950412

Schedule R (Form 941): Allocation Schedule for Aggregate Form 941 Filers OMB No. 1545-0029

(Rev. January 2012)

Department of the Treasury — Internal Revenue Service

Employer identification number 

(EIN) —

Name as shown on

Form 941

Read the instructions before you complete Schedule R (Form 941). Type or print within the boxes. 

Complete a separate line for the amounts allocated to each of your clients.

Report for calendar year:

Check the quarter (same as Form 941):

1: January, February, March

2: April, May, June

3: July, August, September

4: October, November, December

 (a)

Client’s Employer 

Identification 

Number (EIN)

(b) 

Wages, tips, and 

other compensation 

allocated to the listed

client EIN from line 2

of Form 941

(c) 

Total income tax 

withheld from wages, 

tips, and other 

compensation 

allocated to the listed

client EIN from line 3

of Form 941

(d) 

Total social security 

and Medicare taxes 

allocated to the

listed client EIN 

from line 5d 

of Form 941

(e) 

Section 3121(q) 

Notice and DemandTax due on 

unreported tips

allocated to the listed 

client EIN from line 5e 

of Form 941

(f) 

Total taxes after 

adjustments

allocated to the

listed client EIN 

from line 10 

of Form 941

(g) 

Total deposits and 

COBRA payments 

from line 13 of

Form 941 plus any

payments made with

the return allocated 

to the listed client EIN

1 . . . . . .

2 . . . . . .

3 . . . . . .

4 . . . . . .

5 . . . . . .

6 . . . . . .

7 . . . . . .

8 . . . . . .

9 . . . . . .

10 . . . . . .

11 . . . . . .

12 . . . . . .

13 . . . . . .

14 . . . . . .

15 . . . . . . 16 Subtotals for 

clients. Add all

amounts on lines

1 through 15 . . . . . . 17 Enter the 

combined 

subtotal from line 

26 of all 

Continuation 

Sheets for 

Schedule R 

(Form 941) . . . . . .

18 Enter Form 941 

amounts for your 

employees . . . . . . 19 Totals. Add lines

16, 17, and 18.

The column 

totals must

match the

related lines on

the aggregate

Form 941 . . . . . . For Paperwork Reduction Act Notice, see the instructions. Cat. No. 49301K Schedule R (Form 941) (Rev. 1-2012)
Page of 950512

Continuation Sheet for Schedule R (Form 941)

(Rev. January 2012)

Employer identification number 

(EIN) —

Name as shown on

Form 941

Report for calendar year:

Check the quarter (same as Form 941):

1: January, February, March

2: April, May, June

3: July, August, September

4: October, November, December

(a) 

Client’s Employer 

Identification 

Number (EIN)

(b) 

Wages, tips, and 

other compensation 

allocated to the listed

client EIN from line 2

of Form 941

(c) 

Total income tax 

withheld from wages, 

tips, and other 

compensation 

allocated to the listed

client EIN from line 3

of Form 941

(d) 

Total social security 

and Medicare taxes 

allocated to the

listed client EIN 

from line 5d 

of Form 941

(e) 

Section 3121(q) 

Notice and DemandTax due on 

unreported tips

allocated to the listed 

client EIN from line 5e 

of Form 941

(f) 

Total taxes after 

adjustments

allocated to the

listed client EIN 

from line 10 

of Form 941

(g) 

Total deposits and 

COBRA payments 

from line 13 of 

Form 941 plus any

payments made with

the return allocated 

to the listed client EIN

1 . . . . . .

2 . . . . . .

3 . . . . . .

4 . . . . . .

5 . . . . . .

6 . . . . . .

7 . . . . . .

8 . . . . . .

9 . . . . . .

10 . . . . . .

11 . . . . . .

12 . . . . . .

13 . . . . . .

14 . . . . . .

15 . . . . . .

16 . . . . . .

17 . . . . . .

18 . . . . . .

19 . . . . . .

20 . . . . . .

21 . . . . . .

22 . . . . . .

23 . . . . . .

24 . . . . . .

25 . . . . . . 26 Subtotals for clients.

Add lines 1 through 25. 

Include the subtotals 

from line 26 on line 17 

of Schedule R 

(Form 941) . . . . . . Schedule R (Form 941) (Rev. 1-2012)
950612

Schedule R (Form 941) (Rev. 1-2012)

Section references are to the Internal Revenue Code unless otherwise 

noted.

General Instructions

Purpose of Schedule R (Form 941)

Use Schedule R (Form 941) to allocate the aggregate information 

reported on Form 941 to each client. If you have more than 15 clients, 

complete as many Continuation Sheets for Schedule R (Form 941) as 

necessary. Attach Schedule R (Form 941), including any Continuation 

Sheets, to your aggregate Form 941.

Who Must File?

You must complete Schedule R (Form 941) each time you file an 

aggregate Form 941, Employer’s QUARTERLY Federal Tax Return. 

Aggregate Forms 941 are filed by agents approved by the IRS under 

section 3504. To request approval to act as an agent for an employer, 

you must file Form 2678, Employer/Payer Appointment of Agent, with 

the IRS. On Schedule R (Form 941), we call those employers your 

clients.

When Must You File?

If you are an aggregate Form 941 filer, file Schedule R (Form 941) with 

your aggregate Form 941 every quarter when Form 941 is due. The 

Schedule R (Form 941) may be filed electronically or by paper 

submission. However, agents filing for 1,000 or more clients must file a 

paper return.

Note. If you are filing Schedule R (Form 941) for a quarter ending before 

January 1, 2011, that includes advance earned income credit (EIC) 

payments, you must file the January 2011 revision of Schedule R (Form 

941). The January 2011 revision of Schedule R (Form 941) can be 

attached to a late filed Form 941 or Form 941-X, Adjusted Employer's 

QUARTERLY Federal Tax Return or Claim for Refund. The January 2011 

revision of Schedule R (Form 941) is available on IRS.gov.

Specific Instructions

Completing Schedule R (Form 941)

Enter Your Business Information

Carefully enter your employer identification number (EIN) and the name 

of your business at the top of the schedule. Make sure they exactly 

match the EIN and name shown on the attached Form 941.

Calendar Year

Enter the calendar year that applies to the quarter checked.

Check the Box for the Quarter

Check the appropriate box of the quarter for which you are filing 

Schedule R (Form 941). Make sure the quarter checked on the top of the 

Schedule R (Form 941) matches the quarter checked on your Form 941.

Client and Employee Information

On Schedule R (Form 941), including any Continuation Sheets for 

Schedule R (Form 941), you must report the following for each client.

Note. When entering amounts over 999.99 on Schedule R (Form 941), 

do not enter commas.

• Your client’s employer identification number (EIN).

• Wages, tips, and other compensation allocated to the listed client EIN 

from line 2 of Form 941.

• Total income tax withheld from wages, tips, and other compensation 

allocated to the listed client EIN from line 3 of Form 941.

• Total social security and Medicare taxes allocated to the listed client 

EIN from line 5d of Form 941.

• Section 3121(q) Notice and Demand—Tax due on unreported tips 

allocated to the listed client EIN from line 5e of Form 941.

• Total taxes after adjustments allocated to the listed client EIN from line 

10 of Form 941.

• Total deposits and COBRA premium assistance payments from line 13 

of Form 941 plus any payments made with the return allocated to the 

listed client EIN.

You must also report the same information for your employees on line 

18 of Schedule R (Form 941).

Compare the total of each column on line 19 (including your 

information on line 18) of Schedule R (Form 941) to the amounts 

reported on the aggregate Form 941. For each column total of Schedule 

R (Form 941), the relevant line from Form 941 is noted in the column 

heading.

If the totals on line 19 of the Schedule R (Form 941) do not match the 

totals on Form 941, there is an error that must be corrected before 

submitting Form 941 and Schedule R (Form 941).

Paperwork Reduction Act Notice. We ask for the information on

Schedule R (Form 941) to carry out the Internal Revenue laws of the

United States. You are required to give us this 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.

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 section 

6103.

The time needed to complete and file Schedule R (Form 941) will vary 

depending on individual circumstances. The estimated average time is:

Recordkeeping . . . . . . . . . . . 12 hrs., 26 min.

Learning about the law or the form . . . . . . . . 12 min.

Preparing, copying, and assembling the form . . . . . 24 min.

If you have comments concerning the accuracy of these time 

estimates or suggestions for making Schedule R (Form 941) simpler, we 

would be happy to hear from you. You can email us at 

taxforms@irs.gov. Enter “Schedule R (Form 941)” 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 Schedule R (Form 941) to this 

address. Instead, see Where Should You File? in the Instructions for 

Form 941.