Form 941N – Fill Out and Use This PDF

Who Must File. A taxpayer must file a Form 941N if:

The former owner, partnership, LLC, or corporation must cancel all

1. You have an office or conduct business in Nebraska, and pay

permits, licenses, and certificates by filing Nebraska Change Request,

wages, gambling winnings; or

Form 22.

2. You make payments to nonresidents performing personal

Penalty and Interest. There are penalties and interest for failing

services in Nebraska; or

to timely remit income tax withheld. The penalty is 5% per month or

3. You have an office or conduct business in Nebraska and pay

fraction of a month the return is late, up to 25%, of the tax due amount.

pensions or annuities to Nebraska residents who request that you

A $25 penalty can also be levied for failing to timely file Form 941N.

withhold Nebraska income tax from those payments; or

Interest is calculated from the due date to the date the payment

4. You are required to withhold Nebraska income tax from

is received. Refer to Revenue Ruling 99-20-2 and Regulation 21-016

construction contractors.

for applicable interest rates and additional information.

Prior to filing any deposits or returns:

Monthly Deposits, Form 501N. If the Nebraska income tax

1. You must apply for a Nebraska income tax withholding number

withheld is more than $500 for the first or second month in a quarter,

on a Nebraska Tax Application, Form 20; so that

you must make a monthly deposit. If you make the payment

2. An income tax withholding certificate will be issued by the

electronically, do not file Form 501N.

Nebraska Department of Revenue (DOR); and

If a monthly deposit is required for the first month of a calendar

3. A Form 941N must be e-filed or mailed to DOR. DOR will

quarter, a deposit for the second month is also required, even if the

not mail the Form 941N to anyone required to pay and file

amount of income tax withheld is not more than $500.

electronically or to anyone who has e-filed Form 941N for a

Line 1. Enter the amount of wages paid this quarter. If a prior period's

prior quarter. If you have questions about electronic filing or

payment options, visit revenue.nebraska.gov.

wages were reported incorrectly, it is not necessary to file an amended

Even if you temporarily do not have payments or income tax

Form 941N. Refer to the Form W-3N instructions to report wages paid

during the entire tax year. See line 3 instructions if the income tax

withholding to report, Form 941N must be filed for each reporting

withholding was reported incorrectly.

period. See the Nebraska Circular EN for more information.

Line 2. Enter the total amount of income tax withheld for Nebraska

Cancelling an Account. If you are no longer making payments

subject to Nebraska income tax withholding, check the box

during the tax period.

immediately below your name and location address. A final Nebraska

Line 3. Adjustment of Income Tax Withheld (Quarterly

Reconciliation of Income Tax Withheld, Form W-3N, will be mailed

Filers). Use line 3 to correct errors in income tax withheld from

to you. The Form W-3N must be filed even if you did not make any

payments paid in earlier quarters of the same calendar year. When

payments subject to Nebraska income tax withholding.

paper filing, explain by attaching a statement that shows:

Annual Filers. If the Nebraska income tax you withhold is less than

1. What the error was;

$500 a year, you may be licensed to file on an annual basis. Annual

2. The quarter in which the error was made;

filers may e-file or file the preidentified paper Form 941N. Only lines

3. The amount of the error for each quarter;

1 and 2 must be completed.

4. The quarter when you found the error; and

Filing and Payment Information. Start with the first calendar

5. How you and your payees have settled any overcollection or

quarter or year in which you are required to withhold state income tax.

undercollection. If you are adjusting income tax withholding

Quarterly returns are due the last day of the month following the close

for a qualified military spouse, see revenue.nebraska.gov. Under

of the quarter.

“For Businesses,” click on “Income Tax Withholding.” From this

If DOR has assigned you an annual filing status, your return is due by

page, click on “Nebraska Income Tax for U.S. Servicemembers,

Their Spouses, and Civilians Working with U.S. Forces.”

January 31 of the following year.

Do not use line 3 to adjust income tax withholding for earlier years.

A Form 941N is required even if no payments were made that were

subject to income tax withholding. Paper filers should mail this return

If you have requested that an overpayment from a previous year’s

with payment to the Nebraska Department of Revenue, PO Box 98915,

Form W-3N be transferred to this year, do not use the resulting

Lincoln, Nebraska 68509-8915.

credit until it appears on the previous balance line of Form 941N.

All taxpayers are encouraged to pay and file electronically the Nebraska

Line 5. This credit is only available to taxpayers under the Nebraska

income tax they have withheld. See revenue.nebraska.gov for these

Advantage Act or the Invest Nebraska Act who have completed their

options. Checks written to DOR may be presented for payment

qualification audit and have earned compensation or wage benefit

electronically. Taxpayers may be mandated to pay and file returns

credits and taxpayers under the ImagiNE Nebraska Act who have

electronically. You will be notified in writing if this requirement

previously filed a an ImagiNE Nebraska Act Incentive Computation,

applies to you.

Form 1107N showing that they have achieved levels and earned

Preidentified Return. This return is to be used only by the employer

compensation credits. The amount of credits used against income

or payor whose name is printed on it. If you have not received a return

tax withholding cannot exceed the lesser of income tax withholding

for the tax period, and will be filing a paper return, visit DOR’s website

attributable to new employees at the qualified project or qualified

to print a Form 941N. Complete the ID number, tax period, name, and

location, or the amount of credit reported on the taxpayer’s income

address information. DOR will not mail Form 941N to anyone required

tax return and carried forward into the quarter. Attach the Incentive

to pay and file returns electronically, or to anyone who has e-filed

Withholding Worksheet. When e-filing, this credit is shown on line 4

Form 941N for a prior quarter. Paper filers, review line 12 to determine

of Form 941N. DOR will not allow this credit to offset an income tax

if a previous balance or credit exists when filing a paper return. When

liability until a 0.5% administrative fee is paid on the amount of credit

e-filing, check line 6 to determine if a previous balance or credit exists.

used. The fee is computed on an ImagiNE Nebraska Act Payment

Name and/or Address Changes. If the business name, location, or

of Fees for Incentive Credit Use, Form 1107F. The Form 1107F

mailing address is not correct, strike through the incorrect information

must be filed with DOR and the fee is to be paid separately from the

and plainly print the correct information. If you e-file, mailing name

Form 941N.

and address changes can be made during e-filing. Location name and

Line 12. A balance due or credit resulting from a partial payment,

address changes must be made by completing a Nebraska Change

math or clerical errors, penalty, or interest on prior returns may be

Request, Form 22. Note: If you are licensed for sales tax under this

entered in this space by DOR. The interest shown includes interest

same number, the location address must be the same one used for the

on the unpaid income tax withholding calculated through the due date

sales tax permit (cannot be a PO Box number).

of this return. If the amount owed is paid before the due date, interest

If this is a name change only, and the ownership or FEIN number has

will be recomputed and credit will be given on your next return. If

not changed, indicate “Name change only.” If this is: an ownership

the amount entered by DOR has been satisfied by a prior payment, it

transfer or change; a change in legal form; or your Federal ID number

should be disregarded when calculating line 13.

has changed – the new owner, partnership, LLC, or corporation

Contact DOR if you have questions regarding a credit or balance due.

must complete and return a Nebraska Tax Application, Form 20.

When e-filing, a previous balance is shown on line 6 of Form 941N.