Part 1
Quarterly Information
Line 1
Number of employees paid
Line 2
Total wages, tips, and other compensation
Line 3
Federal income tax withheld
Line 4
Check box if no wages subject to SS/Medicare; otherwise, skip to line 5
Line 5a Column 1
Taxable Social Security wages
Line 5a Column 2
Multiply wages in line 5a, column 1 by 12.4% (6.2%x2) and place this amount in this box
Line 5b Column 1
Taxable Social Security tips
Line 5b Column 2
Multiply tips in line 5b, column 1 by 12.4% (6.2%x2) and place this amount in this box
Line 5c Column 1
Taxable Medicare wages & tips
Line 5c Column 2
Multiply wages and tips in line 5c, column 1 by 2.9% (1.45%x2) and place this amount in this box
Line 5d Column 1
Wages subject to Additional Medicare Tax
Line 5d Column 2
Multiply wages and tips in line 5d, column 1 by 0.9% and place this amount in this box
Line 5e Column 1
Total SS & Medicare taxes (sum of lines 5a-5d)
Line 5f
Tax on unreported tips (if any)
Line 6
Total taxes before adjustments (Add Lines 3, 5e, 5f)
Line 7
Adjustments for fractions of cents, sick pay, tips, etc.
Line 8
Line 9
Line 10
Total taxes after adjustments (Line 6 + Lines 7-9)
Line 11
Qualified Small Business Payroll Tax Credit (attach Form 8974)
Line 12
Total taxes after adjustments & credits (Line 10 - Line 11)
Line 13
Total deposits for the quarter
Line 14
Balance Due (if Line 12 > Line 13)