Schedule R (Form 941) - Allocation Schedule For Aggregate Form 941 Filers - 2012
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Schedule R (Form 941):
Allocation Schedule for Aggregate Form 941 Filers
OMB No. 1545-0029
(Rev. January 2012)
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)
Total taxes after
Client’s Employer
Wages, tips, and
Total income tax
Total social security
Total deposits and
Notice and Demand-
adjustments
Identification
other compensation
withheld from wages,
and Medicare taxes
COBRA payments
Tax due on
allocated to the
Number (EIN)
tips, and other
allocated to the listed
allocated to the
from line 13 of
unreported tips
listed client EIN
client EIN from line 2
compensation
listed client EIN
Form 941 plus any
allocated to the listed
from line 10
of Form 941
allocated to the listed
from line 5d
payments made with
client EIN from line 5e
of Form 941
client EIN from line 3
of Form 941
the return allocated
of Form 941
of Form 941
to the listed client EIN
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Subtotals for
clients. Add all
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.
amounts on lines
1 through 15
17
Enter the
combined
subtotal from line
26 of all
Continuation
Sheets for
.
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.
Schedule R
(Form 941)
18
Enter Form 941
amounts for your
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employees
19
Totals. Add lines
16, 17, and 18.
The column
totals must
match the
related lines on
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.
the aggregate
Form 941
For Paperwork Reduction Act Notice, see the instructions.
Cat. No. 49301K
Schedule R (Form 941) (Rev. 1-2012)
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