Form 941-Ss - Employer'S Quarterly Federal Tax Return - American Samoa, Guam, The Commonwealth Of The Northern Mariana Islands, And The U.s. Virgin Islands - 2014

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941-SS for 2014:
Employer’s QUARTERLY Federal Tax Return
Form
American Samoa, Guam, the Commonwealth of the Northern
(Rev. January 2014)
Mariana Islands, and the U.S. Virgin Islands
Department of the Treasury — Internal Revenue Service
OMB No. 1545-0029
Report for this Quarter of 2014
—
(Check one.)
Employer identification number (EIN)
1: January, February, March
Name (not your trade name)
2: April, May, June
Trade name (if any)
3: July, August, September
Address
4: October, November, December
Number
Street
Suite or room number
Instructions and prior year forms are available
at
City
State
ZIP code
Foreign country name
Foreign province/county
Foreign postal code
Read the separate instructions before you complete Form 941-SS. Type or print within the boxes.
Part 1:
Answer these questions for this quarter.
Number of employees who received wages, tips, or other compensation for the pay period
1
including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), or Dec. 12 (Quarter 4)
1
2
3
4
If no wages, tips, and other compensation are subject to social security or Medicare tax
Check and go to line 6.
Column 1
Column 2
.
.
5a
Taxable social security wages
× .124 =
.
.
5b
Taxable social security tips
× .124 =
.
.
5c
Taxable Medicare wages & tips
× .029 =
Taxable wages & tips subject to
5d
.
.
× .009 =
Additional Medicare Tax withholding
.
5e
Add Column 2 from lines 5a, 5b, 5c, and 5d .
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5e
.
5f
Section 3121(q) Notice and Demand—Tax due on unreported tips (see instructions)
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5f
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6
Total taxes before adjustments. Add lines 5e and 5f .
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6
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7
Current quarter’s adjustment for fractions of cents .
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7
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8
Current quarter’s adjustment for sick pay .
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8
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9
Current quarter’s adjustments for tips and group-term life insurance .
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9
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10
Total taxes after adjustments. Combine lines 6 through 9
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10
Total deposits for this quarter, including overpayment applied from a prior quarter and
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11
11
overpayments applied from Form 941-X, 944-X, or 944-X (SP) filed in the current quarter .
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12
Balance due. If line 10 is more than line 11, enter difference and see instructions
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12
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13
Overpayment. If line 11 is more than line 10, enter difference
Check one:
Apply to next return.
Send a refund.
You MUST complete both pages of Form 941-SS and SIGN it.
▶
Next
▶
■
941-SS
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Form
(Rev. 1-2014)
Cat. No. 17016Y

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