Create Form 941 | Pay-Stubs.net

Tax Year

* Tax Year

Employer

* Employer identification number (EIN) * Name (not your trade name) Trade name (if any) Country Address (number and street) Apt / Ste no. City State ZIP code Foreign province/county Foreign postal code

* Report for this quarter 1: January, February, March 2: April, May, June 3: July, August, September 4: October, November, December

Part 1 — Wages and taxes

1. Number of employees 2. Wages, tips, and other compensation 3. Federal income tax withheld 4. If no wages, tips, and other compensation are subject to social security or Medicare tax 5a. Taxable social security wages 5a(i). Qualified sick leave wages 5a(ii). Qualified family leave wages 5b. Taxable social security tips 5c. Taxable Medicare wages & tips 5d. Additional Medicare wages 5e. Total social security and Medicare taxes 5f. Section 3121(q) Notice and Demand 6. Total taxes before adjustments 7. Fractions of cents 8. Sick pay 9. Tips and group-term life 10. Total taxes after adjustments 11. Qualified small business payroll tax credit 12. Total taxes after adjustments and credits 13. Total deposits for this quarter 14. Balance due 15. Overpayment

If line 15 is overpayment Apply to next return Send a refund

15c. Routing number

15d. Account type Checking Savings

15e. Account number

Part 2 — Deposit schedule

16. Deposit schedule Line 12 is less than $2,500 Monthly schedule depositor Semiweekly schedule depositor (attach Schedule B)

Month 1 tax liability Month 2 tax liability Month 3 tax liability Total liability for quarter

Part 3 — Business questions

17. Business closed / stopped paying wages Date you last paid wages 18. Seasonal employer 19. Qualified health plan expenses (sick leave) 20. Qualified health plan expenses (family leave) 21. Qualified wages for ERC 22. Qualified health plan expenses for ERC 23. Credit from Form 5884-C 24. Qualified sick leave wages after 3/31/2021 25. Health plan expenses for those sick leave wages 26. Qualified family leave wages after 3/31/2021 27. Health plan expenses for those family leave wages 28. Other COVID-era amount

Part 4 — Third-party designee

Allow another person to discuss this return? Yes No

Designee’s name Phone 5-digit PIN

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Your signature

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Print first name Print last name Date Title Best daytime phone

Paid preparer

Are you a paid preparer? Yes No

Preparer’s name Preparer’s signature Date PTIN Self-employed Firm’s name Firm’s EIN Firm country Firm’s address Firm apt / ste Firm city Firm state Firm ZIP Firm’s phone

Form 941-V (optional)

Show voucher override fields Voucher EIN Voucher name Voucher address Voucher city / state / ZIP Voucher amount * Email for delivery

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