Form 943 Schedule R 943 Schedule R Allocation Schedule for Aggregate Form 943 Filers

Allocation Schedule for Aggregate Form 943 Filers

(Rev. December 2021)

Department of the Treasury — Internal Revenue Service

Employer identification number (EIN)

430421

DRAFT AS OF
July 15, 2021
DO NOT FILE

Schedule R (Form 943):

OMB No. 1545-0035

Report for calendar year:

—

(Same as Form 943):

Name as shown on Form 943

2021

Type of filer (check one):

Section 3504 Agent

CPEO

Other Third Party

Read the instructions before you complete Schedule R. Type or print within the boxes. Complete a separate line for the amounts
allocated to each of your clients. The term “client” as used on this form includes the term “customer.” See the instructions.
(a) Client’s EIN

(b) Type of wages
(CPEO only)

(c) Form 943, line 1

(d) Form 943, line 2

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4
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6 Subtotals for clients. Add lines 1 through 5
7 Enter the combined subtotal from line 9

of all Continuation Sheets for Schedule R

8 Enter Form 943 amounts for your employees
9 Totals. Add lines 6, 7, and 8.
(j) Form 943, line 12a

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(r) Form 943, line 14i

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(k) Form 943, lines 12b
and 14d, total

(l) Form 943, lines 12c
and 14e, total

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(s) Form 943, lines 18
and 19, total

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(t) Form 943, lines 20
and 21, total

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For Paperwork Reduction Act Notice, see the separate instructions.

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(e) Form 943, line 2a

(f) Form 943, line 2b

(g) Form 943, line 4

(h) Form 943, line 6

(i) Form 943, line 8

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(m) Form 943, lines 12d
and 14f, total

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(u) Form 943, lines 22
and 24, total

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www.irs.gov/Form943

(n) Form 943, lines 12e
and 14g, total

(o) Form 943, line 12f

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(v) Form 943, lines 23
and 26, total

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(p) Form 943, line 13

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(w) Form 943, lines 25
and 27, total

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Cat. No. 69329E

(x) Form 943, line 28

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(q) Form 943, line 14a

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(y) Form 943, line 29

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Schedule R (Form 943) (Rev. 12-2021)

Page

of

430521

DRAFT AS OF
July 15, 2021
DO NOT FILE

Continuation Sheet for Schedule R (Form 943)
(Rev. December 2021)
Employer identification number (EIN)

Report for calendar year:

—

(Same as Form 943):

Name as shown on Form 943

2021

Type of filer (check one):

(a) Client’s EIN

Section 3504 Agent

(b) Type of wages
(CPEO only)

1
2
3
4
5
6
7
8

CPEO

(c) Form 943, line 1

Other Third Party

(d) Form 943, line 2

(e) Form 943, line 2a

(f) Form 943, line 2b

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(g) Form 943, line 4

(h) Form 943, line 6

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(i) Form 943, line 8

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9 Subtotals for clients. Add lines 1 through
8. Include the subtotals from this line on
Schedule R, Page 1, line 7.
(j) Form 943, line 12a

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9

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(r) Form 943, line 14i

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9

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(k) Form 943, lines 12b
and 14d, total

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(s) Form 943, lines 18
and 19, total

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(l) Form 943, lines 12c
and 14e, total

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(t) Form 943, lines 20
and 21, total

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(m) Form 943, lines 12d
and 14f, total

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(u) Form 943, lines 22
and 24, total

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(n) Form 943, lines 12e
and 14g, total

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(o) Form 943, line 12f

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(v) Form 943, lines 23
and 26, total

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(p) Form 943, line 13

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(w) Form 943, lines 25
and 27, total

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(x) Form 943, line 28

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(q) Form 943, line 14a

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(y) Form 943, line 29

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Schedule R (Form 943) (Rev. 12-2021)