Schedule R (Form 943):

(Rev. December 2021)

Allocation Schedule for Aggregate Form 943 Filers

Department of the Treasury — Internal Revenue Service OMB No. 1545-0035

430421

Employer identification number (EIN) —

Name as shown on Form 943

Type of filer (check one): Section 3504 Agent CPEO Other Third Party

Report for calendar year:

(Same as Form 943):

2021

Read the instructions before you complete Schedule R. Type or print within the boxes. Complete a separate line for the amounts 

allocated to each of your clients. The term “client” as used on this form includes the term “customer.” See the instructions.

 (a) Client’s EIN (b) Type of wages 

(CPEO only)

(c) Form 943, line 1 (d) Form 943, line 2 (e) Form 943, line 2a (f) Form 943, line 2b (g) Form 943, line 4 (h) Form 943, line 6 (i) Form 943, line 8

 

1 . . . . . .

2 . . . . . .

3 . . . . . .

4 . . . . . .

5 . . . . . .

6 Subtotals for clients. Add lines 1 through 5 . . . . . .

7 Enter the combined subtotal from line 9 

of all Continuation Sheets for Schedule R . . . . . .

8 Enter Form 943 amounts for your employees . . . . . .

9 Totals. Add lines 6, 7, and 8. . . . . . .

 (j) Form 943, line 12a (k) Form 943, lines 12b 

and 14d, total

(l) Form 943, lines 12c 

and 14e, total

(m) Form 943, lines 12d 

and 14f, total

(n) Form 943, lines 12e 

and 14g, total

(o) Form 943, line 12f (p) Form 943, line 13 (q) Form 943, line 14a

 

1 . . . . . . .

2 . . . . . . .

3 . . . . . . .

4 . . . . . . .

5 . . . . . . .

6 . . . . . . .

7 . . . . . . .

8 . . . . . . .

9 . . . . . . .

 (r) Form 943, line 14i (s) Form 943, lines 18 

and 19, total

(t) Form 943, lines 20 

and 21, total

(u) Form 943, lines 22 

and 24, total

(v) Form 943, lines 23 

and 26, total

(w) Form 943, lines 25 

and 27, total

(x) Form 943, line 28 (y) Form 943, line 29

 

1 . . . . . . . .

2 . . . . . . . .

3 . . . . . . . .

4 . . . . . . . .

5 . . . . . . . .

6 . . . . . . . .

7 . . . . . . . .

8 . . . . . . . .

9 . . . . . . . .

For Paperwork Reduction Act Notice, see the separate instructions. www.irs.gov/Form943 Cat. No. 69329E Schedule R (Form 943) (Rev. 12-2021)
Page of

Continuation Sheet for Schedule R (Form 943)

(Rev. December 2021)

430521

Employer identification number (EIN) —

Name as shown on Form 943

Type of filer (check one): Section 3504 Agent CPEO Other Third Party

Report for calendar year:

(Same as Form 943):

2021

 (a) Client’s EIN (b) Type of wages 

(CPEO only)

(c) Form 943, line 1 (d) Form 943, line 2 (e) Form 943, line 2a (f) Form 943, line 2b (g) Form 943, line 4 (h) Form 943, line 6 (i) Form 943, line 8

 

1 . . . . . .

2 . . . . . .

3 . . . . . .

4 . . . . . .

5 . . . . . .

6 . . . . . .

7 . . . . . .

8 . . . . . .

9 Subtotals for clients. Add lines 1 through 

8. Include the subtotals from this line on 

Schedule R, Page 1, line 7. . . . . . .

 (j) Form 943, line 12a (k) Form 943, lines 12b 

and 14d, total

(l) Form 943, lines 12c 

and 14e, total

(m) Form 943, lines 12d 

and 14f, total

(n) Form 943, lines 12e 

and 14g, total

(o) Form 943, line 12f (p) Form 943, line 13 (q) Form 943, line 14a

 

1 . . . . . . .

2 . . . . . . .

3 . . . . . . .

4 . . . . . . .

5 . . . . . . .

6 . . . . . . .

7 . . . . . . .

8 . . . . . . .

9 . . . . . . .

 (r) Form 943, line 14i (s) Form 943, lines 18 

and 19, total

(t) Form 943, lines 20 

and 21, total

(u) Form 943, lines 22 

and 24, total

(v) Form 943, lines 23 

and 26, total

(w) Form 943, lines 25 

and 27, total

(x) Form 943, line 28 (y) Form 943, line 29

 

1 . . . . . . . .

2 . . . . . . . .

3 . . . . . . . .

4 . . . . . . . .

5 . . . . . . . .

6 . . . . . . . .

7 . . . . . . . .

8 . . . . . . . .

9 . . . . . . . .

Schedule R (Form 943) (Rev. 12-2021)