Name and Mailing Address
Name and Location Address
Nebraska Monthly Income Tax Withholding Deposit
Please Do Not Write In This Space
If required, payment must be made electronically.
The Department encourages you to use our safe and secure electronic payment options.
Please visit revenue.nebraska.gov for information regarding paying online.
Mail this form and payment to: Nebraska Department of Revenue, PO Box 98915, Lincoln, NE 68509-8915
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
Nebraska ID Number Deposit for Month of Due Date
Nebraska income tax withheld this period. (Do not file this form if you are making
payments electronically.) Please pay this amount ..................................................... $
Authorized Signature Daytime Phone Signature of Preparer Other Than Taxpayer Daytime Phone
Title Date Address Date
Under penalties of perjury, I declare that, as taxpayer or preparer, I have examined this deposit, and to the best of my knowledge and
belief, it is correct and complete.
When and Where to File. The payment is due on or before
the 15th day of the month following the calendar month covered
by the deposit. If paying electronically, do not le Form 501N. If
you are not paying electronically, mail Form 501N and payment
to the Nebraska Department of Revenue, PO Box 98915, Lincoln,
Nebraska 68509-8915. Checks written to DOR may be presented for
Penalty and Interest. Penalty and interest may be imposed for
failure to timely remit income tax withheld.
Taxpayer Assistance. See DOR’s website at revenue.nebraska.gov
or call 800-742-7474 (NE and IA) or 402-471-5729.
Nebraska Income Tax Withheld This Period. Enter the amount
of Nebraska income tax withheld during the calendar month shown
above. If a deposit is not required until the second month, all income
tax withheld for the rst and second months must be remitted.
Signatures. If you are ling a paper return, the Form 501N must
be signed by the taxpayer, partner, member, or corporate ocer. If
the taxpayer authorizes another person to sign this Form 501N, there
must be a power of attorney on le with DOR.
Any person who is paid for preparing a taxpayer’s Form 501N must
also sign the Form 501N as preparer.
You must be licensed for Nebraska income tax withholding with
the Nebraska Department of Revenue (DOR) prior to ling this
deposit. If you are not currently licensed, complete Nebraska Tax
Application, Form 20, to apply for this license and mail it together
with the Form 501N.
Who Must File. Monthly income tax withholding deposits are
required when the amount withheld exceeds $500 for either the rst
or second month of a calendar quarter.
Certain taxpayers are required to make payments electronically.
Electronic payments can be made using NebFile for Business
(Withholding Payment/Deposit), Nebraska e-pay, Tele-pay, or by
credit card. See revenue.nebraska.gov for additional information.
DOR no longer mails the Nebraska Monthly Income Tax Withholding
Deposit, Form 501N, to you. Payments can be made using DOR’s
e-pay system, or by using Tele-pay. Payment options are available
on our website.
If you are not mandated to make payments electronically, the
Form 501N can be printed from our website at revenue.nebraska.gov
and submitted via mail.
Payments for the third month of a calendar quarter are made
by filing the Nebraska Income Tax Withholding Return,
Form 941N. Form 941N and payment may be led electronically
or on a preidentied form. Taxpayers required to make payments
electronically should not send a check with Form 941N.
8-008-1967 Rev. 11-2020
Supersedes 8-008-1967 Rev. 10-2019