Purpose of Form
Complete Form 941-V(SS) if you’re making a payment
with Form 941-SS. We will use the completed voucher to
credit your payment more promptly and accurately, and
to improve our service to you.
Making Payments With Form 941-SS
To avoid a penalty, make your payment with Form
941-SS only if:
• Your total taxes after adjustments and credits (Form
941-SS, line 12) for either the current quarter or the
preceding quarter are less than $2,500, you didn’t incur a
$100,000 next-day deposit obligation during the current
quarter, and you’re paying in full with a timely filed return;
• You're a monthly schedule depositor making a payment
in accordance with the Accuracy of Deposits Rule. See
section 8 of Pub. 80 for details. In this case, the amount
of your payment may be $2,500 or more.
Otherwise, you must make deposits by electronic funds
transfer. See section 8 of Pub. 80 for deposit instructions.
Don’t use Form 941-V(SS) to make federal tax deposits.
Use Form 941-V(SS) when making any
payment with Form 941-SS. However, if you pay
an amount with Form 941-SS that should’ve
been deposited, you may be subject to a
penalty. See Deposit Penalties in section 8 of Pub. 80.
Box 1—Employer identification number (EIN). If you
don’t have an EIN, you may apply for one online by
visiting the IRS website at www.irs.gov/EIN. You may also
apply for an EIN by faxing or mailing Form SS-4 to the
IRS. If you haven’t received your EIN by the due date of
Form 941-SS, write “Applied For” and the date you
applied in this entry space.
Box 2—Amount paid. Enter the amount paid with
Box 3—Tax period. Darken the circle identifying the
quarter for which the payment is made. Darken only
Box 4—Name and address. Enter your name and
address as shown on Form 941-SS.
• Enclose your check or money order payable to
“United States Treasury.” Be sure to enter your EIN,
“Form 941-SS,” and the tax period (“1st Quarter 2019,”
“2nd Quarter 2019,” “3rd Quarter 2019,” or “4th Quarter
2019”) on your check or money order. Don’t send cash.
Don’t staple Form 941-V(SS) or your payment to Form
941-SS (or to each other).
• Detach Form 941-V(SS) and send it with your
payment and Form 941-SS to the address in the
Instructions for Form 941-SS.
Note: You must also complete the entity information
above Part 1 on Form 941-SS.
Detach Here and Mail With Your Payment and Form 941-SS.
Department of the Treasury
Internal Revenue Service
Don’t staple this voucher or your payment to Form 941-SS.
OMB No. 1545-0029
Enter your employer identification
Enter the amount of your payment.
Make your check or money order payable to “United States Treasury”
3 Tax period
Enter your business name (individual name if sole proprietor).
Enter your address.
Enter your city, state, and ZIP code; or your city, foreign country name, foreign province/county, and foreign postal code.