Page 336 - Individual Forms & Instructions Guide

16:05 - 2-Feb-2023
Page 20 of 23
Fileid: … ons/i941/202303/a/xml/cycle05/source
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
This amount is also entered on Worksheet 2, Step 2, Part 4: May We Speak With Your
line 2a. Third-Party Designee?
24. Qualified Health Plan Expenses Allocable to
Qualified Sick Leave Wages Reported on If you want to allow an employee, a paid tax preparer, or
Line 23 another person to discuss your Form 941 with the IRS,
check the “Yes” box in Part 4. Enter the name, phone
Enter the qualified health plan expenses allocable to number, and five-digit personal identification number
qualified sick leave wages paid this quarter of 2023 for (PIN) of the specific person to speak with—not the name
leave taken after March 31, 2021, and before October 1, of the firm that prepared your tax return. The designee
2021. This amount is also entered on Worksheet 2, Step may choose any five numbers as their PIN.
2, line 2b.
By checking “Yes,” you authorize the IRS to talk to the
25. Amounts Under Certain Collectively person you named (your designee) about any questions
Bargained Agreements Allocable to Qualified we may have while we process your return. You also
Sick Leave Wages Reported on Line 23 authorize your designee to do all of the following.
Enter the collectively bargained defined benefit pension • Give us any information that is missing from your return.
• Call us for information about processing your return.
plan contributions and collectively bargained • Respond to certain IRS notices that you’ve shared with
apprenticeship program contributions allocable to your designee about math errors and return preparation.
qualified sick leave wages paid this quarter of 2023 for The IRS won't send notices to your designee.
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step You’re not authorizing your designee to bind you to
2, line 2c. anything (including additional tax liability) or to otherwise
Complete lines 26, 27, and 28 only if qualified represent you before the IRS. If you want to expand your
designee's authorization, see Pub. 947.
! family leave wages were paid this quarter of 2023
CAUTION for leave taken after March 31, 2021, and before The authorization will automatically expire 1 year from
October 1, 2021. the due date (without regard to extensions) for filing your
Form 941. If you or your designee wants to terminate the
26. Qualified Family Leave Wages for Leave authorization, write to the IRS office for your location using
Taken After March 31, 2021, and Before October the Without a payment address under Where Should You
1, 2021 File, earlier.
Enter the qualified family leave wages you paid this Part 5: Sign Here (Approved Roles)
quarter of 2023 to your employees for leave taken after
March 31, 2021, and before October 1, 2021, including Complete all information and sign Form 941. The
any qualified family leave wages that were above the following persons are authorized to sign the return for
social security wage base and any qualified family leave each type of business entity.
wages excluded from the definition of employment under • Sole proprietorship—The individual who owns the
sections 3121(b)(1)–(22). See the instructions for line 11d, business.
earlier, for more information about qualified family leave • Corporation (including a limited liability company
wages for leave taken after March 31, 2021, and before (LLC) treated as a corporation)—The president, vice
October 1, 2021. This amount is also entered on president, or other principal officer duly authorized to sign.
• Partnership (including an LLC treated as a
Worksheet 2, Step 2, line 2g. partnership) or unincorporated organization—A
27. Qualified Health Plan Expenses Allocable to responsible and duly authorized partner, member, or
Qualified Family Leave Wages Reported on officer having knowledge of its affairs.
Line 26 • Single-member LLC treated as a disregarded entity
Enter the qualified health plan expenses allocable to for federal income tax purposes—The owner of the
LLC or a principal officer duly authorized to sign.
qualified family leave wages paid this quarter of 2023 for • Trust or estate—The fiduciary.
leave taken after March 31, 2021, and before October 1,
2021. This amount is also entered on Worksheet 2, Step Form 941 may be signed by a duly authorized agent of
2, line 2h. the taxpayer if a valid power of attorney has been filed.

28. Amounts Under Certain Collectively Alternative signature method. Corporate officers or
Bargained Agreements Allocable to Qualified duly authorized agents may sign Form 941 by rubber
stamp, mechanical device, or computer software
Family Leave Wages Reported on Line 26 program. For details and required documentation, see
Enter the collectively bargained defined benefit pension Rev. Proc. 2005-39, 2005-28 I.R.B. 82, available at
plan contributions and collectively bargained IRS.gov/irb/2005-28_IRB#RP-2005-39.
apprenticeship program contributions allocable to
qualified family leave wages paid this quarter of 2023 for Paid Preparer Use Only
leave taken after March 31, 2021, and before October 1, A paid preparer must sign Form 941 and provide the
2021. This amount is also entered on Worksheet 2, Step information in the Paid Preparer Use Only section of Part
2, line 2i. 5 if the preparer was paid to prepare Form 941 and isn't

-20- Instructions for Form 941 (Rev. 3-2023)