Instructions for Form 941-SS

(Rev. March 2023)

Employer's QUARTERLY Federal Tax Return—American Samoa, Guam, the 

Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands

Department of the Treasury

Internal Revenue Service

Section references are to the Internal Revenue Code 

unless otherwise noted.

Contents Page

Future Developments ........................ 1

What's New ............................... 1

Reminders ................................ 2

General Instructions: ......................... 4

Purpose of Form 941-SS ................... 4

Who Must File Form 941-SS? ............... 4

When Must You File? ..................... 6

How Should You Complete Form 941-SS? ...... 6

Where Should You File? ................... 7

Depositing Your Taxes .................... 7

What About Penalties and Interest? ........... 8

Where Can You Obtain Forms? .............. 9

Specific Instructions: ......................... 9

Part 1: Answer These Questions for This 

Quarter ............................. 9

Part 2: Tell Us About Your Deposit Schedule 

and Tax Liability for This Quarter .......... 17

Part 3: Tell Us About Your Business .......... 19

Part 4: May We Speak With Your Third-Party 

Designee? .......................... 20

Part 5: Sign Here (Approved Roles) .......... 20

How To Get Forms, Instructions, and Publications 

From the IRS .......................... 21

Worksheet 1. Credit for Qualified Sick and Family 

Leave Wages Paid This Quarter of 2023 for 

Leave Taken After March 31, 2020, and Before 

April 1, 2021 ........................... 22

Worksheet 2. Credit for Qualified Sick and Family 

Leave Wages Paid This Quarter of 2023 for 

Leave Taken After March 31, 2021, and Before 

October 1, 2021 ........................ 23

Future Developments

For the latest information about developments related to 

Form 941-SS and its instructions, such as legislation 

enacted after they were published, go to IRS.gov/

Form941SS.

What's New

Social security and Medicare tax for 2023. The rate of 

social security tax on taxable wages, including qualified 

sick leave wages and qualified family leave wages paid in 

2023 for leave taken after March 31, 2021, and before 

October 1, 2021, is 6.2% each for the employer and 

employee or 12.4% for both. Qualified sick leave wages 

and qualified family leave wages paid in 2023 for leave 

taken after March 31, 2020, and before April 1, 2021, 

aren't subject to the employer share of social security tax; 

therefore, the tax rate on these wages is 6.2%. The social 

security wage base limit is $160,200.

The Medicare tax rate is 1.45% each for the employee 

and employer, unchanged from 2022 There is no wage 

base limit for Medicare tax.

Social security and Medicare taxes apply to the wages 

of household workers you pay $2,600 or more in cash 

wages in 2023. Social security and Medicare taxes apply 

to election workers who are paid $2,200 or more in cash 

or an equivalent form of compensation in 2023.

Qualified small business payroll tax credit for increasing research activities. For tax years beginning 

before January 1, 2023, a qualified small business may 

elect to claim up to $250,000 of its credit for increasing 

research activities as a payroll tax credit. The Inflation 

Reduction Act of 2022 (the IRA) increases the election 

amount to $500,000 for tax years beginning after 

December 31, 2022. The payroll tax credit election must 

be made on or before the due date of the originally filed 

income tax return (including extensions). The portion of 

the credit used against payroll taxes is allowed in the first 

calendar quarter beginning after the date that the qualified 

small business filed its income tax return. The election 

and determination of the credit amount that will be used 

against the employer’s payroll taxes are made on Form 

6765, Credit for Increasing Research Activities. The 

amount from Form 6765, line 44, must then be reported 

on Form 8974, Qualified Small Business Payroll Tax 

Credit for Increasing Research Activities.

Starting in the first quarter of 2023, the payroll tax credit 

is first used to reduce the employer share of social 

security tax up to $250,000 per quarter and any remaining 

credit reduces the employer share of Medicare tax for the 

quarter. Any remaining credit, after reducing the employer 

share of social security tax and the employer share of 

Medicare tax, is then carried forward to the next quarter. 

Form 8974 is used to determine the amount of the credit 

that can be used in the current quarter. The amount from 

Form 8974, line 12 or, if applicable, line 17, is reported on 

line 11a. For more information about the payroll tax credit, 

see IRS.gov/ResearchPayrollTC. Also see Adjusting tax 

liability for nonrefundable credits claimed on lines 11a, 

11b, and 11d, later.

Forms 941-SS and 941-PR discontinued after 2023. 

Form 941-SS and Form 941-PR, Planilla para la 

Declaración Federal TRIMESTRAL del Patrono, will no 

longer be available after the fourth quarter of 2023. 

Instead, employers in the U.S. territories will file Form 941, 

Employer’s QUARTERLY Federal Tax Return, or, if you 

prefer your form and instructions in Spanish, you can file 

new Form 941 (sp), Declaración del Impuesto Federal 

TRIMESTRAL del Empleador.

Jan 10, 2023 Cat. No. 35530F
Pubs. 80, 51, and 179 discontinued after 2023. Pub. 

80, Federal Tax Guide for Employers in the U.S. Virgin 

Islands, Guam, American Samoa, and the Commonwealth 

of the Northern Mariana Islands; Pub. 51, Agricultural 

Employer's Tax Guide; and Pub. 179, Guía Contributiva 

Federal para Patronos Puertorriqueños, will no longer be 

available after 2023. Instead, information specific to 

employers in the U.S. territories and agricultural 

employers will be included in Pub. 15, Employer's Tax 

Guide, beginning with the Pub. 15 for use in 2024 

(published December 2023). Beginning in 2024, there will 

be a new Pub. 15 (sp) that is a Spanish-language version 

of Pub. 15.

Reminders

Use the March 2023 revision of Form 941-SS to 

report taxes for the first quarter of 2023; don't use 

an earlier revision to report taxes for 2023. At this 

time, the IRS expects the March 2023 revision of Form 

941-SS and these instructions to also be used for the 

second, third, and fourth quarters of 2023. If changes in 

law require additional changes to Form 941-SS, the form 

and/or these instructions may be revised. Prior revisions 

of Form 941-SS are available at IRS.gov/Form941SS 

(select the link for "All Form 941-SS Revisions" under 

"Other Items You May Find Useful").

The COVID-19 related credit for qualified sick and 

family leave wages is limited to leave taken after 

March 31, 2020, and before October 1, 2021. 

Generally, the credit for qualified sick and family leave 

wages, as enacted under the Families First Coronavirus 

Response Act (FFCRA) and amended and extended by 

the COVID-related Tax Relief Act of 2020, for leave taken 

after March 31, 2020, and before April 1, 2021, and the 

credit for qualified sick and family leave wages under 

sections 3131, 3132, and 3133 of the Internal Revenue 

Code, as enacted under American Rescue Plan Act of 

2021 (the ARP), for leave taken after March 31, 2021, and 

before October 1, 2021, have expired. However, 

employers that pay qualified sick and family leave wages 

in 2023 for leave taken after March 31, 2020, and before 

October 1, 2021, are eligible to claim a credit for qualified 

sick and family leave wages in the quarter of 2023 in 

which the qualified wages were paid. For more 

information, see the instructions for line 11b, line 11d, 

line 13c, and line 13e, later.

Use Worksheet 1 to figure the credit for leave taken 

after March 31, 2020, and before April 1, 2021. Use 

Worksheet 2 to figure the credit for leave taken after 

March 31, 2021, and before October 1, 2021. For more 

information about the credit for qualified sick and family 

leave wages, go to IRS.gov/PLC.

Advance payment of COVID-19 credits ended. 

Although you may pay qualified sick and family leave 

wages in 2023 for leave taken after March 31, 2020, and 

before October 1, 2021, you may no longer request an 

advance payment of any credit on Form 7200, Advance 

Payment of Employer Credits Due to COVID-19.

Payroll tax credit for certain tax-exempt organizations affected by qualified disasters. Section 303(d) of 

the Taxpayer Certainty and Disaster Tax Relief Act of 

CAUTION

!

2020 allows for a payroll tax credit for certain tax-exempt 

organizations affected by certain qualified disasters not 

related to COVID-19. This credit is claimed on Form 

5884-D (not on Form 941-SS). Form 5884-D is filed after 

the Form 941-SS for the quarter for which the credit is 

being claimed has been filed. If you will claim this credit 

on Form 5884-D and you're also claiming a credit for 

qualified sick and family leave wages for leave taken 

before April 1, 2021, you must include any credit that will 

be claimed on Form 5884-D on Worksheet 1 for that 

quarter. For more information about this credit, go to 

IRS.gov/Form5884D.

Certification program for professional employer organizations (PEOs). The Stephen Beck, Jr., ABLE Act 

of 2014 required the IRS to establish a voluntary 

certification program for PEOs. PEOs handle various 

payroll administration and tax reporting responsibilities for 

their business clients and are typically paid a fee based on 

payroll costs. To become and remain certified under the 

certification program, certified professional employer 

organizations (CPEOs) must meet various requirements 

described in sections 3511 and 7705 and related 

published guidance. Certification as a CPEO may affect 

the employment tax liabilities of both the CPEO and its 

customers. A CPEO is generally treated for employment 

tax purposes as the employer of any individual who 

performs services for a customer of the CPEO and is 

covered by a contract described in section 7705(e)(2) 

between the CPEO and the customer (CPEO contract), 

but only for wages and other compensation paid to the 

individual by the CPEO. To become a CPEO, the 

organization must apply through the IRS Online 

Registration System. For more information or to apply to 

become a CPEO, go to IRS.gov/CPEO.

CPEOs must generally file Form 941-SS and 

Schedule R (Form 941), Allocation Schedule for 

Aggregate Form 941 Filers, electronically. For more 

information about a CPEO’s requirement to file 

electronically, see Rev. Proc. 2017-14, 2017-3 I.R.B. 426, 

available at IRS.gov/irb/2017-03_IRB#RP-2017-14.

Outsourcing payroll duties. Generally, as an employer, 

you're responsible to ensure that tax returns are filed and 

deposits and payments are made, even if you contract 

with a third party to perform these acts. You remain 

responsible if the third party fails to perform any required 

action. Before you choose to outsource any of your payroll 

and related tax duties (that is, withholding, reporting, and 

paying over social security, Medicare, FUTA, and income 

taxes) to a third-party payer, such as a payroll service 

provider or reporting agent, go to IRS.gov/

OutsourcingPayrollDuties for helpful information on this 

topic. If a CPEO pays wages and other compensation to 

an individual performing services for you, and the services 

are covered by a CPEO contract, then the CPEO is 

generally treated for employment tax purposes as the 

employer, but only for wages and other compensation 

paid to the individual by the CPEO. However, with respect 

to certain employees covered by a CPEO contract, you 

may also be treated as an employer of the employees 

and, consequently, may also be liable for federal 

employment taxes imposed on wages and other 

compensation paid by the CPEO to such employees. For 

-2- Instructions for Form 941-SS (Rev. 3-2023)
more information on the different types of third-party payer 

arrangements, see section 16 of Pub. 15.

COVID-19 employment tax credits when return filed 

by a third-party payer. If you're the common-law 

employer of the individuals that are paid qualified sick or 

family leave wages, you're entitled to the credit for the sick 

and family leave wages, regardless of whether you use a 

third-party payer (such as a PEO, CPEO, or section 3504 

agent) to report and pay your federal employment taxes. 

The third-party payer isn't entitled to the credits with 

respect to the wages and taxes it remits on your behalf 

(regardless of whether the third party is considered an 

"employer" for other purposes).

Aggregate Form 941-SS filers. Approved section 3504 

agents and CPEOs must complete and file Schedule R 

(Form 941) when filing an aggregate Form 941-SS. 

Aggregate Forms 941-SS are filed by agents approved by 

the IRS under section 3504. To request approval to act as 

an agent for an employer, the agent files Form 2678 with 

the IRS unless you’re a state or local government agency 

acting as an agent under the special procedures provided 

in Rev. Proc. 2013-39, 2013-52 I.R.B. 830, available at 

IRS.gov/irb/2013-52_IRB#RP-2013-39. Aggregate Forms 

941-SS are also filed by CPEOs approved by the IRS 

under section 7705. To become a CPEO, the organization 

must apply through the IRS Online Registration System at 

IRS.gov/CPEO. CPEOs file Form 8973, Certified 

Professional Employer Organization/Customer Reporting 

Agreement, to notify the IRS that they started or ended a 

service contract with a customer. CPEOs must generally 

file Form 941-SS and Schedule R (Form 941) 

electronically. For more information about a CPEO’s 

requirement to file electronically, see Rev. Proc. 2017-14, 

2017-3 I.R.B. 426, available at IRS.gov/irb/

2017-03_IRB#RP-2017-14.

Other third-party payers that file aggregate Forms 

941-SS, such as non-certified PEOs, must complete and 

file Schedule R (Form 941) if they have clients that are 

claiming the qualified small business payroll tax credit for 

increasing research activities, and/or the credit for 

qualified sick and family leave wages.

If both an employer and a section 3504 authorized 

agent (or a CPEO or other third-party payer) paid 

wages to an employee during a quarter, both the 

employer and the section 3504 authorized agent (or 

CPEO or other third-party payer, if applicable) should file 

Form 941-SS reporting the wages each entity paid to the 

employee during the applicable quarter and issue Forms 

W-2 reporting the wages each entity paid to the employee 

during the year.

If a third-party payer of sick pay is also paying qualified 

sick leave wages on behalf of an employer, the third party 

would be making the payments as an agent of the 

employer. The employer is required to do the reporting 

and payment of employment taxes with respect to the 

qualified sick leave wages and claim the credit for the 

qualified sick leave wages, unless the employer has an 

agency agreement with the third-party payer that requires 

the third-party payer to do the collecting, reporting, and/or 

paying or depositing employment taxes on the qualified 

sick leave wages. If the employer has an agency 

TIP

agreement with the third-party payer, the third-party payer 

includes the qualified sick leave wages on the third party's 

aggregate Form 941-SS, claims the sick leave credit on 

behalf of the employer on the aggregate Form 941-SS, 

and separately reports the credit allocable to the 

employers on Schedule R (Form 941). See section 6 of 

Pub. 15-A, Employer's Supplemental Tax Guide, for more 

information about sick pay reporting.

Work opportunity tax credit for qualified tax-exempt 

organizations hiring qualified veterans. Qualified 

tax-exempt organizations that hire eligible unemployed 

veterans may be able to claim the work opportunity tax 

credit against their payroll tax liability using Form 5884-C. 

For more information, go to IRS.gov/WOTC.

Correcting a previously filed Form 941-SS. If you 

discover an error on a previously filed Form 941-SS or if 

you otherwise need to amend a previously filed Form 

941-SS, make the correction using Form 941-X. Form 

941-X is filed separately from Form 941-SS. For more 

information, see the Instructions for Form 941-X, section 9 

of Pub. 80, or go to IRS.gov/CorrectingEmploymentTaxes.

Federal tax deposits must be made by electronic 

funds transfer (EFT). You must use EFT to make all 

federal tax deposits. Generally, an EFT is made using the 

Electronic Federal Tax Payment System (EFTPS). If you 

don't want to use EFTPS, you can arrange for your tax 

professional, financial institution, payroll service, or other 

trusted third party to make electronic deposits on your 

behalf. Also, you may arrange for your financial institution 

to initiate a same-day wire payment on your behalf. 

EFTPS is a free service provided by the Department of the 

Treasury. Services provided by your tax professional, 

financial institution, payroll service, or other third party 

may have a fee.

For more information on making federal tax deposits, 

see section 8 of Pub. 80. To get more information about 

EFTPS or to enroll in EFTPS, go to EFTPS.gov or call one 

of the following numbers.

• 800-555-4477 (toll free; for use by U.S. Virgin Islands 

only).

• 800-244-4829 (Spanish).

• 303-967-5916 (toll call).

To contact EFTPS using Telecommunications Relay 

Services (TRS) for people who are deaf, hard of hearing, 

or have a speech disability, dial 711 and then provide the 

TRS assistant the 800-555-4477 number above or 

800-733-4829.

Additional information about EFTPS is also available in 

Pub. 966.

For an EFTPS deposit to be on time, you must 

submit the deposit by 8 p.m. Eastern time the day 

before the date the deposit is due.

Same-day wire payment option. If you fail to submit a 

deposit transaction on EFTPS by 8 p.m. Eastern time the 

day before the date a deposit is due, you can still make 

your deposit on time by using the Federal Tax Collection 

Service (FTCS) to make a same-day wire payment. To 

use the same-day wire payment method, you will need to 

make arrangements with your financial institution ahead of 

time. Please check with your financial institution regarding 

CAUTION

!

Instructions for Form 941-SS (Rev. 3-2023) -3-
availability, deadlines, and costs. Your financial institution 

may charge you a fee for payments made this way. To 

learn more about the information you will need to give 

your financial institution to make a same-day wire 

payment, go to IRS.gov/SameDayWire.

Timeliness of federal tax deposits. If a deposit is 

required to be made on a day that isn't a business day, the 

deposit is considered timely if it is made by the close of 

the next business day. A business day is any day other 

than a Saturday, Sunday, or legal holiday. The term “legal 

holiday” for deposit purposes includes only those legal 

holidays in the District of Columbia. Legal holidays in the 

District of Columbia are provided in section 8 of Pub. 80.

Electronic filing and payment. Businesses can enjoy 

the benefits of filing tax returns and paying their federal 

taxes electronically. Whether you rely on a tax 

professional or handle your own taxes, the IRS offers you 

convenient programs to make filing and paying easier. 

Spend less time worrying about taxes and more time 

running your business. Use e-file and EFTPS to your 

benefit.

• For e-file, go to IRS.gov/EmploymentEfile for additional 

information. A fee may be charged to file electronically.

• For EFTPS, go to EFTPS.gov or call one of the 

numbers provided under Federal tax deposits must be 

made by electronic funds transfer (EFT), earlier.

• For electronic filing of Forms W-2AS, W-2CM, W-2GU, 

and W-2VI, go to SSA.gov/employer. You may be 

required to file Forms W-2 electronically. For details, see 

the General Instructions for Forms W-2 and W-3.

If you’re filing your tax return or paying your 

federal taxes electronically, a valid employer 

identification number (EIN) is required at the time 

the return is filed or the payment is made. If a valid EIN 

isn't provided, the return or payment won't be processed. 

This may result in penalties. See Employer identification 

number (EIN), later, for information about applying for an 

EIN.

Electronic funds withdrawal (EFW). If you file Form 

941-SS electronically, you can e-file and use EFW to pay 

the balance due in a single step using tax preparation 

software or through a tax professional. However, don't use 

EFW to make federal tax deposits. For more information 

on paying your taxes using EFW, go to IRS.gov/EFW.

Credit or debit card payments. You can pay the 

balance due shown on Form 941-SS by credit or debit 

card. Your payment will be processed by a payment 

processor who will charge a processing fee. Don't use a 

credit or debit card to make federal tax deposits. For more 

information on paying your taxes with a credit or debit 

card, go to IRS.gov/PayByCard.

Online payment agreement. You may be eligible to 

apply for an installment agreement online if you can’t pay 

the full amount of tax you owe when you file your return. 

For more information, see What if you can't pay in full, 

later.

Paid preparers. If you use a paid preparer to complete 

Form 941-SS, the paid preparer must complete and sign 

the paid preparer's section of the form.

CAUTION

!

Where can you get telephone help? For answers to 

your questions about completing Form 941-SS or tax 

deposit rules, call the IRS at one of the numbers listed 

below.

• 800-829-4933 (toll free; for use by U.S. Virgin Islands 

only) or 800-829-4059 (TDD/TTY for persons who are 

deaf, hard of hearing, or have a speech disability), 

Monday–Friday from 7:00 a.m. to 7:00 p.m. local time.

• 267-941-1000 (toll call), Monday–Friday from 6:00 a.m. 

to 11:00 p.m. Eastern time.

Photographs of missing children. The IRS is a proud 

partner with the National Center for Missing & Exploited 

Children® (NCMEC). Photographs of missing children 

selected by the Center may appear in instructions on 

pages that would otherwise be blank. You can help bring 

these children home by looking at the photographs and 

calling 1-800-THE-LOST (1-800-843-5678) if you 

recognize a child.

General Instructions:

Purpose of Form 941-SS

Use Form 941-SS to report social security and Medicare 

taxes for workers in American Samoa, Guam, the 

Commonwealth of the Northern Mariana Islands (CNMI), 

and the U.S. Virgin Islands.

Pub. 80 explains the requirements for withholding, 

depositing, and paying social security and Medicare 

taxes. It explains the forms you must give your 

employees, those your employees must give you, and 

those you must send to the IRS. See Pub. 15-A for 

specialized employment tax information supplementing 

the basic information provided in Pub. 80.

Federal law requires you, as an employer, to withhold 

certain taxes from your employees' pay. Each time you 

pay wages, you must withhold—or take out of your 

employees' pay—certain amounts for social security tax 

and Medicare tax. You must also withhold Additional 

Medicare Tax from wages you pay to an employee in 

excess of $200,000 in a calendar year. Under the 

withholding system, taxes withheld from your employees 

are credited to your employees in payment of their tax 

liabilities.

Federal law also requires you to pay any liability for the 

employer share of social security and Medicare taxes. 

This share of social security and Medicare taxes isn't 

withheld from employees.

Who Must File Form 941-SS?

Generally, you must file a return for the first quarter in 

which you pay wages subject to social security and 

Medicare taxes, and for each quarter thereafter until you 

file a final return. Use Form 941-SS if your principal place 

of business is in American Samoa, Guam, the CNMI, or 

the U.S. Virgin Islands, or if you have employees who are 

subject to income tax withholding for these jurisdictions.

Use Form 941-SS to report the following amounts.

• Wages you’ve paid.

• Tips your employees reported to you.

-4- Instructions for Form 941-SS (Rev. 3-2023)
• Both the employer and the employee share of social 

security and Medicare taxes.

• Additional Medicare Tax withheld from employees.

• Current quarter's adjustments to social security and 

Medicare taxes for fractions of cents, sick pay, tips, and 

group-term life insurance.

• Qualified small business payroll tax credit for increasing 

research activities.

• Credit for qualified sick and family leave wages paid 

this quarter of 2023 for leave taken after March 31, 2020, 

and before October 1, 2021.

Don't use Form 941-SS if you have both employees 

who are subject to U.S. income tax withholding and 

employees who aren't subject to U.S. income tax 

withholding. Instead, you must file only Form 941 (or Form 

944, Employer's ANNUAL Federal Tax Return) and 

include all of your employees' wages on that form.

Don't use Form 941-SS to report backup withholding or 

income tax withholding on nonpayroll payments such as 

pensions, annuities, and gambling winnings. Report these 

types of withholding on Form 945, Annual Return of 

Withheld Federal Income Tax. Also, don't use Form 

941-SS to report unemployment taxes. Report 

unemployment taxes (U.S. Virgin Islands employers only) 

on Form 940, Employer's Annual Federal Unemployment 

(FUTA) Tax Return.

After you file your first Form 941-SS, you must file a 

return each quarter, even if you have no taxes to report, 

unless you filed a final return or one of the exceptions 

listed next applies.

Exceptions

Special rules apply to some employers.

• If you received notification to file Form 944, you must 

file Form 944 annually; don't file Form 941-SS quarterly.

• Seasonal employers don't have to file a Form 941-SS 

for quarters in which they have no tax liability because 

they have paid no wages. To tell the IRS that you won't file 

a return for one or more quarters during the year, check 

the box on line 18 every quarter you file Form 941-SS. 

The IRS generally won't inquire about unfiled returns if at 

least one taxable return is filed each year. However, you 

must check the box on line 18 on every quarterly return 

you file. Otherwise, the IRS will expect a return to be filed 

for each quarter.

• Employers of household employees don't usually file 

Form 941-SS. See Pub. 80, Pub. 926, and Schedule H 

(Form 1040) for more information.

• Employers of farm employees don't file Form 941-SS 

for wages paid for agricultural labor. See Form 943 and 

Pub. 51 for more information.

If none of these exceptions apply and you haven't 

filed a final return, you must file Form 941-SS 

each quarter even if you didn't pay wages during 

the quarter. Use IRS e-file, if possible.

Requesting To File Forms 941-SS Instead of 

Form 944, or Requesting To File Form 944 

Instead of Forms 941-SS

Requesting to file Forms 941-SS instead of Form 

944. Employers in American Samoa, Guam, the CNMI, 

TIP

and the U.S. Virgin Islands that would otherwise be 

required to file Form 944 may contact the IRS to request 

to file quarterly Forms 941-SS instead of annual Form 

944. To request to file quarterly Forms 941-SS to report 

your social security and Medicare taxes for the 2023 

calendar year, you must either call the IRS at 

800-829-4933 toll free (U.S. Virgin Islands only) or 

267-941-1000 (toll call) between January 1, 2023, and 

April 3, 2023, or send a written request postmarked 

between January 1, 2023, and March 15, 2023. After you 

contact the IRS, the IRS will send you a written notice that 

your filing requirement has been changed to Forms 

941-SS. You must receive written notice from the IRS to 

file Forms 941-SS instead of Form 944 before you may file 

these forms. If you don't receive this notice, you must file 

Form 944 for calendar year 2023.

Requesting to file Form 944 instead of Forms 

941-SS. If you’re required to file Forms 941-SS but 

believe your employment taxes for 2023 will be $1,000 or 

less, you may request to file Form 944 instead of Forms 

941-SS by calling the IRS at 800-829-4933 toll free (U.S. 

Virgin Islands only) or 267-941-1000 (toll call) between 

January 1, 2023, and April 3, 2023, or sending a written 

request postmarked between January 1, 2023, and March 

15, 2023. After you contact the IRS, the IRS will send you 

a written notice that your filing requirement has been 

changed to Form 944. You must receive written notice 

from the IRS to file Form 944 instead of Forms 941-SS 

before you may file this form. If you don't receive this 

notice, you must file Forms 941-SS for calendar year 

2023.

Where to send written requests. Written requests 

should be sent to:

Department of the Treasury

Internal Revenue Service

Ogden, UT 84201-0038

For more information about these procedures, see Rev. 

Proc. 2009-51, 2009-45 I.R.B. 625, available at 

IRS.gov/irb/2009-45_IRB#RP-2009-51.

What if You Reorganize or Close Your 

Business?

If You Sell or Transfer Your Business . . .

If you sell or transfer your business during the quarter, you 

and the new owner must each file a Form 941-SS for the 

quarter in which the transfer occurred. Report only the 

wages you paid.

When two businesses merge, the continuing firm must 

file a return for the quarter in which the change took place 

and the other firm should file a final return.

Changing from one form of business to another—such 

as from a sole proprietorship to a partnership or 

corporation—is considered a transfer. If a transfer occurs, 

you may need a new EIN. See Pub. 1635 and section 1 of 

Pub. 80 for more information.

Attach a statement to your return with:

Instructions for Form 941-SS (Rev. 3-2023) -5-
• The new owner's name (or the new name of the 

business);

• Whether the business is now a sole proprietorship, 

partnership, or corporation;

• The kind of change that occurred (a sale or transfer);

• The date of the change; and

• The name of the person keeping the payroll records 

and the address where those records will be kept.

If Your Business Has Closed . . .

If you permanently go out of business or stop paying 

wages to your employees, you must file a final return. To 

tell the IRS that Form 941-SS for a particular quarter is 

your final return, check the box on line 17 and enter the 

final date you paid wages. Also attach a statement to your 

return showing the name of the person keeping the payroll 

records and the address where those records will be kept.

See Terminating a business in the General Instructions 

for Forms W-2 and W-3 for information about earlier dates 

for the expedited furnishing and filing of the following 

Wage and Tax Statements when a final Form 941-SS is 

filed.

• W-2AS, American Samoa.

• W-2CM, CNMI.

• W-2GU, Guam.

• W-2VI, U.S. Virgin Islands.

If you participated in a statutory merger or 

consolidation, or qualify for predecessor-successor status 

due to an acquisition, you should generally file 

Schedule D (Form 941), Report of Discrepancies Caused 

by Acquisitions, Statutory Mergers, or Consolidations. 

See the Instructions for Schedule D (Form 941) to 

determine whether you should file Schedule D (Form 941) 

and when you should file it.

When Must You File?

File your initial Form 941-SS for the quarter in which you 

first paid wages that are subject to social security and 

Medicare taxes. See the table titled When To File Form 

941-SS, later.

Then, you must file for every quarter after that—every 3 

months—even if you have no taxes to report, unless 

you’re a seasonal employer or are filing your final return. 

See Seasonal employers and If Your Business Has 

Closed, earlier.

File Form 941-SS only once for each quarter. If you 

filed electronically, don't file a paper Form 941-SS. For 

more information about filing Form 941-SS electronically, 

see Electronic filing and payment, earlier.

When To File Form 941-SS

Your Form 941-SS is due by the last day of the month that follows the end of the 

quarter.

The Quarter Includes . . . Quarter Ends 

Form 941-SS

 Is Due

1. January, February, March March 31 April 30 

2. April, May, June June 30 July 31 

3. July, August, September September 30 October 31 

4. October, November, December December 31 January 31

For example, you must generally report wages you pay 

during the 1st quarter—which is January through 

March—by April 30. If you made timely deposits in full 

payment of your taxes for the quarter, you may file by the 

10th day of the 2nd month that follows the end of the 

quarter. For example, you may file Form 941-SS by May 

10 if you made timely deposits in full payment of your 

taxes for the 1st quarter.

If we receive Form 941-SS after the due date, we will 

treat Form 941-SS as filed on time if the envelope 

containing Form 941-SS is properly addressed, contains 

sufficient postage, and is postmarked by the U.S. Postal 

Service on or before the due date, or sent by an 

IRS-designated private delivery service (PDS) on or 

before the due date. If you don't follow these guidelines, 

we will generally consider Form 941-SS filed when it is 

actually received. For more information about PDSs, see 

Where Should You File, later.

If any due date for filing falls on a Saturday, Sunday, or 

legal holiday, you may file your return on the next 

business day.

How Should You Complete Form 

941-SS?

Type or print your EIN, name, and address in the spaces 

provided. Also enter your name and EIN on the top of 

pages 2 and 3. Don't use your social security number 

(SSN) or individual taxpayer identification number (ITIN). 

Generally, enter the business (legal) name you used when 

you applied for your EIN. For example, if you’re a sole 

proprietor, enter “Haleigh Smith” on the “Name” line and 

“Haleigh's Cycles” on the “Trade name” line. Leave the 

“Trade name” line blank if it is the same as your “Name.”

If you use a tax preparer to fill out Form 941-SS, make 

sure the preparer shows your business name exactly as it 

appeared when you applied for your EIN.

Employer identification number (EIN). To make sure 

that businesses comply with federal tax laws, the IRS 

monitors tax filings and payments by using a numerical 

system to identify taxpayers. A unique nine-digit EIN is 

assigned to all corporations, partnerships, and some sole 

proprietors. Businesses needing an EIN must apply for a 

number and use it throughout the life of the business on all 

tax returns, payments, and reports.

Your business should have only one EIN. If you have 

more than one and aren't sure which one to use, write to 

the IRS office where you file your returns (using the 

Without a payment address under Where Should You 

File, later) or call the IRS at 800-829-4933 (toll free; for 

use by U.S. Virgin Islands only) or 267-941-1099 (toll call).

If you don't have an EIN, you may apply for one online 

by going to IRS.gov/EIN. You may also apply for an EIN 

by faxing or mailing Form SS-4 to the IRS. If the principal 

business was created outside of the United States or U.S. 

territories, you may also apply for an EIN by calling 

267-941-1099 (toll call). 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.

-6- Instructions for Form 941-SS (Rev. 3-2023)
If you’re filing your tax return electronically, a valid 

EIN is required at the time the return is filed. If a 

valid EIN isn't provided, the return won't be 

accepted. This may result in penalties.

Always be sure the EIN on the form you file 

exactly matches the EIN the IRS assigned to your 

business. Don't use your SSN or ITIN on forms 

that ask for an EIN. If you used an EIN (including a prior 

owner's EIN) on Form 941-SS that is different from the 

EIN reported on Form W-3SS, see Box h—Other EIN 

used this year in the General Instructions for Forms W-2 

and W-3. Filing a Form 941-SS with an incorrect EIN or 

using another business's EIN may result in penalties and 

delays in processing your return.

If you change your business name, business address, or responsible party . . . Notify the IRS 

immediately if you change your business name, business 

address, or responsible party.

• Write to the IRS office where you file your returns (using 

the Without a payment address under Where Should You 

File, later) to notify the IRS of any business name change. 

See Pub. 1635 to see if you need to apply for a new EIN.

• Complete and mail Form 8822-B to notify the IRS of a 

business address or responsible party change. Don't mail 

Form 8822-B with your Form 941-SS. For a definition of 

“responsible party,” see the Instructions for Form SS-4.

Check the Box for the Quarter

Under “Report for this Quarter of 2023” at the top of Form 

941-SS, check the appropriate box of the quarter for 

which you're filing. Make sure the quarter checked is the 

same as shown on any attached Schedule B (Form 941), 

Report of Tax Liability for Semiweekly 

Schedule Depositors, and, if applicable, Schedule R 

(Form 941).

Completing and Filing Form 941-SS

Make entries on Form 941-SS as follows to enable 

accurate scanning and processing.

• Use 10-point Courier font (if possible) for all entries if 

you’re typing or using a computer to complete your form. 

Portable Document Format (PDF) forms on IRS.gov have 

fillable fields with acceptable font specifications.

• Don't enter dollar signs and decimal points. Commas 

are optional. Enter dollars to the left of the preprinted 

decimal point and cents to the right of it. Don’t round 

entries to whole dollars. Always show an amount for 

cents, even if it is zero.

• Leave blank any data field (except lines 1 and 12) with 

a value of zero.

• Enter negative amounts using a minus sign (if possible). 

Otherwise, use parentheses.

• Enter your name and EIN on all pages and 

attachments.

• Enter your name, EIN, “Form 941-SS,” and the tax year 

and quarter on all attachments.

• Staple multiple sheets in the upper left corner when 

filing.

Complete all three pages. You must complete all three 

pages of Form 941-SS and sign on page 3. Failure to do 

so may delay processing of your return.

CAUTION

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TIP

Reconciling Forms 941-SS With Form W-3SS

The IRS matches amounts reported on your four quarterly 

Forms 941-SS with Form W-2AS, W-2CM, W-2GU, or 

W-2VI amounts totaled on your yearly Form W-3SS, 

Transmittal of Wage and Tax Statements. If the amounts 

don't agree, you may be contacted by the IRS or the 

Social Security Administration (SSA). The following 

amounts are reconciled.

• Social security wages.

• Social security tips.

• Medicare wages and tips.

Use Schedule D (Form 941) to explain certain wage, 

tax, and payment discrepancies between Forms 941-SS 

and Forms W-2AS, W-2CM, W-2GU, W-2VI, W-3SS, and 

W-2c, Corrected Wage and Tax Statement, that were 

caused by acquisitions, statutory mergers, or 

consolidations. For more information, see the Instructions 

for Schedule D (Form 941). Also see Rev. Proc. 2004-53 

for more information. You can find Rev. Proc. 2004-53 on 

page 320 of I.R.B. 2004-34 at IRS.gov/irb/

2004-34_IRB#RP-2004-53.

Where Should You File?

You're encouraged to file Form 941-SS electronically. Go 

to IRS.gov/EmploymentEfile for more information on 

electronic filing. If you file a paper return, where you file 

depends on whether you include a payment with Form 

941-SS.

PDSs can't deliver to P.O. boxes. You must use the 

U.S. Postal Service to mail an item to a P.O. box address. 

Go to IRS.gov/PDS for the current list of PDSs. For the 

IRS mailing address to use if you're using a PDS, go to 

IRS.gov/PDSstreetAddresses. Select the address on the 

webpage that is given for the Ogden Submission 

Processing Center.

If you’re in . . .

Without a 

payment . . . With a payment . . .

American Samoa, Guam, CNMI, 

U.S. Virgin Islands

Internal Revenue 

Service 

P.O. Box 409101

Ogden, UT 84409

Internal Revenue 

Service 

P.O. Box 932100

Louisville, KY 

40293-2100

Special filing addresses for 

exempt organizations; federal, 

state, and local governmental 

entities; and Indian tribal 

governmental entities, 

regardless of location

Department of the 

Treasury 

Internal Revenue 

Service

Ogden, UT 

84201-0005

Internal Revenue 

Service 

P.O. Box 932100

Louisville, KY 

40293-2100

Your filing address may have changed from that 

used to file your employment tax return in prior 

years. Don't send Form 941-SS or any payments 

to the SSA.

Depositing Your Taxes

You must deposit all depository taxes 

electronically by EFT. For more information, see 

Federal tax deposits must be made by electronic 

funds transfer (EFT) under Reminders, earlier.

CAUTION

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CAUTION

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Instructions for Form 941-SS (Rev. 3-2023) -7-
Must You Deposit Your Taxes?

You may have to deposit both the employer and 

employee social security taxes and Medicare taxes.

• If your total taxes after adjustments and 

nonrefundable credits (line 12) are less than $2,500 

for the current quarter or the prior quarter, and you 

didn't incur a $100,000 next-day deposit obligation 

during the current quarter. You don't have to make a 

deposit. To avoid a penalty, you must pay any amount 

due in full with a timely filed return or you must deposit any 

amount you owe by the due date of the return. For more 

information on paying with a timely filed return, see the 

instructions for line 14, later. If you’re not sure your total 

tax liability for the current quarter will be less than $2,500 

(and your liability for the prior quarter wasn't less than 

$2,500), make deposits using the semiweekly or monthly 

rules so you won't be subject to failure-to-deposit (FTD) 

penalties.

• If your total taxes after adjustments and 

nonrefundable credits (line 12) are $2,500 or more 

for the current quarter and the prior quarter. You 

must make deposits according to your deposit schedule. 

See section 8 of Pub. 80 for information about payments 

made under the accuracy of deposits rule and for rules 

about federal tax deposits.

Reducing your deposits for the credit for qualified 

sick and family leave wages. Employers eligible to 

claim the credit for qualified sick and family leave wages 

paid this quarter of 2023 for leave taken after March 31, 

2020, and before October 1, 2021, can reduce their 

deposits by the amount of their anticipated credit. 

Employers won’t be subject to an FTD penalty for 

reducing their deposits if certain conditions are met. See 

the instructions for line 11b and line 11d, later, for more 

information on these credits. For more information on 

reducing deposits, see Notice 2020-22, 2020-17 I.R.B. 

664, available at IRS.gov/irb/2020-17_IRB#NOT-2020-22; 

and Notice 2021-24, 2021-18 I.R.B. 1122, available at 

IRS.gov/irb/2021-18_IRB#NOT-2021-24. See the 

instructions for line 16, later, for information on adjusting 

tax liabilities reported on line 16 or Schedule B (Form 941) 

for nonrefundable credits.

When Must You Deposit Your Taxes?

Determine if You’re a Monthly or Semiweekly 

Schedule Depositor for the Quarter

The IRS uses two different sets of deposit rules to 

determine when businesses must deposit their social 

security and Medicare taxes. These schedules tell you 

when a deposit is due after you have a payday.

Your deposit schedule isn't determined by how often 

you pay your employees. Your deposit schedule depends 

on the total tax liability you reported on Form 941-SS 

during the previous 4-quarter lookback period (July 1 of 

the second preceding calendar year through June 30 of 

the preceding calendar year). See section 8 of Pub. 80 for 

details. If you filed Form 944 in either 2021 or 2022, your 

lookback period is the 2021 calendar year.

Before the beginning of each calendar year, determine 

which type of deposit schedule you must use.

• If you reported $50,000 or less in taxes during the 

lookback period, you’re a monthly schedule depositor.

• If you reported more than $50,000 of taxes during the 

lookback period, you’re a semiweekly schedule 

depositor.

If you’re a monthly schedule depositor and 

accumulate a $100,000 tax liability on any day 

during the deposit period, you become a 

semiweekly schedule depositor on the next day and 

remain so for at least the rest of the calendar year and for 

the following calendar year. See $100,000 Next-Day 

Deposit Rule in section 8 of Pub. 80 for more information. 

The $100,000 tax liability threshold requiring a next-day 

deposit is determined before you consider any reduction 

of your liability for nonrefundable credits. For more 

information, including an example, see frequently asked 

question 17 at IRS.gov/ETD.

What About Penalties and Interest?

Avoiding Penalties and Interest

You can avoid paying penalties and interest if you do all of 

the following.

• Deposit or pay your taxes when they are due, unless 

you meet the requirements discussed in Notice 2020-22 

and Notice 2021-24.

• File your fully completed Form 941-SS on time.

• Report your tax liability accurately.

• Submit valid checks for tax payments.

• Furnish accurate Forms W-2AS, W-2CM, W-2GU, or 

W-2VI to employees.

• File Form W-3SS and Copy A of Forms W-2AS, 

W-2CM, W-2GU, or W-2VI with the SSA on time and 

accurately.

Penalties and interest are charged on taxes paid late 

and returns filed late at a rate set by law. See section 8 of 

Pub. 80 for details.

Use Form 843 to request abatement of assessed 

penalties or interest. Don't request abatement of 

assessed penalties or interest on Form 941-SS or Form 

941-X.

If you receive a notice about a penalty after you file this 

return, reply to the notice with an explanation and we will 

determine if you meet reasonable-cause criteria. Don't 

attach an explanation when you file your return.

If federal income, social security, and Medicare 

taxes that must be withheld (that is, trust fund 

taxes) aren't withheld or aren't deposited or paid 

to the United States Treasury, the trust fund recovery 

penalty may apply. The penalty is 100% of the unpaid 

trust fund tax. If these unpaid taxes can't be immediately 

collected from the employer or business, the trust fund 

recovery penalty may be imposed on all persons who are 

determined by the IRS to be responsible for collecting, 

accounting for, or paying over these taxes, and who acted 

willfully in not doing so. For more information, see section 

8 of Pub. 80. The trust fund recovery penalty won’t apply 

to any amount of trust fund taxes an employer holds back 

in anticipation of any credits they are entitled to.

CAUTION

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CAUTION

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-8- Instructions for Form 941-SS (Rev. 3-2023)
Adjustment of Tax on Tips

If, by the 10th of the month after the month you received 

an employee's report on tips, you don't have enough 

employee funds available to withhold the employee share 

of social security and Medicare taxes, you no longer have 

to collect it. Report the entire amount of these tips on 

line 5b (Taxable social security tips), line 5c (Taxable 

Medicare wages and tips), and, if the withholding 

threshold is met, line 5d (Taxable wages and tips subject 

to Additional Medicare Tax withholding). Include as a 

negative adjustment on line 9 the total uncollected 

employee share of the social security and Medicare taxes.

Where Can You Obtain Forms?

See Pub. 80 for information on ordering IRS forms. You 

may also be able to get some IRS forms at the addresses 

listed next.

American Samoa Tax Office

Executive Office Building, First Floor

Pago Pago, AS 96799 

CNMI CNMI Division of Revenue and Taxation

Joeten Dandan Commercial Center

Saipan, MP 96950 

Guam Department of Revenue and Taxation

Government of Guam

1240 Army Drive

Barrigada, GU 96913 

U.S. Virgin Islands Bureau of Internal Revenue

6115 Estate Smith Bay, Ste 225

St. Thomas, VI 00802 

Specific Instructions:

Part 1: Answer These Questions for 

This Quarter

1. Number of Employees Who Received Wages, 

Tips, or Other Compensation

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 

Form 941-SS. Don't include:

• Household employees,

• Employees in nonpay status for the pay period,

• Farm employees,

• Pensioners, or

• Active members of the U.S. Armed Forces.

4. If No Wages, Tips, and Other Compensation 

Are Subject to Social Security or Medicare 

Tax . . .

If no wages, tips, and compensation are subject to social 

security or Medicare tax, check the box on line 4. If this 

question doesn't apply to you, leave the box blank. For 

more information about exempt wages, see section 12 of 

Pub. 80. For religious exemptions, see section 4 of Pub. 

15-A.

If you’re a governmental employer, wages you pay 

aren't 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.

For purposes of these instructions, all references 

to “sick pay” mean ordinary sick pay, not “qualified 

sick leave wages” that are reported on line 5a(i) 

for leave taken after March 31, 2020, and before April 1, 

2021, or reported on line 5a for leave taken after March 

31, 2021, and before October 1, 2021.

5a–5e. Taxable Social Security and Medicare 

Wages and Tips

Qualified sick leave wages and qualified family 

leave wages paid this quarter of 2023 for leave 

taken after March 31, 2020, and before April 1, 

2021, are reported on lines 5a(i) and 5a(ii), respectively. 

Qualified sick leave wages and qualified family leave 

wages paid this quarter of 2023 for leave taken after 

March 31, 2021, and before October 1, 2021, are reported 

on line 5a.

5a. Taxable social security wages. Enter the total 

wages, including qualified sick leave wages and qualified 

family leave wages paid this quarter of 2023 for leave 

taken after March 31, 2021, and before October 1, 2021; 

sick pay; and taxable fringe benefits subject to social 

security taxes you paid to your employees during the 

quarter. Don't include the qualified sick leave wages paid 

this quarter of 2023 that are reported on line 5a(i) or 

qualified family leave wages paid this quarter of 2023 that 

are reported on line 5a(ii) for leave taken after March 31, 

2020, and before April 1, 2021. For this purpose, sick pay 

includes payments made by an insurance company to 

your employees for which you received timely notice from 

the insurance company. See section 6 of Pub. 15-A for 

more information about sick pay reporting. See the 

instructions for line 8 for an adjustment that you may need 

to make on Form 941-SS for sick pay.

Enter the amount before payroll deductions. Don't 

include tips on this line. For information on types of wages 

subject to social security taxes, see section 4 of Pub. 80.

For 2023, the rate of social security tax on taxable 

wages, except for qualified sick leave wages and qualified 

family leave wages paid in 2023 for leave taken after 

March 31, 2020, and before April 1, 2021, is 6.2% (0.062) 

each for the employer and employee or 12.4% (0.124) for 

both. Stop paying social security tax on and entering an 

employee's wages on line 5a when the employee's 

taxable wages, including qualified sick leave wages paid 

in 2023 that are reported on line 5a(i), qualified family 

leave wages paid in 2023 that are reported on line 5a(ii), 

and tips, reach $160,200 for the year. However, continue 

to withhold Medicare taxes for the whole year on all 

wages, including qualified sick leave wages paid in 2023, 

qualified family leave wages paid in 2023, and tips, even 

when the social security wage base of $160,200 has been 

reached.

CAUTION

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TIP

CAUTION

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Instructions for Form 941-SS (Rev. 3-2023) -9-
For purposes of the credit for qualified sick and family 

leave wages, qualified sick leave and family leave wages 

are wages for social security and Medicare tax purposes, 

determined without regard to the exclusions from the 

definition of employment under sections 3121(b)(1)–(22), 

that an employer pays that otherwise meet the 

requirements of the Emergency Paid Sick Leave Act 

(EPSLA) or the Emergency Family and Medical Leave 

Expansion Act (Expanded FMLA), as enacted under the 

FFCRA and amended for purposes of the ARP. However, 

don't include any wages otherwise excluded under 

section 3121(b) when reporting qualified sick and family 

leave wages on lines 5a, 5a(i), 5a(ii), 5c, and, if 

applicable, 5d. See the instructions for line 11d for 

information about the credit for qualified sick and family 

leave wages for leave taken after March 31, 2021, and 

before October 1, 2021.

line 5a (column 1)

x  0.124

line 5a (column 2)

EPSLA. Employers with fewer than 500 employees 

and, for leave taken after March 31, 2021, and before 

October 1, 2021, certain governmental employers without 

regard to number of employees (except for the federal 

government and its agencies and instrumentalities unless 

described in section 501(c)(1)) are entitled to a credit if 

they provide paid sick leave to employees that otherwise 

meets the requirements of the EPSLA. Under the EPSLA, 

as amended for purposes of the ARP, wages are qualified 

sick leave wages if paid to employees that are unable to 

work or telework before October 1, 2021, because the 

employee:

1. Is subject to a federal, state (including U.S. 

territories), or local quarantine or isolation order related to 

COVID-19;

2. Has been advised by a health care provider to 

self-quarantine due to concerns related to COVID-19;

3. Is experiencing symptoms of COVID-19 and 

seeking a medical diagnosis; or, for leave taken after 

March 31, 2021, and before October 1, 2021, is seeking 

or awaiting the results of a diagnostic test for, or a medical 

diagnosis of, COVID-19 (and the employee has been 

exposed to COVID-19 or the employee's employer has 

requested such test or diagnosis), or the employee is 

obtaining immunizations related to COVID-19 or 

recovering from an injury, disability, illness, or condition 

related to such immunization;

4. Is caring for an individual subject to an order 

described in (1) or who has been advised as described in 

(2);

5. Is caring for a son or daughter because the school 

or place of care for that child has been closed, or the 

childcare provider for that child is unavailable, due to 

COVID-19 precautions; or

6. Is experiencing any other substantially similar 

condition specified by the U.S. Department of Health and 

Human Services, which for leave taken after March 31, 

2021, and before October 1, 2021, includes to 

accompany an individual to obtain immunization related to 

COVID-19, or to care for an individual who is recovering 

from any injury, disability, illness, or condition related to 

the immunization.

Son or daughter. A son or daughter must generally 

have been under 18 years of age or incapable of self-care 

because of a mental or physical disability. A son or 

daughter includes a biological child, adopted child, 

stepchild, foster child, legal ward, or a child for whom the 

employee assumes parental status and carries out the 

obligations of a parent.

Limits on qualified sick leave wages. The EPSLA, 

as amended for purposes of the ARP, provides different 

limitations for different circumstances under which 

qualified sick leave wages are paid. For paid sick leave 

qualifying under (1), (2), or (3) above, the amount of 

qualified sick leave wages is determined at the 

employee's regular rate of pay, but the wages may not 

exceed $511 for any day (or portion of a day) for which the 

individual is paid sick leave. For paid sick leave qualifying 

under (4), (5), or (6) above, the amount of qualified sick 

leave wages is determined at two-thirds the employee's 

regular rate of pay, but the wages may not exceed $200 

for any day (or portion of a day) for which the individual is 

paid sick leave. The EPSLA also limits each individual to a 

maximum of up to 80 hours of paid sick leave in total for 

leave taken after March 31, 2020, and before April 1, 

2021. The ARP resets this limit at 80 hours of paid sick 

leave for leave taken after March 31, 2021, and before 

October 1, 2021. Therefore, for leave taken after March 

31, 2020, and before April 1, 2021, the maximum amount 

of paid sick leave wages can't exceed $5,110 for an 

employee for leave under (1), (2), or (3), and it can't 

exceed $2,000 for an employee for leave under (4), (5), or 

(6). These maximum amounts also reset and apply to 

leave taken after March 31, 2021, and before October 1, 

2021.

For more information about qualified sick leave wages, 

go to IRS.gov/PLC.

Expanded FMLA. Employers with fewer than 500 

employees and, for leave taken after March 31, 2021, and 

before October 1, 2021, certain governmental employers 

without regard to number of employees (except for the 

federal government and its agencies and instrumentalities 

unless described in section 501(c)(1)) are entitled to a 

credit under the FFCRA, as amended for purposes of the 

ARP, if they provide paid family leave to employees that 

otherwise meets the requirements of the Expanded 

FMLA. For leave taken after March 31, 2020, and before 

April 1, 2021, wages are qualified family leave wages if 

paid to an employee who has been employed for at least 

30 calendar days when an employee is unable to work or 

telework due to the need to care for a son or daughter 

under 18 years of age or incapable of self-care because of 

a mental or physical disability because the school or place 

of care for that child has been closed, or the childcare 

provider for that child is unavailable, due to a public health 

emergency. See Son or daughter, earlier, for more 

information. For leave taken after March 31, 2021, and 

before October 1, 2021, the leave can be granted for any 

other reason provided by the EPSLA, as amended for 

purposes of the ARP.

-10- Instructions for Form 941-SS (Rev. 3-2023)
For leave taken after March 31, 2020, and before April 

1, 2021, the first 10 days for which an employee takes 

leave may be unpaid. During this period, employees may 

use other forms of paid leave, such as qualified sick leave, 

accrued sick leave, annual leave, or other paid time off. 

After an employee takes leave for 10 days, the employer 

must provide the employee paid leave (that is, qualified 

family leave wages) for up to 10 weeks. For leave taken 

after March 31, 2021, and before October 1, 2021, the 

10-day rule discussed above doesn't apply and the paid 

leave can be provided for up to 12 weeks.

Rate of pay and limit on wages. The rate of pay must 

be at least two-thirds of the employee’s regular rate of pay 

(as determined under the Fair Labor Standards Act of 

1938), multiplied by the number of hours the employee 

would have otherwise been scheduled to work. For leave 

taken after March 31, 2020, and before April 1, 2021, the 

total qualified family leave wages can’t exceed $200 per 

day or $10,000 in the aggregate per employee. For leave 

taken after March 31, 2021, and before October 1, 2021, 

the limit resets and the total qualified family leave wages 

can't exceed $200 per day or $12,000 in the aggregate 

per employee.

For more information about qualified family leave 

wages, go to IRS.gov/PLC.

5a(i). Qualified sick leave wages. Enter the qualified 

taxable (subject to social security tax) sick leave wages 

you paid this quarter of 2023 to your employees for leave 

taken after March 31, 2020, and before April 1, 2021. 

Qualified sick leave wages for leave taken after March 31, 

2020, and before April 1, 2021, aren't subject to the 

employer share of social security tax; therefore, the tax 

rate on these wages is 6.2% (0.062). Stop paying social 

security tax on and entering an employee's wages on 

line 5a(i) when the employee's taxable wages, including 

wages reported on line 5a, qualified sick leave wages 

reported on line 5a(i), qualified family leave wages 

reported on line 5a(ii), and tips, reach $160,200 for the 

year. See the instructions for line 5c for reporting 

Medicare tax on qualified sick leave wages, including the 

portion above the social security wage base.

For purposes of the credit for qualified sick and family 

leave wages, qualified sick leave wages are wages for 

social security and Medicare tax purposes, determined 

without regard to the exclusions from the definition of 

employment under sections 3121(b)(1)–(22), that an 

employer pays that otherwise meet the requirements of 

the EPSLA, as enacted under the FFCRA and amended 

by the COVID-related Tax Relief Act of 2020. However, 

don't include any wages otherwise excluded under 

section 3121(b) when reporting qualified sick leave wages 

on lines 5a(i), 5c, and, if applicable, 5d. See the 

instructions for line 11b for information about the credit for 

qualified sick and family leave wages for leave taken after 

March 31, 2020, and before April 1, 2021.

line 5a(i) (column 1)

x    0.062

line 5a(i) (column 2)

5a(ii). Qualified family leave wages. Enter the qualified 

taxable (subject to social security tax) family leave wages 

you paid this quarter of 2023 to your employees for leave 

taken after March 31, 2020, and before April 1, 2021. 

Qualified family leave wages for leave taken after March 

31, 2020, and before April 1, 2021, aren't subject to the 

employer share of social security tax; therefore, the tax 

rate on these wages is 6.2% (0.062). Stop paying social 

security tax on and entering an employee's wages on 

line 5a(ii) when the employee's taxable wages, including 

wages reported on line 5a, qualified sick leave wages 

reported on line 5a(i), qualified family leave wages 

reported on line 5a(ii), and tips, reach $160,200 for the 

year. See the instructions for line 5c for reporting 

Medicare tax on qualified family leave wages, including 

the portion above the social security wage base.

For purposes of the credit for qualified sick and family 

leave wages, qualified family leave wages are wages for 

social security and Medicare tax purposes, determined 

without regard to the exclusions from the definition of 

employment under sections 3121(b)(1)–(22), that an 

employer pays that otherwise meet the requirements of 

the Expanded FMLA, as enacted under the FFCRA and 

amended by the COVID-related Tax Relief Act of 2020. 

However, don't include any wages otherwise excluded 

under section 3121(b) when reporting qualified family 

leave wages on lines 5a(ii), 5c, and, if applicable, 5d. See 

the instructions for line 11b for information about the credit 

for qualified sick and family leave wages for leave taken 

after March 31, 2020, and before April 1, 2021.

line 5a(ii) (column 1)

x    0.062

line 5a(ii) (column 2)

5b. Taxable social security tips. Enter all tips your 

employees reported to you during the quarter until the 

total of the tips and taxable wages, including wages 

reported on line 5a, qualified sick leave wages reported 

on line 5a(i), and qualified family leave wages reported on 

line 5a(ii), for an employee reach $160,200 for the year. 

Include all tips your employee reported to you even if you 

were unable to withhold the employee tax of 6.2%. You 

will reduce your total taxes by the amount of any 

uncollected employee share of social security and 

Medicare taxes on tips later on line 9; see Current 

quarter's adjustments for tips and group-term life 

insurance, later. Don't include service charges on line 5b. 

For details about the difference between tips and service 

charges, see Rev. Rul. 2012-18, 2012-26 I.R.B. 1032, 

available at IRS.gov/irb/2012-26_IRB#RR-2012-18.

Your employee must report cash tips to you by the 10th 

day of the month after the month the tips are received. 

Cash tips include tips paid by cash, check, debit card, and 

credit card. The report should include charged tips (for 

example, credit and debit card charges) you paid over to 

the employee for charge customers, tips the employee 

received directly from customers, and tips received from 

other employees under any tip-sharing arrangement. Both 

directly and indirectly tipped employees must report tips to 

you. No report is required for months when tips are less 

than $20. Employees may use Form 4070 (available only 

Instructions for Form 941-SS (Rev. 3-2023) -11-
in Pub. 1244) or submit a written statement or electronic 

tip record.

Don't include allocated tips on this line. Instead, report 

them on Form 8027. Allocated tips aren't reportable on 

Form 941-SS and aren't subject to withholding of social 

security or Medicare taxes.

line 5b (column 1)

x   0.124

line 5b (column 2)

5c. Taxable Medicare wages & tips. Enter all wages, 

including qualified sick leave wages paid this quarter of 

2023, and qualified family leave wages paid this quarter of 

2023; tips; sick pay; and taxable fringe benefits that are 

subject to Medicare tax. Unlike social security wages, 

there is no limit on the amount of wages subject to 

Medicare tax.

The rate of Medicare tax is 1.45% (0.0145) each for the 

employer and employee or 2.9% (0.029) for both. Include 

all tips your employees reported during the quarter, even if 

you were unable to withhold the employee tax of 1.45%.

line 5c (column 1)

x   0.029

line 5c (column 2)

For more information on tips, see section 5 of Pub. 80. 

See the instructions for line 8 for an adjustment that you 

may need to make on Form 941-SS for sick pay.

5d. Taxable wages & tips subject to Additional Medicare Tax withholding. Enter all wages, including 

qualified sick leave wages paid this quarter of 2023, and 

qualified family leave wages paid this quarter of 2023; 

tips; sick pay; and taxable fringe benefits that are subject 

to Additional Medicare Tax withholding. You’re required to 

begin withholding Additional Medicare Tax in the pay 

period in which you pay wages in excess of $200,000 to 

an employee and continue to withhold it each pay period 

until the end of the calendar year. Additional Medicare 

Tax is only imposed on the employee. There is no 

employer share of Additional Medicare Tax. All wages that 

are subject to Medicare tax are subject to Additional 

Medicare Tax withholding if paid in excess of the 

$200,000 withholding threshold.

For more information on what wages are subject to 

Medicare tax, see the chart, Special Rules for Various 

Types of Employment and Payments, in section 12 of 

Pub. 80. For more information on Additional Medicare 

Tax, go to IRS.gov/ADMTfaqs. See the instructions for 

line 8 for an adjustment that you may need to make on 

Form 941-SS for sick pay.

Once wages and tips exceed the $200,000 withholding 

threshold, include all tips your employees reported during 

the quarter, even if you were unable to withhold the 

employee tax of 0.9%.

line 5d (column 1)

x     0.009

line 5d (column 2)

5e. Total social security and Medicare taxes. Add the 

column 2 amounts on lines 5a–5d. Enter the result on 

line 5e.

5f. Section 3121(q) Notice and Demand—Tax 

Due on Unreported Tips

Enter the tax due from your Section 3121(q) Notice and 

Demand on line 5f. The IRS issues a Section 3121(q) 

Notice and Demand to advise an employer of the amount 

of tips received by employees who failed to report or 

underreported tips to the employer. An employer isn't 

liable for the employer share of the social security and 

Medicare taxes on unreported tips until notice and 

demand for the taxes is made to the employer by the IRS 

in a Section 3121(q) Notice and Demand. The tax due 

may have been determined from tips reported to the IRS 

on employees' Forms 4137, Social Security and Medicare 

Tax on Unreported Tip Income, or other tips that weren't 

reported to their employer as determined by the IRS 

during an examination. For additional information, see 

Rev. Rul. 2012-18.

Deposit the tax within the time period required under 

your deposit schedule to avoid any possible deposit 

penalty. The tax is treated as accumulated by the 

employer on the “Date of Notice and Demand” as printed 

on the Section 3121(q) Notice and Demand. The 

employer must include this amount on the appropriate line 

of the record of federal tax liability (Part 2 of Form 941-SS 

for a monthly schedule depositor or Schedule B (Form 

941) for a semiweekly schedule depositor).

6. Total Taxes Before Adjustments

Add the total social security and Medicare taxes before 

adjustments (line 5e) and any tax due under a Section 

3121(q) Notice and Demand (line 5f). Enter the result on 

line 6.

7–9. Tax Adjustments

Enter tax amounts on lines 7–9 that result from current 

quarter adjustments. Use a minus sign (if possible) to 

show an adjustment that decreases the total taxes shown 

on line 6 instead of parentheses. Doing so enhances the 

accuracy of our scanning software. For example, enter 

“-10.59” instead of “(10.59).” However, if your software 

only allows for parentheses in entering negative amounts, 

you may use them.

Current quarter's adjustments. In certain cases, you 

must adjust the amounts you entered as social security 

and Medicare taxes in column 2 of lines 5a–5d to figure 

your correct tax liability for this quarter's Form 941-SS. 

See section 9 of Pub. 80.

7. Current quarter's adjustment for fractions of 

cents. Enter adjustments for fractions of cents (due to 

rounding) relating to the employee share of social security 

and Medicare taxes withheld. The employee share of 

amounts shown in column 2 of lines 5a–5d may differ 

slightly from amounts actually withheld from employees' 

-12- Instructions for Form 941-SS (Rev. 3-2023)
pay due to the rounding of social security and Medicare 

taxes based on statutory rates. This adjustment may be a 

positive or negative adjustment.

8. Current quarter's adjustment for sick pay. If 

your third-party payer of sick pay that isn't your agent (for 

example, an insurance company) transfers the liability for 

the employer share of the social security and Medicare 

taxes to you, enter a negative adjustment on line 8 for the 

employee share of social security and Medicare taxes that 

were withheld and deposited by your third-party sick pay 

payer on the sick pay. If you’re the third-party sick pay 

payer and you transferred the liability for the employer 

share of the social security and Medicare taxes to the 

employer, enter a negative adjustment on line 8 for any 

employer share of these taxes required to be paid by the 

employer. The sick pay should be included on line 5a, 

line 5c, and, if the withholding threshold is met, line 5d.

No adjustment is reported on line 8 for sick pay that is 

paid through a third party as an employer’s agent. An 

employer’s agent bears no insurance risk and is 

reimbursed on a cost-plus-fee basis for payment of sick 

pay and similar amounts. If an employer uses an agent to 

pay sick pay, the employer reports the wages on line 5a, 

line 5c, and, if the withholding threshold is met, line 5d, 

unless the employer has an agency agreement with the 

third-party payer that requires the third-party payer to do 

the collecting, reporting, and/or paying or depositing 

employment taxes on the sick pay. See section 6 of Pub. 

15-A for more information about sick pay reporting.

9. Current quarter's adjustments for tips and 

group-term life insurance. Enter a negative adjustment 

for:

• Any uncollected employee share of social security and 

Medicare taxes on tips, and

• The uncollected employee share of social security and 

Medicare taxes on group-term life insurance premiums 

paid for former employees.

See the General Instructions for Forms W-2 and W-3 

for information on how to report the uncollected employee 

share of social security and Medicare taxes on tips and 

group-term life insurance on Form W-2.

Prior quarter's adjustments. If you need to correct any 

adjustment reported on a previously filed Form 941-SS, 

complete and file Form 941-X. Form 941-X is an adjusted 

return or claim for refund and is filed separately from Form 

941-SS. See section 9 of Pub. 80.

10. Total Taxes After Adjustments

Combine the amounts shown on lines 6–9 and enter the 

result on line 10.

11a. Qualified Small Business Payroll Tax Credit 

for Increasing Research Activities

Enter the amount of the credit from Form 8974, line 12 or, 

if applicable, line 17.

If you enter an amount on line 11a, you must 

attach Form 8974.

CAUTION

!

Form 941-SS and these instructions use the terms 

“nonrefundable” and “refundable” when 

discussing credits. The term “nonrefundable” 

means the portion of the credit which is limited by law to 

the amount of certain taxes. The term “refundable” means 

the portion of the credit which is in excess of those taxes.

11b. Nonrefundable Portion of Credit for 

Qualified Sick and Family Leave Wages for 

Leave Taken After March 31, 2020, and Before 

April 1, 2021

Complete line 11b only if qualified sick leave 

wages and/or qualified family leave wages were 

paid this quarter of 2023 for leave taken after 

March 31, 2020, and before April 1, 2021.

Certain private employers with fewer than 500 

employees that provide paid sick leave under the EPSLA 

and/or provide paid family leave under the Expanded 

FMLA are eligible to claim the credit for qualified sick and 

family leave wages for leave taken after March 31, 2020, 

and before April 1, 2021. For purposes of this credit, 

qualified sick leave wages and qualified family leave 

wages are wages for social security and Medicare tax 

purposes, determined without regard to the exclusions 

from the definition of employment under sections 3121(b)

(1)–(22), that an employer pays that otherwise meet the 

requirements of the EPSLA or Expanded FMLA. Enter the 

nonrefundable portion of the credit for qualified sick and 

family leave wages from Worksheet 1, Step 2, line 2j. The 

credit for qualified sick and family leave wages consists of 

the qualified sick leave wages, the qualified family leave 

wages, the qualified health plan expenses allocable to 

those wages, and the employer share of Medicare tax 

allocable to those wages. The nonrefundable portion of 

the credit is limited to the employer share of social 

security tax reported on Form 941-SS, lines 5a and 5b, 

after that share is first reduced by any credit claimed 

against the employer share of social security tax on Form 

8974 for the qualified small business payroll tax credit for 

increasing research activities, any credit to be claimed on 

Form 5884-C for the work opportunity credit for qualified 

tax-exempt organizations hiring qualified veterans, and/or 

any credit to be claimed on Form 5884-D for the disaster 

credit for qualified tax-exempt organizations.

If you're a third-party payer of sick pay that isn't an 

agent (for example, an insurance company) and 

you're claiming the credit for qualified sick and 

family leave wages for amounts paid to your own 

employees, the amount of the employer share of social 

security tax reported on line 5a must be reduced by any 

adjustment you make on line 8 for the employer share of 

social security tax transferred to your client. If you 

received a Section 3121(q) Notice and Demand for tax 

due on unreported tips (Letter 3263 or Letter 4520) during 

the quarter, you report the amount for the employer share 

of social security tax and Medicare tax on Form 941-SS, 

line 5f. Letter 3263 or Letter 4520 includes an attachment 

that shows the employer share of social security tax. This 

amount of the employer share of social security tax can 

also be reduced by the nonrefundable portion of the 

credit. See Worksheet 1 to figure your credit.

TIP

CAUTION

!

CAUTION

!

Instructions for Form 941-SS (Rev. 3-2023) -13-
Any credit in excess of the remaining amount of the 

employer share of social security tax is refundable and 

reported on Form 941-SS, line 13c. For more information 

on the credit for qualified sick and family leave wages, go 

to IRS.gov/PLC.

Qualified health plan expenses allocable to qualified 

sick leave and family leave wages. The credit for 

qualified sick leave wages and qualified family leave 

wages is increased to cover the qualified health plan 

expenses that are properly allocable to the qualified leave 

wages for which the credit is allowed. These qualified 

health plan expenses are amounts paid or incurred by the 

employer to provide and maintain a group health plan but 

only to the extent such amounts are excluded from the 

employees’ income as coverage under an accident or 

health plan. The amount of qualified health plan expenses 

generally includes both the portion of the cost paid by the 

employer and the portion of the cost paid by the employee 

with pre-tax salary reduction contributions. However, 

qualified health plan expenses don’t include amounts that 

the employee paid for with after-tax contributions. For 

more information, go to IRS.gov/PLC.

You must include the full amount (both the 

nonrefundable and refundable portions) of the 

credit for qualified sick and family leave wages in 

your gross income for the tax year that includes the last 

day of any calendar quarter in which a credit is allowed.

11d. Nonrefundable Portion of Credit for 

Qualified Sick and Family Leave Wages for 

Leave Taken After March 31, 2021, and Before 

October 1, 2021

Complete line 11d only if qualified sick leave 

wages and/or qualified family leave wages were 

paid this quarter of 2023 for leave taken after 

March 31, 2021, and before October 1, 2021.

Employers with fewer than 500 employees and certain 

governmental employers without regard to number of 

employees (except for the federal government and its 

agencies and instrumentalities unless described in 

section 501(c)(1)) are entitled to a credit if they provide 

paid sick leave to employees that otherwise meets the 

requirements of the EPSLA, as amended for purposes of 

the ARP, and/or provide paid family leave to employees 

that otherwise meets the requirements under the 

Expanded FMLA, as amended for purposes of the ARP, 

for qualified sick and family leave wages for leave taken 

after March 31, 2021, and before October 1, 2021. For 

purposes of this credit, qualified sick leave wages and 

qualified family leave wages are wages for social security 

and Medicare tax purposes, determined without regard to 

the exclusions from the definition of employment under 

sections 3121(b)(1)–(22), that an employer pays that 

otherwise meet the requirements of the EPSLA or 

Expanded FMLA, as enacted under the FFCRA and 

amended for purposes of the ARP. Enter the 

nonrefundable portion of the credit for qualified sick and 

family leave wages from Worksheet 2, Step 2, line 2p.

The credit for qualified sick and family leave wages 

consists of the:

TIP

CAUTION

!

• Qualified sick leave wages and/or qualified family leave 

wages;

• Qualified health plan expenses allocable to qualified 

sick leave and family leave wages;

• Collectively bargained defined benefit pension plan 

contributions, subject to the qualified leave wage 

limitations, allocable to the qualified sick and family leave 

wages;

• Collectively bargained apprenticeship program 

contributions, subject to the qualified leave wage 

limitations, allocable to the qualified sick and family leave 

wages; and

• Employer share of social security and Medicare tax 

allocable to the qualified sick and family leave wages.

The nonrefundable portion of the credit is limited to the 

employer share of Medicare tax reported on Form 

941-SS, line 5c, after that share is first reduced by any 

credit claimed against the employer share of Medicare tax 

on Form 8974 for the qualified small business payroll tax 

credit for increasing research activities. You can’t claim 

the credit for leave taken after March 31, 2021, and before 

October 1, 2021, if, during the applicable quarter in which 

the qualified sick or family leave wages were paid, you 

made qualified sick or family leave wages available in a 

manner that discriminates in favor of highly compensated 

employees, full-time employees, or employees on the 

basis of employment tenure. See Highly compensated 

employee, later, for the definition.

For leave taken after March 31, 2021, and before 

October 1, 2021, the credit for qualified sick and family 

leave wages is reduced by the amount of the credit 

allowed under section 41 (for the credit for increasing 

research activities) with respect to wages taken into 

account for determining the credit for qualified sick and 

family leave wages; and any wages taken into account in 

determining the credit for qualified sick and family leave 

wages can't be taken into account as wages for purposes 

of the credits under sections 45A, 45P, 45S, and 51. For 

leave taken after March 31, 2021, and before October 1, 

2021, qualified wages also don't include wages that were 

used as payroll costs in connection with a Shuttered 

Venue Operator Grant under section 324 of the Economic 

Aid to Hard-Hit Small Businesses, Nonprofits, and Venues 

Act; or a restaurant revitalization grant under section 5003 

of the ARP. Employers can receive both a Small Business 

Interruption Loan under the Paycheck Protection Program 

(PPP) and the credit for qualified sick and family leave 

wages; however, employers can't receive both loan 

forgiveness and a credit for the same wages. The same 

wages can’t be treated as both qualified sick leave wages 

and qualified family leave wages.

If you're a third-party payer of sick pay that isn't an 

agent (for example, an insurance company) and 

you're claiming the credit for qualified sick and 

family leave wages for amounts paid to your own 

employees, the amount of the employer share of 

Medicare tax reported on line 5c must be reduced by any 

adjustment you make on line 8 for the employer share of 

Medicare tax transferred to your client. If you received a 

Section 3121(q) Notice and Demand for tax due on 

unreported tips (Letter 3263 or Letter 4520) during the 

quarter, you report the amount for the employer share of 

CAUTION

!

-14- Instructions for Form 941-SS (Rev. 3-2023)
social security tax and Medicare tax on Form 941-SS, 

line 5f. Letter 3263 or Letter 4520 includes an attachment 

that shows the employer share of Medicare tax. This 

amount of the employer share of Medicare tax can also be 

reduced by the nonrefundable portion of the credit. See 

Worksheet 2 to figure your credit.

Any credit in excess of the remaining amount of the 

employer share of Medicare tax is refundable and 

reported on Form 941-SS, line 13e. For more information 

on the credit for qualified sick and family leave wages, go 

to IRS.gov/PLC.

Qualified health plan expenses allocable to qualified 

sick leave and family leave wages. The credit for 

qualified sick leave wages and qualified family leave 

wages is increased to cover the qualified health plan 

expenses that are properly allocable to the qualified leave 

wages for which the credit is allowed. These qualified 

health plan expenses are amounts paid or incurred by the 

employer to provide and maintain a group health plan but 

only to the extent such amounts are excluded from the 

employees' income as coverage under an accident or 

health plan. The amount of qualified health plan expenses 

generally includes both the portion of the cost paid by the 

employer and the portion of the cost paid by the employee 

with pre-tax salary reduction contributions. However, 

qualified health plan expenses don't include amounts that 

the employee paid for with after-tax contributions. For 

more information, go to IRS.gov/PLC.

Collectively bargained defined benefit pension plan 

contributions. For purposes of qualified sick and family 

leave wages, collectively bargained defined benefit 

pension plan contributions are contributions for a calendar 

quarter that are:

• Paid or incurred by an employer on behalf of its 

employees to a defined benefit plan, as defined in section 

414(j), which meets the requirements of section 401(a);

• Made based on a pension contribution rate; and

• Required to be made under the terms of a collective 

bargaining agreement in effect for the quarter.

Pension contribution rate. The pension contribution 

rate is the contribution rate that the employer is obligated 

to pay under the terms of a collective bargaining 

agreement to a defined benefit plan, as the rate is applied 

to contribution base units, as defined by section 4001(a)

(11) of the Employee Retirement Income Security Act of 

1974 (ERISA).

Allocation rules. The amount of collectively bargained 

defined benefit pension plan contributions allocated to 

qualified sick leave wages and/or qualified family leave 

wages in a quarter is the pension contribution rate 

(expressed as an hourly rate) multiplied by the number of 

hours qualified sick leave wages and/or qualified family 

leave wages were provided to employees covered under 

the collective bargaining agreement during the quarter.

Collectively bargained apprenticeship program contributions. For purposes of qualified sick and family 

leave wages, collectively bargained apprenticeship 

program contributions are contributions for a calendar 

quarter that are:

• Paid or incurred by an employer on behalf of its 

employees to a registered apprenticeship program, which 

is an apprenticeship registered under the National 

Apprenticeship Act of August 16, 1937, and meets the 

standards of Federal Regulations under subpart A of Part 

29 and Part 30 of title 29;

• Made based on an apprenticeship program contribution 

rate; and

• Required to be made under the terms of a collective 

bargaining agreement in effect for the quarter.

Apprenticeship program contribution rate. The 

apprenticeship program contribution rate is the 

contribution rate that the employer is obligated to pay 

under the terms of a collective bargaining agreement for 

benefits under a registered apprenticeship program, as 

the rate is applied to contribution base units, as defined by 

section 4001(a)(11) of ERISA.

Allocation rules. The amount of collectively bargained 

apprenticeship program contributions allocated to 

qualified sick leave wages and/or qualified family leave 

wages in a quarter is the apprenticeship program 

contribution rate (expressed as an hourly rate) multiplied 

by the number of hours qualified sick leave wages and/or 

qualified family leave wages were provided to employees 

covered under the collective bargaining agreement during 

the quarter.

Highly compensated employee. A highly compensated 

employee is an employee who meets either of the 

following tests.

1. The employee was a 5% owner at any time during 

the year or the preceding year.

2. The employee received more than $135,000 in pay 

for the preceding year.

You can choose to ignore test (2) if the employee 

wasn’t also in the top 20% of employees when ranked by 

pay for the preceding year.

11g. Total Nonrefundable Credits

Add lines 11a, 11b, and 11d. Enter the total on line 11g.

12. Total Taxes After Adjustments and 

Nonrefundable Credits

Subtract line 11g from line 10 and enter the result on 

line 12. The amount entered on line 12 can't be less than 

zero.

• If line 12 is less than $2,500 or line 12 on the prior 

quarterly return was less than $2,500, and you didn't 

incur a $100,000 next-day deposit obligation during 

the current quarter. You may pay the amount with Form 

941-SS or you may deposit the amount. To avoid a 

penalty, you must pay any amount you owe in full with a 

timely filed return or you must deposit any amount you 

owe before the due date of the return. For more 

information on paying with a timely filed return, see the 

instructions for line 14, later.

• If line 12 is $2,500 or more and line 12 on the prior 

quarterly return was $2,500 or more, or if you 

incurred a $100,000 next-day deposit obligation 

during the current quarter. You must make required 

deposits according to your deposit schedule. See Notice 

2020-22 and Notice 2021-24 for information on reducing 

deposits for certain credits. The amount shown on line 12 

must equal the “Total liability for quarter” shown on line 16 

Instructions for Form 941-SS (Rev. 3-2023) -15-
or the “Total liability for the quarter” shown on Schedule B 

(Form 941). For more information, see the line 16 

instructions, later.

For more information and rules about federal tax 

deposits, see Depositing Your Taxes, earlier, and section 

8 of Pub. 80.

If you’re a semiweekly schedule depositor, you 

must complete Schedule B (Form 941). If you fail 

to complete and submit Schedule B (Form 941), 

the IRS may assess deposit penalties based on available 

information.

13a. Total Deposits for This Quarter

Enter your deposits for this quarter, including any 

overpayment from a prior quarter that you applied to this 

return. Also include in the amount shown any 

overpayment that you applied from filing Form 941-X, 

944-X, or 944-X (SP) in the current quarter. Don't include 

any amount that you didn't deposit because you reduced 

your deposits in anticipation of the credit for qualified sick 

and family leave wages, as discussed in Notice 2020-22 

and Notice 2021-24.

13c. Refundable Portion of Credit for Qualified 

Sick and Family Leave Wages for Leave Taken 

After March 31, 2020, and Before April 1, 2021

Complete line 13c only if qualified sick leave 

wages and/or qualified family leave wages were 

paid this quarter of 2023 for leave taken after 

March 31, 2020, and before April 1, 2021.

Certain private employers with fewer than 500 

employees that provide paid sick leave under the EPSLA 

and/or provide paid family leave under the Expanded 

FMLA are eligible to claim the credit for qualified sick and 

family leave wages. Enter the refundable portion of the 

credit for qualified sick and family leave wages from 

Worksheet 1, Step 2, line 2k. The credit for qualified sick 

and family leave wages consists of the qualified sick leave 

wages, the qualified family leave wages, the qualified 

health plan expenses allocable to those wages, and the 

employer share of Medicare tax allocable to those wages. 

The refundable portion of the credit is allowed after the 

employer share of social security tax is reduced to zero by 

nonrefundable credits that are applied against the 

employer share of social security tax.

13e. Refundable Portion of Credit for Qualified 

Sick and Family Leave Wages for Leave Taken 

After March 31, 2021, and Before October 1, 

2021

Complete line 13e only if qualified sick leave 

wages and/or qualified family leave wages were 

paid this quarter of 2023 for leave taken after 

March 31, 2021, and before October 1, 2021.

Employers with fewer than 500 employees and certain 

governmental employers without regard to number of 

employees (except for the federal government and its 

agencies and instrumentalities unless described in 

section 501(c)(1)) are entitled to a credit if they provide 

paid sick leave to employees that otherwise meets the 

CAUTION

!

CAUTION

!

CAUTION

!

requirements of the EPSLA, as amended for purposes of 

the ARP, and/or provide paid family leave to employees 

that otherwise meets the requirements under the 

Expanded FMLA, as amended for purposes of the ARP, 

for leave taken after March 31, 2021, and before October 

1, 2021. Enter the refundable portion of the credit for 

qualified sick and family leave wages from Worksheet 2, 

Step 2, line 2q. The refundable portion of the credit is 

allowed after the employer share of Medicare tax is 

reduced to zero by nonrefundable credits that are applied 

against the employer share of Medicare tax.

13g. Total Deposits and Refundable Credits

Add lines 13a, 13c, and 13e. Enter the total on line 13g.

14. Balance Due

If line 12 is more than line 13g, enter the difference on 

line 14. Otherwise, see the instructions for line 15, later.

Never make an entry on both lines 14 and 15.

You don't have to pay if line 14 is under $1. Generally, 

you should have a balance due only if your total taxes 

after adjustments and nonrefundable credits (line 12) for 

the current quarter or prior quarter are less than $2,500, 

and you didn't incur a $100,000 next-day deposit 

obligation during the current quarter. However, see 

section 8 of Pub. 80 for information about payments made 

under the accuracy of deposits rule.

If you were required to make federal tax deposits, pay 

the amount shown on line 14 by EFT. If you weren't 

required to make federal tax deposits (see Must You 

Deposit Your Taxes, earlier) or you're a monthly schedule 

depositor making a payment under the accuracy of 

deposits rule, you may pay the amount shown on line 14 

by EFT, credit card, debit card, check, money order, or 

EFW. For more information on electronic payment 

options, go to IRS.gov/Payments.

If you pay by EFT, credit card, or debit card, file your 

return using the Without a payment address under Where 

Should You File, earlier, and don't file Form 941-V(SS), 

Payment Voucher.

If you pay by check or money order, make it payable to 

“United States Treasury.” Enter your EIN, “Form 941-SS,” 

and the tax period (“1st Quarter 2023,” “2nd Quarter 

2023,” “3rd Quarter 2023,” or “4th Quarter 2023”) on your 

check or money order. Complete Form 941-V(SS) and 

enclose it with Form 941-SS.

If line 12 is $2,500 or more on both your prior and 

current quarter Form 941-SS, and you’ve deposited all 

taxes when due, the balance due on line 14 should be 

zero.

If you’re required to make deposits and instead 

pay the taxes with Form 941-SS, you may be 

subject to a penalty. See Must You Deposit Your 

Taxes, earlier.

What if you can't pay in full? If you can't pay the full 

amount of tax you owe, you can apply for an installment 

agreement online. You can apply for an installment 

agreement online if:

• You can't pay the full amount shown on line 14,

CAUTION

!

-16- Instructions for Form 941-SS (Rev. 3-2023)
• The total amount you owe is $25,000 or less, and

• You can pay the liability in full in 24 months.

To apply using the Online Payment Agreement 

Application, go to IRS.gov/OPA.

Under an installment agreement, you can pay what you 

owe in monthly installments. There are certain conditions 

you must meet to enter into and maintain an installment 

agreement, such as paying the liability within 24 months, 

and making all required deposits and timely filing tax 

returns during the length of the agreement.

If your installment agreement is accepted, you will be 

charged a fee and you will be subject to penalties and 

interest on the amount of tax not paid by the due date of 

the return.

15. Overpayment

If line 13g is more than line 12, enter the difference on 

line 15.

Never make an entry on 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 only 

one box on line 15. If you don't check either box or if you 

check both boxes, we will generally apply the 

overpayment to your next return. Regardless of any boxes 

you check or don’t check on line 15, 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.

Part 2: Tell Us About Your Deposit 

Schedule and Tax Liability for This 

Quarter

16. Tax Liability for the Quarter

Check one of the boxes on line 16. Follow the instructions 

for each box to determine if you need to enter your 

monthly tax liability on Form 941-SS or your daily tax 

liability on Schedule B (Form 941).

De minimis exception. If line 12 is less than $2,500 or 

line 12 on the prior quarterly return was less than $2,500, 

and you didn't incur a $100,000 next-day deposit 

obligation during the current quarter, check the first box 

on line 16 and go to Part 3.

If you meet the de minimis exception based on the 

prior quarter and line 12 for the current quarter 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 on line 16. If 

you’re a semiweekly schedule depositor, attach 

Schedule B (Form 941).

Monthly schedule depositor. If you reported $50,000 or 

less in taxes during the lookback period, you’re a monthly 

schedule depositor unless the $100,000 Next-Day 

Deposit Rule discussed in section 8 of Pub. 80 applies. 

Check the second box on line 16 and enter your tax 

liability for each month in the quarter. Enter your tax 

liabilities in the month that corresponds to the dates you 

CAUTION

!

paid wages to your employees, not the date payroll 

liabilities were accrued or deposits were made. Add the 

amounts for each month. Enter the result in the “Total 

liability for quarter” box.

Note that your total tax liability for the quarter must 

equal your total taxes shown on line 12. If it doesn't, your 

tax deposits and payments may not be counted as timely. 

Don't reduce your total liability reported on line 16 by the 

refundable portion of the credit for qualified sick and 

family leave wages. Don't change your tax liability on 

line 16 by adjustments reported on any Forms 941-X.

You’re a monthly schedule depositor for the calendar 

year if the amount of your Form 941-SS taxes reported for 

the lookback period is $50,000 or less. The lookback 

period is the 4 consecutive quarters ending on June 30 of 

the prior year. For 2023, the lookback period begins July 

1, 2021, and ends June 30, 2022. For details on the 

deposit rules, see section 8 of Pub. 80. If you filed Form 

944 in either 2021 or 2022, your lookback period is the 

2021 calendar year.

The amounts entered on line 16 are a summary of 

your monthly tax liability, not a summary of 

deposits you made. If you don't properly report 

your liabilities when required or if you’re a semiweekly 

schedule depositor and enter your liabilities on line 16 

instead of on Schedule B (Form 941), you may be 

assessed an “averaged” FTD penalty. See Deposit 

Penalties in section 8 of Pub. 80 for more information.

Reporting adjustments from lines 7–9 on line 16. If 

your net adjustment during a month is negative and it 

exceeds your total tax liability for the month, don't enter a 

negative amount for the month. Instead, enter "-0-" for the 

month and carry over the unused portion of the 

adjustment to the next month.

Semiweekly schedule depositor. If you reported more 

than $50,000 of taxes for the lookback period, you’re a 

semiweekly schedule depositor. Check the third box on 

line 16.

You must complete Schedule B (Form 941) and submit 

it with your Form 941-SS. Don't file Schedule B (Form 

941) with your Form 941-SS if you’re a monthly schedule 

depositor.

Don't change your tax liability on Schedule B (Form 

941) by adjustments reported on any Forms 941-X.

Adjusting tax liability for nonrefundable credits 

claimed on lines 11a, 11b, and 11d. Monthly schedule 

depositors and semiweekly schedule depositors must 

account for nonrefundable credits claimed on lines 11a, 

11b, and 11d when reporting their tax liabilities on line 16 

or Schedule B (Form 941). The total tax liability for the 

quarter must equal the amount reported on line 12. Failure 

to account for the nonrefundable credits on line 16 or 

Schedule B (Form 941) may cause line 16 or Schedule B 

(Form 941) to report more than the total tax liability 

reported on line 12. Don't reduce your monthly tax liability 

reported on line 16 or your daily tax liability reported on 

Schedule B (Form 941) below zero.

Qualified small business payroll tax credit for 

increasing research activities (line 11a). Beginning 

with the first quarter of 2023, the qualified small business 

CAUTION

!

Instructions for Form 941-SS (Rev. 3-2023) -17-
payroll tax credit for increasing research activities is first 

used to reduce the employer share of social security tax 

(up to $250,000) for the quarter and any remaining credit 

is then used to reduce the employer share of Medicare tax 

for the quarter until it reaches zero. In completing line 16 

or Schedule B (Form 941), you take into account the 

payroll tax credit against the liability for the employer 

share of social security tax starting with the first payroll 

payment of the quarter that includes payments of wages 

subject to social security tax to your employees until you 

use up to $250,000 of credit against the employer share of 

social security tax and you then take into account any 

remaining payroll tax credit against the liability for the 

employer share of Medicare tax starting with the first 

payroll payment of the quarter that includes payments of 

wages subject to Medicare tax to employees. Consistent 

with the entries on line 16 or Schedule B (Form 941), the 

payroll tax credit should be taken into account in making 

deposits of employment tax. If any payroll tax credit is 

remaining at the end of the quarter that hasn’t been used 

completely because it exceeds $250,000 of the employer 

share of social security tax and the employer share of 

Medicare tax for the quarter, the excess credit may be 

carried forward to the succeeding quarter and allowed as 

a payroll tax credit for the succeeding quarter. The payroll 

tax credit may not be taken as a credit against income tax 

withholding, the employee share of social security tax, or 

the employee share of Medicare tax. Also, the remaining 

payroll tax credit may not be carried back and taken as a 

credit against wages paid from preceding quarters.

Example. Rose Co. is an employer with a calendar tax 

year that filed its timely 2022 income tax return on April 

18, 2023. Rose Co. elected to take the qualified small 

business payroll tax credit for increasing research 

activities on Form 6765. The third quarter of 2023 is the 

first quarter that begins after Rose Co. filed the income tax 

return making the payroll tax credit election. Therefore, 

the payroll tax credit applies against Rose Co.'s share of 

social security tax (up to $250,000) and Medicare tax on 

wages paid to employees in the third quarter of 2023. 

Rose Co. is a semiweekly schedule depositor. Rose Co. 

completes Schedule B (Form 941) by reducing the 

amount of liability entered for the first payroll payment in 

the third quarter of 2023 that includes wages subject to 

social security tax by the lesser of (1) its share of social 

security tax (up to $250,000) on the wages, or (2) the 

available payroll tax credit. If the payroll tax credit elected 

is more than Rose Co.'s share of social security tax on the 

first payroll payment of the quarter, the excess payroll tax 

credit would be carried forward to succeeding payroll 

payments in the third quarter until it is used against up to 

$250,000 of Rose Co.'s share of social security tax for the 

quarter. If the amount of the payroll tax credit exceeds 

Rose Co.'s share of social security tax (up to $250,000) 

on wages paid to its employees in the third quarter, any 

remaining credit is used against Rose Co.'s share of 

Medicare tax on the first payroll payment of the quarter 

and then the excess payroll tax credit would be carried 

forward to succeeding payroll payments in the third 

quarter until it is used against Rose Co.'s share of 

Medicare tax for the quarter. If Rose Co. still has credit 

remaining after reducing its share of social security tax (up 

to $250,000) and Medicare tax for the third quarter, the 

remainder would be treated as a payroll tax credit against 

its share of social security tax (up to $250,000) and 

Medicare tax on wages paid in the fourth quarter. If the 

amount of the payroll tax credit remaining exceeded Rose 

Co.'s share of social security tax (up to $250,000) and 

Medicare tax on wages paid in the fourth quarter, it could 

be carried forward and treated as a payroll tax credit for 

the first quarter of 2024.

Nonrefundable portion of credit for qualified sick 

and family leave wages for leave taken after March 

31, 2020, and before April 1, 2021 (line 11b). The 

nonrefundable portion of the credit for qualified sick and 

family leave wages paid this quarter of 2023 for leave 

taken after March 31, 2020, and before April 1, 2021, is 

limited to the employer share of social security tax on 

wages paid in the quarter that is remaining after that share 

is first reduced by any credit claimed against the employer 

share of social security tax on Form 8974, line 12, for the 

qualified small business payroll tax credit for increasing 

research activities; any credit to be claimed on Form 

5884-C, line 11, for the work opportunity credit for 

qualified tax-exempt organizations hiring qualified 

veterans; and/or any credit to be claimed on Form 5884-D 

for the disaster credit for qualified tax-exempt 

organizations. In completing line 16 or Schedule B (Form 

941), you take into account the entire quarter's 

nonrefundable portion of the credit for qualified sick and 

family leave wages against the liability for the first payroll 

payment of the quarter, but not below zero. Then reduce 

the liability for each successive payroll payment in the 

quarter until the nonrefundable portion of the credit is 

used. Any credit for qualified sick and family leave wages 

paid this quarter of 2023 for leave taken after March 31, 

2020, and before April 1, 2021, that is remaining at the 

end of the quarter because it exceeds the employer share 

of social security tax for the quarter is claimed on line 13c 

as a refundable credit. The refundable portion of the credit 

doesn’t reduce the liability reported on line 16 or 

Schedule B (Form 941).

Example. Maple Co. is a semiweekly schedule 

depositor that pays employees every other Friday. In the 

first quarter of 2023, Maple Co. had pay dates of January 

6, January 20, February 3, February 17, March 3, March 

17, and March 31. Maple Co. paid qualified sick and 

family leave wages on January 6 and January 20 for leave 

taken after March 31, 2020, and before April 1, 2021. The 

nonrefundable portion of the credit for qualified sick and 

family leave wages for the quarter is $10,000. On 

Schedule B (Form 941), Maple Co. will use the $10,000 to 

reduce the liability for the January 6 pay date, but not 

below zero. If any nonrefundable portion of the credit 

remains, Maple Co. applies it to the liability for the 

January 20 pay date, then the February 3 pay date, and 

so forth until the entire $10,000 is used.

Nonrefundable portion of credit for qualified sick 

and family leave wages for leave taken after March 

31, 2021, and before October 1, 2021 (line 11d). The 

nonrefundable portion of the credit for qualified sick and 

family leave wages paid this quarter of 2023 for leave 

taken after March 31, 2021, and before October 1, 2021, 

is limited to the employer share of Medicare tax on wages 

paid in the quarter that is remaining after that share is first 

reduced by any credit claimed against the employer share 

-18- Instructions for Form 941-SS (Rev. 3-2023)
of Medicare tax on Form 8974, line 16, for the qualified 

small business payroll tax credit for increasing research 

activities. In completing line 16 or Schedule B (Form 941), 

you take into account the entire quarter's nonrefundable 

portion of the credit for qualified sick and family leave 

wages paid this quarter of 2023 against the liability for the 

first payroll payment of the quarter, but not below zero. 

Then reduce the liability for each successive payroll 

payment in the quarter until the nonrefundable portion of 

the credit is used. Any credit for qualified sick and family 

leave wages paid this quarter of 2023 for leave taken after 

March 31, 2021, and before October 1, 2021, that is 

remaining at the end of the quarter because it exceeds the 

employer share of Medicare tax for the quarter is claimed 

on line 13e as a refundable credit. The refundable portion 

of the credit doesn’t reduce the liability reported on line 16 

or Schedule B (Form 941).

You may reduce your deposits by the amount of 

the nonrefundable and refundable portions of the 

credit for qualified sick and family leave wages, as 

discussed earlier under Reducing your deposits for the 

credit for qualified sick and family leave wages.

Part 3: Tell Us About Your Business

In Part 3, answer only those questions that apply to your 

business. If the questions don't apply, leave them blank 

and go to Part 4.

17. If Your Business Has Closed . . .

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 17 and 

enter the final date you paid wages in the space provided. 

For additional filing requirements, including information 

about attaching a statement to your final return, see If 

Your Business Has Closed, earlier.

18. If You’re a Seasonal Employer . . .

If you hire employees seasonally—such as for summer or 

winter only—check the box on line 18. Checking the box 

tells the IRS not to expect four Forms 941-SS from you 

throughout the year because you haven't paid wages 

regularly.

Generally, we won't ask about unfiled returns if at least 

one taxable return is filed each year. However, you must 

check the box on line 18 on every Form 941-SS you file. 

Otherwise, the IRS will expect a return to be filed for each 

quarter.

Also, when you complete Form 941-SS, be sure to 

check the box on the top of the form that corresponds to 

the quarter reported.

The amounts entered on lines 19 through 28 are 

amounts that you use on the worksheets at the 

end of these instructions to figure certain credits. 

If you’re claiming these credits, you must enter the 

applicable amounts.

TIP TIP

Complete lines 19 and 20 only if qualified health 

plan expenses allocable to qualified sick leave 

wages and/or qualified family leave wages were 

paid this quarter of 2023 for leave taken after March 31, 

2020, and before April 1, 2021.

19. Qualified Health Plan Expenses Allocable to 

Qualified Sick Leave Wages for Leave Taken 

After March 31, 2020, and Before April 1, 2021

Enter the qualified health plan expenses allocable to 

qualified sick leave wages paid this quarter of 2023 for 

leave taken after March 31, 2020, and before April 1, 

2021. This amount is also entered on Worksheet 1, Step 

2, line 2b.

20. Qualified Health Plan Expenses Allocable to 

Qualified Family Leave Wages for Leave Taken 

After March 31, 2020, and Before April 1, 2021

Enter the qualified health plan expenses allocable to 

qualified family leave wages paid this quarter of 2023 for 

leave taken after March 31, 2020, and before April 1, 

2021. This amount is also entered on Worksheet 1, Step 

2, line 2f.

Complete lines 23, 24, and 25 only if qualified 

sick leave wages were paid this quarter of 2023 

for leave taken after March 31, 2021, and before 

October 1, 2021.

23. Qualified Sick Leave Wages for Leave Taken 

After March 31, 2021, and Before October 1, 

2021

Enter the qualified sick leave wages you paid this quarter 

of 2023 to your employees for leave taken after March 31, 

2021, and before October 1, 2021, including any qualified 

sick leave wages that were above the social security wage 

base and any qualified sick leave wages excluded from 

the definition of employment under sections 3121(b)(1)–

(22). See the instructions for line 11d, earlier, for more 

information about qualified sick leave wages for leave 

taken after March 31, 2021, and before October 1, 2021. 

This amount is also entered on Worksheet 2, Step 2, 

line 2a.

24. Qualified Health Plan Expenses Allocable to 

Qualified Sick Leave Wages Reported on 

Line 23

Enter the qualified health plan expenses allocable to 

qualified sick leave wages paid this quarter of 2023 for 

leave taken after March 31, 2021, and before October 1, 

2021. This amount is also entered on Worksheet 2, Step 

2, line 2b.

25. Amounts Under Certain Collectively 

Bargained Agreements Allocable to Qualified 

Sick Leave Wages Reported on Line 23

Enter the collectively bargained defined benefit pension 

plan contributions and collectively bargained 

apprenticeship program contributions allocable to 

qualified sick leave wages paid this quarter of 2023 for 

leave taken after March 31, 2021, and before October 1, 

CAUTION

!

CAUTION

!

Instructions for Form 941-SS (Rev. 3-2023) -19-
2021. This amount is also entered on Worksheet 2, Step 

2, line 2c.

Complete lines 26, 27, and 28 only if qualified 

family leave wages were paid this quarter of 2023 

for leave taken after March 31, 2021, and before 

October 1, 2021.

26. Qualified Family Leave Wages for Leave 

Taken After March 31, 2021, and Before October 

1, 2021

Enter the qualified family leave wages you paid this 

quarter of 2023 to your employees for leave taken after 

March 31, 2021, and before October 1, 2021, including 

any qualified family leave wages that were above the 

social security wage base and any qualified family leave 

wages excluded from the definition of employment under 

sections 3121(b)(1)–(22). See the instructions for line 11d, 

earlier, for more information about qualified family leave 

wages for leave taken after March 31, 2021, and before 

October 1, 2021. This amount is also entered on 

Worksheet 2, Step 2, line 2g.

27. Qualified Health Plan Expenses Allocable to 

Qualified Family Leave Wages Reported on 

Line 26

Enter the qualified health plan expenses allocable to 

qualified family leave wages paid this quarter of 2023 for 

leave taken after March 31, 2021, and before October 1, 

2021. This amount is also entered on Worksheet 2, Step 

2, line 2h.

28. Amounts Under Certain Collectively 

Bargained Agreements Allocable to Qualified 

Family Leave Wages Reported on Line 26

Enter the collectively bargained defined benefit pension 

plan contributions and collectively bargained 

apprenticeship program contributions allocable to 

qualified family leave wages paid this quarter of 2023 for 

leave taken after March 31, 2021, and before October 1, 

2021. This amount is also entered on Worksheet 2, Step 

2, line 2i.

Part 4: May We Speak With Your 

Third-Party Designee?

If you want to allow an employee, a paid tax preparer, or 

another person to discuss your Form 941-SS with the IRS, 

check the “Yes” box in Part 4. Enter the name, phone 

number, and five-digit personal identification number 

(PIN) of the specific person to speak with—not the name 

of the firm that prepared your tax return. The designee 

may choose any five numbers as their PIN.

By checking “Yes,” you authorize the IRS to talk to the 

person you named (your designee) about any questions 

we may have while we process your return. You also 

authorize your designee to do all of the following.

• Give us any information that is missing from your return.

• Call us for information about processing your return.

• Respond to certain IRS notices that you’ve shared with 

your designee about math errors and return preparation. 

The IRS won't send notices to your designee.

CAUTION

!

You’re not authorizing your designee to bind you to 

anything (including additional tax liability) or to otherwise 

represent you before the IRS. If you want to expand your 

designee's authorization, see Pub. 947.

The authorization will automatically expire 1 year from 

the due date (without regard to extensions) for filing your 

Form 941-SS. If you or your designee wants to terminate 

the authorization, write to the IRS office for your location 

using the Without a payment address under Where 

Should You File, earlier.

Part 5: Sign Here (Approved Roles)

Complete all information and sign Form 941-SS. The 

following persons are authorized to sign the return for 

each type of business entity.

• 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 sign.

• Partnership (including an LLC treated as a 

partnership) or unincorporated organization—A 

responsible and duly authorized partner, member, or 

officer having knowledge of its affairs.

• Single-member LLC treated as a disregarded entity 

for federal income tax purposes—The owner of the 

LLC or a principal officer duly authorized to sign.

• Trust or estate—The fiduciary.

Form 941-SS may be signed by a duly authorized 

agent of the taxpayer if a valid power of attorney has been 

filed.

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, 2005-28 I.R.B. 82, available at 

IRS.gov/irb/2005-28_IRB#RP-2005-39.

Paid Preparer Use Only

A paid preparer must sign Form 941-SS and provide the 

information in the Paid Preparer Use Only section of Part 

5 if the preparer was paid to prepare Form 941-SS and 

isn't 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’re a paid preparer, enter your Preparer Tax 

Identification Number (PTIN) in the space provided. 

Include your complete address. If you work for a firm, 

enter the firm's name and the EIN of the firm. You can 

apply for a PTIN online or by filing Form W-12. For more 

information about applying for a PTIN online, go to 

IRS.gov/PTIN. You can't use your PTIN in place of the EIN 

of the tax preparation firm.

Generally, don't complete this section if you’re filing the 

return as a reporting agent and have a valid Form 8655 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.

-20- Instructions for Form 941-SS (Rev. 3-2023)
How To Get Forms, Instructions, and 

Publications From the IRS

You can view, download, or print most of the 

forms, instructions, and publications you may 

need at IRS.gov/Forms. Otherwise, you can go to 

IRS.gov/OrderForms to place an order and have them 

mailed to you. The IRS will process your order for forms 

and publications as soon as possible. Don't resubmit 

requests you've already sent us. You can get forms and 

publications faster online.

Instructions for Form 941-SS (Rev. 3-2023) -21-
Worksheet 1. Credit for Qualified Sick and Family Leave Wages 

Paid This Quarter of 2023 for Leave Taken After March 31, 2020, 

and Before April 1, 2021 Keep for Your Records

Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which 

it is applicable, on a client-by-client basis.)

If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2020, and before April 1, 

2021, complete Step 1 and Step 2. Caution: Use Worksheet 2 to figure the credit for qualified sick and family leave wages paid this quarter of 2023 for 

leave taken after March 31, 2021, and before October 1, 2021.

Step 1. Determine the employer share of social security tax this quarter after it is reduced by any credit claimed on Form 8974 

and any credit to be claimed on Form 5884-C and/or Form 5884-D

1a Enter the amount of social security tax from Form 941-SS, Part 1, line 5a, 

column 2 .......................................................... 1a

1b Enter the amount of social security tax from Form 941-SS, Part 1, line 5b, 

column 2 .......................................................... 1b

1c Add lines 1a and 1b .................................................. 1c

1d Multiply line 1c by 50% (0.50) ........................................... 1d

1e If you’re a third-party payer of sick pay that isn't an agent and you're claiming credits for 

amounts paid to your employees, enter the employer share of social security tax included 

on Form 941-SS, Part 1, line 8 (enter as a positive number) ...................... 1e

1f Subtract line 1e from line 1d ............................................ 1f

1g If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount 

of the employer share of social security tax from the notice ...................... 1g

1h Employer share of social security tax. Add lines 1f and 1g .................... 1h

1i Enter the amount from Form 8974, line 12, for this quarter ....................... 1i

1j Enter the amount to be claimed on Form 5884-C, line 11, for this quarter ............. 1j

1j(i) Enter the amount to be claimed on Form 5884-D, line 12, for this quarter ............. 1j(i)

1k Total nonrefundable credits already used against the employer share of social 

security tax. Add lines 1i, 1j, and 1j(i) ..................................... 1k

1l Employer share of social security tax remaining. Subtract line 1k from line 1h ...... 1l

Step 2. Figure the sick and family leave credit

2a Qualified sick leave wages reported on Form 941-SS, Part 1, line 5a(i), column 1 ...... 2a

2a(i) Qualified sick leave wages included on Form 941-SS, Part 1, line 5c, but not included on 

Form 941-SS, Part 1, line 5a(i), column 1, because the wages reported on that line were 

limited by the social security wage base .................................... 2a(i)

2a(ii) Total qualified sick leave wages. Add lines 2a and 2a(i) ......................... 2a(ii)

2a(iii) Qualified sick leave wages excluded from the definition of employment under sections 

3121(b)(1)–(22) ..................................................... 2a(iii)

2b Qualified health plan expenses allocable to qualified sick leave wages (Form 941-SS, Part 

3, line 19) ......................................................... 2b

2c Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45% 

(0.0145) .......................................................... 2c

2d Credit for qualified sick leave wages. Add lines 2a(ii), 2a(iii), 2b, and 2c ........... 2d

2e Qualified family leave wages reported on Form 941-SS, Part 1, line 5a(ii), 

column 1 .......................................................... 2e

2e(i) Qualified family leave wages included on Form 941-SS, Part 1, line 5c, but not included on 

Form 941-SS, Part 1, line 5a(ii), column 1, because the wages reported on that line were 

limited by the social security wage base .................................... 2e(i)

2e(ii) Total qualified family leave wages. Add lines 2e and 2e(i) ....................... 2e(ii)

2e(iii) Qualified family leave wages excluded from the definition of employment under sections 

3121(b)(1)–(22) ..................................................... 2e(iii)

2f Qualified health plan expenses allocable to qualified family leave wages (Form 941-SS, 

Part 3, line 20) ...................................................... 2f

2g Employer share of Medicare tax on qualified family leave wages. Multiply line 2e(ii) by 

1.45% (0.0145) ..................................................... 2g

2h Credit for qualified family leave wages. Add lines 2e(ii), 2e(iii), 2f, and 2g ......... 2h

2i Credit for qualified sick and family leave wages. Add lines 2d and 2h ............ 2i

2j Nonrefundable portion of credit for qualified sick and family leave wages for leave 

taken after March 31, 2020, and before April 1, 2021. Enter the smaller of line 1l or 

line 2i. Enter this amount on Form 941-SS, Part 1, line 11b ....................... 2j

2k Refundable portion of credit for qualified sick and family leave wages for leave 

taken after March 31, 2020, and before April 1, 2021. Subtract line 2j from line 2i and 

enter this amount on Form 941-SS, Part 1, line 13c ............................ 2k

-22- Instructions for Form 941-SS (Rev. 3-2023)
Worksheet 2. Credit for Qualified Sick and Family Leave Wages 

Paid This Quarter of 2023 for Leave Taken After March 31, 2021, 

and Before October 1, 2021 Keep for Your Records

Determine how you will complete this worksheet. (If you’re a third-party payer, you must complete this worksheet for each client for which 

it is applicable, on a client-by-client basis.)

If you paid qualified sick leave wages and/or qualified family leave wages this quarter of 2023 for leave taken after March 31, 2021, and before October 

1, 2021, complete Step 1 and Step 2. Caution: Use Worksheet 1 to figure the credit for qualified sick and family leave wages paid this quarter of 2023 

for leave taken after March 31, 2020, and before April 1, 2021.

Step 1. Determine the employer share of Medicare tax this quarter after it is reduced by any credit claimed on Form 8974 

1a Enter the amount of Medicare tax from Form 941-SS, Part 1, line 5c, column 2 ........ 1a

1b Multiply line 1a by 50% (0.50) ........................................... 1b

1c If you’re a third-party payer of sick pay that isn't an agent and you're claiming credits for 

amounts paid to your employees, enter the employer share of Medicare tax included on 

Form 941-SS, Part 1, line 8 (enter as a positive number) ........................ 1c

1d Subtract line 1c from line 1b ............................................ 1d

1e If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount 

of the employer share of Medicare tax from the notice .......................... 1e

1f Employer share of Medicare tax. Add lines 1d and 1e ........................ 1f

1g Enter the amount from Form 8974, line 16, for this quarter ....................... 1g

1h Employer share of Medicare tax remaining. Subtract line 1g from line 1f .......... 1h

Step 2. Figure the sick and family leave credit

2a Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 

2021 (Form 941-SS, Part 3, line 23) ....................................... 2a

2a(i) Qualified sick leave wages included on Form 941-SS, Part 3, line 23, that were not 

included as wages reported on Form 941-SS, Part 1, lines 5a and 5c, because the 

qualified sick leave wages were excluded from the definition of employment under sections 

3121(b)(1)–(22) ..................................................... 2a(i)

2a(ii) Subtract line 2a(i) from line 2a ........................................... 2a(ii)

2a(iii) Qualified sick leave wages included on Form 941-SS, Part 3, line 23, that were not 

included as wages reported on Form 941-SS, Part 1, line 5a, because the qualified sick 

leave wages were limited by the social security wage base ...................... 2a(iii)

2a(iv) Subtract line 2a(iii) from line 2a(ii) ........................................ 2a(iv)

2b Qualified health plan expenses allocable to qualified sick leave wages for leave taken after 

March 31, 2021, and before October 1, 2021 (Form 941-SS, Part 3, line 24) .......... 2b

2c Amounts under certain collectively bargained agreements allocable to qualified sick leave 

wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 941-SS, 

Part 3, line 25) ...................................................... 2c

2d Employer share of social security tax on qualified sick leave wages. Multiply line 2a(iv) by 

6.2% (0.062) ....................................................... 2d

2e Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45% 

(0.0145) .......................................................... 2e

2f Credit for qualified sick leave wages. Add lines 2a, 2b, 2c, 2d, and 2e ............ 2f

2g Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 

2021 (Form 941-SS, Part 3, line 26) ....................................... 2g

2g(i) Qualified family leave wages included on Form 941-SS, Part 3, line 26, that were not 

included as wages reported on Form 941-SS, Part 1, lines 5a and 5c, because the 

qualified family leave wages were excluded from the definition of employment under 

sections 3121(b)(1)–(22) ............................................... 2g(i)

2g(ii) Subtract line 2g(i) from line 2g ........................................... 2g(ii)

2g(iii) Qualified family leave wages included on Form 941-SS, Part 3, line 26, that were not 

included as wages reported on Form 941-SS, Part 1, line 5a, because the qualified family 

leave wages were limited by the social security wage base ...................... 2g(iii)

2g(iv) Subtract line 2g(iii) from line 2g(ii) ........................................ 2g(iv)

2h Qualified health plan expenses allocable to qualified family leave wages for leave taken 

after March 31, 2021, and before October 1, 2021 (Form 941-SS, Part 3, line 27) ...... 2h

2i Amounts under certain collectively bargained agreements allocable to qualified family 

leave wages for leave taken after March 31, 2021, and before October 1, 2021 (Form 

941-SS, Part 3, line 28) ................................................ 2i

2j Employer share of social security tax on qualified family leave wages. Multiply line 2g(iv) 

by 6.2% (0.062) ..................................................... 2j

2k Employer share of Medicare tax on qualified family leave wages. Multiply line 2g(ii) by 

1.45% (0.0145) ..................................................... 2k

2l Credit for qualified family leave wages. Add lines 2g, 2h, 2i, 2j, and 2k ............ 2l

2m Credit for qualified sick and family leave wages. Add lines 2f and 2l ............. 2m

2n Enter any credit claimed under section 41 for increasing research activities with respect to 

any wages taken into account for the credit for qualified sick and family leave 

wages ............................................................ 2n

2o Credit for qualified sick and family leave wages after adjusting for other credits.

Subtract line 2n from line 2m ............................................ 2o

2p Nonrefundable portion of credit for qualified sick and family leave wages for leave 

taken after March 31, 2021, and before October 1, 2021. Enter the smaller of line 1h or 

line 2o. Enter this amount on Form 941-SS, Part 1, line 11d ...................... 2p

2q Refundable portion of credit for qualified sick and family leave wages for leave 

taken after March 31, 2021, and before October 1, 2021. Subtract line 2p from line 2o 

and enter this amount on Form 941-SS, Part 1, line 13e ......................... 2q

Instructions for Form 941-SS (Rev. 3-2023) -23-