Enter the number of employees on your payroll for the pay period including March 12, June 12, September 12, or December 12 for the quarter indicated at the top of the return. Do not include:

If you enter “250” or more on line 1, you must file Forms W-2 electronically. For details, call the SSA at 1-800-772-6270 or visit SSA's Employer W-2 Filing Instructions & Information website at
www.socialsecurity.gov/employer.

If no wages, tips, and compensation are subject to social security or Medicare tax, check the box on line 4. If this question does not apply to you, leave the box blank. For more information about exempt wages, see section 12 of Pub. 80 (Circular SS) and section 4 of Pub. 15-A.

If you are a government employer, wages you pay are not automatically exempt from social security and Medicare taxes. Your employees may be covered by law or by a voluntary Section 218 Agreement with the SSA. For more information, see Pub. 963, Federal-State Reference Guide.

Enter tax amounts on lines 7a through 7c that result from current quarter adjustments. Use a minus sign (if possible) to show an adjustment that decreases the total taxes shown on line 5d, instead of parentheses. Doing so enhances the accuracy of our scanning software. For example, report "-10.59" instead of "(10.59)." However, if your software only allows for parentheses in reporting negative amounts, you may use them.

Enter adjustments for fractions of cents (due to rounding) relating to the employee share of social security and Medicare taxes withheld. The employee share (one-half) of amounts shown in column 2 of lines 5a–5c may differ slightly from amounts actually withheld from employees' paychecks due to the rounding of social security and Medicare taxes based on statutory rates.

Enter the adjustment for the employee share of social security and Medicare taxes that were withheld by your third-party sick pay payer.

Enter adjustments for:

Combine all adjustments shown on lines 7a through 7c and enter the result here.

Combine the amounts shown on lines 5d and 7d and enter the result here.

If you are a semiweekly depositor, you must complete Schedule B (Form 941). If you fail to complete and submit Schedule B (Form 941), the IRS will assert deposit penalties based on available information.

Enter your deposits for this quarter, including any overpayment that you applied from filing Form 941-X or Form 944-X in the current quarter. Also include in the amount shown any overpayment from a previous period that you applied to this return.

Report on this line the COBRA premium assistance payments you made. Only report the premium assistance payments you made for the assistance eligible individuals who have paid their reduced premiums. This amount should be 65% of the total COBRA premiums for assistance eligible individuals without regard to the reduction. Do not include any amounts paid to you by the COBRA assistance eligible individuals. For COBRA coverage provided under a self-funded plan, COBRA premium assistance payments are treated as having been made for each assistance eligible individual who pays 35% of the COBRA premium.

Enter the total number of individuals provided COBRA premium assistance payments reported on line 12a.

Add lines 11 and 12a.

If line 8 is more than line 13, write the difference in line 14. Otherwise, see Overpayment below.You do not have to pay if line 14 is under $1. Generally, you should have a balance due only if your total taxes for the quarter (line 8) are less than $2,500. However, see section 8 of Pub. 80 (Circular SS) for information about payments made under the Accuracy of Deposits Rule.

You may pay the amount shown on line 14 using EFTPS, a credit card, a check or money order, or electronic funds withdrawal (EFW). Do not use a credit card or EFW to pay taxes that were required to be deposited. For more information on paying your taxes with a credit card or EFW, visit the IRS website at www.irs.gov and click on the Online Services link.

If you pay by EFTPS, credit card, or EFW, file your return using the without a payment address on page 2 under Where Should You File? and do not file Form 941-V, Payment Voucher.

If you pay by check or money order, make it payable to the United States Treasury. Enter your EIN, Form 941-SS, and the tax period on your check or money order. Complete Form 941-V(SS) and enclose with Form 941-SS.

If line 8 is $2,500 or more and you have deposited all taxes when due, the balance due on line 14 should be zero.

If you do not deposit as required and, instead, pay the taxes with Form 941-SS, you may be subject to a penalty.

If line 13 is more than line 8, write the difference in line 15. Never make an entry in both lines 14 and 15.

If you deposited more than the correct amount for the quarter, you can choose to have the IRS either refund the overpayment or apply it to your next return. Check the appropriate box in line 15. If you do not check either box, we will automatically refund the overpayment. We may apply your overpayment to any past due tax account that is shown in our records under your EIN.

If line 15 is under $1, we will send a refund or apply it to your next return only if you ask us in writing to do so.

You must complete both pages of Form 941-SS and sign on page 2. Failure to do so may delay processing of your return.

If you go out of business or stop paying wages, you must file a final return. To tell the IRS that a particular Form 941-SS is your final return, check the box on line 18 and enter the date you last paid wages in the space provided. For additional filing requirements, see Final Return on page 2 of these instructions.

If you hire employees seasonally—such as for summer or winter only—check the box on line 19. Checking the box tells the IRS not to expect four Forms 941-SS from you throughout the year because you have not paid wages regularly.

Generally, we will not ask about unfiled returns if you file at least one return showing tax due each year. However, you must check the box every time you file a Form 941-SS.

Also, when you fill out Form 941-SS, be sure to check the box on the top of the form that corresponds to the quarter reported.

•Sole proprietorship—   The individual who owns the business.

•Corporation (including a limited liability company (LLC) treated as a corporation)—   The president, vice president, or other principal officer duly authorized to act.

•Partnership (including an LLC treated as a partnership) or unincorporated organization—   A responsible and duly authorized member or officer having knowledge of its affairs.

•Single member LLC treated as a disregarded entity—   The owner of the LLC.

•Trust or estate—   The fiduciary.

Alternative signature method.   Corporate officers or duly authorized agents may sign Form 941-SS by rubber stamp, mechanical device, or computer software program. For details and required documentation, see Rev. Proc. 2005-39. You can find Rev. Proc. 2005-39 on page 82 of Internal Revenue Bulletin 2005-28 at
www.irs.gov/pub/irs-irbs/irb05-28.pdf.

Paid preparers.   A paid preparer must sign Form 941-SS and provide the information in the Paid preparer's use only section of Part 5 if the preparer was paid to prepare Form 941-SS and is not an employee of the filing entity. Paid preparers must sign paper returns with a manual signature. The preparer must give you a copy of the return in addition to the copy to be filed with the IRS.

  If you are a paid preparer, write your SSN or your Preparer Tax Identification Number (PTIN) in the space provided. Include your complete address. If you work for a firm, write the firm's name and the EIN of the firm. You can apply for a PTIN using Form W-7P, Application for Preparer Tax Identification Number. You cannot use your PTIN in place of the EIN of the tax preparation firm.

  Generally, do not complete this section if you are filing the return as a reporting agent and have a valid Form 8655, Reporting Agent Authorization, on file with the IRS. However, a reporting agent must complete this section if the reporting agent offered legal advice, for example, advising the client on determining whether its workers are employees or independent contractors for federal tax purposes.