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Form 944 for 2021:                   Employer’s ANNUAL Federal Tax Return
                                     Department of the Treasury — Internal Revenue Service                                                                                                                OMB No. 1545-2007

Employer identification number (EIN)           —                                                                                                                                             Who Must File Form 944
                                                                                                                                                                                          You must file annual Form 944 
Name (not your trade name)                                                                                                                                                                instead of filing quarterly Forms 941 
                                                                                                                                                                                          only if the IRS notified you in 
                                                                                                                                                                                          writing. 
Trade name (if any)
                                                                                                                                                                                          Go to www.irs.gov/Form944 for 
                                                                                                                                                                                          instructions and the latest 
Address                                                                                                                                                                                   information.
        Number                                                                          Street                                                                    Suite or room number

        City                                                   State                           ZIP code

        Foreign country name                            Foreign province/county              Foreign postal code
Read the separate instructions before you complete Form 944. Type or print within the boxes.
        Answer these questions for this year. Employers in American Samoa, Guam, the Commonwealth of the Northern 
Part 1: Mariana Islands, the U.S. Virgin Islands, and Puerto Rico can skip lines 1 and 2, unless you have employees who are 
        subject to U.S. income tax withholding.

1    Wages, tips, and other compensation       .  . . . .  . . .  .  .                     . . . .     . .                                                                            .   1                            .

2    Federal income tax withheld from wages, tips, and other compensation                    . . .     . .                                                                            .   2                            .
3    If no wages, tips, and other compensation are subject to social security or Medicare tax                                                                                             3     Check and go to line 5.
4    Taxable social security and Medicare wages and tips:
                                                  Column 1                                       Column 2
     4a Taxable social security wages*                     .   ×  0.124 =                                                                                                               .         *Include taxable qualified sick 
                                                                                                                                                                                                  and family leave wages for leave 
                                                                                                                                                                                                  taken after March 31, 2021, on 
     4a (i) Qualified sick leave wages*                    .   ×  0.062 =                                                                                                               .         line 4a. Use lines 4a(i) and 4a(ii) 
                                                                                                                                                                                                  only to report wages paid for 
                                                                                                                                                                                                  leave taken before April 1, 2021.
     4a (ii) Qualified family leave wages*                 .   ×  0.062 =                                                                                                               .

     4b Taxable social security tips                       .   ×  0.124 =                                                                                                               .

     4c Taxable Medicare wages & tips                      .   ×  0.029 =                                                                                                               .
     4d  Taxable wages & tips subject     
        to Additional Medicare Tax 
        withholding        . . .     . . .                 .   ×  0.009 =                                                                                                               .

     4e Total social security and Medicare taxes. Add Column 2 from lines 4a, 4a(i), 4a(ii), 4b, 4c, and 4d                                                                               4e                           .

5    Total taxes before adjustments. Add lines 2 and 4e .  . . .  .  .                     . . . .     . .                                                                            .   5                            .

6    Current year’s adjustments (see instructions)  . . .  . . .  .  .                     . . . .     . .                                                                            .   6                            .

7    Total taxes after adjustments. Combine lines 5 and 6  . . .  .  .                     . . . .     . .                                                                            .   7                            .

8a   Qualified small business payroll tax credit for increasing research activities. Attach Form 8974                                                                                     8a                           .
8 b  Nonrefundable portion of credit for qualified sick and family leave wages for leave taken 
     before April 1, 2021      .     . . . . . .  . . . .  . . .  .  .                     . . . .     . .                                                                            .   8b                           .

8c   Nonrefundable portion of employee retention credit    . . .  .  .                     . . . .     . .                                                                            .   8c                           .
8 d  Nonrefundable portion of credit for qualified sick and family leave wages for leave taken 
     after March 31, 2021   .        . . . . . .  . . . .  . . .  .  .                     . . . .     . .                                                                            .   8d                           .
     ▶  You MUST complete all three pages of Form 944 and SIGN it.                                                                                                                                                     Next ■▶
For Privacy Act and Paperwork Reduction Act Notice, see the back of the Payment Voucher.                                                                                                 Cat. No. 39316N  Form 944 (2021)

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Name  (not your trade name)                                                                       Employer identification number (EIN)

Part 1:   Answer these questions for this year. (continued)

8e     Nonrefundable portion of COBRA premium assistance credit                  . . . .   . .  . . .      8e                         .

8f     Number of individuals provided COBRA premium assistance 

8g     Total nonrefundable credits. Add lines 8a, 8b, 8c, 8d, and 8e           . . . . .   . .  . . .      8g                         .

9      Total taxes after adjustments and nonrefundable credits. Subtract line 8g from line 7      . .      9                          .
10 a  Total  deposits  for  this  year,  including  overpayment  applied  from  a  prior  year  and 
       overpayments applied from Form 944-X, 944-X (SP), 941-X, or 941-X (PR)              . .  . . .      10a                        .

10b    Reserved for future use  . .  . . .    . . . .     .               . .  . . . . .   . .  . . .      10b                        .

10c    Reserved for future use  . .  . . .    . . . .     .               . .  . . . . .   . .  . . .      10c                        .
10 d  Refundable  portion  of  credit  for  qualified  sick  and  family  leave  wages  for  leave  taken 
       before April 1, 2021 . . . .  . .    . . . .     . .               . .  . . . . .   . .  . . .  10d                            .

10e    Refundable portion of employee retention credit    .               . .  . . . . .   . .  . . .      10e                        .
10 f   Refundable  portion  of  credit  for  qualified  sick  and  family  leave  wages  for  leave  taken 
       after March 31, 2021   . . .  . .    . . . .     . .               . .  . . . . .   . .  . . .      10f                        .

10g    Refundable portion of COBRA premium assistance credit                .  . . . . .   . .  . . .      10g                        .

10h    Total deposits and refundable credits. Add lines 10a, 10d, 10e, 10f, and 10g        . .  . . .      10h                        .

10i    Total advances received from filing Form(s) 7200 for the year             . . . .   . .  . . .   10i                           .

10j    Total deposits and refundable credits less advances. Subtract line 10i from line 10h       . .      10j                        .

11     Balance due. If line 9 is more than line 10j, enter the difference and see instructions. . . .      11                         .

12     Overpayment. If line 10j is more than line 9, enter the difference              .     Check one:    Apply to next return. Send a refund.
Part 2:   Tell us about your deposit schedule and tax liability for this year.
13 Check one:               Line 9 is less than $2,500. Go to Part 3.
                            Line 9 is $2,500 or more. Enter your tax liability for each month. If you’re a semiweekly schedule depositor or 
                            you became one because you accumulated $100,000 or more of liability on any day during a deposit period, 
                            you must complete Form 945-A instead of the boxes below.
                                Jan.                                      Apr.                    July                           Oct.
              13a                    .        13d                              .       13g                 .   13j                    .
                                Feb.                                      May                     Aug.                           Nov.
              13b                    .        13e                              .       13h                 .   13k                    .
                                Mar.                                      June                    Sept.                          Dec.
              13c                    .        13f                              .       13i                 .   13l                    .

              Total liability for year. Add lines 13a through 13l. Total must equal line 9.         13m                               .
       ▶  You MUST complete all three pages of Form 944 and SIGN it.                                                                  Next ■▶
Page 2                                                                                                                           Form 944 (2021)

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Name (not your trade name) Employer identification number (EIN)

Part 3: Tell us about your business. If any question does NOT apply to your business, leave it blank.
14 If your business has closed or you stopped paying wages . . . . . . . . . . . . . . Check here, and

enter the final date you paid wages / / ; also attach a statement to your return. See instructions.

15 Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021 15 .

16 Qualified health plan expenses allocable to qualified family leave wages for leave taken before 16 April 1, 2021 .

17 Qualified wages for the employee retention credit . . . . . . . . . . . . . 17 .

18 Qualified health plan expenses for the employee retention credit . . . . . . . . 18 .

19 Qualified sick leave wages for leave taken after March 31, 2021 . . . . . . . . 19 .

20 Qualified health plan expenses allocable to qualified sick leave wages reported on line 19 20 .
21 Amounts under certain collectively bargained agreements allocable to qualified sick
leave wages reported on line 19 . . . . . . . . . . . . . . . . . . . 21 .

22 Qualified family leave wages for leave taken after March 31, 2021 . . . . . . . . 22 .

23 Qualified health plan expenses allocable to qualified family leave wages reported on line 22 23 .
24 Amounts under certain collectively bargained agreements allocable to qualified family
leave wages reported on line 22 . . . . . . . . . . . . . . . . . . . 24 .
25 If you’re eligible for the employee retention credit in the third quarter solely because
your business is a recovery startup business, enter the total of any amounts included on
lines 8c and 10e for the third quarter . . . . . . . . . . . . . . . . . 25 .
26 If you’re eligible for the employee retention credit in the fourth quarter solely because
your business is a recovery startup business, enter the total of any amounts included on
lines 8c and 10e for the fourth quarter . . . . . . . . . . . . . . . . . 26 .
Part 4: May we speak with your third-party designee?
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with theSeeIRS?the instructions for details.

Yes. Designee’s name and phone number
Select a 5-digit personal identification number (PIN) to use when talking to the IRS.
No.
Part 5: Sign here. You MUST complete all three pages of Form 944 and SIGN it.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Print your
Sign your name here
name here Print your
title here
✗
Date Best daytime phone

Paid Preparer Use Only Check if you’re self-employed

Preparer’s name PTIN

Preparer’s signature Date

Firm’s name (or yours EIN
if self-employed)
Address Phone

City State ZIP code

Page 3 Form 944 (2021)

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Form 944-V,
Payment Voucher

Purpose of Form Use Form 944-V when making any payment with
Form 944. However, if you pay an amount with
Complete Form 944-V if you’re making a payment with ▲! Form 944 that should’ve been deposited, you
Form 944. We will use the completed voucher to credit CAUTION
may be subject to a penalty. See section 11 of
your payment more promptly and accurately, and to Pub. 15, section 8 of Pub. 80, or section 11 of Pub. 179
improve our service to you. for details.
Making Payments With Form 944
Specific Instructions
To avoid a penalty, make your payment with your 2021
Form 944 only if one of the following applies. Box 1—Employer identification number (EIN). If you
don’t have an EIN, you may apply for one online by
• Your net taxes for the year (Form 944, line 9) are less visiting the IRS website at www.irs.gov/EIN. You may also
than $2,500 and you’re paying in full with a timely filed apply for an EIN by faxing or mailing Form SS-4 to the
return. IRS. If you haven’t received your EIN by the due date of
• Your net taxes for the year (Form 944, line 9) are $2,500 Form 944, write “Applied For” and the date you applied in
or more and you already deposited the taxes you owed this entry space.
for the first, second, and third quarters of 2021; your net Box 2—Amount paid.Enter the amount paid with Form
taxes for the fourth quarter are less than $2,500; and 944.
you’re paying, in full, the tax you owe for the fourth
quarter of 2021 with a timely filed return. Box 3—Name and address. Enter your name and
address as shown on Form 944.
• You’re a monthly schedule depositor making a payment
in accordance with the Accuracy of Deposits Rule. See • Enclose your check or money order made payable to
section 11 of Pub. 15, section 8 of Pub. 80, or section 11 “United States Treasury.” Be sure to enter your EIN,
of Pub. 179 for details. In this case, the amount of your “Form 944,” and “2021” on your check or money order.
payment may be $2,500 or more. Don’t send cash. Don’t staple Form 944-V or your
payment to Form 944 (or to each other).
Otherwise, you must make deposits by electronic funds
transfer. See section 11 of Pub. 15, section 8 of Pub. 80, • Detach Form 944-V and send it with your payment and
or section 11 of Pub. 179 for deposit instructions. Don’t Form 944 to the address provided in the Instructions for
use Form 944-V to make federal tax deposits. Form 944.
Note: You must also complete the entity information
above Part 1 on Form 944.

Detach Here and Mail With Your Payment and Form 944. ✃
▼ ▼
✁
OMB No. 1545-2007
Payment Voucher
Form 944-V
Department of the Treasury ▶
Internal Revenue Service Don’t staple this voucher or your payment to Form 944. 2021
1 Enter your employer identification 2 Dollars Cents
number (EIN).
Enter the amount of your payment. ▶
Make your check or money order payable to “United States Treasury”
3 Enter your business name (individual name if sole proprietor).

Enter your address.

Enter your city, state, and ZIP code; or your city, foreign country name, foreign province/county, and foreign postal code.

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Form 944 (2021)

Privacy Act and Paperwork Reduction Act Notice. and criminal litigation, and to cities, states, the District of
We ask for the information on this form to carry out the Columbia, and U.S. commonwealths and possessions for
Internal Revenue laws of the United States. We need it to use in administering their tax laws. We may also disclose
figure and collect the right amount of tax. Subtitle C, this information to other countries under a tax treaty, to
Employment Taxes, of the Internal Revenue Code federal and state agencies to enforce federal nontax
imposes employment taxes on wages and provides for criminal laws, or to federal law enforcement and
income tax withholding. This form is used to determine intelligence agencies to combat terrorism.
the amount of the taxes that you owe. Section 6011 The time needed to complete and file Form 944 will
requires you to provide the requested information if the vary depending on individual circumstances. The
tax is applicable to you. Section 6109 requires you to estimated average time is:
provide your identification number. If you fail to provide
this information in a timely manner, or provide false or Recordkeeping . . . . . . . . . . 18 hr., 39 min.
fraudulent information, you may be subject to penalties. Learning about the law or the form . . . 1 hr., 2 min.
You’re not required to provide the information Preparing, copying, assembling, and
requested on a form that is subject to the Paperwork sending the form to the IRS . . . . . 3 hr., 46 min.
Reduction Act unless the form displays a valid OMB
If you have comments concerning the accuracy of
control number. Books and records relating to a form or
these time estimates or suggestions for making Form 944
instructions must be retained as long as their contents
simpler, we would be happy to hear from you. You can
may become material in the administration of any Internal
send us comments from www.irs.gov/FormComments. Or
Revenue law.
you can send your comments to Internal Revenue
Generally, tax returns and return information are Service, Tax Forms and Publications Division, 1111
confidential, as required by section 6103. However, Constitution Ave. NW, IR-6526, Washington, DC 20224.
section 6103 allows or requires the IRS to disclose or give Don’t send Form 944 to this address. Instead, see Where
the information shown on your tax return to others as Should You File? in the Instructions for Form 944.
described in the Code. For example, we may disclose
your tax information to the Department of Justice for civil

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