to see if you need to apply for a new EIN.  
Where Should You File?  
Complete and mail Form 8822-B to notify the IRS of a  
business address or responsible party change. Don't mail  
Form 8822-B with your Form 941-SS. For a definition of  
“responsible party,” see the Instructions for Form SS-4.  
You're encouraged to file Form 941-SS electronically. Go  
to IRS.gov/EmploymentEfile for more information on  
electronic filing. If you file a paper return, where you file  
depends on whether you include a payment with Form  
941-SS.  
Check the Box for the Quarter  
Under “Report for this Quarter of 2023” at the top of Form  
941-SS, check the appropriate box of the quarter for  
which you're filing. Make sure the quarter checked is the  
same as shown on any attached Schedule B (Form 941),  
Report of Tax Liability for Semiweekly  
PDSs can't deliver to P.O. boxes. You must use the  
U.S. Postal Service to mail an item to a P.O. box address.  
Go to IRS.gov/PDS for the current list of PDSs. For the  
IRS mailing address to use if you're using a PDS, go to  
IRS.gov/PDSstreetAddresses. Select the address on the  
webpage that is given for the Ogden Submission  
Processing Center.  
Schedule Depositors, and, if applicable, Schedule R  
(Form 941).  
Completing and Filing Form 941-SS  
Without a  
payment . . .  
Make entries on Form 941-SS as follows to enable  
accurate scanning and processing.  
If you’re in . . .  
With a payment . . .  
American Samoa, Guam, CNMI, Internal Revenue  
Internal Revenue  
Service  
P.O. Box 932100  
Louisville, KY  
40293-2100  
Use 10-point Courier font (if possible) for all entries if  
U.S. Virgin Islands  
Service  
you’re typing or using a computer to complete your form.  
Portable Document Format (PDF) forms on IRS.gov have  
fillable fields with acceptable font specifications.  
P.O. Box 409101  
Ogden, UT 84409  
Don't enter dollar signs and decimal points. Commas  
Special filing addresses for  
exempt organizations; federal,  
state, and local governmental  
entities; and Indian tribal  
governmental entities,  
Department of the  
Treasury  
Internal Revenue  
Service  
P.O. Box 932100  
Louisville, KY  
40293-2100  
are optional. Enter dollars to the left of the preprinted  
decimal point and cents to the right of it. Don’t round  
entries to whole dollars. Always show an amount for  
cents, even if it is zero.  
Internal Revenue  
Service  
Ogden, UT  
84201-0005  
regardless of location  
Leave blank any data field (except lines 1 and 12) with  
a value of zero.  
Enter negative amounts using a minus sign (if possible).  
Your filing address may have changed from that  
used to file your employment tax return in prior  
years. Don't send Form 941-SS or any payments  
Otherwise, use parentheses.  
Enter your name and EIN on all pages and  
!
CAUTION  
attachments.  
Enter your name, EIN, “Form 941-SS,” and the tax year  
to the SSA.  
and quarter on all attachments.  
Depositing Your Taxes  
Staple multiple sheets in the upper left corner when  
You must deposit all depository taxes  
filing.  
electronically by EFT. For more information, see  
!
Complete all three pages. You must complete all three  
pages of Form 941-SS and sign on page 3. Failure to do  
so may delay processing of your return.  
CAUTION  
funds transfer (EFT) under Reminders, earlier.  
Instructions for Form 941-SS (Rev. 3-2023)  
-7-  
   
If you reported $50,000 or less in taxes during the  
Must You Deposit Your Taxes?  
lookback period, you’re a monthly schedule depositor.  
You may have to deposit both the employer and  
employee social security taxes and Medicare taxes.  
If you reported more than $50,000 of taxes during the  
lookback period, you’re a semiweekly schedule  
depositor.  
If your total taxes after adjustments and  
nonrefundable credits (line 12) are less than $2,500  
for the current quarter or the prior quarter, and you  
didn't incur a $100,000 next-day deposit obligation  
during the current quarter. You don't have to make a  
deposit. To avoid a penalty, you must pay any amount  
due in full with a timely filed return or you must deposit any  
amount you owe by the due date of the return. For more  
information on paying with a timely filed return, see the  
instructions for line 14, later. If you’re not sure your total  
tax liability for the current quarter will be less than $2,500  
(and your liability for the prior quarter wasn't less than  
$2,500), make deposits using the semiweekly or monthly  
rules so you won't be subject to failure-to-deposit (FTD)  
penalties.  
If you’re a monthly schedule depositor and  
accumulate a $100,000 tax liability on any day  
!
CAUTION  
during the deposit period, you become a  
semiweekly schedule depositor on the next day and  
remain so for at least the rest of the calendar year and for  
the following calendar year. See $100,000 Next-Day  
Deposit Rule in section 8 of Pub. 80 for more information.  
The $100,000 tax liability threshold requiring a next-day  
deposit is determined before you consider any reduction  
of your liability for nonrefundable credits. For more  
information, including an example, see frequently asked  
question 17 at IRS.gov/ETD.  
If your total taxes after adjustments and  
What About Penalties and Interest?  
nonrefundable credits (line 12) are $2,500 or more  
for the current quarter and the prior quarter. You  
must make deposits according to your deposit schedule.  
See section 8 of Pub. 80 for information about payments  
made under the accuracy of deposits rule and for rules  
about federal tax deposits.  
Avoiding Penalties and Interest  
You can avoid paying penalties and interest if you do all of  
the following.  
Deposit or pay your taxes when they are due, unless  
you meet the requirements discussed in Notice 2020-22  
Reducing your deposits for the credit for qualified  
sick and family leave wages. Employers eligible to  
claim the credit for qualified sick and family leave wages  
paid this quarter of 2023 for leave taken after March 31,  
2020, and before October 1, 2021, can reduce their  
deposits by the amount of their anticipated credit.  
Employers won’t be subject to an FTD penalty for  
reducing their deposits if certain conditions are met. See  
the instructions for line 11b and line 11d, later, for more  
information on these credits. For more information on  
reducing deposits, see Notice 2020-22, 2020-17 I.R.B.  
and Notice 2021-24, 2021-18 I.R.B. 1122, available at  
instructions for line 16, later, for information on adjusting  
tax liabilities reported on line 16 or Schedule B (Form 941)  
for nonrefundable credits.  
File your fully completed Form 941-SS on time.  
Report your tax liability accurately.  
Submit valid checks for tax payments.  
Furnish accurate Forms W-2AS, W-2CM, W-2GU, or  
W-2VI to employees.  
File Form W-3SS and Copy A of Forms W-2AS,  
W-2CM, W-2GU, or W-2VI with the SSA on time and  
accurately.  
Penalties and interest are charged on taxes paid late  
and returns filed late at a rate set by law. See section 8 of  
Pub. 80 for details.  
Use Form 843 to request abatement of assessed  
penalties or interest. Don't request abatement of  
assessed penalties or interest on Form 941-SS or Form  
941-X.  
When Must You Deposit Your Taxes?  
Determine if You’re a Monthly or Semiweekly  
Schedule Depositor for the Quarter  
If you receive a notice about a penalty after you file this  
return, reply to the notice with an explanation and we will  
determine if you meet reasonable-cause criteria. Don't  
attach an explanation when you file your return.  
The IRS uses two different sets of deposit rules to  
determine when businesses must deposit their social  
security and Medicare taxes. These schedules tell you  
when a deposit is due after you have a payday.  
If federal income, social security, and Medicare  
taxes that must be withheld (that is, trust fund  
!
CAUTION  
taxes) aren't withheld or aren't deposited or paid  
to the United States Treasury, the trust fund recovery  
penalty may apply. The penalty is 100% of the unpaid  
trust fund tax. If these unpaid taxes can't be immediately  
collected from the employer or business, the trust fund  
recovery penalty may be imposed on all persons who are  
determined by the IRS to be responsible for collecting,  
accounting for, or paying over these taxes, and who acted  
willfully in not doing so. For more information, see section  
8 of Pub. 80. The trust fund recovery penalty won’t apply  
to any amount of trust fund taxes an employer holds back  
in anticipation of any credits they are entitled to.  
Your deposit schedule isn't determined by how often  
you pay your employees. Your deposit schedule depends  
on the total tax liability you reported on Form 941-SS  
during the previous 4-quarter lookback period (July 1 of  
the second preceding calendar year through June 30 of  
the preceding calendar year). See section 8 of Pub. 80 for  
details. If you filed Form 944 in either 2021 or 2022, your  
lookback period is the 2021 calendar year.  
Before the beginning of each calendar year, determine  
which type of deposit schedule you must use.  
-8-  
Instructions for Form 941-SS (Rev. 3-2023)  
     
If you’re a governmental employer, wages you pay  
aren't automatically exempt from social security  
and Medicare taxes. Your employees may be  
Adjustment of Tax on Tips  
!
If, by the 10th of the month after the month you received  
an employee's report on tips, you don't have enough  
employee funds available to withhold the employee share  
of social security and Medicare taxes, you no longer have  
to collect it. Report the entire amount of these tips on  
line 5b (Taxable social security tips), line 5c (Taxable  
Medicare wages and tips), and, if the withholding  
CAUTION  
covered by law or by a voluntary Section 218 Agreement  
with the SSA. For more information, see Pub. 963,  
Federal-State Reference Guide.  
For purposes of these instructions, all references  
to “sick pay” mean ordinary sick pay, not “qualified  
sick leave wages” that are reported on line 5a(i)  
TIP  
threshold is met, line 5d (Taxable wages and tips subject  
to Additional Medicare Tax withholding). Include as a  
negative adjustment on line 9 the total uncollected  
employee share of the social security and Medicare taxes.  
for leave taken after March 31, 2020, and before April 1,  
2021, or reported on line 5a for leave taken after March  
31, 2021, and before October 1, 2021.  
Where Can You Obtain Forms?  
See Pub. 80 for information on ordering IRS forms. You  
may also be able to get some IRS forms at the addresses  
listed next.  
5a–5e. Taxable Social Security and Medicare  
Wages and Tips  
Qualified sick leave wages and qualified family  
leave wages paid this quarter of 2023 for leave  
!
CAUTION  
taken after March 31, 2020, and before April 1,  
American Samoa  
Tax Office  
Executive Office Building, First Floor  
Pago Pago, AS 96799  
2021, are reported on lines 5a(i) and 5a(ii), respectively.  
Qualified sick leave wages and qualified family leave  
wages paid this quarter of 2023 for leave taken after  
March 31, 2021, and before October 1, 2021, are reported  
on line 5a.  
CNMI  
CNMI Division of Revenue and Taxation  
Joeten Dandan Commercial Center  
Saipan, MP 96950  
Guam  
Department of Revenue and Taxation  
Government of Guam  
5a. Taxable social security wages. Enter the total  
wages, including qualified sick leave wages and qualified  
family leave wages paid this quarter of 2023 for leave  
taken after March 31, 2021, and before October 1, 2021;  
sick pay; and taxable fringe benefits subject to social  
security taxes you paid to your employees during the  
quarter. Don't include the qualified sick leave wages paid  
this quarter of 2023 that are reported on line 5a(i) or  
qualified family leave wages paid this quarter of 2023 that  
are reported on line 5a(ii) for leave taken after March 31,  
2020, and before April 1, 2021. For this purpose, sick pay  
includes payments made by an insurance company to  
your employees for which you received timely notice from  
the insurance company. See section 6 of Pub. 15-A for  
more information about sick pay reporting. See the  
instructions for line 8 for an adjustment that you may need  
to make on Form 941-SS for sick pay.  
1240 Army Drive  
Barrigada, GU 96913  
U.S. Virgin Islands  
Bureau of Internal Revenue  
6115 Estate Smith Bay, Ste 225  
St. Thomas, VI 00802  
Specific Instructions:  
Part 1: Answer These Questions for  
This Quarter  
1. Number of Employees Who Received Wages,  
Tips, or Other Compensation  
Enter the number of employees on your payroll for the pay  
period including March 12, June 12, September 12, or  
December 12, for the quarter indicated at the top of the  
Form 941-SS. Don't include:  
Enter the amount before payroll deductions. Don't  
include tips on this line. For information on types of wages  
subject to social security taxes, see section 4 of Pub. 80.  
For 2023, the rate of social security tax on taxable  
wages, except for qualified sick leave wages and qualified  
family leave wages paid in 2023 for leave taken after  
March 31, 2020, and before April 1, 2021, is 6.2% (0.062)  
each for the employer and employee or 12.4% (0.124) for  
both. Stop paying social security tax on and entering an  
employee's wages on line 5a when the employee's  
taxable wages, including qualified sick leave wages paid  
in 2023 that are reported on line 5a(i), qualified family  
leave wages paid in 2023 that are reported on line 5a(ii),  
and tips, reach $160,200 for the year. However, continue  
to withhold Medicare taxes for the whole year on all  
wages, including qualified sick leave wages paid in 2023,  
qualified family leave wages paid in 2023, and tips, even  
when the social security wage base of $160,200 has been  
reached.  
Household employees,  
Employees in nonpay status for the pay period,  
Farm employees,  
Pensioners, or  
Active members of the U.S. Armed Forces.  
4. If No Wages, Tips, and Other Compensation  
Are Subject to Social Security or Medicare  
Tax . . .  
If no wages, tips, and compensation are subject to social  
security or Medicare tax, check the box on line 4. If this  
question doesn't apply to you, leave the box blank. For  
more information about exempt wages, see section 12 of  
Pub. 80. For religious exemptions, see section 4 of Pub.  
15-A.  
Instructions for Form 941-SS (Rev. 3-2023)  
-9-  
       
For purposes of the credit for qualified sick and family  
leave wages, qualified sick leave and family leave wages  
are wages for social security and Medicare tax purposes,  
determined without regard to the exclusions from the  
definition of employment under sections 3121(b)(1)–(22),  
that an employer pays that otherwise meet the  
COVID-19, or to care for an individual who is recovering  
from any injury, disability, illness, or condition related to  
the immunization.  
Son or daughter. A son or daughter must generally  
have been under 18 years of age or incapable of self-care  
because of a mental or physical disability. A son or  
daughter includes a biological child, adopted child,  
stepchild, foster child, legal ward, or a child for whom the  
employee assumes parental status and carries out the  
obligations of a parent.  
Limits on qualified sick leave wages. The EPSLA,  
as amended for purposes of the ARP, provides different  
limitations for different circumstances under which  
qualified sick leave wages are paid. For paid sick leave  
qualifying under (1), (2), or (3) above, the amount of  
qualified sick leave wages is determined at the  
requirements of the Emergency Paid Sick Leave Act  
(EPSLA) or the Emergency Family and Medical Leave  
Expansion Act (Expanded FMLA), as enacted under the  
FFCRA and amended for purposes of the ARP. However,  
don't include any wages otherwise excluded under  
section 3121(b) when reporting qualified sick and family  
leave wages on lines 5a, 5a(i), 5a(ii), 5c, and, if  
applicable, 5d. See the instructions for line 11d for  
information about the credit for qualified sick and family  
leave wages for leave taken after March 31, 2021, and  
before October 1, 2021.  
employee's regular rate of pay, but the wages may not  
exceed $511 for any day (or portion of a day) for which the  
individual is paid sick leave. For paid sick leave qualifying  
under (4), (5), or (6) above, the amount of qualified sick  
leave wages is determined at two-thirds the employee's  
regular rate of pay, but the wages may not exceed $200  
for any day (or portion of a day) for which the individual is  
paid sick leave. The EPSLA also limits each individual to a  
maximum of up to 80 hours of paid sick leave in total for  
leave taken after March 31, 2020, and before April 1,  
2021. The ARP resets this limit at 80 hours of paid sick  
leave for leave taken after March 31, 2021, and before  
October 1, 2021. Therefore, for leave taken after March  
31, 2020, and before April 1, 2021, the maximum amount  
of paid sick leave wages can't exceed $5,110 for an  
employee for leave under (1), (2), or (3), and it can't  
exceed $2,000 for an employee for leave under (4), (5), or  
(6). These maximum amounts also reset and apply to  
leave taken after March 31, 2021, and before October 1,  
2021.  
line 5a (column 1)  
xꢀꢀ0.124  
line 5a (column 2)  
EPSLA. Employers with fewer than 500 employees  
and, for leave taken after March 31, 2021, and before  
October 1, 2021, certain governmental employers without  
regard to number of employees (except for the federal  
government and its agencies and instrumentalities unless  
described in section 501(c)(1)) are entitled to a credit if  
they provide paid sick leave to employees that otherwise  
meets the requirements of the EPSLA. Under the EPSLA,  
as amended for purposes of the ARP, wages are qualified  
sick leave wages if paid to employees that are unable to  
work or telework before October 1, 2021, because the  
employee:  
1. Is subject to a federal, state (including U.S.  
territories), or local quarantine or isolation order related to  
COVID-19;  
For more information about qualified sick leave wages,  
go to IRS.gov/PLC.  
2. Has been advised by a health care provider to  
Expanded FMLA. Employers with fewer than 500  
employees and, for leave taken after March 31, 2021, and  
before October 1, 2021, certain governmental employers  
without regard to number of employees (except for the  
federal government and its agencies and instrumentalities  
unless described in section 501(c)(1)) are entitled to a  
credit under the FFCRA, as amended for purposes of the  
ARP, if they provide paid family leave to employees that  
otherwise meets the requirements of the Expanded  
FMLA. For leave taken after March 31, 2020, and before  
April 1, 2021, wages are qualified family leave wages if  
paid to an employee who has been employed for at least  
30 calendar days when an employee is unable to work or  
telework due to the need to care for a son or daughter  
under 18 years of age or incapable of self-care because of  
a mental or physical disability because the school or place  
of care for that child has been closed, or the childcare  
provider for that child is unavailable, due to a public health  
emergency. See Son or daughter, earlier, for more  
information. For leave taken after March 31, 2021, and  
before October 1, 2021, the leave can be granted for any  
other reason provided by the EPSLA, as amended for  
purposes of the ARP.  
self-quarantine due to concerns related to COVID-19;  
3. Is experiencing symptoms of COVID-19 and  
seeking a medical diagnosis; or, for leave taken after  
March 31, 2021, and before October 1, 2021, is seeking  
or awaiting the results of a diagnostic test for, or a medical  
diagnosis of, COVID-19 (and the employee has been  
exposed to COVID-19 or the employee's employer has  
requested such test or diagnosis), or the employee is  
obtaining immunizations related to COVID-19 or  
recovering from an injury, disability, illness, or condition  
related to such immunization;  
4. Is caring for an individual subject to an order  
described in (1) or who has been advised as described in  
(2);  
5. Is caring for a son or daughter because the school  
or place of care for that child has been closed, or the  
childcare provider for that child is unavailable, due to  
COVID-19 precautions; or  
6. Is experiencing any other substantially similar  
condition specified by the U.S. Department of Health and  
Human Services, which for leave taken after March 31,  
2021, and before October 1, 2021, includes to  
accompany an individual to obtain immunization related to  
-10-  
Instructions for Form 941-SS (Rev. 3-2023)  
     
For leave taken after March 31, 2020, and before April  
1, 2021, the first 10 days for which an employee takes  
leave may be unpaid. During this period, employees may  
use other forms of paid leave, such as qualified sick leave,  
accrued sick leave, annual leave, or other paid time off.  
After an employee takes leave for 10 days, the employer  
must provide the employee paid leave (that is, qualified  
family leave wages) for up to 10 weeks. For leave taken  
after March 31, 2021, and before October 1, 2021, the  
10-day rule discussed above doesn't apply and the paid  
leave can be provided for up to 12 weeks.  
Rate of pay and limit on wages. The rate of pay must  
be at least two-thirds of the employee’s regular rate of pay  
(as determined under the Fair Labor Standards Act of  
1938), multiplied by the number of hours the employee  
would have otherwise been scheduled to work. For leave  
taken after March 31, 2020, and before April 1, 2021, the  
total qualified family leave wages can’t exceed $200 per  
day or $10,000 in the aggregate per employee. For leave  
taken after March 31, 2021, and before October 1, 2021,  
the limit resets and the total qualified family leave wages  
can't exceed $200 per day or $12,000 in the aggregate  
per employee.  
5a(ii). Qualified family leave wages. Enter the qualified  
taxable (subject to social security tax) family leave wages  
you paid this quarter of 2023 to your employees for leave  
taken after March 31, 2020, and before April 1, 2021.  
Qualified family leave wages for leave taken after March  
31, 2020, and before April 1, 2021, aren't subject to the  
employer share of social security tax; therefore, the tax  
rate on these wages is 6.2% (0.062). Stop paying social  
security tax on and entering an employee's wages on  
line 5a(ii) when the employee's taxable wages, including  
wages reported on line 5a, qualified sick leave wages  
reported on line 5a(i), qualified family leave wages  
reported on line 5a(ii), and tips, reach $160,200 for the  
year. See the instructions for line 5c for reporting  
Medicare tax on qualified family leave wages, including  
the portion above the social security wage base.  
For purposes of the credit for qualified sick and family  
leave wages, qualified family leave wages are wages for  
social security and Medicare tax purposes, determined  
without regard to the exclusions from the definition of  
employment under sections 3121(b)(1)–(22), that an  
employer pays that otherwise meet the requirements of  
the Expanded FMLA, as enacted under the FFCRA and  
amended by the COVID-related Tax Relief Act of 2020.  
However, don't include any wages otherwise excluded  
under section 3121(b) when reporting qualified family  
leave wages on lines 5a(ii), 5c, and, if applicable, 5d. See  
the instructions for line 11b for information about the credit  
for qualified sick and family leave wages for leave taken  
after March 31, 2020, and before April 1, 2021.  
For more information about qualified family leave  
wages, go to IRS.gov/PLC.  
5a(i). Qualified sick leave wages. Enter the qualified  
taxable (subject to social security tax) sick leave wages  
you paid this quarter of 2023 to your employees for leave  
taken after March 31, 2020, and before April 1, 2021.  
Qualified sick leave wages for leave taken after March 31,  
2020, and before April 1, 2021, aren't subject to the  
employer share of social security tax; therefore, the tax  
rate on these wages is 6.2% (0.062). Stop paying social  
security tax on and entering an employee's wages on  
line 5a(i) when the employee's taxable wages, including  
wages reported on line 5a, qualified sick leave wages  
reported on line 5a(i), qualified family leave wages  
reported on line 5a(ii), and tips, reach $160,200 for the  
year. See the instructions for line 5c for reporting  
line 5a(ii) (column 1)  
xꢀꢀꢀꢀ0.062  
line 5a(ii) (column 2)  
5b. Taxable social security tips. Enter all tips your  
employees reported to you during the quarter until the  
total of the tips and taxable wages, including wages  
reported on line 5a, qualified sick leave wages reported  
on line 5a(i), and qualified family leave wages reported on  
line 5a(ii), for an employee reach $160,200 for the year.  
Include all tips your employee reported to you even if you  
were unable to withhold the employee tax of 6.2%. You  
will reduce your total taxes by the amount of any  
Medicare tax on qualified sick leave wages, including the  
portion above the social security wage base.  
For purposes of the credit for qualified sick and family  
leave wages, qualified sick leave wages are wages for  
social security and Medicare tax purposes, determined  
without regard to the exclusions from the definition of  
employment under sections 3121(b)(1)–(22), that an  
employer pays that otherwise meet the requirements of  
the EPSLA, as enacted under the FFCRA and amended  
by the COVID-related Tax Relief Act of 2020. However,  
don't include any wages otherwise excluded under  
section 3121(b) when reporting qualified sick leave wages  
on lines 5a(i), 5c, and, if applicable, 5d. See the  
uncollected employee share of social security and  
Medicare taxes on tips later on line 9; see Current  
insurance, later. Don't include service charges on line 5b.  
For details about the difference between tips and service  
charges, see Rev. Rul. 2012-18, 2012-26 I.R.B. 1032,  
Your employee must report cash tips to you by the 10th  
day of the month after the month the tips are received.  
Cash tips include tips paid by cash, check, debit card, and  
credit card. The report should include charged tips (for  
example, credit and debit card charges) you paid over to  
the employee for charge customers, tips the employee  
received directly from customers, and tips received from  
other employees under any tip-sharing arrangement. Both  
directly and indirectly tipped employees must report tips to  
you. No report is required for months when tips are less  
than $20. Employees may use Form 4070 (available only  
instructions for line 11b for information about the credit for  
qualified sick and family leave wages for leave taken after  
March 31, 2020, and before April 1, 2021.  
line 5a(i) (column 1)  
xꢀꢀꢀꢀ0.062  
line 5a(i) (column 2)  
Instructions for Form 941-SS (Rev. 3-2023)  
-11-  
     
in Pub. 1244) or submit a written statement or electronic  
tip record.  
line 5d (column 1)  
x ꢀꢀꢀꢀ0.009  
Don't include allocated tips on this line. Instead, report  
them on Form 8027. Allocated tips aren't reportable on  
Form 941-SS and aren't subject to withholding of social  
security or Medicare taxes.  
line 5d (column 2)  
5e. Total social security and Medicare taxes. Add the  
column 2 amounts on lines 5a–5d. Enter the result on  
line 5e.  
line 5b (column 1)  
xꢀꢀ 0.124  
line 5b (column 2)  
5f. Section 3121(q) Notice and Demand—Tax  
Due on Unreported Tips  
Enter the tax due from your Section 3121(q) Notice and  
Demand on line 5f. The IRS issues a Section 3121(q)  
Notice and Demand to advise an employer of the amount  
of tips received by employees who failed to report or  
underreported tips to the employer. An employer isn't  
liable for the employer share of the social security and  
Medicare taxes on unreported tips until notice and  
demand for the taxes is made to the employer by the IRS  
in a Section 3121(q) Notice and Demand. The tax due  
may have been determined from tips reported to the IRS  
on employees' Forms 4137, Social Security and Medicare  
Tax on Unreported Tip Income, or other tips that weren't  
reported to their employer as determined by the IRS  
during an examination. For additional information, see  
5c. Taxable Medicare wages & tips. Enter all wages,  
including qualified sick leave wages paid this quarter of  
2023, and qualified family leave wages paid this quarter of  
2023; tips; sick pay; and taxable fringe benefits that are  
subject to Medicare tax. Unlike social security wages,  
there is no limit on the amount of wages subject to  
Medicare tax.  
The rate of Medicare tax is 1.45% (0.0145) each for the  
employer and employee or 2.9% (0.029) for both. Include  
all tips your employees reported during the quarter, even if  
you were unable to withhold the employee tax of 1.45%.  
line 5c (column 1)  
x ꢀꢀ0.029  
line 5c (column 2)  
Deposit the tax within the time period required under  
your deposit schedule to avoid any possible deposit  
penalty. The tax is treated as accumulated by the  
employer on the “Date of Notice and Demand” as printed  
on the Section 3121(q) Notice and Demand. The  
employer must include this amount on the appropriate line  
of the record of federal tax liability (Part 2 of Form 941-SS  
for a monthly schedule depositor or Schedule B (Form  
941) for a semiweekly schedule depositor).  
For more information on tips, see section 5 of Pub. 80.  
See the instructions for line 8 for an adjustment that you  
may need to make on Form 941-SS for sick pay.  
5d. Taxable wages & tips subject to Additional Medi-  
care Tax withholding. Enter all wages, including  
qualified sick leave wages paid this quarter of 2023, and  
qualified family leave wages paid this quarter of 2023;  
tips; sick pay; and taxable fringe benefits that are subject  
to Additional Medicare Tax withholding. You’re required to  
begin withholding Additional Medicare Tax in the pay  
period in which you pay wages in excess of $200,000 to  
an employee and continue to withhold it each pay period  
until the end of the calendar year. Additional Medicare  
Tax is only imposed on the employee. There is no  
employer share of Additional Medicare Tax. All wages that  
are subject to Medicare tax are subject to Additional  
Medicare Tax withholding if paid in excess of the  
$200,000 withholding threshold.  
For more information on what wages are subject to  
Medicare tax, see the chart, Special Rules for Various  
Types of Employment and Payments, in section 12 of  
Pub. 80. For more information on Additional Medicare  
Tax, go to IRS.gov/ADMTfaqs. See the instructions for  
line 8 for an adjustment that you may need to make on  
Form 941-SS for sick pay.  
6. Total Taxes Before Adjustments  
Add the total social security and Medicare taxes before  
adjustments (line 5e) and any tax due under a Section  
3121(q) Notice and Demand (line 5f). Enter the result on  
line 6.  
7–9. Tax Adjustments  
Enter tax amounts on lines 7–9 that result from current  
quarter adjustments. Use a minus sign (if possible) to  
show an adjustment that decreases the total taxes shown  
on line 6 instead of parentheses. Doing so enhances the  
accuracy of our scanning software. For example, enter  
“-10.59” instead of “(10.59).” However, if your software  
only allows for parentheses in entering negative amounts,  
you may use them.  
Current quarter's adjustments. In certain cases, you  
must adjust the amounts you entered as social security  
and Medicare taxes in column 2 of lines 5a–5d to figure  
your correct tax liability for this quarter's Form 941-SS.  
See section 9 of Pub. 80.  
7. Current quarter's adjustment for fractions of  
cents. Enter adjustments for fractions of cents (due to  
rounding) relating to the employee share of social security  
and Medicare taxes withheld. The employee share of  
amounts shown in column 2 of lines 5a–5d may differ  
slightly from amounts actually withheld from employees'  
Once wages and tips exceed the $200,000 withholding  
threshold, include all tips your employees reported during  
the quarter, even if you were unable to withhold the  
employee tax of 0.9%.  
-12-  
Instructions for Form 941-SS (Rev. 3-2023)  
 
pay due to the rounding of social security and Medicare  
taxes based on statutory rates. This adjustment may be a  
positive or negative adjustment.  
Form 941-SS and these instructions use the terms  
“nonrefundable” and “refundable” when  
TIP  
discussing credits. The term “nonrefundable”  
means the portion of the credit which is limited by law to  
the amount of certain taxes. The term “refundable” means  
the portion of the credit which is in excess of those taxes.  
8. Current quarter's adjustment for sick pay. If  
your third-party payer of sick pay that isn't your agent (for  
example, an insurance company) transfers the liability for  
the employer share of the social security and Medicare  
taxes to you, enter a negative adjustment on line 8 for the  
employee share of social security and Medicare taxes that  
were withheld and deposited by your third-party sick pay  
payer on the sick pay. If you’re the third-party sick pay  
payer and you transferred the liability for the employer  
share of the social security and Medicare taxes to the  
employer, enter a negative adjustment on line 8 for any  
employer share of these taxes required to be paid by the  
employer. The sick pay should be included on line 5a,  
line 5c, and, if the withholding threshold is met, line 5d.  
11b. Nonrefundable Portion of Credit for  
Qualified Sick and Family Leave Wages for  
Leave Taken After March 31, 2020, and Before  
April 1, 2021  
Complete line 11b only if qualified sick leave  
wages and/or qualified family leave wages were  
!
CAUTION  
paid this quarter of 2023 for leave taken after  
March 31, 2020, and before April 1, 2021.  
Certain private employers with fewer than 500  
No adjustment is reported on line 8 for sick pay that is  
paid through a third party as an employer’s agent. An  
employer’s agent bears no insurance risk and is  
reimbursed on a cost-plus-fee basis for payment of sick  
pay and similar amounts. If an employer uses an agent to  
pay sick pay, the employer reports the wages on line 5a,  
line 5c, and, if the withholding threshold is met, line 5d,  
unless the employer has an agency agreement with the  
third-party payer that requires the third-party payer to do  
the collecting, reporting, and/or paying or depositing  
employment taxes on the sick pay. See section 6 of Pub.  
15-A for more information about sick pay reporting.  
9. Current quarter's adjustments for tips and  
group-term life insurance. Enter a negative adjustment  
for:  
employees that provide paid sick leave under the EPSLA  
and/or provide paid family leave under the Expanded  
FMLA are eligible to claim the credit for qualified sick and  
family leave wages for leave taken after March 31, 2020,  
and before April 1, 2021. For purposes of this credit,  
qualified sick leave wages and qualified family leave  
wages are wages for social security and Medicare tax  
purposes, determined without regard to the exclusions  
from the definition of employment under sections 3121(b)  
(1)–(22), that an employer pays that otherwise meet the  
requirements of the EPSLA or Expanded FMLA. Enter the  
nonrefundable portion of the credit for qualified sick and  
family leave wages from Worksheet 1, Step 2, line 2j. The  
credit for qualified sick and family leave wages consists of  
the qualified sick leave wages, the qualified family leave  
wages, the qualified health plan expenses allocable to  
those wages, and the employer share of Medicare tax  
allocable to those wages. The nonrefundable portion of  
the credit is limited to the employer share of social  
security tax reported on Form 941-SS, lines 5a and 5b,  
after that share is first reduced by any credit claimed  
against the employer share of social security tax on Form  
8974 for the qualified small business payroll tax credit for  
increasing research activities, any credit to be claimed on  
Form 5884-C for the work opportunity credit for qualified  
tax-exempt organizations hiring qualified veterans, and/or  
any credit to be claimed on Form 5884-D for the disaster  
credit for qualified tax-exempt organizations.  
Any uncollected employee share of social security and  
Medicare taxes on tips, and  
The uncollected employee share of social security and  
Medicare taxes on group-term life insurance premiums  
paid for former employees.  
See the General Instructions for Forms W-2 and W-3  
for information on how to report the uncollected employee  
share of social security and Medicare taxes on tips and  
group-term life insurance on Form W-2.  
Prior quarter's adjustments. If you need to correct any  
adjustment reported on a previously filed Form 941-SS,  
complete and file Form 941-X. Form 941-X is an adjusted  
return or claim for refund and is filed separately from Form  
941-SS. See section 9 of Pub. 80.  
If you're a third-party payer of sick pay that isn't an  
agent (for example, an insurance company) and  
!
10. Total Taxes After Adjustments  
Combine the amounts shown on lines 6–9 and enter the  
result on line 10.  
CAUTION  
you're claiming the credit for qualified sick and  
family leave wages for amounts paid to your own  
employees, the amount of the employer share of social  
security tax reported on line 5a must be reduced by any  
adjustment you make on line 8 for the employer share of  
social security tax transferred to your client. If you  
received a Section 3121(q) Notice and Demand for tax  
due on unreported tips (Letter 3263 or Letter 4520) during  
the quarter, you report the amount for the employer share  
of social security tax and Medicare tax on Form 941-SS,  
line 5f. Letter 3263 or Letter 4520 includes an attachment  
that shows the employer share of social security tax. This  
amount of the employer share of social security tax can  
also be reduced by the nonrefundable portion of the  
credit. See Worksheet 1 to figure your credit.  
11a. Qualified Small Business Payroll Tax Credit  
for Increasing Research Activities  
Enter the amount of the credit from Form 8974, line 12 or,  
if applicable, line 17.  
If you enter an amount on line 11a, you must  
attach Form 8974.  
!
CAUTION  
Instructions for Form 941-SS (Rev. 3-2023)  
-13-  
     
Any credit in excess of the remaining amount of the  
employer share of social security tax is refundable and  
reported on Form 941-SS, line 13c. For more information  
on the credit for qualified sick and family leave wages, go  
Qualified sick leave wages and/or qualified family leave  
wages;  
contributions, subject to the qualified leave wage  
limitations, allocable to the qualified sick and family leave  
wages;  
Qualified health plan expenses allocable to qualified  
sick leave and family leave wages. The credit for  
qualified sick leave wages and qualified family leave  
wages is increased to cover the qualified health plan  
expenses that are properly allocable to the qualified leave  
wages for which the credit is allowed. These qualified  
health plan expenses are amounts paid or incurred by the  
employer to provide and maintain a group health plan but  
only to the extent such amounts are excluded from the  
employees’ income as coverage under an accident or  
health plan. The amount of qualified health plan expenses  
generally includes both the portion of the cost paid by the  
employer and the portion of the cost paid by the employee  
with pre-tax salary reduction contributions. However,  
qualified health plan expenses don’t include amounts that  
the employee paid for with after-tax contributions. For  
more information, go to IRS.gov/PLC.  
contributions, subject to the qualified leave wage  
limitations, allocable to the qualified sick and family leave  
wages; and  
Employer share of social security and Medicare tax  
allocable to the qualified sick and family leave wages.  
The nonrefundable portion of the credit is limited to the  
employer share of Medicare tax reported on Form  
941-SS, line 5c, after that share is first reduced by any  
credit claimed against the employer share of Medicare tax  
on Form 8974 for the qualified small business payroll tax  
credit for increasing research activities. You can’t claim  
the credit for leave taken after March 31, 2021, and before  
October 1, 2021, if, during the applicable quarter in which  
the qualified sick or family leave wages were paid, you  
made qualified sick or family leave wages available in a  
manner that discriminates in favor of highly compensated  
employees, full-time employees, or employees on the  
basis of employment tenure. See Highly compensated  
employee, later, for the definition.  
You must include the full amount (both the  
nonrefundable and refundable portions) of the  
credit for qualified sick and family leave wages in  
TIP  
your gross income for the tax year that includes the last  
day of any calendar quarter in which a credit is allowed.  
11d. Nonrefundable Portion of Credit for  
Qualified Sick and Family Leave Wages for  
Leave Taken After March 31, 2021, and Before  
October 1, 2021  
For leave taken after March 31, 2021, and before  
October 1, 2021, the credit for qualified sick and family  
leave wages is reduced by the amount of the credit  
allowed under section 41 (for the credit for increasing  
research activities) with respect to wages taken into  
account for determining the credit for qualified sick and  
family leave wages; and any wages taken into account in  
determining the credit for qualified sick and family leave  
wages can't be taken into account as wages for purposes  
of the credits under sections 45A, 45P, 45S, and 51. For  
leave taken after March 31, 2021, and before October 1,  
2021, qualified wages also don't include wages that were  
used as payroll costs in connection with a Shuttered  
Venue Operator Grant under section 324 of the Economic  
Aid to Hard-Hit Small Businesses, Nonprofits, and Venues  
Act; or a restaurant revitalization grant under section 5003  
of the ARP. Employers can receive both a Small Business  
Interruption Loan under the Paycheck Protection Program  
(PPP) and the credit for qualified sick and family leave  
wages; however, employers can't receive both loan  
forgiveness and a credit for the same wages. The same  
wages can’t be treated as both qualified sick leave wages  
and qualified family leave wages.  
Complete line 11d only if qualified sick leave  
wages and/or qualified family leave wages were  
!
CAUTION  
paid this quarter of 2023 for leave taken after  
March 31, 2021, and before October 1, 2021.  
Employers with fewer than 500 employees and certain  
governmental employers without regard to number of  
employees (except for the federal government and its  
agencies and instrumentalities unless described in  
section 501(c)(1)) are entitled to a credit if they provide  
paid sick leave to employees that otherwise meets the  
requirements of the EPSLA, as amended for purposes of  
the ARP, and/or provide paid family leave to employees  
that otherwise meets the requirements under the  
Expanded FMLA, as amended for purposes of the ARP,  
for qualified sick and family leave wages for leave taken  
after March 31, 2021, and before October 1, 2021. For  
purposes of this credit, qualified sick leave wages and  
qualified family leave wages are wages for social security  
and Medicare tax purposes, determined without regard to  
the exclusions from the definition of employment under  
sections 3121(b)(1)–(22), that an employer pays that  
otherwise meet the requirements of the EPSLA or  
Expanded FMLA, as enacted under the FFCRA and  
amended for purposes of the ARP. Enter the  
If you're a third-party payer of sick pay that isn't an  
agent (for example, an insurance company) and  
!
CAUTION  
you're claiming the credit for qualified sick and  
family leave wages for amounts paid to your own  
employees, the amount of the employer share of  
Medicare tax reported on line 5c must be reduced by any  
adjustment you make on line 8 for the employer share of  
Medicare tax transferred to your client. If you received a  
Section 3121(q) Notice and Demand for tax due on  
unreported tips (Letter 3263 or Letter 4520) during the  
quarter, you report the amount for the employer share of  
nonrefundable portion of the credit for qualified sick and  
family leave wages from Worksheet 2, Step 2, line 2p.  
The credit for qualified sick and family leave wages  
consists of the:  
-14-  
Instructions for Form 941-SS (Rev. 3-2023)  
   
social security tax and Medicare tax on Form 941-SS,  
line 5f. Letter 3263 or Letter 4520 includes an attachment  
that shows the employer share of Medicare tax. This  
amount of the employer share of Medicare tax can also be  
reduced by the nonrefundable portion of the credit. See  
Worksheet 2 to figure your credit.  
is an apprenticeship registered under the National  
Apprenticeship Act of August 16, 1937, and meets the  
standards of Federal Regulations under subpart A of Part  
29 and Part 30 of title 29;  
Made based on an apprenticeship program contribution  
rate; and  
Required to be made under the terms of a collective  
bargaining agreement in effect for the quarter.  
Apprenticeship program contribution rate. The  
apprenticeship program contribution rate is the  
contribution rate that the employer is obligated to pay  
under the terms of a collective bargaining agreement for  
benefits under a registered apprenticeship program, as  
the rate is applied to contribution base units, as defined by  
section 4001(a)(11) of ERISA.  
Any credit in excess of the remaining amount of the  
employer share of Medicare tax is refundable and  
reported on Form 941-SS, line 13e. For more information  
on the credit for qualified sick and family leave wages, go  
Qualified health plan expenses allocable to qualified  
sick leave and family leave wages. The credit for  
qualified sick leave wages and qualified family leave  
wages is increased to cover the qualified health plan  
expenses that are properly allocable to the qualified leave  
wages for which the credit is allowed. These qualified  
health plan expenses are amounts paid or incurred by the  
employer to provide and maintain a group health plan but  
only to the extent such amounts are excluded from the  
employees' income as coverage under an accident or  
health plan. The amount of qualified health plan expenses  
generally includes both the portion of the cost paid by the  
employer and the portion of the cost paid by the employee  
with pre-tax salary reduction contributions. However,  
qualified health plan expenses don't include amounts that  
the employee paid for with after-tax contributions. For  
more information, go to IRS.gov/PLC.  
Allocation rules. The amount of collectively bargained  
apprenticeship program contributions allocated to  
qualified sick leave wages and/or qualified family leave  
wages in a quarter is the apprenticeship program  
contribution rate (expressed as an hourly rate) multiplied  
by the number of hours qualified sick leave wages and/or  
qualified family leave wages were provided to employees  
covered under the collective bargaining agreement during  
the quarter.  
Highly compensated employee. A highly compensated  
employee is an employee who meets either of the  
following tests.  
1. The employee was a 5% owner at any time during  
the year or the preceding year.  
Collectively bargained defined benefit pension plan  
contributions. For purposes of qualified sick and family  
leave wages, collectively bargained defined benefit  
pension plan contributions are contributions for a calendar  
quarter that are:  
2. The employee received more than $135,000 in pay  
for the preceding year.  
You can choose to ignore test (2) if the employee  
wasn’t also in the top 20% of employees when ranked by  
pay for the preceding year.  
Paid or incurred by an employer on behalf of its  
employees to a defined benefit plan, as defined in section  
414(j), which meets the requirements of section 401(a);  
11g. Total Nonrefundable Credits  
Add lines 11a, 11b, and 11d. Enter the total on line 11g.  
Made based on a pension contribution rate; and  
Required to be made under the terms of a collective  
12. Total Taxes After Adjustments and  
Nonrefundable Credits  
Subtract line 11g from line 10 and enter the result on  
line 12. The amount entered on line 12 can't be less than  
zero.  
bargaining agreement in effect for the quarter.  
Pension contribution rate. The pension contribution  
rate is the contribution rate that the employer is obligated  
to pay under the terms of a collective bargaining  
agreement to a defined benefit plan, as the rate is applied  
to contribution base units, as defined by section 4001(a)  
(11) of the Employee Retirement Income Security Act of  
1974 (ERISA).  
If line 12 is less than $2,500 or line 12 on the prior  
quarterly return was less than $2,500, and you didn't  
incur a $100,000 next-day deposit obligation during  
the current quarter. You may pay the amount with Form  
941-SS or you may deposit the amount. To avoid a  
penalty, you must pay any amount you owe in full with a  
timely filed return or you must deposit any amount you  
owe before the due date of the return. For more  
information on paying with a timely filed return, see the  
instructions for line 14, later.  
Allocation rules. The amount of collectively bargained  
defined benefit pension plan contributions allocated to  
qualified sick leave wages and/or qualified family leave  
wages in a quarter is the pension contribution rate  
(expressed as an hourly rate) multiplied by the number of  
hours qualified sick leave wages and/or qualified family  
leave wages were provided to employees covered under  
the collective bargaining agreement during the quarter.  
If line 12 is $2,500 or more and line 12 on the prior  
Collectively bargained apprenticeship program con-  
tributions. For purposes of qualified sick and family  
leave wages, collectively bargained apprenticeship  
program contributions are contributions for a calendar  
quarter that are:  
quarterly return was $2,500 or more, or if you  
incurred a $100,000 next-day deposit obligation  
during the current quarter. You must make required  
deposits according to your deposit schedule. See Notice  
2020-22 and Notice 2021-24 for information on reducing  
deposits for certain credits. The amount shown on line 12  
must equal the “Total liability for quarter” shown on line 16  
Paid or incurred by an employer on behalf of its  
employees to a registered apprenticeship program, which  
Instructions for Form 941-SS (Rev. 3-2023)  
-15-  
       
or the “Total liability for the quarter” shown on Schedule B  
(Form 941). For more information, see the line 16  
instructions, later.  
requirements of the EPSLA, as amended for purposes of  
the ARP, and/or provide paid family leave to employees  
that otherwise meets the requirements under the  
Expanded FMLA, as amended for purposes of the ARP,  
for leave taken after March 31, 2021, and before October  
1, 2021. Enter the refundable portion of the credit for  
qualified sick and family leave wages from Worksheet 2,  
Step 2, line 2q. The refundable portion of the credit is  
allowed after the employer share of Medicare tax is  
reduced to zero by nonrefundable credits that are applied  
against the employer share of Medicare tax.  
For more information and rules about federal tax  
deposits, see Depositing Your Taxes, earlier, and section  
8 of Pub. 80.  
If you’re a semiweekly schedule depositor, you  
must complete Schedule B (Form 941). If you fail  
!
CAUTION  
to complete and submit Schedule B (Form 941),  
the IRS may assess deposit penalties based on available  
information.  
13g. Total Deposits and Refundable Credits  
Add lines 13a, 13c, and 13e. Enter the total on line 13g.  
13a. Total Deposits for This Quarter  
Enter your deposits for this quarter, including any  
overpayment from a prior quarter that you applied to this  
return. Also include in the amount shown any  
14. Balance Due  
If line 12 is more than line 13g, enter the difference on  
line 14. Otherwise, see the instructions for line 15, later.  
overpayment that you applied from filing Form 941-X,  
944-X, or 944-X (SP) in the current quarter. Don't include  
any amount that you didn't deposit because you reduced  
your deposits in anticipation of the credit for qualified sick  
and family leave wages, as discussed in Notice 2020-22  
Never make an entry on both lines 14 and 15.  
You don't have to pay if line 14 is under $1. Generally,  
you should have a balance due only if your total taxes  
after adjustments and nonrefundable credits (line 12) for  
the current quarter or prior quarter are less than $2,500,  
and you didn't incur a $100,000 next-day deposit  
obligation during the current quarter. However, see  
section 8 of Pub. 80 for information about payments made  
under the accuracy of deposits rule.  
13c. Refundable Portion of Credit for Qualified  
Sick and Family Leave Wages for Leave Taken  
After March 31, 2020, and Before April 1, 2021  
Complete line 13c only if qualified sick leave  
If you were required to make federal tax deposits, pay  
the amount shown on line 14 by EFT. If you weren't  
required to make federal tax deposits (see Must You  
Deposit Your Taxes, earlier) or you're a monthly schedule  
depositor making a payment under the accuracy of  
deposits rule, you may pay the amount shown on line 14  
by EFT, credit card, debit card, check, money order, or  
EFW. For more information on electronic payment  
options, go to IRS.gov/Payments.  
wages and/or qualified family leave wages were  
!
CAUTION  
paid this quarter of 2023 for leave taken after  
March 31, 2020, and before April 1, 2021.  
Certain private employers with fewer than 500  
employees that provide paid sick leave under the EPSLA  
and/or provide paid family leave under the Expanded  
FMLA are eligible to claim the credit for qualified sick and  
family leave wages. Enter the refundable portion of the  
credit for qualified sick and family leave wages from  
Worksheet 1, Step 2, line 2k. The credit for qualified sick  
and family leave wages consists of the qualified sick leave  
wages, the qualified family leave wages, the qualified  
health plan expenses allocable to those wages, and the  
employer share of Medicare tax allocable to those wages.  
The refundable portion of the credit is allowed after the  
employer share of social security tax is reduced to zero by  
nonrefundable credits that are applied against the  
employer share of social security tax.  
If you pay by EFT, credit card, or debit card, file your  
return using the Without a payment address under Where  
Should You File, earlier, and don't file Form 941-V(SS),  
Payment Voucher.  
If you pay by check or money order, make it payable to  
“United States Treasury.” Enter your EIN, “Form 941-SS,”  
and the tax period (“1st Quarter 2023,” “2nd Quarter  
2023,” “3rd Quarter 2023,” or “4th Quarter 2023”) on your  
check or money order. Complete Form 941-V(SS) and  
enclose it with Form 941-SS.  
13e. Refundable Portion of Credit for Qualified  
Sick and Family Leave Wages for Leave Taken  
After March 31, 2021, and Before October 1,  
2021  
If line 12 is $2,500 or more on both your prior and  
current quarter Form 941-SS, and you’ve deposited all  
taxes when due, the balance due on line 14 should be  
zero.  
Complete line 13e only if qualified sick leave  
If you’re required to make deposits and instead  
wages and/or qualified family leave wages were  
!
CAUTION  
pay the taxes with Form 941-SS, you may be  
paid this quarter of 2023 for leave taken after  
!
CAUTION  
subject to a penalty. See Must You Deposit Your  
March 31, 2021, and before October 1, 2021.  
Taxes, earlier.  
Employers with fewer than 500 employees and certain  
governmental employers without regard to number of  
employees (except for the federal government and its  
agencies and instrumentalities unless described in  
section 501(c)(1)) are entitled to a credit if they provide  
paid sick leave to employees that otherwise meets the  
What if you can't pay in full? If you can't pay the full  
amount of tax you owe, you can apply for an installment  
agreement online. You can apply for an installment  
agreement online if:  
You can't pay the full amount shown on line 14,  
-16-  
Instructions for Form 941-SS (Rev. 3-2023)  
       
The total amount you owe is $25,000 or less, and  
You can pay the liability in full in 24 months.  
paid wages to your employees, not the date payroll  
liabilities were accrued or deposits were made. Add the  
amounts for each month. Enter the result in the “Total  
liability for quarter” box.  
To apply using the Online Payment Agreement  
Application, go to IRS.gov/OPA.  
Note that your total tax liability for the quarter must  
equal your total taxes shown on line 12. If it doesn't, your  
tax deposits and payments may not be counted as timely.  
Don't reduce your total liability reported on line 16 by the  
refundable portion of the credit for qualified sick and  
family leave wages. Don't change your tax liability on  
line 16 by adjustments reported on any Forms 941-X.  
You’re a monthly schedule depositor for the calendar  
year if the amount of your Form 941-SS taxes reported for  
the lookback period is $50,000 or less. The lookback  
period is the 4 consecutive quarters ending on June 30 of  
the prior year. For 2023, the lookback period begins July  
1, 2021, and ends June 30, 2022. For details on the  
deposit rules, see section 8 of Pub. 80. If you filed Form  
944 in either 2021 or 2022, your lookback period is the  
2021 calendar year.  
Under an installment agreement, you can pay what you  
owe in monthly installments. There are certain conditions  
you must meet to enter into and maintain an installment  
agreement, such as paying the liability within 24 months,  
and making all required deposits and timely filing tax  
returns during the length of the agreement.  
If your installment agreement is accepted, you will be  
charged a fee and you will be subject to penalties and  
interest on the amount of tax not paid by the due date of  
the return.  
15. Overpayment  
If line 13g is more than line 12, enter the difference on  
line 15.  
Never make an entry on both lines 14 and 15.  
If you deposited more than the correct amount for the  
quarter, you can choose to have the IRS either refund the  
overpayment or apply it to your next return. Check only  
one box on line 15. If you don't check either box or if you  
check both boxes, we will generally apply the  
The amounts entered on line 16 are a summary of  
your monthly tax liability, not a summary of  
!
CAUTION  
deposits you made. If you don't properly report  
your liabilities when required or if you’re a semiweekly  
schedule depositor and enter your liabilities on line 16  
instead of on Schedule B (Form 941), you may be  
assessed an “averaged” FTD penalty. See Deposit  
Penalties in section 8 of Pub. 80 for more information.  
overpayment to your next return. Regardless of any boxes  
you check or don’t check on line 15, we may apply your  
overpayment to any past due tax account that is shown in  
our records under your EIN.  
Reporting adjustments from lines 7–9 on line 16. If  
your net adjustment during a month is negative and it  
exceeds your total tax liability for the month, don't enter a  
negative amount for the month. Instead, enter "-0-" for the  
month and carry over the unused portion of the  
adjustment to the next month.  
Semiweekly schedule depositor. If you reported more  
than $50,000 of taxes for the lookback period, you’re a  
semiweekly schedule depositor. Check the third box on  
line 16.  
If line 15 is under $1, we will send a refund or apply it to  
your next return only if you ask us in writing to do so.  
Part 2: Tell Us About Your Deposit  
Schedule and Tax Liability for This  
Quarter  
16. Tax Liability for the Quarter  
Check one of the boxes on line 16. Follow the instructions  
for each box to determine if you need to enter your  
monthly tax liability on Form 941-SS or your daily tax  
liability on Schedule B (Form 941).  
You must complete Schedule B (Form 941) and submit  
it with your Form 941-SS. Don't file Schedule B (Form  
941) with your Form 941-SS if you’re a monthly schedule  
depositor.  
De minimis exception. If line 12 is less than $2,500 or  
line 12 on the prior quarterly return was less than $2,500,  
and you didn't incur a $100,000 next-day deposit  
obligation during the current quarter, check the first box  
on line 16 and go to Part 3.  
Don't change your tax liability on Schedule B (Form  
941) by adjustments reported on any Forms 941-X.  
Adjusting tax liability for nonrefundable credits  
claimed on lines 11a, 11b, and 11d. Monthly schedule  
depositors and semiweekly schedule depositors must  
account for nonrefundable credits claimed on lines 11a,  
11b, and 11d when reporting their tax liabilities on line 16  
or Schedule B (Form 941). The total tax liability for the  
quarter must equal the amount reported on line 12. Failure  
to account for the nonrefundable credits on line 16 or  
Schedule B (Form 941) may cause line 16 or Schedule B  
(Form 941) to report more than the total tax liability  
reported on line 12. Don't reduce your monthly tax liability  
reported on line 16 or your daily tax liability reported on  
Schedule B (Form 941) below zero.  
If you meet the de minimis exception based on the  
prior quarter and line 12 for the current quarter is  
!
CAUTION  
$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 on line 16. If  
you’re a semiweekly schedule depositor, attach  
Schedule B (Form 941).  
Monthly schedule depositor. If you reported $50,000 or  
less in taxes during the lookback period, you’re a monthly  
schedule depositor unless the $100,000 Next-Day  
Deposit Rule discussed in section 8 of Pub. 80 applies.  
Check the second box on line 16 and enter your tax  
liability for each month in the quarter. Enter your tax  
liabilities in the month that corresponds to the dates you  
Qualified small business payroll tax credit for  
increasing research activities (line 11a). Beginning  
with the first quarter of 2023, the qualified small business  
Instructions for Form 941-SS (Rev. 3-2023)  
-17-  
       
payroll tax credit for increasing research activities is first  
used to reduce the employer share of social security tax  
(up to $250,000) for the quarter and any remaining credit  
is then used to reduce the employer share of Medicare tax  
for the quarter until it reaches zero. In completing line 16  
or Schedule B (Form 941), you take into account the  
payroll tax credit against the liability for the employer  
share of social security tax starting with the first payroll  
payment of the quarter that includes payments of wages  
subject to social security tax to your employees until you  
use up to $250,000 of credit against the employer share of  
social security tax and you then take into account any  
remaining payroll tax credit against the liability for the  
employer share of Medicare tax starting with the first  
payroll payment of the quarter that includes payments of  
wages subject to Medicare tax to employees. Consistent  
with the entries on line 16 or Schedule B (Form 941), the  
payroll tax credit should be taken into account in making  
deposits of employment tax. If any payroll tax credit is  
remaining at the end of the quarter that hasn’t been used  
completely because it exceeds $250,000 of the employer  
share of social security tax and the employer share of  
Medicare tax for the quarter, the excess credit may be  
carried forward to the succeeding quarter and allowed as  
a payroll tax credit for the succeeding quarter. The payroll  
tax credit may not be taken as a credit against income tax  
withholding, the employee share of social security tax, or  
the employee share of Medicare tax. Also, the remaining  
payroll tax credit may not be carried back and taken as a  
credit against wages paid from preceding quarters.  
remainder would be treated as a payroll tax credit against  
its share of social security tax (up to $250,000) and  
Medicare tax on wages paid in the fourth quarter. If the  
amount of the payroll tax credit remaining exceeded Rose  
Co.'s share of social security tax (up to $250,000) and  
Medicare tax on wages paid in the fourth quarter, it could  
be carried forward and treated as a payroll tax credit for  
the first quarter of 2024.  
Nonrefundable portion of credit for qualified sick  
and family leave wages for leave taken after March  
31, 2020, and before April 1, 2021 (line 11b). The  
nonrefundable portion of the credit for qualified sick and  
family leave wages paid this quarter of 2023 for leave  
taken after March 31, 2020, and before April 1, 2021, is  
limited to the employer share of social security tax on  
wages paid in the quarter that is remaining after that share  
is first reduced by any credit claimed against the employer  
share of social security tax on Form 8974, line 12, for the  
qualified small business payroll tax credit for increasing  
research activities; any credit to be claimed on Form  
5884-C, line 11, for the work opportunity credit for  
qualified tax-exempt organizations hiring qualified  
veterans; and/or any credit to be claimed on Form 5884-D  
for the disaster credit for qualified tax-exempt  
organizations. In completing line 16 or Schedule B (Form  
941), you take into account the entire quarter's  
nonrefundable portion of the credit for qualified sick and  
family leave wages against the liability for the first payroll  
payment of the quarter, but not below zero. Then reduce  
the liability for each successive payroll payment in the  
quarter until the nonrefundable portion of the credit is  
used. Any credit for qualified sick and family leave wages  
paid this quarter of 2023 for leave taken after March 31,  
2020, and before April 1, 2021, that is remaining at the  
end of the quarter because it exceeds the employer share  
of social security tax for the quarter is claimed on line 13c  
as a refundable credit. The refundable portion of the credit  
doesn’t reduce the liability reported on line 16 or  
Example. Rose Co. is an employer with a calendar tax  
year that filed its timely 2022 income tax return on April  
18, 2023. Rose Co. elected to take the qualified small  
business payroll tax credit for increasing research  
activities on Form 6765. The third quarter of 2023 is the  
first quarter that begins after Rose Co. filed the income tax  
return making the payroll tax credit election. Therefore,  
the payroll tax credit applies against Rose Co.'s share of  
social security tax (up to $250,000) and Medicare tax on  
wages paid to employees in the third quarter of 2023.  
Rose Co. is a semiweekly schedule depositor. Rose Co.  
completes Schedule B (Form 941) by reducing the  
amount of liability entered for the first payroll payment in  
the third quarter of 2023 that includes wages subject to  
social security tax by the lesser of (1) its share of social  
security tax (up to $250,000) on the wages, or (2) the  
available payroll tax credit. If the payroll tax credit elected  
is more than Rose Co.'s share of social security tax on the  
first payroll payment of the quarter, the excess payroll tax  
credit would be carried forward to succeeding payroll  
payments in the third quarter until it is used against up to  
$250,000 of Rose Co.'s share of social security tax for the  
quarter. If the amount of the payroll tax credit exceeds  
Rose Co.'s share of social security tax (up to $250,000)  
on wages paid to its employees in the third quarter, any  
remaining credit is used against Rose Co.'s share of  
Medicare tax on the first payroll payment of the quarter  
and then the excess payroll tax credit would be carried  
forward to succeeding payroll payments in the third  
quarter until it is used against Rose Co.'s share of  
Schedule B (Form 941).  
Example. Maple Co. is a semiweekly schedule  
depositor that pays employees every other Friday. In the  
first quarter of 2023, Maple Co. had pay dates of January  
6, January 20, February 3, February 17, March 3, March  
17, and March 31. Maple Co. paid qualified sick and  
family leave wages on January 6 and January 20 for leave  
taken after March 31, 2020, and before April 1, 2021. The  
nonrefundable portion of the credit for qualified sick and  
family leave wages for the quarter is $10,000. On  
Schedule B (Form 941), Maple Co. will use the $10,000 to  
reduce the liability for the January 6 pay date, but not  
below zero. If any nonrefundable portion of the credit  
remains, Maple Co. applies it to the liability for the  
January 20 pay date, then the February 3 pay date, and  
so forth until the entire $10,000 is used.  
Nonrefundable portion of credit for qualified sick  
and family leave wages for leave taken after March  
31, 2021, and before October 1, 2021 (line 11d). The  
nonrefundable portion of the credit for qualified sick and  
family leave wages paid this quarter of 2023 for leave  
taken after March 31, 2021, and before October 1, 2021,  
is limited to the employer share of Medicare tax on wages  
paid in the quarter that is remaining after that share is first  
reduced by any credit claimed against the employer share  
Medicare tax for the quarter. If Rose Co. still has credit  
remaining after reducing its share of social security tax (up  
to $250,000) and Medicare tax for the third quarter, the  
-18-  
Instructions for Form 941-SS (Rev. 3-2023)  
of Medicare tax on Form 8974, line 16, for the qualified  
small business payroll tax credit for increasing research  
activities. In completing line 16 or Schedule B (Form 941),  
you take into account the entire quarter's nonrefundable  
portion of the credit for qualified sick and family leave  
wages paid this quarter of 2023 against the liability for the  
first payroll payment of the quarter, but not below zero.  
Then reduce the liability for each successive payroll  
payment in the quarter until the nonrefundable portion of  
the credit is used. Any credit for qualified sick and family  
leave wages paid this quarter of 2023 for leave taken after  
March 31, 2021, and before October 1, 2021, that is  
remaining at the end of the quarter because it exceeds the  
employer share of Medicare tax for the quarter is claimed  
on line 13e as a refundable credit. The refundable portion  
of the credit doesn’t reduce the liability reported on line 16  
or Schedule B (Form 941).  
Complete lines 19 and 20 only if qualified health  
plan expenses allocable to qualified sick leave  
wages and/or qualified family leave wages were  
!
CAUTION  
paid this quarter of 2023 for leave taken after March 31,  
2020, and before April 1, 2021.  
19. Qualified Health Plan Expenses Allocable to  
Qualified Sick Leave Wages for Leave Taken  
After March 31, 2020, and Before April 1, 2021  
Enter the qualified health plan expenses allocable to  
qualified sick leave wages paid this quarter of 2023 for  
leave taken after March 31, 2020, and before April 1,  
2021. This amount is also entered on Worksheet 1, Step  
2, line 2b.  
20. Qualified Health Plan Expenses Allocable to  
Qualified Family Leave Wages for Leave Taken  
After March 31, 2020, and Before April 1, 2021  
Enter the qualified health plan expenses allocable to  
qualified family leave wages paid this quarter of 2023 for  
leave taken after March 31, 2020, and before April 1,  
2021. This amount is also entered on Worksheet 1, Step  
2, line 2f.  
You may reduce your deposits by the amount of  
the nonrefundable and refundable portions of the  
credit for qualified sick and family leave wages, as  
TIP  
discussed earlier under Reducing your deposits for the  
Part 3: Tell Us About Your Business  
In Part 3, answer only those questions that apply to your  
business. If the questions don't apply, leave them blank  
and go to Part 4.  
Complete lines 23, 24, and 25 only if qualified  
sick leave wages were paid this quarter of 2023  
!
CAUTION  
for leave taken after March 31, 2021, and before  
October 1, 2021.  
17. If Your Business Has Closed . . .  
23. Qualified Sick Leave Wages for Leave Taken  
After March 31, 2021, and Before October 1,  
2021  
If you go out of business or stop paying wages, you must  
file a final return. To tell the IRS that a particular Form  
941-SS is your final return, check the box on line 17 and  
enter the final date you paid wages in the space provided.  
For additional filing requirements, including information  
about attaching a statement to your final return, see If  
Enter the qualified sick leave wages you paid this quarter  
of 2023 to your employees for leave taken after March 31,  
2021, and before October 1, 2021, including any qualified  
sick leave wages that were above the social security wage  
base and any qualified sick leave wages excluded from  
the definition of employment under sections 3121(b)(1)–  
(22). See the instructions for line 11d, earlier, for more  
information about qualified sick leave wages for leave  
taken after March 31, 2021, and before October 1, 2021.  
This amount is also entered on Worksheet 2, Step 2,  
line 2a.  
18. If You’re a Seasonal Employer . . .  
If you hire employees seasonally—such as for summer or  
winter only—check the box on line 18. Checking the box  
tells the IRS not to expect four Forms 941-SS from you  
throughout the year because you haven't paid wages  
regularly.  
Generally, we won't ask about unfiled returns if at least  
one taxable return is filed each year. However, you must  
check the box on line 18 on every Form 941-SS you file.  
Otherwise, the IRS will expect a return to be filed for each  
quarter.  
24. Qualified Health Plan Expenses Allocable to  
Qualified Sick Leave Wages Reported on  
Line 23  
Enter the qualified health plan expenses allocable to  
qualified sick leave wages paid this quarter of 2023 for  
leave taken after March 31, 2021, and before October 1,  
2021. This amount is also entered on Worksheet 2, Step  
2, line 2b.  
Also, when you complete Form 941-SS, be sure to  
check the box on the top of the form that corresponds to  
the quarter reported.  
The amounts entered on lines 19 through 28 are  
25. Amounts Under Certain Collectively  
Bargained Agreements Allocable to Qualified  
Sick Leave Wages Reported on Line 23  
amounts that you use on the worksheets at the  
end of these instructions to figure certain credits.  
TIP  
If you’re claiming these credits, you must enter the  
applicable amounts.  
qualified sick leave wages paid this quarter of 2023 for  
leave taken after March 31, 2021, and before October 1,  
Instructions for Form 941-SS (Rev. 3-2023)  
-19-  
           
2021. This amount is also entered on Worksheet 2, Step  
2, line 2c.  
You’re not authorizing your designee to bind you to  
anything (including additional tax liability) or to otherwise  
represent you before the IRS. If you want to expand your  
designee's authorization, see Pub. 947.  
The authorization will automatically expire 1 year from  
the due date (without regard to extensions) for filing your  
Form 941-SS. If you or your designee wants to terminate  
the authorization, write to the IRS office for your location  
using the Without a payment address under Where  
Should You File, earlier.  
Complete lines 26, 27, and 28 only if qualified  
family leave wages were paid this quarter of 2023  
!
CAUTION  
for leave taken after March 31, 2021, and before  
October 1, 2021.  
26. Qualified Family Leave Wages for Leave  
Taken After March 31, 2021, and Before October  
1, 2021  
Part 5: Sign Here (Approved Roles)  
Complete all information and sign Form 941-SS. The  
following persons are authorized to sign the return for  
each type of business entity.  
Enter the qualified family leave wages you paid this  
quarter of 2023 to your employees for leave taken after  
March 31, 2021, and before October 1, 2021, including  
any qualified family leave wages that were above the  
social security wage base and any qualified family leave  
wages excluded from the definition of employment under  
sections 3121(b)(1)–(22). See the instructions for line 11d,  
earlier, for more information about qualified family leave  
wages for leave taken after March 31, 2021, and before  
October 1, 2021. This amount is also entered on  
Worksheet 2, Step 2, line 2g.  
Sole proprietorship—The individual who owns the  
business.  
Corporation (including a limited liability company  
(LLC) treated as a corporation)—The president, vice  
president, or other principal officer duly authorized to sign.  
Partnership (including an LLC treated as a  
partnership) or unincorporated organization—A  
responsible and duly authorized partner, member, or  
officer having knowledge of its affairs.  
27. Qualified Health Plan Expenses Allocable to  
Qualified Family Leave Wages Reported on  
Line 26  
Enter the qualified health plan expenses allocable to  
qualified family leave wages paid this quarter of 2023 for  
leave taken after March 31, 2021, and before October 1,  
2021. This amount is also entered on Worksheet 2, Step  
2, line 2h.  
Single-member LLC treated as a disregarded entity  
for federal income tax purposes—The owner of the  
LLC or a principal officer duly authorized to sign.  
Trust or estate—The fiduciary.  
Form 941-SS may be signed by a duly authorized  
agent of the taxpayer if a valid power of attorney has been  
filed.  
28. Amounts Under Certain Collectively  
Bargained Agreements Allocable to Qualified  
Family Leave Wages Reported on Line 26  
qualified family leave wages paid this quarter of 2023 for  
leave taken after March 31, 2021, and before October 1,  
2021. This amount is also entered on Worksheet 2, Step  
2, line 2i.  
Alternative signature method. Corporate officers or  
duly authorized agents may sign Form 941-SS by rubber  
stamp, mechanical device, or computer software  
program. For details and required documentation, see  
Rev. Proc. 2005-39, 2005-28 I.R.B. 82, available at  
Paid Preparer Use Only  
A paid preparer must sign Form 941-SS and provide the  
information in the Paid Preparer Use Only section of Part  
5 if the preparer was paid to prepare Form 941-SS and  
isn't an employee of the filing entity. Paid preparers must  
sign paper returns with a manual signature. The preparer  
must give you a copy of the return in addition to the copy  
to be filed with the IRS.  
Part 4: May We Speak With Your  
Third-Party Designee?  
If you want to allow an employee, a paid tax preparer, or  
another person to discuss your Form 941-SS with the IRS,  
check the “Yes” box in Part 4. Enter the name, phone  
number, and five-digit personal identification number  
(PIN) of the specific person to speak with—not the name  
of the firm that prepared your tax return. The designee  
may choose any five numbers as their PIN.  
If you’re a paid preparer, enter your Preparer Tax  
Identification Number (PTIN) in the space provided.  
Include your complete address. If you work for a firm,  
enter the firm's name and the EIN of the firm. You can  
apply for a PTIN online or by filing Form W-12. For more  
information about applying for a PTIN online, go to  
IRS.gov/PTIN. You can't use your PTIN in place of the EIN  
of the tax preparation firm.  
Generally, don't complete this section if you’re filing the  
return as a reporting agent and have a valid Form 8655 on  
file with the IRS. However, a reporting agent must  
complete this section if the reporting agent offered legal  
advice, for example, advising the client on determining  
whether its workers are employees or independent  
contractors for federal tax purposes.  
By checking “Yes,” you authorize the IRS to talk to the  
person you named (your designee) about any questions  
we may have while we process your return. You also  
authorize your designee to do all of the following.  
Give us any information that is missing from your return.  
Call us for information about processing your return.  
Respond to certain IRS notices that you’ve shared with  
your designee about math errors and return preparation.  
The IRS won't send notices to your designee.  
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Instructions for Form 941-SS (Rev. 3-2023)  
         
How To Get Forms, Instructions, and  
Publications From the IRS  
You can view, download, or print most of the  
forms, instructions, and publications you may  
need at IRS.gov/Forms. Otherwise, you can go to  
IRS.gov/OrderForms to place an order and have them  
mailed to you. The IRS will process your order for forms  
and publications as soon as possible. Don't resubmit  
requests you've already sent us. You can get forms and  
publications faster online.  
Instructions for Form 941-SS (Rev. 3-2023)  
-21-  
 
Worksheet 1. Credit for Qualified Sick and Family Leave Wages  
Paid This Quarter of 2023 for Leave Taken After March 31, 2020,  
and Before April 1, 2021  
Keep for Your Records  
Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which  
it is applicable, on a client-by-client basis.)  
If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2020, and before April 1,  
2021, complete Step 1 and Step 2. Caution: Use Worksheet 2 to figure the credit for qualified sick and family leave wages paid this quarter of 2023 for  
leave taken after March 31, 2021, and before October 1, 2021.  
Step 1.  
Determine the employer share of social security tax this quarter after it is reduced by any credit claimed on Form 8974  
and any credit to be claimed on Form 5884-C and/or Form 5884-D  
1a  
1b  
Enter the amount of social security tax from Form 941-SS, Part 1, line 5a,  
column 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a  
Enter the amount of social security tax from Form 941-SS, Part 1, line 5b,  
column 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b  
1c  
1d  
1e  
Add lines 1a and 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
Multiply line 1c by 50% (0.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1d  
1c  
If you’re 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  
on Form 941-SS, Part 1, line 8 (enter as a positive number) . . . . . . . . . . . . . . . . . . . . . . 1e  
1f  
1g  
Subtract line 1e from line 1d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount  
1f  
of the employer share of social security tax from the notice . . . . . . . . . . . . . . . . . . . . . . 1g  
1h  
1i  
1j  
1j(i)  
1k  
Employer share of social security tax. Add lines 1f and 1g . . . . . . . . . . . . . . . . . . . .  
1h  
Enter the amount from Form 8974, line 12, for this quarter . . . . . . . . . . . . . . . . . . . . . . .  
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 . . . . . . . . . . . . .  
1i  
1j  
1j(i)  
Total nonrefundable credits already used against the employer share of social  
security tax. Add lines 1i, 1j, and 1j(i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
1k  
1l  
1l  
Employer share of social security tax remaining. Subtract line 1k from line 1h . . . . . .  
Step 2.  
Figure the sick and family leave credit  
2a  
2a(i)  
Qualified sick leave wages reported on Form 941-SS, Part 1, line 5a(i), column 1 . . . . . .  
2a  
Qualified sick leave wages included on Form 941-SS, Part 1, line 5c, but not included on  
Form 941-SS, Part 1, line 5a(i), column 1, because the wages reported on that line were  
limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(i)  
2a(ii) Total qualified sick leave wages. Add lines 2a and 2a(i) . . . . . . . . . . . . . . . . . . . . . . . . .  
2a(iii) Qualified sick leave wages excluded from the definition of employment under sections  
2a(ii)  
3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(iii)  
2b  
2c  
Qualified health plan expenses allocable to qualified sick leave wages (Form 941-SS, Part  
3, line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b  
Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45%  
(0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c  
2d  
2e  
Credit for qualified sick leave wages. Add lines 2a(ii), 2a(iii), 2b, and 2c . . . . . . . . . . .  
2d  
Qualified family leave wages reported on Form 941-SS, Part 1, line 5a(ii),  
column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e  
2e(i)  
Qualified family leave wages included on Form 941-SS, Part 1, line 5c, but not included on  
Form 941-SS, Part 1, line 5a(ii), column 1, because the wages reported on that line were  
limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e(i)  
2e(ii) Total qualified family leave wages. Add lines 2e and 2e(i) . . . . . . . . . . . . . . . . . . . . . . .  
2e(iii) Qualified family leave wages excluded from the definition of employment under sections  
2e(ii)  
3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e(iii)  
2f  
Qualified health plan expenses allocable to qualified family leave wages (Form 941-SS,  
Part 3, line 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f  
2g  
Employer share of Medicare tax on qualified family leave wages. Multiply line 2e(ii) by  
1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g  
2h  
2i  
Credit for qualified family leave wages. Add lines 2e(ii), 2e(iii), 2f, and 2g . . . . . . . . .  
Credit for qualified sick and family leave wages. Add lines 2d and 2h . . . . . . . . . . . .  
2h  
2i  
2j  
Nonrefundable portion of credit for qualified sick and family leave wages for leave  
taken after March 31, 2020, and before April 1, 2021. Enter the smaller of line 1l or  
line 2i. Enter this amount on Form 941-SS, Part 1, line 11b . . . . . . . . . . . . . . . . . . . . . . .  
2j  
2k  
Refundable portion of credit for qualified sick and family leave wages for leave  
taken after March 31, 2020, and before April 1, 2021. Subtract line 2j from line 2i and  
enter this amount on Form 941-SS, Part 1, line 13c . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
2k  
-22-  
Instructions for Form 941-SS (Rev. 3-2023)  
 
Worksheet 2. Credit for Qualified Sick and Family Leave Wages  
Paid This Quarter of 2023 for Leave Taken After March 31, 2021,  
and Before October 1, 2021  
Keep for Your Records  
Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which  
it is applicable, on a client-by-client basis.)  
If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2021, and before October  
1, 2021, complete Step 1 and Step 2. Caution: Use Worksheet 1 to figure the credit for qualified sick and family leave wages paid this quarter of 2023  
for leave taken after March 31, 2020, and before April 1, 2021.  
Step 1.  
Determine the employer share of Medicare tax this quarter after it is reduced by any credit claimed on Form 8974  
1a  
1b  
1c  
Enter the amount of Medicare tax from Form 941-SS, Part 1, line 5c, column 2 . . . . . . . .  
Multiply line 1a by 50% (0.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
1a  
1b  
If you’re 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 on  
Form 941-SS, Part 1, line 8 (enter as a positive number) . . . . . . . . . . . . . . . . . . . . . . . . 1c  
Subtract line 1c from line 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1d  
1d  
1e  
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 . . . . . . . . . . . . . . . . . . . . . . . . . . 1e  
1f  
1g  
1h  
Employer share of Medicare tax. Add lines 1d and 1e . . . . . . . . . . . . . . . . . . . . . . . .  
Enter the amount from Form 8974, line 16, for this quarter . . . . . . . . . . . . . . . . . . . . . . .  
Employer share of Medicare tax remaining. Subtract line 1g from line 1f . . . . . . . . . .  
1f  
1g  
1h  
Step 2.  
Figure the sick and family leave credit  
2a  
Qualified sick leave wages for leave taken after March 31, 2021, and before October 1,  
2021 (Form 941-SS, Part 3, line 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a  
2a(i)  
Qualified sick leave wages included on Form 941-SS, Part 3, line 23, that were not  
included as wages reported on Form 941-SS, 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(i)  
2a(ii) Subtract line 2a(i) from line 2a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
2a(ii)  
2a(iii) Qualified sick leave wages included on Form 941-SS, Part 3, line 23, that were not  
included as wages reported on Form 941-SS, Part 1, line 5a, because the qualified sick  
leave wages were limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . 2a(iii)  
2a(iv) Subtract line 2a(iii) from line 2a(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
2a(iv)  
2b  
Qualified health plan expenses allocable to qualified sick leave wages for leave taken after  
March 31, 2021, and before October 1, 2021 (Form 941-SS, Part 3, line 24) . . . . . . . . . . 2b  
2c  
Amounts under certain collectively bargained agreements allocable to qualified sick leave  
wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941-SS,  
Part 3, line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c  
2d  
2e  
Employer share of social security tax on qualified sick leave wages. Multiply line 2a(iv) by  
6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d  
Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45%  
(0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e  
2f  
Credit for qualified sick leave wages. Add lines 2a, 2b, 2c, 2d, and 2e . . . . . . . . . . . .  
2f  
2g  
Qualified family leave wages for leave taken after March 31, 2021, and before October 1,  
2021 (Form 941-SS, Part 3, line 26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g  
2g(i)  
Qualified family leave wages included on Form 941-SS, Part 3, line 26, that were not  
included as wages reported on Form 941-SS, 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g(i)  
2g(ii) Subtract line 2g(i) from line 2g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
2g(iii) Qualified family leave wages included on Form 941-SS, Part 3, line 26, that were not  
2g(ii)  
included as wages reported on Form 941-SS, Part 1, line 5a, because the qualified family  
leave wages were limited by the social security wage base . . . . . . . . . . . . . . . . . . . . . . 2g(iii)  
2g(iv) Subtract line 2g(iii) from line 2g(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
2h  
2g(iv)  
Qualified health plan expenses allocable to qualified family leave wages for leave taken  
after March 31, 2021, and before October 1, 2021 (Form 941-SS, Part 3, line 27) . . . . . . 2h  
2i  
Amounts under certain collectively bargained agreements allocable to qualified family  
leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form  
941-SS, Part 3, line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2i  
2j  
Employer share of social security tax on qualified family leave wages. Multiply line 2g(iv)  
by 6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2j  
2k  
Employer share of Medicare tax on qualified family leave wages. Multiply line 2g(ii) by  
1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2k  
2l  
2m  
2n  
Credit for qualified family leave wages. Add lines 2g, 2h, 2i, 2j, and 2k . . . . . . . . . . . .  
Credit for qualified sick and family leave wages. Add lines 2f and 2l . . . . . . . . . . . . .  
2l  
2m  
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2n  
2o  
2p  
Credit for qualified sick and family leave wages after adjusting for other credits.  
Subtract line 2n from line 2m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
2o  
2p  
2q  
Nonrefundable portion of credit for qualified sick and family leave wages for leave  
taken after March 31, 2021, and before October 1, 2021. Enter the smaller of line 1h or  
line 2o. Enter this amount on Form 941-SS, Part 1, line 11d . . . . . . . . . . . . . . . . . . . . . .  
2q  
Refundable portion of credit for qualified sick and family leave wages for leave  
taken after March 31, 2021, and before October 1, 2021. Subtract line 2p from line 2o  
and enter this amount on Form 941-SS, Part 1, line 13e . . . . . . . . . . . . . . . . . . . . . . . . .  
Instructions for Form 941-SS (Rev. 3-2023)  
-23-