SCHEDULE Q 

(Form 1120-F)

Department of the Treasury 

Internal Revenue Service 

Tax Liability of Qualified Derivatives Dealer (QDD)

▶ Attach to Form 1120-F.

▶ Go to www.irs.gov/Form1120F for the latest information.

OMB No. 1545-0123

2019

Name of corporation Employer identification number

Name of QDD QI-EIN

QDD Taxable Year (enter month, day, and year for beginning and ending dates)

Beginning , 20 , and ending , 20

Indicate the year or portion of the year to which the schedule relates (enter month, day, and year for beginning and ending dates)

Beginning , 20 , and ending , 20

Schedule of

Summary of QDD Tax Liability

(a) 

Gross Amount

(b)

Tax Rate

(c) 

Amount of 

Tax Liability 

(column (a) x 

column (b))

1 Total section 871(m) amount . . . . . . . . . . . . 1

2 Total dividends received in equity derivatives dealer capacity . . 2

3 Total QDD tax liability pursuant to section 3.09(A) of the Qualified 

Intermediary Agreement . . . . . . . . . . . . . . 3

4 Total QDD tax liability pursuant to section 3.09(B) of the Qualified 

Intermediary Agreement . . . . . . . . . . . . . . 4

5 Total QDD tax liability pursuant to section 3.09(C) of the Qualified 

Intermediary Agreement:

a Income Type ▶ 5a

b Income Type ▶ 5b

c Income Type ▶ 5c

d Income Type ▶ 5d

6 Total of line 5 amounts . . . . . . . . . . . . . . 6

Who Must File

If the corporation or any branch of the corporation was a 

qualified derivatives dealer (QDD) (defined below) during the tax 

year, Schedule Q must be completed and filed for each of those 

QDDs. The corporation must file Schedule Q as an attachment 

to Form 1120-F even if the QDD has zero tax liability. 

Qualified derivatives dealer (QDD). A QDD is a home office or 

branch that, in accordance with the qualified intermediary 

agreement (QIA) (defined below), qualifies and has been 

approved for QDD status and satisfies the requirements of the 

QIA. See the QIA for additional information.

Qualified intermediary agreement (QIA). The QIA is section 6 

of Rev. Proc. 2017-15.

General Instructions

A separate Schedule Q is required for each QDD. In addition, if 

a corporation has a tax year other than the calendar year, the 

corporation must provide separate Schedules Q for each QDD 

for the portion of the tax year in the first calendar year and the 

portion in the second calendar year.

Specific Instructions

Name of QDD. The name of the QDD should follow the naming 

protocol used for applying to be a QDD.

Number of schedules filed. A QDD may be required to file 

multiple Schedules Q, for example, if it has multiple branches 

that are QDDs or if it is a fiscal year taxpayer (as explained in 

General Instructions above). Indicate the number of each 

Schedule Q filed, as well as the total number of Schedules Q 

being filed by the corporation in the entry spaces provided.

Column (c), Amount of Tax Liability. Except as provided in the 

Note that immediately follows this paragraph, the amount in 

column (c) is determined by multiplying column (a) by column (b). 

This column is not reduced by any withholding that has occurred.

Note: For calendar years 2018 through 2020, certain information 

is not required, as indicated in the line instructions below. 

However, if the taxpayer has a tax year that begins in 2020 other 

than the calendar year, information is required for any amounts 

paid or accrued on or after January 1, 2021.

Line 1, total section 871(m) amount. The gross amount to be 

entered in column (a) is the sum of each section 871(m) amount 

for the QDD for the relevant period. See section 2.73 of the QIA 

for the definition of section 871(m) amount.

Note: For calendar years 2019 and 2020, this information is not 

required.

Line 2, total dividends received in equity derivatives dealer 

capacity.

Note: For calendar years 2019 and 2020, only the gross amount 

(column (a)) and tax rate (column (b)) are required.

Line 3, total QDD tax liability pursuant to section 3.09(A) of 

the Qualified Intermediary Agreement. Column (c) is the sum 

of each section 3.09(A) amount for the QDD for the relevant 

period.

Note: For calendar years 2019 and 2020, this information is not 

required.

Line 4, total QDD tax liability pursuant to section 3.09(B) of 

the Qualified Intermediary Agreement. Enter the information 

requested in columns (a), (b), and (c).

Line 5, total QDD tax liability pursuant to section 3.09(C) of 

the Qualified Intermediary Agreement. In addition to 

specifying the type of income (for example, dividends or 

interest), enter the information requested in columns (a), (b), and 

(c) separately for each income type. For dividends, include all 

dividends, including dividends separately stated on line 2.

Note: For calendar years 2019 and 2020, do not include 

dividends included on line 2.

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-F. Cat. No. 71803X Schedule Q (Form 1120-F) 2019