941 Ss Form PDF Details

Fulfilling obligations to the Internal Revenue Service (IRS) is a critical part of running a business, and for employers in U.S. territories, submitting Form 941-SS is a key component of this process. Revised in June 2021, this form, titled Employer's QUARTERLY Federal Tax Return, serves businesses in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands by facilitating the reporting of wages paid, tips earned, and other compensation that falls under Social Security, Medicare, and withheld income taxes for each quarter. The form intricately details the number of employees, taxable wages and tips subject to Social Security and Medicare taxes, and adjustments for sick pay, fractions of cents, and tips among others. Additionally, it provides spaces for claiming credits against the employer's quarterly tax liability, including credits for qualified sick and family leave wages and the employee retention credit under specific conditions. Requirements for depositing tax amounts, indicating your deposit schedule, and detailing your tax liability for the quarter are also outlined. Completing Form 941-SS requires employers to navigate through a series of parts that culminate in signing under penalties of perjury that the information provided is true, accurate, and complete. Moreover, the form encompasses a segment for appointing a third-party designee to discuss the return with the IRS, further emphasizing its comprehensive nature in ensuring employers accurately fulfill their tax obligations.

QuestionAnswer
Form Name941 Ss Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesand the U.S. Virgin Islands, Form 941-SS (Rev. June 2021). Employer's Quarterly Federal Tax Return American Samoa, Guam, the Commonwealth of the Northern Mariana Islands

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Form 941-SS FOR 2021:

Employer’s QUARTERLY Federal Tax Return

 

(Rev. June 2021)

 

American Samoa, Guam, the Commonwealth of the Northern

 

Department of the Treasury — Internal Revenue Service

Mariana Islands, and the U.S. Virgin Islands

OMB No. 1545-0029

Employer identification number (EIN)

Name (not your trade name)

Trade name (if any)

Address

Report for this Quarter of 2021

(Check one.)

1: January, February, March

2: April, May, June

3: July, August, September

4: October, November, December

Number

Street

 

 

 

 

 

Suite or room number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

State

 

ZIP code

 

 

 

 

 

 

 

 

 

 

Foreign country name

 

Foreign province/county

 

Foreign postal code

Go to www.irs.gov/Form941SS for instructions and the latest information.

Read the separate instructions before you complete Form 941-SS. 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: June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4) .

. . . . . .

1

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

*Include taxable qualified sick and

 

 

.

 

 

.

 

 

5a

Taxable social security wages*

× 0.124 =

 

 

 

family leave wages for leave taken

 

 

 

after March 31, 2021, on line 5a. Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

lines 5a(i) and 5a(ii) only for wages

5a

(i) Qualified sick leave wages*

.

× 0.062 =

 

.

 

 

paid after March 31, 2020, for leave

 

 

 

taken before April 1, 2021.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

.

× 0.009 =

 

.

 

 

 

Additional Medicare Tax withholding

 

 

 

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 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 for leave taken before

 

 

 

April 1, 2021

. . .

11b

11c

Nonrefundable portion of employee retention credit

. . .

11c

.

.

.

.

.

.

.

.

.

.

You MUST complete all three pages of Form 941-SS and SIGN it.

Next

 

 

 

 

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.

Cat. No. 17016Y

Form 941-SS (Rev. 6-2021)

Name (not your trade name)

Employer identification number (EIN)

Part 1: Answer these questions for this quarter. (continued)

11d

Nonrefundable portion of credit for qualified sick and family leave wages for leave taken

 

 

after March 31, 2021

11d

11e

Nonrefundable portion of COBRA premium assistance credit (see instructions for applicable

 

 

quarters)

11e

 

 

 

 

11f

Number of individuals provided COBRA premium assistance

 

 

 

11g

Total nonrefundable credits. Add lines 11a, 11b, 11c, 11d, and 11e

11g

12

Total taxes after adjustments and nonrefundable credits. Subtract line 11g from line 10 . .

12

13a

Total deposits for this quarter, including overpayment applied from a prior quarter and

 

 

overpayments applied from Form 941-X, 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 for leave taken before

 

 

 

 

 

April 1, 2021

13c

 

.

 

 

 

 

 

 

 

 

 

 

13d

Refundable portion of employee retention credit

13d

 

.

13e

Refundable portion of credit for qualified sick and family leave wages for leave taken after

 

 

 

 

 

March 31, 2021

13e

 

.

13f

Refundable portion of COBRA premium assistance credit (see instructions for applicable

 

 

 

 

 

 

.

 

quarters)

13f

 

 

 

 

 

 

 

 

 

 

 

13g

Total deposits and refundable credits. Add lines 13a, 13c, 13d, 13e, and 13f

13g

 

.

 

 

 

 

 

 

 

 

 

 

13h

Total advances received from filing Form(s) 7200 for the quarter

13h

 

.

 

 

 

 

 

 

 

 

 

 

13i

Total deposits and refundable credits less advances. Subtract line 13h from line 13g

13i

 

.

 

 

 

 

 

 

 

 

 

 

 

14

Balance due. If line 12 is more than line 13i, enter the difference and see instructions . . . .

14

 

.

 

 

 

 

 

 

 

 

 

 

15

Overpayment. If line 13i 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 8 of Pub. 80.

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-SS. Go to Part 3.

 

 

You MUST complete all three pages of Form 941-SS and SIGN it.

 

 

 

 

 

 

 

Next

 

 

 

 

 

 

Page 2

 

 

 

Form 941-SS (Rev. 6-2021)

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.

18a If you’re a seasonal employer and you don’t have to file a return for every quarter of the year . . .

18b If you’re eligible for the employee retention credit solely because your business is a recovery startup business

Check here. Check here.

19

Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021

19

20

Qualified health plan expenses allocable to qualified family leave wages for leave taken before April 1, 2021

20

21

Qualified wages for the employee retention credit

21

22

Qualified health plan expenses for the employee retention credit

22

23

Qualified sick leave wages for leave taken after March 31, 2021

23

24

Qualified health plan expenses allocable to qualified sick leave wages reported on line 23 .

24

25

Amounts under certain collectively bargained agreements allocable to qualified sick leave

 

 

wages reported on line 23

25

26

Qualified family leave wages for leave taken after March 31, 2021

26

27

Qualified health plan expenses allocable to qualified family leave wages reported on line 26 .

27

28Amounts under certain collectively bargained agreements allocable to qualified family leave wages reported on line 26 . . . . . . . . . . . . . . . . . . . . . . 28

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-SS 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

Preparer’s name

Preparer’s signature

Firm’s name (or yours if self-employed)

Check if you’re self-employed . . .

PTIN

Date

/

/

EIN

Address

Phone

City

State

ZIP code

Page 3

Form 941-SS (Rev. 6-2021)

This page intentionally left blank

Form 941-V(SS), Payment Voucher

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 nonrefundable 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; or

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

CAUTION

been deposited, you may be subject to a

 

penalty. See Deposit Penalties in section 8 of Pub. 80.

Specific Instructions

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 Form 941-SS.

Box 3—Tax period. Darken the circle identifying the quarter for which the payment is made. Darken only one circle.

Box 4—Name and address. Enter your name and address as shown on Form 941-SS.

Enclose your check or money order made payable to “United States Treasury.” Be sure to enter your EIN, “Form 941-SS,” and the tax period (“1st Quarter 2021,” “2nd Quarter 2021,” “3rd Quarter 2021,” or “4th Quarter 2021”) 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.

Form 941-V(SS)

Department of the Treasury Internal Revenue Service

Detach Here and Mail With Your Payment and Form 941-SS.

Payment Voucher

Don’t staple this voucher or your payment to Form 941-SS.

OMB No. 1545-0029

2021

1Enter your employer identification number (EIN).

3 Tax Period

1st

3rd

Quarter

Quarter

2nd

4th

Quarter

Quarter

2

Dollars

Cents

Enter the amount of your payment.

Make your check or money order payable to “United States Treasury”

4Enter 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.

Form 941-SS (Rev. 6-2021)

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 941-SS to carry out the Internal Revenue laws of the United States. We need it to figure and collect the right amount of tax. Subtitle C, Employment Taxes, of the Internal Revenue Code imposes employment taxes on wages and provides for income tax withholding. Form 941-SS is used to determine the amount of the taxes that you owe. Section 6011 requires you to provide the requested information if the tax is applicable to you. Section 6109 requires you to provide your identification number. If you fail to provide this information in a timely manner or provide false or fraudulent information, you may be subject to penalties.

You’re not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books and records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law.

Generally, tax returns and return information are confidential, as required by section 6103. However, section 6103 allows or requires the IRS to disclose or give the information shown on your tax return to others as described in the Code. For example, we may disclose your tax information to the Department of

Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

The time needed to complete and file Form 941-SS will vary depending on individual circumstances. The estimated average time is:

Recordkeeping . . . . . . . . . . 17 hr., 42 min.

Learning about the law or the form . . . .

24 min.

Preparing, copying, assembling, and

 

sending the form to the IRS

42 min.

If you have comments concerning the accuracy of these time estimates or suggestions for making Form 941-SS simpler, we would be happy to hear from you. You can send us comments from www.irs.gov/FormComments. Or you can send your comments to Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Don’t send Form 941-SS to this address. Instead, see Where Should You File? in the Instructions for Form 941-SS.

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Completing this PDF will require care for details. Make sure every field is done accurately.

1. You'll want to fill out the the Commonwealth of the Northern Mariana Islands accurately, thus be mindful when filling in the sections including these blanks:

The best ways to fill in Form 941-SS (Rev. June 2021). Employer's Quarterly Federal Tax Return American Samoa part 1

2. Once the previous array of fields is done, you have to put in the needed particulars in a i Qualified sick leave wages, a ii Qualified family leave wages, b Taxable social security tips, c Taxable Medicare wages tips, d Taxable wages tips subject to, Additional Medicare Tax withholding, Include taxable qualified sick, e Total social security and, Section q Notice and DemandTax due, Total taxes before adjustments Add, Current quarters adjustment for, Current quarters adjustment for, Current quarters adjustments for, Total taxes after adjustments, and a Qualified small business payroll so you're able to move forward to the next step.

a ii Qualified family leave wages, Current quarters adjustment for, and Section q Notice and DemandTax due of Form 941-SS (Rev. June 2021). Employer's Quarterly Federal Tax Return American Samoa

3. Your next stage is normally hassle-free - complete all the blanks in Name not your trade name, Employer identification number EIN, Part Answer these questions for, d Nonrefundable portion of credit, after March and before October , e Reserved for future use , f Reserved for future use, g Total nonrefundable credits Add, Total taxes after adjustments and, a Total deposits for this quarter, overpayments applied from Form X X, b Reserved for future use , c Refundable portion of credit, April , and d Reserved for future use to finish this process.

Form 941-SS (Rev. June 2021). Employer's Quarterly Federal Tax Return American Samoa writing process described (stage 3)

4. Filling in g Total deposits and refundable, h Reserved for future use , i Reserved for future use , Balance due If line is more than, Part Tell us about your deposit, Overpayment If line g is more than, Check one, Apply to next return, Send a refund, If youre unsure about whether, Check one, Line on this return is less than , You were a monthly schedule, Tax liability, and Month is crucial in this fourth section - don't forget to be patient and be attentive with each empty field!

The best way to complete Form 941-SS (Rev. June 2021). Employer's Quarterly Federal Tax Return American Samoa part 4

As for Month and Balance due If line is more than, make certain you take a second look in this section. Those two are the key fields in the page.

5. As you draw near to the last parts of your form, you'll find a couple more requirements that need to be met. Notably, Total liability for quarter, Total must equal line , You were a semiweekly schedule, You MUST complete all three pages, Page , and Next Form SS Rev must be filled in.

Part # 5 in completing Form 941-SS (Rev. June 2021). Employer's Quarterly Federal Tax Return American Samoa

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