Schedule R (Form 941) - Allocation Schedule For Aggregate Form 941 Filers - 2017
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3Schedule R (Form 941):
Allocation Schedule for Aggregate Form 941 Filers
OMB No. 1545-0029
(Rev. January 2017)
Department of the Treasury — Internal Revenue Service
Report for calendar year:
Employer identification number (EIN)
Check the quarter (same as Form 941):
—
1: January, February, March
Name as shown on Form 941
2: April, May, June
Type of filer (check one):
Section 3504 Agent
Certified Professional Employer Organization (CPEO)
3: July, August, September
4: October, November, December
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)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
Client’s
Type of wages,
Wages, tips, and
Federal income tax
Total social security
Section 3121(q) Notice
Qualified small business
Total taxes
Total deposits
Employer
tips, and other
other compensation
withheld from wages,
and Medicare taxes
and Demand-Tax due
payroll tax credit for
after adjustments
from Form 941, line 13,
identification
compensation
allocated to the
tips, and other
allocated to the
on unreported tips
increasing research
and credits
plus any payments
number (EIN)
(CPEO Use Only)
listed client EIN from
compensation allocated
listed client EIN from
allocated to the listed
activities allocated to the
allocated to the
made with the return
Form 941, line 2
to the listed client EIN
Form 941, line 5e
client EIN from
listed client EIN from
listed client EIN from
allocated to the
from Form 941, line 3
Form 941, line 5f
Form 941, line 11
Form 941, line 12
listed client EIN
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Subtotals for
clients. Add all
amounts on lines
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1 through 10
12
Enter the
combined
subtotal from
line 24 of all
Continuation
Sheets for
Schedule R
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13
Enter Form 941
amounts
for your
employees
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Totals. Add lines
11, 12, and 13.
The column
totals must
match the
related lines on
the aggregate
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Form 941.
For Paperwork Reduction Act Notice, see the instructions.
IRS.gov/form941
Cat. No. 49301K
Schedule R (Form 941) (Rev. 1-2017)
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