Form PA-501R at a glance
What it is: Form PA-501R is the Employer Deposit Statement of Income Tax Withheld. Use only when employers do not have preprinted coupons.
Where and when to file: Mail the deposit statement and payment to: PA Department of Revenue, Dept. 280401, Harrisburg, PA 17128-0401.
In addition to the PA-501 or PA-501R deposit statement, all employers must file a PA-W3 Reconciliation Return for each quarter. If the taxpayer does not have a preprinted coupon, a PA-W3R return must be filed.
A filled-in Form PA-501R example: a cafe owner makes a quarterly deposit

How to fill out Form PA-501R, box by box
Quarter, year, Employer Account ID and Entity ID

Enter the quarter (1st quarter YY01, 2nd quarter YY02, 3rd quarter YY03, and 4th quarter YY04), calendar year, the Employer Account ID (if none assigned, leave blank), Entity ID, Federal EIN (if none assigned, leave blank), quarter ending date (1st quarter 0331YYYY, 2nd quarter 0630YYYY, 3rd quarter 0930YYYY and 4th quarter 1231YYYY), date wages were first paid and payment frequency.
Legal name, trade name and business mailing address
Line 1, Line 2, Line 3 and Line 4

Line 1. Enter the total amount of compensation subject to PA Withholding Tax for the deposit period.
Line 2. Enter the total amount of PA Withholding Tax required to be withheld (or actually withheld, if greater) for the deposit period. Enter tax withheld, not deposits.
Line 3. Enter the amount of credit from a previous period which is being applied to the amount withheld for the deposit period.
Line 4. Enter interest due for this payment if remitting after the due date.
More rules for Form PA-501R
Payment frequency, expected quarterly withholding will be: quarterly less than $300 and monthly more than $300 but less than $1,000 and semi-monthly $1,000 or greater. (checked November 11, 2026)
Questions regarding the completion of this form can be directed to the Employer Tax Division at (717) 783-1488.
Common questions about Form PA-501R
Where do I file it?
Mail the deposit statement and payment to: PA Department of Revenue, Dept. 280401, Harrisburg, PA 17128-0401.
Sources
[1] Form PA-501R (1-99), Pennsylvania Department of Revenue (the Official source link on this page).



