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 Prex
(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
