944-SS for 2011:
Employer’s ANNUAL Federal Tax Return
Form
American Samoa, Guam, the Commonwealth of the Northern
OMB No. 1545-2010
Mariana Islands, and the U.S. Virgin Islands
Department of the Treasury — Internal Revenue Service
Who Must File Form 944-SS
—
Employer identification number (EIN)
You must file annual
Form 944-SS instead of
Name (not your trade name)
filing quarterly Forms
941-SS only if the IRS
Trade name (if any)
notified you in writing.
Prior-year forms are
available at
Address
form944ss.
Number
Street
Suite or room number
City
State
ZIP code
Read the separate instructions before you complete Form 944-SS. Type or print within the boxes.
Answer these questions for this year.
Part 1:
1
2
3
If no wages, tips, and other compensation are subject to social security or Medicare tax
3
Check and go to line 6.
4
Taxable social security and Medicare wages and tips:
Column 1
Column 2
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For 2011, the employee social security tax
4a Taxable social security wages
× .104 =
rate is 4.2% and the Medicare tax rate is
1.45%. The employer social security tax
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rate is 6.2% and the Medicare tax rate is
4b Taxable social security tips
× .104 =
1.45%.
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4c Taxable Medicare wages & tips
× .029 =
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4d Add Column 2, line 4a, Column 2, line 4b, and Column 2, line 4c .
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4d
5
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6
Current year’s adjustments (see instructions)
6
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7
Total taxes after adjustments. Combine lines 4d and 6
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7
Total deposits for this year, including overpayment applied from a prior year and
8
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8
overpayment applied from Form 944-X or Form 941-X .
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9
a
COBRA premium assistance payments (see instructions)
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9a
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b
Number of individuals provided COBRA premium assistance
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10
Add lines 8 and 9a .
10
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11
Balance due. If line 7 is more than line 10, enter the difference and see instructions .
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11
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12
Overpayment. If line 10 is more than line 7, enter the difference
Check one:
Apply to next return.
Send a refund.
You MUST complete both pages of Form 944-SS and SIGN it.
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Next
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944-SS
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.
Form
(2011)
Cat. No. 47935C