Attention: 

This form is not for general public use and 

should only be filed with an IRS compliance 

representative, when provided directly to the 

employer by the IRS. 
Form 941-M

(Rev. February 2003)

Employer’s Monthly Federal Tax Return

Department of the Treasury

Internal Revenue Service

OMB No. 1545-0718

Return for (enter month and year) 

For IRS

Use Only

T

FF

FD

FP

T

Make any necessary changes to preprinted information.

For March Only: Number of employees (except household) employed in the pay period that includes

March 12th  1

2 Total wages and tips, plus other compensation 2

3 Total income tax withheld from wages, tips, and sick pay 3

4 Adjustment of withheld income tax for preceding months of this calendar year 4

5 Adjusted total of income tax withheld (line 3 as adjusted by line 4) 5

6 Taxable social security wages 6b

Taxable social security tips  12.4% (.124) = 6d

7 Taxable Medicare wages and tips  2.9% (.029) = 7b

8 Total social security and Medicare taxes (add lines 6b, 6d, and 7b) 8

9 Adjustment of social security and Medicare taxes (see instructions) 9

10 Adjusted total of social security and Medicare taxes (line 8 as adjusted by line 9) 10

11 Total taxes (add lines 5 and 10) 11

12 Advance earned income credit (EIC) payments made to employees (see instructions) 12

13 Net taxes (subtract line 12 from line 11) 13

16 If line 14b is more than line 14a, enter overpayment here  $ and check if to be: Applied to next return or Refunded.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief

it is true, correct, and complete.

Signature  Print Your Name and Title  Date 

Form 941-M (Rev. 2-2003)

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Tax Liability Amount Deposited Amount Deposited Amount Deposited Tax Liability Tax Liability

Overpayment from

previous month 

Total tax liability for the month (must equal line 13)

Total deposits for the month (including overpayment from previous month)

14 Record of Federal Tax Liability and Deposits (See instructions on page 4.)

15 Undeposited taxes due (subtract line 14b from line 14a). See instructions  15

For Privacy Act and Paperwork Reduction Act Notice, see page 4.

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6c

 Do not file this form unless instructed to do so by the IRS.

Name (as distinguished from trade name) Employer identification number

Trade name, if any

Address (number and street) City, state, and ZIP code
Form 941-M (Rev. 2-2003) Page 2

Specific Instructions

When to file. Form 941-M for any month is

due by the 15th day of the following month. If

the due date for filing a return falls on a

Saturday, Sunday, or legal holiday, you may

file the return on the next business day.

Reconciliation of Forms 941-M and W-3.

Certain amounts reported on the monthly

Forms 941-M for the year should agree with

the Form W-2 totals reported on Form W-3.

The amounts that should agree are: income

tax withholding, social security wages, social

security tips, Medicare wages and tips, and

the advance earned income credit (EIC).

Where to file. File Form 941-M, with any

payment due, using the preaddressed

envelope furnished to you. Keep the

duplicate Form 941-M for your records.

Form W-2. By January 31, furnish Forms W-2

to employees who worked for you during the

previous year. If an employee stops working

for you before the end of the year, you may

Forms W-4. You are required to send to the

IRS copies of any Forms W-4 received during

the month from employees still employed by

you at the end of the month claiming: 

(a) more than 10 withholding allowances or

(b) exemption from income tax withholding if

their wages are expected to exceed $200 a

week. For details, see section 9 of Circular E

(Pub. 15), Employer’s Tax Guide. Do not

send any Forms W-4P or W-4S to the IRS.

General Instructions

Purpose of form. Use this form to report

monthly: (a) income tax you withheld from

wages, tips, supplemental unemployment

compensation benefits, and third-party

payments of sick pay; and (b) social security

and Medicare taxes. If you report just one

kind of tax, fill in only the lines that apply.

Who must file. File Form 941-M if you are

required to report income taxes withheld,

social security taxes, and Medicare taxes on

a monthly basis by an IRS compliance

representative. The IRS may require monthly

returns on this form and payments of tax

from any employer who has not complied

with the requirements for the filing of returns

or the paying or depositing of taxes reported

on quarterly returns. Do not file monthly

returns unless you received written

notification from the IRS to do so. A

preaddressed return envelope and blank

Form 941-M will be mailed to you before your

first monthly return is due and for each month

thereafter. If you no longer expect to pay

amounts subject to tax reportable on Form

941-M, write “Final Return” at the top of your

last return and attach an explanation of the

reason that you are no longer liable.

Change To Note

Related publications. Circular E (Pub. 15)

explains the rules for withholding, paying,

depositing, and reporting Federal income tax,

social security and Medicare taxes, and

Federal unemployment (FUTA) tax on wages.

See Pub. 15-A, Employer’s Supplemental Tax

Guide, for information on sick pay paid by

third-party payers. Circular A, Agricultural

Employer’s Tax Guide, explains rules for

employers of farmworkers. These publications

are available by calling 1-800-TAX-FORM

(1-800-829-3676). See Circular E (Pub. 15) for

additional methods of obtaining forms and

publications.

Form W-5. Each eligible employee wishing to

receive any advance earned income credit

(EIC) payments must give you a completed

Form W-5, Earned Income Credit Advance

Payment Certificate. The employer’s

requirement to notify certain employees about

the EIC can be met by giving each eligible

employee Notice 797, Possible Federal Tax

Refund Due to the Earned Income Credit

(EIC). See section 10 of Circular E (Pub. 15)

and Pub. 596, Earned Income Credit, for

more information.

Penalties and interest. There are penalties

for filing a return late and paying or

depositing taxes late, unless there is

reasonable cause. If you are late, attach an

explanation to your return. There are also

penalties for failure to: (a) furnish Forms W-2

to employees and file copies with the SSA

and (b) deposit taxes when required. In

addition, there are penalties for willful failure

to file returns and pay taxes when due and

for filing false returns or submitting bad

checks. Interest is charged on taxes paid late

at the rate set by law. See Circular E

(Pub. 15) for additional information.

Caution: A trust fund recovery penalty may

apply if income, social security, and Medicare

taxes that must be withheld are not withheld

or are not paid. The penalty is the full amount

of the unpaid trust fund tax. This penalty may

apply to you if these unpaid taxes cannot 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, and paying over

these taxes, and who acted willfully in not

doing so. 

Line 1—(March Only) Number of

employees. Do not include household

employees, persons who received no pay

during the pay period, pensioners, or

members of the Armed Forces. An entry of

250 or more on line 1 indicates that you must

file Forms W-2 electronically or on magnetic

media. Call the SSA at 1-800-772-6270 for

more information on electronic or magnetic

media filing requirements.

Line 2—Total wages and tips, plus other

compensation. Enter the total of all wages

paid, tips reported, taxable fringe benefits

provided, and other compensation paid to

your employees, even if you do not have to

withhold income or social security and

Medicare taxes on it. Do not include

supplemental unemployment compensation

benefits, even if you withheld income tax on

them. Do not include contributions to

employee plans that are excluded from the

employee’s wages (e.g., section 401(k) and

125 plans).

Social security wage base for 2003. Stop

withholding social security tax after an

employee reaches $87,000 in taxable wages.

Section references are to the Internal

Revenue Code.

Note: If you file a final return on Form 941-M,

you are also required to furnish Form W-2 to

your employees by the last day of the month

in which the final Form 941-M is due. File

Forms W-2 and W-3 with the Social Security

Administration by the last day of the month

following the month your final Form 941-M

was due. See the Instructions for Forms

W-2 and W-3 for details.

Line 6a—Taxable social security wages.

Enter the total wages subject to social

security taxes that you paid to your

employees during the month. Also include

any sick pay and taxable fringe benefits

subject to social security taxes. Enter the

amount before deductions. Do not include

tips on this line. Stop reporting for any

employee whose wages (including tips) reach

$87,000 for 2003. However, continue to

withhold income tax for the whole year on

wages and tips even when the limit of

$87,000 is reached. See the Line 7a

instructions for Medicare tax.

Line 3—Total income tax withheld. Enter

the total income tax that you withheld on

wages, tips, taxable fringe benefits, sick pay,

and supplemental unemployment

compensation benefits.

Line 4—Adjustment of withheld income tax.

Use line 4 to correct errors in income tax

withheld from wages paid in earlier months

of this calendar year or to correct

administrative errors. See section 13 of

Circular E (Pub. 15) for more information.

Consult your IRS compliance representative

before claiming a credit or adjustment.

Line 5—Adjusted total of income tax

withheld. Combine lines 3 and 4; enter the

result on line 5.

A responsible person can be an officer or

employee of a corporation, a partner or

employee of a partnership, an accountant, a

volunteer director/trustee, or an employee of a

sole proprietorship. A responsible person also

may include one who signs checks for the

business or otherwise has authority to cause

the spending of business funds. Willfully

means voluntarily, consciously, and

intentionally.

furnish him or her Form W-2 any time after

employment ends but no later than January

31 of the following year. However, if the

employee asks you for Form W-2, furnish him

or her the completed form within 30 days

after the request or the final wage payment,

whichever is later. Send Copy A of all Forms

W-2, Wage and Tax Statement, issued for the

year with a Form W-3, Transmittal of Wage

and Tax Statements, filed on paper, or

reports filed on magnetic media, to the Social

Security Administration (SSA) by the last day

of February. If you file Forms W-2

electronically (not by magnetic media) file

them with SSA by the last day of March.

Note: This form is not for general public use

and should only be filed directly with an IRS

compliance representative.

If the totals do not agree, the IRS may

require you to explain the differences and

correct any errors. See section 12 of Circular

E (Pub. 15) for details.
Form 941-M

(Rev. February 2003)

Employer’s Monthly Federal Tax Return

Department of the Treasury

Internal Revenue Service

OMB No. 1545-0718

Return for (enter month and year) 

For IRS

Use Only

T

FF

FD

FP

T

Make any necessary changes to preprinted information.

For March Only: Number of employees (except household) employed in the pay period that includes

March 12th  1

2 Total wages and tips, plus other compensation 2

3 Total income tax withheld from wages, tips, and sick pay 3

4 Adjustment of withheld income tax for preceding months of this calendar year 4

5 Adjusted total of income tax withheld (line 3 as adjusted by line 4) 5

6 Taxable social security wages 6b

Taxable social security tips  12.4% (.124) = 6d

7 Taxable Medicare wages and tips  2.9% (.029) = 7b

8 Total social security and Medicare taxes (add lines 6b, 6d, and 7b) 8

9 Adjustment of social security and Medicare taxes (see instructions) 9

10 Adjusted total of social security and Medicare taxes (line 8 as adjusted by line 9) 10

11 Total taxes (add lines 5 and 10) 11

12 Advance earned income credit (EIC) payments made to employees (see instructions) 12

13 Net taxes (subtract line 12 from line 11) 13

16 If line 14b is more than line 14a, enter overpayment here  $ and check if to be: Applied to next return or Refunded.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief

it is true, correct, and complete.

Signature  Print Your Name and Title  Date 

Form 941-M (Rev. 2-2003)

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14a

14b

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Tax Liability Amount Deposited Amount Deposited Amount Deposited Tax Liability Tax Liability

Overpayment from

previous month 

Total tax liability for the month (must equal line 13)

Total deposits for the month (including overpayment from previous month)

14 Record of Federal Tax Liability and Deposits (See instructions on page 4.)

15 Undeposited taxes due (subtract line 14b from line 14a). See instructions  15

For Privacy Act and Paperwork Reduction Act Notice, see page 4.

6a

7a

6c

 Do not file this form unless instructed to do so by the IRS.

Name (as distinguished from trade name) Employer identification number

Trade name, if any

Address (number and street) City, state, and ZIP code
Form 941-M (Rev. 2-2003) Page 4

Federal tax deposits. If you are not required

to have a special deposit account, in general,

you must deposit your tax liabilities at an

authorized financial institution with Form 8109

or by using EFTPS. For more information on

the deposit rules and the electronic deposit

requirements, see section 11 of Circular E

(Pub. 15).

Line 6c—Taxable social security tips. Enter

all tips that your employees reported during

the month until tips and wages for an

employee reach $87,000 in 2003. Do this

even if you were not able to withhold the

employee tax (6.2%). Report the uncollected

employee’s share of social security tax on line

9. Also see section 6 of Circular E (Pub. 15).

Line 7a—Taxable Medicare wages and tips.

Report all wages and tips subject to Medicare

tax. Also include any sick pay and taxable

fringe benefits subject to Medicare tax. See

section 5 in Circular E (Pub. 15) for

information on types of wages subject to

Medicare tax. If none of the payments are

subject to Medicare tax, enter “-0-.”

Line 9—Adjustment of social security and

Medicare taxes.

Line 10—Adjusted total of social security

and Medicare taxes. Combine lines 8 and 9;

enter the result on line 10.

Line 12—Advance earned income credit

(EIC) payments made to employees. Enter

advance EIC payments made to employees.

Your eligible employees may elect to receive

part of the EIC as an advance payment.

Eligible employees who have a qualifying

child must give you a completed Form W-5

stating that they qualify for the EIC. Once the

employee gives you a signed and completed

Special deposit account. Do not make

deposits using the Electronic Federal Tax

Payment System (EFTPS) or Form 8109,

Federal Tax Deposit Coupon, and do not

complete line 14, Record of Federal Tax

Liability and Deposits, if you are required to

have a special deposit account under section

7512(b). If you have received, by hand

delivery, Form 2481, Notice To Make Special

Deposits of Taxes, you are required to

deposit in a separate bank account any taxes

collected or required by law to be collected.

Your deposit must be made not later than the

end of the second banking day after any

taxes were required to be collected from your

employees. The taxes deposited must be

kept in the account until paid with any

employer tax that may be due. The account

must be designated as a special fund in trust

for the United States, payable to the “United

States Treasury” by you as trustee. For the

definition of the term “bank,” see Form 2481.

Line 15—Undeposited taxes due. You do

not have to pay if line 15 is under $1.

Caution: If you fail to make deposits as

required and instead pay the taxes with Form

941-M, you may be subject to a penalty.

Line 16—Overpayment. If you deposited

more than the correct amount for a month,

you can have the overpayment refunded

(applies only to March, June, September, and

December Forms 941-M) or applied to your

next return. Show any amount applied in the

Record of Federal Tax Liability and Deposits

Signature. Be sure to sign the return, print

your name and title, and enter the date.

If the amount of your advance EIC

payments exceeds your total taxes (line 11)

for the month, you may claim a refund of the

overpayment or elect to have the credit

applied to your return for the following month.

Provide a statement with your return

identifying the amount of excess payment(s)

and the pay period(s) in which it was paid.

See section 10 of Circular E (Pub. 15).

Line 14—Record of Federal Tax Liability

and Deposits. If you are required to deposit

taxes using the Federal Tax Deposit System,

complete both columns of the record. In the

tax liability column, include income tax

withheld plus both the employer and

employee shares of social security and

Medicare taxes minus advance EIC payments

(if any) for each day. Enter each tax liability in

the numbered entry space corresponding to

the date of payment (payday). Enter each

deposit amount in the numbered entry space

corresponding to the date of deposit.

Line 14a—Total tax liability for the month.

The amount on this line must equal net taxes

(line 13). Otherwise, you may be subject to a

penalty for failure to make deposits of taxes.

An employee must report to you cash tips,

including tips you paid the employee for

charge customers, totaling $20 or more in a

month by the 10th day of the next month.

The employee may use Form 4070,

Employee’s Report of Tips to Employer, or

give you a written statement.

Do not include allocated tips on this line.

Instead, report them on Form 8027,

Employer’s Annual Information Return of Tip

Income and Allocated Tips. Allocated tips are

not reportable on Form 941-M and are not

subject to withholding of income, social

security, or Medicare tax.

Include all tips that your employees

reported during the month, even if you were

not able to withhold the employee tax

(1.45%). Report the uncollected employee’s

share of Medicare tax on line 9. Also see

section 6 of Circular E (Pub. 15).

Current period adjustments. In certain

cases, amounts reported as social security

and Medicare taxes on lines 6b, 6d, and 7b

must be adjusted to arrive at your correct tax

liability. See section 13 of Circular E (Pub. 15)

for information on the following adjustments:

● Adjustment for the uncollected employee

share of social security and Medicare taxes

on tips.

● Adjustment for the employee share of

social security and Medicare taxes on

group-term life insurance premiums paid for

former employees.

● Adjustment for the employee share of

social security and Medicare taxes withheld

by a third-party sick pay payer.

● Fractions of cents adjustment.

Prior period adjustments. Use line 9 to

correct errors in social security and

Medicare taxes reported on an earlier return.

If you report both an underpayment and an

overpayment, show only the net difference.

Explain any prior period adjustments on an

attached Form 941c, Supporting Statement

To Correct Information.

Privacy Act and Paperwork Reduction Act

Notice. We ask for the information on this

form to carry out the Internal Revenue laws of

the United States. We need it to figure and

collect the right amount of tax. Subtitle C,

Employment Taxes, of the Internal Revenue

Code imposes employment taxes on wages,

including income tax withholding. This form is

used to determine the amount of the taxes

that you owe. Section 6011 requires you to

provide the requested information if the tax is

applicable to you. Section 6109 requires you

to provide your employer identification

number (EIN). If you fail to provide this

information in a timely manner, you may be

subject to penalties and interest.

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time

is: Recordkeeping, 12 hr., 26 min.; Learning

about the law or the form, 35 min.;

Preparing, copying, assembling, and

sending the form to the IRS, 49 min. If you

have comments concerning the accuracy of

these time estimates or suggestions for

making this form simpler, we would be happy

to hear from you. You can write to the Tax

Forms Committee, Western Area Distribution

Center, Rancho Cordova, CA 95743-0001.

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

unless the form displays a valid OMB control

number. Books or records relating to a form

or its instructions must be retained as long as

their contents may become material in the

administration of any Internal Revenue law.

● Sole Proprietorship—The individual

owning the business.

Form 941-M must be signed as follows:

● Corporation—The president, vice

president, or other principal officer.

● Partnership or unincorporated

organization— A responsible and duly

authorized member or officer having

knowledge of its affairs.

● Trust or estate—The fiduciary.

The return may also be signed by a duly

authorized agent of the taxpayer if a valid

power of attorney has been filed.

Generally, tax returns and return

information are confidential, as required by

section 6103. However, section 6103 allows

or requires the IRS to disclose or give the

information shown on your tax return to

others as described in the Code. For

example, we may disclose your tax

information to the Department of Justice for

civil and criminal litigation, and to cities,

states, and the District of Columbia for use in

administering their tax laws. We may also

disclose this information to Federal and state

agencies to enforce Federal nontax criminal

laws and to combat terrorism.

Do not send Form 941-M to this address.

Instead, use the preaddressed envelope

furnished to you.

Form W-5, you must make the advance EIC

payments. Advance EIC payments are

generally made from withheld income tax and

employee and employer social security and

Medicare taxes. See section 10 of Circular E

(Pub. 15) and Pub. 596 for more information

on advance EIC payments and eligibility

requirements.

on your next return. If line 16 is under $1, we

will send a refund or apply it to your next

return only on written request.