Page 325 - Individual Forms & Instructions Guide

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Adjustment of Tax on Tips this quarter of 2023 for leave taken after March 31, 2020,
and before October 1, 2021, and qualified family leave
If, by the 10th of the month after the month you received wages paid this quarter of 2023 for leave taken after
an employee's report on tips, you don't have enough March 31, 2020, and before October 1, 2021; tips; taxable
employee funds available to withhold the employee share fringe benefits; and supplemental unemployment
of social security and Medicare taxes, you no longer have compensation benefits. Don't include any income tax
to collect it. Report the entire amount of these tips on withheld by a third-party payer of sick pay even if you
line 5b (Taxable social security tips), line 5c (Taxable reported it on Forms W-2. You will reconcile this
Medicare wages and tips), and, if the withholding difference on Form W-3. Also include here any excise
threshold is met, line 5d (Taxable wages and tips subject taxes you were required to withhold on golden parachute
to Additional Medicare Tax withholding). Include as a payments (section 4999). For information on the
negative adjustment on line 9 the total uncollected employment tax treatment of fringe benefits, see Pub.
employee share of the social security and Medicare taxes. 15-B, Employer's Tax Guide to Fringe Benefits. For
information about supplemental unemployment
Specific Instructions: compensation benefits and golden parachute payments,
see section 5 of Pub. 15-A.
Part 1: Answer These Questions for If you’re a third-party payer of sick pay, enter the
This Quarter federal income tax you withheld (or were required to
withhold) on third-party sick pay here.
1. Number of Employees Who Received Wages, 4. If No Wages, Tips, and Other Compensation
Tips, or Other Compensation Are Subject to Social Security or Medicare
Enter the number of employees on your payroll for the pay Tax . . .
period including March 12, June 12, September 12, or If no wages, tips, and other compensation on line 2 are
December 12, for the quarter indicated at the top of Form subject to social security or Medicare tax, check the box
941. Don't include: on line 4. If this question doesn't apply to you, leave the
• Household employees, box blank. For more information about exempt wages, see
• Employees in nonpay status for the pay period, section 15 of Pub. 15. For religious exemptions, see
• Farm employees, section 4 of Pub. 15-A.
• Pensioners, or
• Active members of the U.S. Armed Forces. If you’re a governmental employer, wages you pay
For purposes of these instructions, all references ! aren't automatically exempt from social security
and Medicare taxes. Your employees may be
CAUTION
TIP to “sick pay” mean ordinary sick pay, not “qualified covered by law or by a voluntary Section 218 Agreement
sick leave wages” that are reported on line 5a(i) with the SSA. For more information, see Pub. 963,
for leave taken after March 31, 2020, and before April 1, Federal-State Reference Guide.
2021, or reported on line 5a for leave taken after March
31, 2021, and before October 1, 2021.
5a–5e. Taxable Social Security and Medicare
2. Wages, Tips, and Other Compensation Wages and Tips
Enter amounts on line 2 that would also be included in Qualified sick leave wages and qualified family
box 1 of your employees' Forms W-2. See Box ! leave wages paid this quarter of 2023 for leave
1—Wages, tips, other compensation in the General CAUTION taken after March 31, 2020, and before April 1,
Instructions for Forms W-2 and W-3 for details. Include 2021, are reported on lines 5a(i) and 5a(ii), respectively.
sick pay paid by your agent. Also include sick pay paid by Qualified sick leave wages and qualified family leave
a third party that isn't your agent (for example, an wages paid this quarter of 2023 for leave taken after
insurance company) if you were given timely notice of the March 31, 2021, and before October 1, 2021, are reported
payments and the third party transferred liability for the on line 5a.
employer's taxes to you. 5a. Taxable social security wages. Enter the total
If you’re a third-party payer of sick pay and not an agent wages, including qualified sick leave wages and qualified
of the employer, don't include sick pay that you paid to family leave wages paid this quarter of 2023 for leave
policyholders' employees here if you gave the taken after March 31, 2021, and before October 1, 2021;
policyholders timely notice of the payments. See section 6 sick pay; and taxable fringe benefits subject to social
of Pub. 15-A for more information about sick pay reporting security taxes you paid to your employees during the
and the procedures for transferring the liability to the quarter. Don't include the qualified sick leave wages paid
employer. this quarter of 2023 that are reported on line 5a(i) or
3. Federal Income Tax Withheld From Wages, qualified family leave wages paid this quarter of 2023 that
are reported on line 5a(ii) for leave taken after March 31,
Tips, and Other Compensation 2020, and before April 1, 2021. For this purpose, sick pay
Enter the federal income tax you withheld (or were includes payments made by an insurance company to
required to withhold) from your employees on this your employees for which you received timely notice from
quarter's wages, including qualified sick leave wages paid the insurance company. See section 6 of Pub. 15-A for

Instructions for Form 941 (Rev. 3-2023) -9-