Form 944-SS for 2011:

Department of the Treasury — Internal Revenue Service

Employer’s ANNUAL Federal Tax Return

American Samoa, Guam, the Commonwealth of the Northern 

Mariana Islands, and the U.S. Virgin Islands OMB No. 1545-2010

Employer identification number (EIN) —

Name (not your trade name)

Trade name (if any)

Address

Number Street Suite or room number

City State ZIP code

Part 1: Answer these questions for this year.

9

Who Must File Form 944-SS

You must file annual 

Form 944-SS instead of 

filing quarterly Forms 

941-SS only if the IRS

notified you in writing. 

Prior-year forms are 

available at www.irs.gov/

form944ss.

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

1

2

3 If no wages, tips, and other compensation are subject to social security or Medicare tax 3 Check and go to line 6.

4 Taxable social security and Medicare wages and tips:

Column 1 Column 2

4a Taxable social security wages . × .104 = . For 2011, 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%. 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

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

7 Total taxes after adjustments. Combine lines 4d and 6 . . . . . . . . . . . . 7 .

8

9

10

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

overpayment applied from Form 944-X or Form 941-X . . . . . . . . . . . . 8 .

11

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

b Number of individuals provided COBRA premium assistance 

12

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

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

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-SS and SIGN it.

Next ■▶

For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher. Cat. No. 47935C Form 944-SS (2011)
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.

Jan.

13a . Feb.

13b . Mar.

13c .

Apr.

13d . May

13e . Jun.

13f .

Jul.

13g . Aug.

13h . Sep.

13i .

Oct.

13j . Nov.

13k . Dec.

13l .

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

14

Part 3: Tell us about your business. If question 15 does NOT apply to your business, leave it blank.

15 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-SS 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

Print your 

name here

Print your 

title here

Date Best daytime phone

Paid Preparer Use Only Check if you are self-employed . . .

Preparer’s name

Preparer’s signature

Firm’s name (or yours 

if self-employed)

Address

City State

PTIN

Date

EIN

Phone

ZIP code

Page 2 Form 944-SS (2011)
Form 944-V(SS), 

Payment Voucher

Purpose of Form

Complete Form 944-V(SS), Payment Voucher, if you are 

making a payment with Form 944-SS, 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.

If you have your return prepared by a third party and 

make a payment with that return, please provide this 

payment voucher to the return preparer.

Making Payments With Form 944-SS

To avoid a penalty, make your payment with your 2011 

Form 944-SS only if one of the following applies.

• Your net taxes for the year (line 7 on Form 944-SS) 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 2011, and the tax you owe 

for the fourth quarter of 2011 is less than $2,500, and you 

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

of 2011 with a timely filed return.

• You are a monthly schedule depositor making a 

payment in accordance with the Accuracy of Deposits

Rule. See section 8 of Pub. 80 (Circular SS), Federal Tax 

Guide for Employers in the U.S. Virgin Islands, Guam, 

American Samoa, and the Commonwealth of the 

Northern Mariana Islands, 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 8 of Pub. 80 (Circular SS) for deposit

instructions. Do not use Form 944-V(SS) to make federal 

tax deposits.

Caution. Use Form 944-V(SS) when making any payment 

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

Form 944-SS that should have been deposited, you may 

be subject to a penalty. See Deposit Penalties in section 8 

of Pub. 80 (Circular SS).

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 Employer 

Identification Number (EIN) Online link. 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-SS, write “Applied For” and 

the date you applied in this entry space.

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

944-SS.

Box 3—Name and address. Enter your name and

address as shown on Form 944-SS.

• Enclose your check or money order made payable to 

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

944-SS,” and “2011” on your check or money order. Do 

not send cash. Do not staple Form 944-V(SS) or your 

payment to Form 944-SS (or to each other).

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

and Form 944-SS to the address provided in the 

Instructions for Form 944-SS. 

Note. You must also complete the entity information 

above Part 1 on Form 944-SS.

Detach Here and Mail With Your Payment and Form 944-SS.

✁ ▼ ▼

✃

Form

944-V(SS)

Department of the Treasury 

Internal Revenue Service

Payment Voucher

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

OMB No. 1545-2010

2011

1 Enter your employer identification 

number (EIN).

2

Enter the amount of your payment. ▶

Dollars Cents

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

Enter your address.

Enter your city, state, and ZIP code.
Form 944-SS (2011)

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. 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 this form will vary 

depending on individual circumstances. The estimated 

average time is:

Recordkeeping . . . . . . . . . . 8 hr., 36 min.

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

Preparing, copying, assembling, 

and sending the form to the IRS . . . . . 33 min.

If you have comments concerning the accuracy of 

these time estimates or suggestions for making 

Form 944-SS simpler, we would be happy to hear from 

you. You can email us at taxforms@irs.gov. Enter 

“Form 944-SS” 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-SS to this address. Instead, see Where Should

You File? in the Instructions for Form 944-SS.