SAME-DAY TAXPAYER WORKSHEET
To arrange an electronic same-day federal tax payment, complete this form and present it at your financial institution.
Please type or print clearly.
1 Total tax payment: (Include interest and penalty if applicable)
2 Taxpayer identification number:
3 Taxpayer name control: (the first four letters of your business name)*
4 Taxpayer name:
5 Tax type: (5 characters) see Common IRS Tax Type table below**
6 Tax year: (2 digits)
7 Tax month/quarter: (2 digits) see Common IRS Tax Type table below
OPTIONAL INFORMATION:
If the payment includes tax, interest, and penalty:
NOTE: The sum of lines 8–10 must equal the amount in line 1.
8 Tax amount
9 Interest amount
10 Penalty amount
$
$
$
$
*For assistance determining the name control, see page 10.
**A comprehensive Tax Type list is available online at www.irs.gov. Personal assistance is available by calling 1.800.829.4933.
Legend for Tax Type Suffixes (the one character suffix follows the 4-digit form number for the tax type):
*7200 D does not have a paper form associated with it. It is the only tax type used for the Branded Prescription Drug Fee.
25
Suffix Type
0 Amended
2 Extension
3 Designated Payment of Fees or Collection Costs
4 Advance Payment of Determined Deficiency
5 Payment
6 Estimated
Suffix Type
7 Subsequent/With Return
8 Designated Payment of Interest
9 Designated Payment of Penalty
B IRS 6603 Deporits (cash bond)
D Branded Prescription Drug Fee (only)
Form Number Form Name
Tax Type Prex
(First 4 Digits)
Valid Suffixes
(Last Digit—see Legend Below)
Valid Months
720 Quarterly Excise Tax 7200 3, 4, 5, 7, 8, 9, B 03, 06, 09, 12
7200D* Branded Prescription Drug Fee 7200 D 08
940 Employer’s Annual Unemployment Tax 0940 3, 4, 5, 7, 8, 9, B 12
941 Employer’s Quarterly Tax 9410 0, 3, 4, 5, 7, 8, 9, B 03, 06, 09, 12
944 Employer’s Annual Federal Tax 9440 0, 1, 3, 4, 5, 7, 8, 9, B 12
945 Withheld Federal Income Tax 0945 0, 3, 4, 5, 7, 8, 9, B 12
990T Exempt Organization Business Income Tax 9904 2, 3, 4, 6, 7, 8, 9, B Fiscal Year Month (01–02)
1042 Annual Withholding Tax for U.S. Source of Income of Foreign Persons 1024 2, 3, 4, 5, 7, 8, 9, B 12
1120 Corporation Income Tax Federal 1120 0, 2, 3, 4, 6, 7, 8, 9, B Fiscal Year Month (01–02)
2290 Heavy Vehicle Use Tax 2290 3, 4, 7, 8, 9, B 01–12
8804 Annual Return of Partnership Withholding Tax (Section 1446) 8804 3, 4, 7, 8, 9, B 01–12
8963 Health Insurance Providers Fee 8963 7 09
COMMON IRS TAX TYPES AND SUBTYPES
26
WIRE INSTRUCTIONS
TRANSACTION CONFIRMATION
NOTE
Mandatory elds below are BOLD.
Receiving ABA/Routing Number [3400]
Receiving FI Name [3400]
Beneciary [4200]
091036164
US TREAS SINGLE TX
Taxpayer Identication Number: Name Control: Taxpayer Name: Tax
Type: Tax Year: Tax Month:
Example: 123456789:ABCC:ABC Company:94105:08:03:
This information is obtained from the worksheet lines 2–7 on page 25
Note: Financial Institutions or vendors may refer to
this as the Beneficiary Account Number
Wires received after 5 p.m. ET will be rejected and returned to the financial institution. FTCS does not warehouse
payments for the next business day.
Errors in the information listed above or wires sent in an incorrect format may result in the wire being rejected
and returned, potentially causing a late payment and penalties.
You may call FTCS at 1.800.382.0045 and follow the automated prompts to receive the 15-digit Electronic Funds
Transfer (EFT) number for your transaction
If the customer is enrolled in EFTPS, he or she may check EFTPS.gov or call 1.800.605.9876 the business day
after the transaction was completed to obtain the EFT acknowledgment number.
15-digit EFT number
If using FedLine
®
Advantage to make same-day federal tax payments (wires), financial institutions should use
the Federal Tax Payment Form.
SAME-DAY TAXPAYER WORKSHEET
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