Form 944 for 2012: Employer’s ANNUAL Federal Tax Return

Department of the Treasury — Internal Revenue Service OMB No. 1545-2007

Employer identification number (EIN) —

Name (not your trade name)

Trade name (if any)

Address

Number Street Suite or room number

City State ZIP code

Who Must File Form 944

You must file annual Form 944 

instead of filing quarterly Forms 941 

only if the IRS notified you in 

writing. You also must file Form 944 

(or Form 944 (SP)) for 2012 if you 

filed Form 944-SS or Form 944-PR 

in 2011 and you did not request to 

file Forms 941-SS or Forms 941-PR 

for 2012. 

Instructions and prior-year forms are 

available at www.irs.gov/form944.

Read the separate instructions before you complete Form 944. Type or print within the boxes.

Part 1: Answer these questions for this year. Employers in American Samoa, Guam, the Commonwealth of the Northern 

Mariana Islands, the U.S. Virgin Islands, and Puerto Rico can skip lines 1 and 2. 

1 Wages, tips, and other compensation . . . . . . . . . . . . . . . . . 1 .

2 FEDERAL income tax withheld from wages, tips, and other compensation . . . . . 2 .

3 If no wages, tips, and other compensation are subject to social security or Medicare tax 3 Check and go to line 5.

4 Taxable social security and Medicare wages and tips:

Column 1 Column 2

For 2012, the employee social 

security tax rate is 4.2% and the 

Medicare tax rate is 1.45%. The 

employer social security tax rate is 

6.2% and the Medicare tax rate is 

1.45%.

4a Taxable social security wages . × . 104 = .

4b Taxable social security tips . × .104 = .

4c Taxable Medicare wages & tips . × .029 = .

4d Add Column 2 line 4a, Column 2 line 4b, and Column 2 line 4c . . . . . . . . 4d .

5 Total taxes before adjustments (add lines 2 and 4d) . . . . . . . . . . . . . 5 .

6 Current year’s adjustments (see instructions) . . . . . . . . . . . . . . . 6 .

7 Total taxes after adjustments. Combine lines 5 and 6 . . . . . . . . . . . . . 7 .

8 Total deposits for this year, including overpayment applied from a prior year and 

overpayment applied from Form 944-X, 944-X (PR), 944-X (SP), 941-X, or 941-X (PR) . . 8 .

9a COBRA premium assistance payments (see instructions) . . . . . . . . . . . 9a .

9b Number of individuals provided COBRA premium assistance

10 Add lines 8 and 9a . . . . . . . . . . . . . . . . . . . . . . . . 10 .

11 Balance due. If line 7 is more than line 10, enter the difference and see instructions . . . . 11 .

12 Overpayment. If line 10 is more than line 7, enter the difference . Check one: Apply to next return. Send a refund.

▶ You MUST complete both pages of Form 944 and SIGN it. Next ■▶

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat. No. 39316N Form 944 (2012)
Name (not your trade name) Employer identification number (EIN)

Part 2: Tell us about your deposit schedule and tax liability for this year.

13 Check one: Line 7 is less than $2,500. Go to Part 3.

Line 7 is $2,500 or more. Enter your tax liability for each month. If you are a semiweekly depositor or you accumulate 

$100,000 or more of liability on any day during a deposit period, you must complete Form 945-A instead of the boxes below.

13a

Jan.

.

13b

Feb.

.

13c

Mar.

.

13d

Apr.

.

13e

May

.

13f

Jun.

.

13g

Jul.

.

13h

Aug.

.

13i

Sep.

.

13j

Oct.

.

13k

Nov.

.

13l

Dec.

.

Total liability for year. Add lines 13a through 13l. Total must equal line 7. 13m .

Part 3: Tell us about your business. If question 14 does NOT apply to your business, leave it blank.

14 If your business has closed or you stopped paying wages...

Check here and enter the final date you paid wages.

Part 4: May we speak with your third-party designee?

Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the instructions

for details.

Yes. Designee’s name and phone number

Select a 5-digit Personal Identification Number (PIN) to use when talking to IRS.

No.

Part 5: Sign Here. You MUST complete both pages of Form 944 and SIGN it.

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. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

✗ Sign your 

name here

Date

Print your 

name here

Print your 

title here

Best daytime phone

Paid Preparer Use Only Check if you are self-employed

Preparer’s name PTIN

Preparer’s signature Date

Firm’s name (or yours 

if self-employed) EIN

Address Phone

City State ZIP code

Page 2 Form 944 (2012)
Form 944-V, 

Payment Voucher

Purpose of Form

Complete Form 944-V, Payment Voucher, if you are 

making a payment with Form 944, Employer’s ANNUAL 

Federal Tax Return. We will use the completed voucher to 

credit your payment more promptly and accurately, and 

to improve our service to you.

Making Payments With Form 944

To avoid a penalty, make your payment with your 2012 

Form 944 only if one of the following applies.

• Your net taxes for the year (Form 944, line 7) are less 

than $2,500 and you are paying in full with a timely filed 

return.

• You already deposited the taxes you owed for the first, 

second, and third quarters of 2012, and the tax you owe 

for the fourth quarter of 2012 is less than $2,500, and you 

are paying, in full, the tax you owe for the fourth quarter 

of 2012 with a timely filed return.

• Your net taxes for the third quarter are $2,500 or more, 

net taxes for the fourth quarter are less than $2,500, and 

you did not incur a $100,000 next-day deposit obligation 

during the fourth quarter.

• You are a monthly schedule depositor making a 

payment in accordance with the Accuracy of Deposits 

Rule. See section 11 of Pub. 15 (Circular E), Employer’s 

Tax Guide, for details. In this case, the amount of your 

payment may be $2,500 or more.

Otherwise, you must make deposits by electronic funds 

transfer. See section 11 of Pub. 15 (Circular E) for deposit

instructions. Do not use Form 944-V to make federal tax 

deposits.

Caution. Use Form 944-V when making any payment with 

Form 944. However, if you pay an amount with Form 944 

that should have been deposited, you may be subject to a 

penalty. See Deposit Penalties in section 11 of Pub. 15 

(Circular E).

Specific Instructions

Box 1—Employer identification number (EIN). If you do 

not have an EIN, you may apply for one online. Go to 

IRS.gov and click on the Apply for an EIN Online link 

under Tools. You may also apply for an EIN by calling 

1-800-829-4933, or you can fax or mail Form SS-4, 

Application for Employer Identification Number. If you 

have not received your EIN by the due date of Form 944, 

write “Applied For” and the date you applied in this entry 

space.

Box 2—Amount paid. Enter the amount paid with Form 

944.

Box 3—Name and address. Enter your name and

address as shown on Form 944.

• Enclose your check or money order made payable to 

the “United States Treasury” and write your EIN, “Form 

944,” and “2012” on your check or money order. Do not 

send cash. Do not staple Form 944-V or your payment to 

Form 944 (or to each other).

• Detach Form 944-V and send it with your payment and 

Form 944 to the address provided in the Instructions for 

Form 944. Do not send a photocopy of Form 944-V 

because your payment may be misapplied or delayed.

Note. You must also complete the entity information

above Part 1 on Form 944.

✁

Detach Here and Mail With Your Payment and Form 944.

▼ ▼ ✃

Form 944-V

Department of the Treasury 

Internal Revenue Service

Payment Voucher

▶ Do not staple this voucher or your payment to Form 944.

OMB No. 1545-2007

2012

1 Enter your employer identification 

number (EIN).

2

Enter the amount of your payment. ▶

Make your check or money order payable to “United States Treasury”

Dollars Cents

3 Enter your business name (individual name if sole proprietor).

Enter your address.

Enter your city, state, and ZIP code.
Form 944 (2012)

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 identification number. If you fail to provide this 

information in a timely manner, or provide false or

fraudulent information, you may be subject to penalties

and interest.

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 and records relating to a form or 

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 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, the District of 

Columbia, and U.S. commonwealths and possessions for 

use in administering their tax laws. We may also disclose 

this information to other countries under a tax treaty, to 

federal and state agencies to enforce federal nontax 

criminal laws, or to federal law enforcement and 

intelligence agencies to combat terrorism.

The time needed to complete and file Form 944 will 

vary depending on individual circumstances. The 

estimated average time is:

Recordkeeping . . . . . . . . . 10 hrs., 45 min.

Learning about the law or the form . . . . 24 min.

Preparing, copying, assembling, and sending 

the form to the IRS . . . . . . . . . . 35 min.

If you have comments concerning the accuracy of 

these time estimates or suggestions for making Form 944 

simpler, we would be happy to hear from you. You can 

email us at taxforms@irs.gov. Enter “Form 944” on the 

subject line. Or write to: Internal Revenue Service, Tax 

Products Coordinating Committee, SE:W:CAR:MP:T:M:S, 

1111 Constitution Ave. NW, IR-6526, Washington, DC 

20224. Do not send Form 944 to this address. Instead, 

see Where Should You File? in the Instructions for 

Form 944.