Fillable Form 950121: Employers QUARTERLY Federal Tax Return

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Form 950121: Employers QUARTERLY Federal Tax Return

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Form 941 for 2021:
(Rev. March 2021)
Employer’s QUARTERLY Federal Tax Return
Department of the Treasury — Internal Revenue Service
950121
OMB No. 1545-0029
Employer identification number (EIN)
—
Name (not your trade name)
Trade name (if any)
Address
Number Street Suite or room number
City State ZIP code
Foreign country name
Foreign province/county
Foreign postal code
Report for this Quarter of 2021
(Check one.)
1: January, February, March
2: April, May, June
3: July, August, September
4: October, November, December
Go to www.irs.gov/Form941 for
instructions and the latest information.
Read the separate instructions before you complete Form 941. Type or print within the boxes.
Part 1:
Answer these questions for this quarter.
1
Number of employees who received wages, tips, or other compensation for the pay period
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)
1
2 Wages, tips, and other compensation . . . . . . . . . . . . . . . . . 2
.
3 Federal income tax withheld from wages, tips, and other compensation . . . . . . 3
.
4 If no wages, tips, and other compensation are subject to social security or Medicare tax Check and go to line 6.
Column 1 Column 2
5a Taxable social security wages . .
.
× 0.124 =
.
5a (i) Qualified sick leave wages . .
.
× 0.062 =
.
5a (ii) Qualified family leave wages .
.
× 0.062 =
.
5b Taxable social security tips . . .
.
× 0.124 =
.
5c Taxable Medicare wages & tips. .
.
× 0.029 =
.
5d
Taxable wages & tips subject to
Additional Medicare Tax withholding
.
× 0.009 =
.
5e
Total social security and Medicare taxes. Add Column 2 from lines 5a, 5a(i), 5a(ii), 5b, 5c, and 5d
5e
.
5f Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions) . . 5f
.
6 Total taxes before adjustments. Add lines 3, 5e, and 5f . . . . . . . . . . . . 6
.
7 Current quarter’s adjustment for fractions of cents . . . . . . . . . . . . . 7
.
8 Current quarter’s adjustment for sick pay . . . . . . . . . . . . . . . . 8
.
9 Current quarter’s adjustments for tips and group-term life insurance . . . . . . . 9
.
10 Total taxes after adjustments. Combine lines 6 through 9 . . . . . . . . . . . 10
.
11a
Qualified small business payroll tax credit for increasing research activities. Attach Form 8974
11a
.
11b
Nonrefundable portion of credit for qualified sick and family leave wages from Worksheet 1
11b
.
11c Nonrefundable portion of employee retention credit from Worksheet 1 . . . . . .
11c
.
▶
You MUST complete all three pages of Form 941 and SIGN it.
Next
■
▶
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Cat. No. 17001Z
Form 941 (Rev. 3-2021)
950221
Name (not your trade name) Employer identification number (EIN)
Part 1:
Answer these questions for this quarter. (continued)
11d Total nonrefundable credits. Add lines 11a, 11b, and 11c . . . . . . . . . . .
11d
.
12 Total taxes after adjustments and nonrefundable credits. Subtract line 11d from line 10 . 12
.
13a
Total deposits for this quarter, including overpayment applied from a prior quarter and
overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter
13a
.
13b Reserved for future use . . . . . . . . . . . . . . . . . . . . . .
13b
.
13c Refundable portion of credit for qualified sick and family leave wages from Worksheet 1
13c
.
13d Refundable portion of employee retention credit from Worksheet 1 . . . . . . . .
13d
.
13e Total deposits and refundable credits. Add lines 13a, 13c, and 13d . . . . . . . .
13e
.
13f Total advances received from filing Form(s) 7200 for the quarter . . . . . . . . .
13f
.
13g
Total deposits and refundable credits less advances. Subtract line 13f from line 13e
. . . .
13g
.
14 Balance due. If line 12 is more than line 13g, enter the difference and see instructions . . . 14
.
15
Overpayment. If line 13g is more than line 12, enter the difference
.
Check one:
Apply to next return.
Send a refund.
Part 2: Tell us about your deposit schedule and tax liability for this quarter.
If you’re unsure about whether you’re a monthly schedule depositor or a semiweekly schedule depositor, see section 11 of Pub. 15.
16 Check one:
Line 12 on this return is less than $2,500 or line 12 on the return for the prior quarter was less than $2,500,
and you didn’t incur a $100,000 next-day deposit obligation during the current quarter. If line 12 for the prior
quarter was less than $2,500 but line 12 on this return is $100,000 or more, you must provide a record of your
federal tax liability. If you’re a monthly schedule depositor, complete the deposit schedule below; if you’re a
semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3.
You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total
liability for the quarter, then go to Part 3.
Tax liability: Month 1
.
Month 2
.
Month 3
.
Total liability for quarter
.
Total must equal line 12.
You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941),
Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Go to Part 3.
▶
You MUST complete all three pages of Form 941 and SIGN it.
Next
■
▶
Page 2 Form 941 (Rev. 3-2021)
950921
Name (not your trade name) Employer identification number (EIN)
Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank.
17 If your business has closed or you stopped paying wages . . . . . . . . . . . . . . . Check here, and
enter the final date you paid wages
/ / ; also attach a statement to your return. See instructions.
18 If you’re a seasonal employer and you don’t have to file a return for every quarter of the year . . .
Check here.
19 Qualified health plan expenses allocable to qualified sick leave wages . . . . . . 19
.
20 Qualified health plan expenses allocable to qualified family leave wages . . . . . . 20
.
21 Qualified wages for the employee retention credit . . . . . . . . . . . . . 21
.
22 Qualified health plan expenses allocable to wages reported on line 21 . . . . . . . 22
.
23 Credit from Form 5884-C, line 11, for this quarter . . . . . . . . . . . . . 23
.
24 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . 24
.
25 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . 25
.
Part 4: May we speak with your third-party designee?
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions
for details.
Yes. Designee’s name and phone number
Select a 5-digit personal identification number (PIN) to use when talking to the IRS.
No.
Part 5: Sign here. You MUST complete all three pages of Form 941 and SIGN it.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
✗
Sign your
name here
Date / /
Print your
name here
Print your
title here
Best daytime phone
Paid Preparer Use Only
Check if you’re self-employed . . .
Preparer’s name
PTIN
Preparer’s signature
Date / /
Firm’s name (or yours
if self-employed)
EIN
Address Phone
City State
ZIP code
Page 3 Form 941 (Rev. 3-2021)
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Form 950121: Employers QUARTERLY Federal Tax Return

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Completed 13 April 2022

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