Enter the number of employees on your payroll for the pay period including March 12, June 12, September 12, or December 12 for the quarter indicated at the top of the return. Do not include:

If no wages, tips, and compensation are subject to social security or Medicare tax, check the box on line 4. If this question does not apply to you, leave the box blank. For more information about exempt wages, see section 12 of Pub. 80 (Circular SS) and section 4 of Pub. 15-A.

Enter the tax due from a Section 3121(q) Notice and Demand. The IRS issues a Section 3121(q) Notice and Demand to advise an employer of the amount of tips received by employees who failed to report or underreported tips to the employer. An employer is not liable for the employer share of the social security and Medicare taxes on unreported tips until a Section 3121(q) Notice and Demand for the taxes is made to the employer by the IRS. The tax due may have been determined from tips reported to the IRS on employees' Forms 4137, Social Security and Medicare Tax on Unreported Tip Income, or other tips that were not reported to their employer as determined by the IRS during an examination.

Deposit the tax within the time period required under your deposit schedule to avoid any possible deposit penalty. The tax is treated as accumulated by the employer on the "Date of Notice and Demand" as printed on the Section 3121(q) Notice and Demand. The employer must include this amount on the appropriate line of the record of federal tax liability (Part 2 of Form 941 for a monthly schedule depositor or Schedule B (Form 941) for a semiweekly schedule depositor).

Add the total social security and Medicare taxes before adjustments (line 5d), and any tax due under section 3121(q) as reported on line 5e. Enter the result on line 6e.

Enter tax amounts on lines 7, 8, and 9 that result from current quarter adjustments. Use a minus sign (if possible) to show an adjustment that decreases the total taxes shown on line 6e, instead of parentheses. Doing so enhances the accuracy of our scanning software. For example, report "-10.59" instead of "(10.59)." However, if your software only allows for parentheses in reporting negative amounts, you may use them.

Enter adjustments for fractions of cents (due to rounding) relating to the employee share of social security and Medicare taxes withheld. The employee share of amounts shown in column 2 of lines 5a, 5b, or 5c may differ slightly from amounts actually withheld from employees' paychecks due to the rounding of social security and Medicare taxes based on statutory rates.

Enter the adjustment for the employee share of social security and Medicare taxes that were withheld and deposited by your third-party sick pay payer with regard to sick pay paid by the third party. These wages should be included on lines 5a and 5c. If you are the third-party sick pay payer, enter the adjustment for any employer share of these taxes required to be paid by the employer.

Enter adjustments for:

Combine the amounts shown on lines 6e through 9 and enter the result on line 10.

Enter your deposits for this quarter, including any overpayment that you applied from filing Form 941-X or Form 944-X in the current quarter. Also include in the amount shown any overpayment from a previous period that you applied to this return.

Report on this line 65% of the COBRA premiums for assistance eligible individuals. Take the COBRA premium assistance credit on this line only after the assistance eligible individual's 35% share of the premium has been paid. For COBRA coverage provided under a self-insured plan, COBRA premium assistance is treated as having been made for each assistance eligible individual who pays 35% of the COBRA premium. Do not include the assistance eligible individual's 35% of the premium in the amount entered on this line. For more information on the COBRA premium assistance credits, visit IRS.gov and enter the keyword COBRA.

If you provided premium assistance in a prior quarter of the current year and did not report the amount of that premium assistance on Form 941-SS for that quarter, you may include the amount of that premium assistance in the amount entered on this line, or file Form 941-X to report the amount for the prior quarter of the current year.

Enter the total number of assistance eligible individuals provided COBRA premium assistance reported on line 12a. Count each assistance eligible individual who paid a reduced COBRA premium in the quarter as one individual, whether or not the reduced premium was for insurance that covered more than one assistance eligible individual. For example, if the reduced COBRA premium was for coverage for a former employee, spouse, and two children, you would include one individual in the number entered on line 12b for the premium assistance. Further, each individual is reported only once per quarter. For example, an assistance eligible individual who made monthly premium payments during the quarter would only be reported as one individual.

Add lines 11 and 12a.

If line 10 is more than line 13, enter the difference on line 14. Otherwise, see Overpayment below. You do not have to pay if line 14 is under $1. Generally, you should have a balance due only if your total taxes for the current quarter or preceding quarter are less than $2,500, and you did not incur a $100,000 next-day deposit obligation during the current quarter. However, see section 8 of Pub. 80 (Circular SS) for information about payments made under the Accuracy of Deposits Rule.

You may pay the amount shown on line 14 using EFTPS, credit card, debit card, check, money order, or EFW. Do not use a credit card, debit card, or EFW to pay taxes that were required to be deposited. For more information on electronic payment options, visit the IRS website at www.irs.gov/e-pay.

If you pay by EFTPS, credit card, debit card, or EFW, file your return using the Without a payment address on page 3 under Where Should You File? and do not file Form 941-V, Payment Voucher.

If you pay by check or money order, make it payable to the “United States Treasury.” Enter your EIN, Form 941-SS, and the tax period on your check or money order. Complete Form 941-V(SS) and enclose it with Form 941-SS.

If line 10 is $2,500 or more and you have deposited all taxes when due, the balance due on line 14 should be zero.

If line 13 is more than line 10, enter the difference on line 15. Never make an entry on both lines 14 and 15.

If you deposited more than the correct amount for the quarter, you can choose to have the IRS either refund the overpayment or apply it to your next return. Check only one box on line 15. If you do not check either box or if you check both boxes, generally we will apply the overpayment to your account. We may apply your overpayment to any past due tax account that is shown in our records under your EIN.

If line 15 is under $1, we will send a refund or apply it to your next return only if you ask us in writing to do so.

You must complete both pages of Form 941-SS and sign on page 2. Failure to do so may delay processing of your return.

If you go out of business or stop paying wages, you must file a final return. To tell the IRS that a particular Form 941-SS is your final return, check the box on line 18 and enter the date you last paid wages in the space provided. For additional filing requirements, see Final Return on page 2.

If you hire employees seasonally—such as for summer or winter only—check the box on line 19. Checking the box tells the IRS not to expect four Forms 941-SS from you throughout the year because you have not paid wages regularly.

Generally, we will not ask about unfiled returns if you file at least one return showing tax due each year. However, you must check the box every time you file a Form 941-SS.

Also, when you complete Form 941-SS, be sure to check the box on the top of the form that corresponds to the quarter reported.

A paid preparer must sign Form 941-SS and provide the information in the Paid Preparer Use Only section of Part 5 if the preparer was paid to prepare Form 941-SS and is not an employee of the filing entity. Paid preparers must sign paper returns with a manual signature. The preparer must give you a copy of the return in addition to the copy to be filed with the IRS.

If you are a paid preparer, enter your preparer tax identification number (PTIN) in the space provided. Include your complete address. If you work for a firm, enter the firm's name and the EIN of the firm. You can apply for a PTIN online or by filing Form W-12, IRS Paid Preparer Tax Identification Number (PTIN) Application. For more information about applying for a PTIN online, visit the IRS website at www.irs.gov/taxpros . You cannot use your PTIN in place of the EIN of the tax preparation firm.

Generally, do not complete this section if you are filing the return as a reporting agent and have a valid Form 8655, Reporting Agent Authorization, on file with the IRS. However, a reporting agent must complete this section if the reporting agent offered legal advice, for example, advising the client on determining whether its workers are employees or independent contractors for federal tax purposes.