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

2021

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)

Withholding 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 fiscal year rather than a calendar year, the 

corporation must provide a separate Schedule Q for each QDD 

for each portion of the fiscal year that falls within the calendar 

year. 

Example: A QDD with a fiscal year beginning September 1 and 

ending August 31 would complete 2 schedules (one for the 

period of January 1, 2021 through August 31, 2021, and one for 

the period of September 1, 2021 through December 31, 2021). 

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 2022, certain information 

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

However, if the corporation has a fiscal year (rather than a 

calendar year) that begins in 2022 and ends in 2023, information 

is required for any amounts paid or accrued on or after January 

1, 2023.

Line 1. 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 through 2022, this information is 

not required.

Line 2. For calendar years 2019 through 2022, only the gross 

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

Line 3. Column (c) is the sum of each section 3.09(A) amount for 

the QDD for the relevant period.

Note: For calendar years 2019 through 2022, this information is 

not required.

Line 4. Enter the information requested in columns (a), (b), and 

(c).

Line 5. 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 through 2022, 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) 2021