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. 

COMMON IRS TAX TYPES AND SUBTYPES 

Form Number Form Name 

720 Quarterly Excise Tax 

940 Employer

’

s Annual Unemployment Tax 

941 Employer

’

s Quarterly Tax 

944 Employer

’

s Annual Federal Tax 

945 Withheld Federal Income Tax 

990T Exempt Organization Business Income Tax 

1042 Annual Withholding Tax for U.S. Source Income of Foreign Persons 

1120 Corporation Income Tax Federal 

2290 Heavy Vehicle Use Tax 

8804 Annual Return of Partnership Withholding Tax (Section 1446) 

Tax Type Prefix 

(First 4 Digits) 

7200 3, 4, 5, 7, 8, 9, B 03, 06, 09, 12 

0940 3, 4, 5, 7, 8, 9, B 12 

9410 0, 3, 4, 5, 7, 8, 9, B 03, 06, 09, 12 

9440 0, 1, 3, 4, 5, 7, 8, 9, B 12 

0945 0, 3, 4, 5, 7, 8, 9, B 12 

9904 2, 3, 4, 6, 7, 8, 9, B Fiscal Year Month (01–12) 

1042 2, 3, 4, 5, 7, 8, 9, B 12 

1120 0, 2, 3, 4, 6, 7, 8, 9, B Fiscal Year Month (01–12) 

2290 3, 4, 7, 8, 9, B 01–12 

8804 3, 4, 7, 8, 9, B 01–12 

Valid Suffixes 

(Last Digit—see Legend below) Valid Months 

25

7200D* Branded Prescription Drug Fee 7200 D 08 

Legend for Tax Type Suffixes (the one character suffix follows the 4-digit form number for the tax type): 

Suffix Type Suffix Type 

0 Amended 

6

*7200D does not have a paper form associated with it. It is the only tax type used for the Branded Prescription Drug Fee. 

Estimated 

2 Extension 

7 Subsequent/With Return 

3 Designated Payment of Fees or Collection Costs 

8 Designated Payment of Interest 

4 Advance Payment of Determined Deficiency 

9 Designated Payment of Penalty 

5 Payment 

B IRS 6603 Deposits (cash bond) 

D Branded Prescription Drug Fee (only) 

8963 Health Insurance Providers Fee 8963 7 09
WIRE INSTRUCTIONS 

Mandatory fields below are BOLD. 

Receiving ABA/Routing Number [3400] 091036164 

Receiving FI Name [3400] US TREAS SINGLE TX 

Beneficiary [4200] Taxpayer Identification Number: Name Control: Taxpayer Name: Tax

Type: Tax Year: Tax Month: 

Example: 123456789:ABCC:ABC Company:94105:08:03: 

Note: Financial Institutions or vendors may refer to 

This information is obtained from the worksheet lines 2–7 on page 25 

this as the Beneficiary Account Number 

Wires received after 5 p.m. ET will be rejected and returned to the financial institution. FTCS does not warehouse 

payments for the next business day. 

Errors in the information listed above or wires sent in an incorrect format may result in the wire being rejected 

and returned, potentially causing a late payment and penalties. 

TRANSACTION CONFIRMATION 

You may call FTCS at 1.800.382.0045 and follow the automated prompts to receive the 15-digit Electronic Funds 

Transfer (EFT) number for your transaction. 

If the customer is enrolled in EFTPS, he or she may check EFTPS.gov or call 1.800.605.9876 the business day 

after the transaction was completed to obtain the EFT acknowledgment number. 

15-digit EFT number 

NOTE 

If using FedLine® Advantage to make same-day federal tax payments (wires), financial institutions should use 

the Federal Tax Payment Form. 

SAME-DAY TAXPAYER WORKSHEET 

26