Employer’s Annual Federal OMB No. 1545-1110

Unemployment (FUTA) Tax Return Form 940-EZ

Department of the Treasury

Internal Revenue Service

Name (as distinguished from trade name) Calendar year FF

FD

Trade name, if any FP

Address and ZIP code Employer identification number

T

I

T

Follow the chart under Who May Use Form 940-EZ on page 2. If you cannot use Form 940-EZ, you must use Form 940 instead.

A Enter the amount of contributions paid to your state unemployment fund. (See instructions for line A on page 4.) ©

B (1) Enter the name of the state where you have to pay contributions ©

(2) Enter your state reporting number as shown on state unemployment tax return ©

If this is an Amended Return, check here ©

Taxable Wages and FUTA Tax

1 Total payments (including payments shown on lines 2 and 3) during the calendar year for services of employees 1

Amount paid

Exempt payments. (Explain all exempt payments, attaching additional sheets

if necessary.) ©

2

2

Payments for services of more than $7,000. Enter only amounts over the first $7,000

paid to each employee. Do not include any exempt payments from line 2. Do not

use your state wage limitation. The $7,000 amount is the Federal wage base. Your

state wage base may be different

3

3

4 Total exempt payments (add lines 2 and 3) 4

5 Total taxable wages (subtract line 4 from line 1) © 5

6 FUTA tax. Multiply the wages on line 5 by .008 and enter here. (If the result is over $100, also complete Part II.) 6

7 Total FUTA tax deposited for the year, including any overpayment applied from a prior year (from your records) 7

8 Amount you owe (subtract line 7 from line 6). This should be $100 or less. Pay to “Internal Revenue Service.” © 8

9 Overpayment (subtract line 6 from line 7). Check if it is to be: Applied to next return, or Refunded © 9

Record of Quarterly Federal Unemployment Tax Liability (Do not include state liability.) Complete only if line 6 is over $100.

Quarter First (Jan. 1 – Mar. 31) Second (Apr. 1 – June 30) Third (July 1 – Sept. 30) Fourth (Oct. 1 – Dec. 31) Total for year

Liability for quarter

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, and that no part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments to employees.

Signature © Title (Owner, etc.) © Date ©

Form 940-EZ (1996)

If you will not have to file returns in the future, check here (see Who Must File on page 2) and complete and sign the return ©

$

Part I

Part II

Cat. No. 10983G

(98)

Form 940-EZ(V)

Department of the Treasury

Internal Revenue Service

Form 940-EZ Payment Voucher

Enter the amount of the payment you are making Enter the first four letters of your last name

(business name if partnership or corporation)

1 2

4 Enter your name

DETACH HERE

OMB No. 1545-1110

© $ .

Use this voucher only when making a payment with your return.

3 Enter your employer identification number

Enter your address

Enter your city, state, and ZIP code

Complete boxes 1, 2, 3, and 4. Do not send cash and do not staple your payment to this voucher. Make your check or money order payable to the

Internal Revenue Service. Be sure to enter your employer identification number, “Form 940-EZ,” and “1996” on your payment.

96

96

© For Paperwork Reduction Act Notice, see page 2.

Instructions for Box 2

—Individuals (sole proprietors, trusts, and estates)—

Enter the first four letters of your last name.

—Corporations and partnerships—Enter the first four

characters of your business name (omit “The” if

followed by more than one word).
Ä

Form 940-EZ (1996) Page 2

Count all regular, temporary, and part-time employees. A partnership

should not count its partners. If a business changes hands during the

year, each employer meeting test 1 or 2 must file. Do not report wages

paid by the other.

Paperwork Reduction Act Notice.—We ask for the information on this

form to carry out the Internal Revenue laws of the United States. You

are required to give us the information. We need it to ensure that you

are complying with these laws and to allow us to figure and collect the

right amount of tax.

Did you pay

unemployment

contributions to only one

state?

No ©

Household Employers.—File a FUTA tax return ONLY if you paid total

cash wages of $1,000 or more to any individual in any calendar quarter

in 1995 or 1996 for household work in a private home, local college

club, or a local chapter of a college fraternity or sorority. Individuals,

estates, and trusts that owe FUTA tax for household work in a private

home, in most cases must file Schedule H (Form 1040), Household

Employment Taxes, instead of Form 940 or 940-EZ. See the Instructions

for Schedule H. In some cases, such as when you employ both

household employees and other employees, you may have the option to

report social security, Medicare, and withheld Federal income taxes for

your household employee(s) on Form 941, Employer’s Quarterly Federal

Tax Return, or 943, Employer’s Annual Tax Return for Agricultural

Employees, instead of on Schedule H. If you choose to report on Form

941 or 943, you must use Form 940 or 940-EZ to report FUTA taxes.

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. Generally, tax

returns and return information are confidential, as required by the

Internal Revenue Code section 6103.

Did you pay all state

unemployment

contributions by

January 31?*

No ©

Agricultural Employers.—File a FUTA tax return if either of the

following tests applies:

Were all wages that were

taxable for FUTA tax also

taxable for your state’s

unemployment tax?

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.

DO NOT send the form to this office. Instead, see Where To File on

page 4.

No ©

1. You paid cash wages of $20,000 or more to farmworkers during

any calendar quarter in 1995 or 1996; or

2. You employed 10 or more farmworkers during some part of a day

(whether or not at the same time) for at least 1 day during any 20

different weeks in 1995 or 1996.

Ä

You may use Form

940-EZ.

Who Must File.—The General Rule (household and agricultural

employers see below) states you must file if either of the following

tests applies:

1. You paid wages of $1,500 or more in any calendar quarter in 1995

or 1996; or

2. You had at least one employee for some part of a day in any 20

different weeks in 1995 or 1996.

(Instructions continued on next page.)

The following chart will lead you to the right form to use; however, if

you owe FUTA tax only for household work in a private home you

generally must use Schedule H (see Household Employers below).

Yes

Ä

Yes

Ä

Yes

Note: Do not file Form 940-EZ if you have already filed Form 940 for 1996.

Who May Use Form 940-EZ

When To File.—Form 940-EZ for 1996 is due by January 31, 1997.

However, if you deposited all FUTA tax when due, you may file on or

before February 10, 1997.

You must use Form

940 instead.**

General Instructions

Purpose of Form.—Use this form to report your annual Federal

Unemployment Tax Act (FUTA) tax. FUTA tax, together with state

unemployment systems, provides for payments of unemployment

compensation to workers who have lost their jobs. Most employers pay

both Federal and state unemployment taxes. Only the employer pays

this tax. The tax applies to the first $7,000 you pay each employee in a

year. The $7,000 amount is the Federal wage base. Your state wage

base may be different.

*If you are a successor employer claiming a credit for state

unemployment contributions paid by the prior employer, you must use

Form 940.

**If you need to file Form 940 or Schedule H (Form 1040), you can get

the form by calling 1-800 TAX-FORM (1-800-829-3676).

The time needed to complete and file this form will vary depending on

individual circumstances. Estimated average time is: Recordkeeping—6

hr., 23 min., Learning about the law or form—7 min., and Preparing

and sending the form to the IRS—34 min.

Changes To Note.—The exclusion from FUTA tax of wages paid to

H-2(A) visa farmworkers was reinstated as a permanent exclusion for

services performed after 1994. If you paid FUTA tax on wages paid to

these workers in 1995, file an amended return to get a refund. See

Amended Return on page 4.

If your total deposits of social security, Medicare, railroad retirement,

and withheld income taxes exceeded $50,000 in 1995, beginning July 1,

1997, all depository tax liabilities (including FUTA tax) must be

deposited using the Electronic Federal Tax Payment System (EFTPS).

Call 1-800-945-8400 or 1-800-555-4477 for information.
Employer’s Annual Federal OMB No. 1545-1110

Unemployment (FUTA) Tax Return Form 940-EZ

Department of the Treasury

Internal Revenue Service

Name (as distinguished from trade name)

Trade name, if any

Address and ZIP code Employer identification number

Employer’s Name, Address, and Identification Number.—If you are

not using a preaddressed Form 940-EZ, type or print your name, trade

name, address, and employer identification number (EIN) on the form.

See Circular E, Employer’s Tax Guide, for details on how to make

tax deposits, file a return, etc., if these are due before you get your EIN.

Follow the chart under Who May Use Form 940-EZ on page 2. If you cannot use Form 940-EZ, you must use Form 940 instead.

A Enter the amount of contributions paid to your state unemployment fund. (See instructions for line A on page 4.) ©

B (1) Enter the name of the state where you have to pay contributions ©

(2) Enter your state reporting number as shown on state unemployment tax return ©

If this is an Amended Return, check here ©

Taxable Wages and FUTA Tax

1 Total payments (including payments shown on lines 2 and 3) during the calendar year for services of employees 1

Amount paid

Exempt payments. (Explain all exempt payments, attaching additional sheets

if necessary.) ©

2

2

Payments for services of more than $7,000. Enter only amounts over the first $7,000

paid to each employee. Do not include any exempt payments from line 2. Do not

use your state wage limitation. The $7,000 amount is the Federal wage base. Your

state wage base may be different

3

3

4 Total exempt payments (add lines 2 and 3) 4

5 Total taxable wages (subtract line 4 from line 1) © 5

6 FUTA tax. Multiply the wages on line 5 by .008 and enter here. (If the result is over $100, also complete Part II.) 6

7 Total FUTA tax deposited for the year, including any overpayment applied from a prior year (from your records) 7

8 Amount you owe (subtract line 7 from line 6). This should be $100 or less. Pay to “Internal Revenue Service.” © 8

9 Overpayment (subtract line 6 from line 7). Check if it is to be: Applied to next return, or Refunded © 9

Record of Quarterly Federal Unemployment Tax Liability (Do not include state liability.) Complete only if line 6 is over $100.

Quarter First (Jan. 1 – Mar. 31) Second (Apr. 1 – June 30) Third (July 1 – Sept. 30) Fourth (Oct. 1 – Dec. 31) Total for year

Liability for quarter

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, and that no part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments to employees.

Signature © Title (Owner, etc.) © Date ©

Form 940-EZ (1996)

If you will not have to file returns in the future, check here (see Who Must File on page 2) and complete and sign the return ©

$

Part I

Part II

There are also penalties for willful failure to pay tax, keep records,

make returns, and for filing false or fraudulent returns.

Credit for Contributions Paid Into State Funds.—You get a credit for

amounts you pay to a state (including Puerto Rico) unemployment fund

by January 31. This credit is reflected in the FUTA tax rate (.008) on line

6. The rate is effective through 1998.

“Contributions” are payments that a state requires you, as an

employer, to make to its unemployment fund for the payment of

unemployment benefits. However, contributions do not include:

● Any payments deducted or deductible from your employees’ pay.

● Penalties, interest, or special administrative taxes not included in the

contribution rate the state assigned to you.

(Instructions continued on next page.)

Completing Form 940-EZ.—If your FUTA tax for 1996 (line 6) is $100

or less, complete only Part I of the form. If your FUTA tax is over $100,

complete Parts I and II. See the instructions for Part II for information on

FUTA tax deposits.

Not Liable for FUTA Tax?—If you receive Form 940-EZ and are not

liable for FUTA tax for 1996, write “Not Liable” across the front of the

form, sign the return, and return it to the IRS.

Note: If you will not have to file returns in the future, check the box on

the line below B(2), complete and sign the return.

Identifying Your Payments.—When you pay any amount you owe to

the IRS (line 8) or make Federal tax deposits, write the following on your

check or money order: your EIN, “Form 940-EZ,” and the tax year to

which the payment applies. This helps us credit your account properly.

Penalties and Interest.—Avoid penalties and interest by making tax

deposits when due, filing a correct return, and paying all taxes

when due. There are penalties for late deposits and late filing unless

you can show reasonable cause. If you file late, attach an explanation to

the return.

(99)

96

Count wages paid to aliens admitted on a temporary basis to the

United States to perform farmwork, also known as workers with

“H-2(A)” visas, to see if you meet either test. However, wages paid to

H-2(A) visa workers are not subject to FUTA tax.

Nonprofit Organizations.—Religious, educational, charitable, etc.,

organizations described in section 501(c)(3) of the Internal Revenue

Code and exempt from tax under section 501(a) are not subject to

FUTA tax and are not required to file.

© For Paperwork Reduction Act Notice, see page 2.

Calendar year
Form 940-EZ (1996) Page 4

Where To File.—In the list below, find the state where your legal

residence, principal place of business, office, or agency is located. Send

your return to the Internal Revenue Service at the address listed for

your location. No street address is needed.

Florida, Georgia, South Carolina

New Jersey, New York (New York City and counties of Nassau, Rockland, Suffolk,

and Westchester)

Holtsville, NY 00501-0047

New York (all other counties), Connecticut, Maine, Massachusetts,

New Hampshire, Rhode Island, Vermont

Illinois, Iowa, Minnesota, Missouri, Wisconsin

Delaware, District of Columbia, Maryland, Pennsylvania, Puerto Rico, Virginia,

U.S. Virgin Islands

Philadelphia, PA 19255-0047

Indiana, Kentucky, Michigan, Ohio, West Virginia

Cincinnati, OH 45999-0047

Kansas, New Mexico, Oklahoma, Texas

Alaska, Arizona, California (counties of Alpine, Amador, Butte, Calaveras, Colusa,

Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin,

Mendocino, Modoc, Napa, Nevada, Placer, Plumas, Sacramento, San Joaquin,

Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Yolo, and

Yuba), Colorado, Idaho, Montana, Nebraska, Nevada, North Dakota, Oregon,

South Dakota, Utah, Washington, Wyoming

Ogden, UT 84201-0047

California (all other counties), Hawaii

Fresno, CA 93888-0047

Alabama, Arkansas, Louisiana, Mississippi, North Carolina, Tennessee

Memphis, TN 37501-0047

If you have no legal residence or principal place of business in any IRS district,

file with the Internal Revenue Service Center, Philadelphia, PA 19255.

How you make the payments is not important to determine if they are

wages. Thus, you may pay wages for piecework or as a percentage of

profits. You may pay wages hourly, daily, etc. You may pay wages in

cash or some other way, such as goods, lodging, food, or clothing. For

items other than cash, use the fair market value when paid.

Line 2—Exempt payments.—For FUTA purposes, “wages” and

“employment” do not include every payment and every kind of service

an employee may perform. In general, payments that are not wages and

payments for services that are not employment are not subject to tax.

Enter payments such as the following on line 2.

1. Agricultural labor if you did not meet either test in Agricultural

Employers on page 2.

2. Benefit payments for sickness or injury under a worker’s

compensation law.

3. Household service if you did not pay total cash wages of $1,000 or

more in any calendar quarter in 1995 or 1996, and you included the

amount on line 1.

4. Certain family employment.

5. Certain fishing activities.

6. Noncash payments for farmwork or household services in a private

home that are included on line 1. Only cash wages to these workers are

taxable.

7. Value of certain meals and lodging.

8. Cost of group-term life insurance.

11. Any other exempt service or pay.

For more information, see Special Rules for Various Types of Services

and Payments in Circular E.

Line 3—Payments for services of more than $7,000.—Enter the total

amounts over $7,000 you paid each employee. For example, if you have

10 employees and paid each $8,000 during the year, enter $80,000 on

line 1 and $10,000 on line 3. The $10,000 is the amount over $7,000

paid to each employee. Do not include any exempt payments from line

2 in figuring the $7,000.

Part II. Record of Quarterly Federal Unemployment Tax

Liability

Complete this part only if your FUTA tax on line 6 is over $100. To

figure your FUTA tax liability, multiply by .008 that part of the first

$7,000 of each employee’s annual wages you paid during the quarter.

Enter the result in the space for that quarter. Your total liability must

equal your total tax. If not, you may be charged a failure to deposit

penalty.

Record your liability based on when you pay the wages, not on when

you deposit the tax. For example, if you pay wages on March 29, your

FUTA tax liability on those wages is $200, and you deposit the $200 on

April 30, you would record that $200 in the first quarter, not the second.

Depositing FUTA Taxes.—Generally, FUTA taxes are deposited

quarterly. If you deposited the right amounts, following these rules, the

amount you owe with Form 940-EZ will never be over $100.

Note: The total amount of all deposits must be shown on line 7.

9. Payments attributable to the employee’s contributions to a

sick-pay plan.

10. Benefits excludable under a section 125 plan (cafeteria plan).

P.O. Box 210

Newark, NJ 07101-0210

P.O. Box 8738

Philadelphia, PA 19162-8738

P.O. Box 6796

Chicago, IL 60680-6796

P.O. Box 7028

San Francisco, CA 94120-7028

Return without payment: Return with payment:

P.O. Box 60150

Los Angeles, CA 90060-0150

Return without payment: Return with payment:

P.O. Box 1210

Charlotte, NC 28201-1210

Return without payment:

Return without payment:

Return without payment:

Return without payment:

Return with payment:

Return with payment:

Return with payment:

Return with payment:

If your liability for any of the first three quarters of 1996 (plus any

undeposited amount of $100 or less from any earlier quarter) is over

$100, deposit it by the last day of the month after the end of the

quarter. If it is $100 or less, carry it to the next quarter; a deposit is not

required. If your liability for the fourth quarter (plus any undeposited

amount from any earlier quarter) is over $100, deposit the entire amount

by January 31, 1997. If it is $100 or less, you can either make a deposit

or pay it with your Form 940-EZ by January 31.

Atlanta, GA 39901-0047

Return without payment:

P.O. Box 105659

Atlanta, GA 30348-5659

Return with payment:

Andover, MA 05501-0047

Return without payment: Return with payment:

P.O. Box 371324

Pittsburgh, PA 15250-7324

Kansas City, MO 64999-0047

Return without payment: Return with payment:

P.O. Box 970010

St. Louis, MO 63197-0010

Austin, TX 73301-0047 P.O. Box 970017

St. Louis, MO 63197-0017

Return without payment: Return with payment:

Note: Where you file depends on whether or not you are including a

payment.

Amended Returns.—Use a new Form 940-EZ to amend a previously

filed Form 940-EZ. Check the Amended Return box above Part I, enter

the amounts that should have been on the original return, and sign the

amended return. Attach an explanation of the reasons for amending the

original return.

If you were required to file Form 940 but filed Form 940-EZ instead,

file the amended return on Form 940. See Form 940 and its instructions.

Specific Instructions

You must complete lines A and B and Part I. If your FUTA tax (line

6) is over $100, you must also complete Part II. Please remember to

sign the return.

Line A.—Enter the amount of state unemployment contributions. If your

state has given you a 0% experience rate, so there are no required

contributions, enter “0% rate” in the space.

Part I. Taxable Wages and FUTA Tax

Line 1—Total payments.—Enter the total payments you made during

the calendar year for services of employees, even if the payments are

not taxable for FUTA tax. Include salaries, wages, commissions, fees,

bonuses, vacation allowances, amounts paid to temporary or part-time

employees, and the value of goods, lodging, food, clothing, noncash

fringe benefits, and contributions to a 401(k) pension plan. Also, include

the amount of tips reported to you in writing by your employees. Enter

the amount before any deductions.

● Voluntary contributions you paid to get a lower assigned rate.

Note: Be sure to enter your state reporting number on line B(2) at the

top of the form. The IRS needs this to verify your state contributions.

If you are not required to use EFTPS, use Form 8109, Federal Tax

Deposit Coupon, to deposit FUTA tax in an authorized financial

institution or the Federal Reserve bank for your area. Records of your

deposits will be sent to the IRS for crediting to your business accounts.

If your total deposits of employment taxes (withheld income, social

security, Medicare and railroad retirement) exceeded $50,000 in 1995

beginning July 1 1997, you must deposit taxes using the Electronic

Federal Tax Payments System (EFTPS). Call 1-800-945-8400 or

1-800-555-4477 for information.