950413
Schedule R (Form 941):
Allocation Schedule for Aggregate Form 941 Filers
OMB No. 1545-0029
(Rev. January 2014)
Report for calendar year:
Department of the Treasury — Internal Revenue Service
Check the quarter (same as Form 941):
Employer identification number
—
(EIN)
1: January, February, March
Name as shown on
Form 941
2: April, May, June
3: July, August, September
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.
4: October, November, December
(a)
(b)
(c)
(d)
(e)
(f)
(g)
Section 3121(q)
Client’s
Wages, tips, and
Federal income tax
Total social security
Total taxes after
Total deposits from
Notice and Demand-
Employer
other compensation
withheld from wages,
and Medicare taxes
adjustments
Form 941, line 11,
Tax due on
identification
tips, and other
allocated to the
allocated to the
allocated to the
plus any payments
unreported tips
number (EIN)
listed client EIN from
compensation
listed client EIN from
listed client EIN from
made with the return
allocated to the
Form 941, line 2
allocated to the
Form 941, line 5e
Form 941, line 10
allocated to the
listed client EIN from
listed client EIN from
listed client EIN
Form 941, line 5f
Form 941, line 3
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14
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15
16
Subtotals for
clients. Add all
amounts on lines
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1 through 15
17
Enter the
combined
subtotal from
line 26 of all
Continuation
Sheets for
Schedule R
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(Form 941)
18
Enter Form 941
amounts for your
employees
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19
Totals. Add lines
16, 17, and 18.
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. 1-2014)