Foreign Province/county Foreign Postal code instructions and the latest information. Read the separate instructions before you complete Form 941 Type or print within the boxes. Part 1: Answer these questions for this quarter. 1 Number of employees who received wages, tips, or other compensation for the pay period including: March 12 (Quarter 1) 2 Wages, tips, and other compensation 3 Federal income tax withheld from wages, tips, and other compensation 4 If no wages, tips, and other compensation are subject to social security or Medicare tax 1 2 3 Check and go to line 6. *Include taxable qualified sick and family leave wages paid in 2022 for leave taken after March 31, 2021, and before October 1, 2021, on line 5a. Use lines 5a(1) and 5a(11) only for taxable qualified sick and family leave wages paid in 2022 for leave taken after March 31, 2020, and before April 1, 2021. 5a Taxable social security wages 5a (i) Qualified sick leave wages 5a (ii) Qualified family leave wages 5b Taxable social security tips 5c Taxable Medicare wages & tips 5d Taxable wages & tips subject to Additional Medicare Tax withholding 5e Total social security and Medicare taxes Add Column 2 from lines 5a, 5b, 5c, and 5d 5f Section 3121(q) Notice and Demand - Tax due on unreported tips 6 Total taxes before adjustments. 7 Current quarter's adjustment for fractions of cents 8 Current quarter's adjustment for sick pay Add lines 3, 5e, and 5f 9 Current quarter's adjustments for tips and group-term life insurance 10 Total taxes after adjustments. Combine lines 6 through 9 Column 1 Column 2 x 0.124 0.062 0.062 x 0.124 0.029 x 0.009 11a Qualified small business payroll tax credit for increasing research activities. Attach Form 8974 11b Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021 11c Reserved for future use (see instructions) 11d Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021 11e Nonrefundable portion of COBRA premium assistance credit (see instructions for applicable quarters) 11f Number of individuals provided COBRA premium assistance 11g Total nonrefundable credits. Add lines 11a, 11b, 11c, 11d, and 11e 12 Total taxes after adjustments and nonrefundable credits. Subtract line 11g from line 10 13a Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter 13b Reserved for future use 13c Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021 13d Refundable portion of employee retention credit 13e Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021 5e 5f 6 7 8 9 10 11a 11b 11c 11d 11e 12 921 11g 13a 13b 13c 13d