Reminder:
Internal Revenue Manual Part 3. Submission Processing · 2026-10-03 edition · updated 2026-10-04 · United States
Use these instructions for form revision 2020 only.
Qualified health plan expenses allocable to wages reported on Line 24 from Form 941, Line 25
Enter the amount from column (y) box 1 through 5 of Sch R and/or box 1 through 8 of Sch R Continuation Sheet for form revision 2020.
Line 6/Line 9, Column c through Column y (form revisions 2020 and Later)
Line 11/Line 24, Column c through Column i (form revisions 2017 and 2018)
Line 16/Line 26, Column b through Column g (form revisions 2010 through 2014)
Subtotal for Clients
Enter the amount from:
column (c) through column (y) box 6 of Sch R and/or box 9 of Sch R Continuation Sheet for form revisions 2020 and Later
column (c) through column (i) box 11 of Sch R and/or box 24 of Sch R Continuation Sheet for form revisions 2017 and 2018
column (b) through column (g) box 16 of Sch R and/or box 26 of Sch R Continuation Sheet for form revisions 2010 through 2014
Line 7 Column c through Column y (form revisions 2020 and Later)
Line 12 Column c through Column i (form revisions 2017 and 2018)
Line 17 Column b through Column g (form revisions 2010 through 2014)
Combined subtotals of all Continuation Sheets
Enter the amount from:
column (c) through column (y) box 7 of Sch R for form revisions 2020 and Later
column (c) through column (i) box 12 of Sch R for form revisions 2017 and 2018
column (b) through column (g) box 17 of Sch R for form revisions 2010 through 2014
Line 8 Column c through Column y (form revisions 2020 and Later)
Line 13 Column c through Column i form revisions 2017 and 2018)
Line 18 Column b through Column g (form revisions 2010 through 2014)
Form 941 amounts for your employees
Enter the amount from:
column (c) through column (y) box 8 of Sch R for form revisions 2020 and Later
column (c) through column (i) box 13 of Sch R for form revisions 2017 and 2018
column (b) through column (g) box 18 of Sch R for form revisions 2010 through 2014
Line 9 Column c through Column y (form revisions 2020 and Later)
Line 14 Column c through Column i (form revisions 2017 and 2018)
Line 19 Column b through Column g (form revisions 2010 through 2014)
Total of Lines 6, 7 and 8 Total of Lines 11, 12 and 13 (form revisions 2017 and 2018) Total of Lines 16, 17 and 18 (form revisions 2010 through 2014)
Enter the amount from:
column (c) through column (y) box 9 of Sch R for form revisions 2020 and Later
column (c) through column (i) box 14 of Sch R for form revisions 2017 and 2018
column (b) through column (g) box 19 of Sch R for form revisions 2010 through 2014
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