Schedule R (Form 940):

(December 2010)

Department of the Treasury — Internal Revenue Service

860510

OMB No. 1545-0028

Employer identification number 

(EIN) —

Name as shown on

Form 940

Report for calendar year:

(Same as Form 940):

Read the separate instructions before you complete Schedule R (Form 940). Type or print within the boxes. Complete a separate line 

for the allocated amounts of each of your clients.

 (a) 

Client’s Employer 

Identification Number 

(EIN)

(b) 

State 

abbreviation 

from line 1a

of Form 940

or line 1 of

Schedule A

(Form 940) 

(c) 

Total taxable FUTA 

wages allocated to

the listed client EIN

from line 7 of

Form 940

(d) 

Total adjustments 

to FUTA tax 

allocated to the

listed client EIN from

line 9 or line 10 of

Form 940

(e) 

Credit reduction 

amount allocated

to the listed client

EIN from line 11 

of Form 940

(f) 

Total FUTA tax 

after adjustments 

allocated to the

listed client EIN from

line 12 of Form 940

(g) 

Total FUTA tax 

deposits from line 

13 of Form 940 

plus any payment 

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 Subtotal 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 940)

. . . . . 18 Enter Form 940 amounts for 

employees of the agent

. . . . . 19 Totals. Add lines 16, 17, and 

18. The column totals must 

match the related lines on the 

aggregate Form 940

. . . . . For Paperwork Reduction Act Notice, see the instructions. Cat. No. 53082A Schedule R (Form 940) (12-2010)

Allocation Schedule for Aggregate Form 940 Filers
Page of 860610

Continuation Sheet for Schedule R (Form 940)

(December 2010)

Employer identification number 

(EIN) —

Name as shown on

Form 940

Report for calendar year:

(Same as Form 940):

Read the separate instructions before you complete Schedule R (Form 940). Type or print within the boxes. Complete a separate line 

for the allocated amounts of each of your clients.

(a) 

Client’s Employer 

Identification Number 

(EIN)

(b) 

State 

abbreviation 

from line 1a

of Form 940

or line 1 of

Schedule A

(Form 940) 

(c) 

Total taxable FUTA 

wages allocated to

the listed client EIN

from line 7 of

Form 940

(d) 

Total adjustments 

to FUTA tax 

allocated to the

listed client EIN from

line 9 or line 10 of

Form 940

(e) 

Credit reduction 

amount allocated

to the listed client

EIN from line 11 

of Form 940

(f) 

Total FUTA tax 

after adjustments 

allocated to the

listed client EIN from

line 12 of Form 940

(g) 

Total FUTA tax 

deposits from line 

13 of Form 940 

plus any other 

payments 

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 

940). . . . . . Schedule R (Form 940) (12-2010)
860710

Schedule R (Form 940) (12-2010)

Instructions for Schedule R

Allocation Schedule for Aggregate 

Form 940 Filers

General Instructions

Purpose of Schedule R (Form 940)

Use Schedule R (Form 940) to allocate the aggregate 

information reported on Form 940 to each home care service 

recipient client. An aggregate Form 940 may only be filed by 

section 3504 Agents acting on behalf of home care service 

recipients. If you are an agent for home care service recipients 

and have more than 15 clients, complete continuation sheets 

as necessary. Attach Schedule R (Form 940), including any 

continuation sheets, to your aggregate Form 940 and file it 

with your return.

Who Must File?

You must complete Schedule R (Form 940) each time you file 

an aggregate Form 940, Employer’s Annual Federal 

Unemployment (FUTA) Tax Return. Aggregate Forms 940 are 

filed by agents of home care service recipients approved by 

the IRS under section 3504 of the Internal Revenue Code. To 

request approval to act as an agent for an employer, you must 

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

the IRS, unless you are a state or local government agency 

acting as agent under the special procedures provided in 

Notice 2003-70. On Schedule R (Form 940), we call those 

employers your clients.

When Must You File?

If you are an aggregate Form 940 filer, file Schedule R (Form 

940) with your aggregate Form 940 every year when your 

Form 940 is due.

Specific Instructions

Completing Schedule R (Form 940)

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 940.

Calendar Year

Enter the calendar year for which you are filing your Form 940. 

Make sure that the year entered on the top of Schedule R 

(Form 940) matches the year on Form 940.

On Schedule R (Form 940), including any continuation 

sheets, you must report the following for each client:

Your client’s employer identification number (EIN).

The state abbreviation of the listed client’s location.

Total taxable FUTA wages (line 7 of Form 940) allocated to 

the listed client EIN.

Total adjustments to FUTA tax (line 9 or line 10 of Form 940) 

allocated to the listed client EIN.

Credit reduction amount (line 11 of Form 940) allocated to 

the listed client EIN.

Total FUTA tax after adjustments (line 12 of Form 940) 

allocated to the listed client EIN.

Total FUTA tax deposits for the tax year plus any other 

payments (line 13 of Form 940) allocated for the listed client 

EIN.

You must also report the same information for your 

employees on line 18 of Schedule R (Form 940).

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

information on 18) to the amounts reported on the aggregate 

Form 940. For each column total, the relevant line from Form 

940 is noted in the column heading.

If the totals on line 19 of the Schedule R (Form 940) do not 

match the totals on Form 940, there is an error that must be 

corrected before submitting Form 940 and Schedule R (Form 

940).

Paperwork Reduction Act Notice. We ask for the

information on Schedule R (Form 940) 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 940) 

will vary depending on individual circumstances. The estimated 

average time is:

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

Learning about the law or the form . . . . .0 hrs., 12 min.

Preparing, copying, assembling, 

and sending form to IRS . . . . . . . 0 hrs., 00 min.

If you have comments concerning the accuracy of these 

time estimates or suggestions for making Schedule R (Form 

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

write to: Internal Revenue Service, Tax Products Coordinating 

Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave., 

NW, IR-6526, Washington, DC 20224. Do not send Schedule 

R (Form 940) to this address. Instead, see Where Do You File?

on page 2 of the Instructions for Form 940.