Allocation Schedule for Aggregate Form 941 Filers

(February 2010)

OMB No. 1545-0029

Department of the Treasury — Internal Revenue Service

950410

Employer identification number

Name as shown on

Form 941

—

For Paperwork Reduction Act Notice, see the instructions. Cat. No. 49301K Schedule R (Form 941) (2-2010)

(EIN)

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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.

Schedule R (Form 941):

Subtotals for

clients. Add all

amounts on lines

1 through 15

Enter the

combined 

subtotal from line

26 of all

Continuation

Sheets for

Schedule R

(Form 941)

Totals. Add lines

16, 17, and 18.

The column

totals must

match the

related lines on

the aggregate

Form 941

Enter Form 941

amounts for your

employees

(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

(f)

Advance earned

income credit

payments

allocated to the

listed client EIN

from line 9

of Form 941

(e)

Total taxes after

adjustments

allocated to the

listed client EIN

from line 8

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

Report for calendar year:

1: January, February, March

2: April, May, June

3: July, August, September

4: October, November, December

Check the quarter (same as Form 941):

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13

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14

Continuation Sheet for Schedule R (Form 941)

26 Subtotals for clients.

Add lines 1 through 25.

Include the subtotals

from line 26 on line 17

of Schedule R

(Form 941)

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Page of 950510

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Report for calendar year:

1: January, February, March

2: April, May, June

3: July, August, September

4: October, November, December

Check the quarter (same as Form 941):

(February 2010)

Employer identification number

Name as shown on

Form 941

— (EIN)

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(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

(f)

Advance earned

income credit

payments

allocated to the

listed client EIN

from line 9

of Form 941

(e)

Total taxes after

adjustments

allocated to the

listed client EIN

from line 8

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
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 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. On Schedule R

(Form 941), we call those employers your clients.

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 and file it with

your return.

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

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

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

● Wages, tips, and other compensation (line 2 of Form 941)

allocated to the listed client EIN.

j() 

listed client EIN.

● Advance earned income credit (EIC) payments (line 9 

allocated to the listed client EIN.

● Total deposits and COBRA premium assistance pay

quarter (line 13 of Form 941) and amounts paid with 

allocated to the listed client EIN.

You must also report the same information for your 

line 18 of Schedule R (Form 941).

Paperwork Reduction Act Notice. We ask for the info

Schedule R (Form 941) to carry out the Internal Revenu

United States. You are required to give us this informa

it to ensure that you are complying with these laws an

to figure and collect the right amount of tax.

You are not required to provide the information requ

form that is subject to the Paperwork Reduction Act u

displays a valid OMB control number. Books or record

form or its instructions must be retained as long as the

may become material in the administration of any Inter

law. Generally, tax returns and return information are c

required by section 6103.

The time needed to complete and file Schedule R (F

vary depending on individual circumstances. The estim

time is:

If you have comments concerning the accuracy of t

estimates or suggestions for making Schedule R (Form 

we would be happy to hear from you. You can write to

Revenue Service, Tax Products Coordinating Committe

SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-

Washington, DC 20224. Do not send Schedule R (Form 

address. Instead, see Where Should You File? on page 

Instructions for Form 941.

Recordkeeping 1

Learning about the law or the form 

Preparing, copying, and assembling the form 

Compare the total of each column on line 19 (includ

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

reported on the aggregate Form 941. For each column 

Schedule R (Form 941), the relevant line from Form 94

the column heading.

If the totals on line 19 of the Schedule R (Form 941) 

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

before submitting Form 941 and Schedule R (Form 94

Who Must 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.

When Must You File?

Specific Instructions

Enter Your Business Information

Carefully enter your employer identification number (EIN) and name

at the top of the schedule. Make sure they exactly match the EIN the

IRS assigned to your business, the name of your business, and the

EIN and name shown on the attached Form 941.

Completing Schedule R (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

Note. When entering amounts over 999.99 on Schedule R 

(Form 941), do not enter commas.