SS-16

Certificate of Election of Coverage

Agency
IRS
Revision
Rev. December 2025
Fillable fields
28
Pages
4
Official source
IRS form page
Checked
October 21, 2026
Fill SS-16 online
Page 1 of form SS-16

Form SS-16: Certificate of Election of Coverage

Form SS-16, Certificate of Election of Coverage Under the Federal Insurance Contributions Act, is for religious orders whose members are required to take a vow of poverty. The form says a religious order (or autonomous subdivision of a religious order) may file it to certify that it elects social security and Medicare coverage under section 3121(r) for services its members perform in exercising their required duties.

The form says the certificate is irrevocable and applies to all current and future members of the order. The order pays the social security and Medicare taxes imposed on employees and employers on the wages of each active member, reported on Form 941 or 941-X.

The form has four pages, Copies A to D. Copies A, B and C go to the IRS and Copy D is kept. You can fill it out free in your browser on this page and download the result without an account.

What's on Form SS-16

Order name and EIN

The full name of the religious order (or autonomous subdivision of the religious order) and its employer identification number.

Address

The street address with apartment or suite number, and the city, town or post office, state and ZIP code. Foreign addresses follow the instructions.

Effective date

A date in mm/dd/yyyy format, entered in the space to the right of the address.

Certification

Under penalties of perjury, the order irrevocably elects coverage for all current and future members in exercising their required duties. Each member's wages are determined as provided in section 3121(i)(4).

Signature block

The signature of the authorized official, title, date, printed or typed name and telephone number.

Four copies

Copy A is retained by the IRS, Copy B is forwarded to the Social Security Administration by the IRS, Copy C is returned to the taxpayer, and Copy D is kept. Copies B and D carry the Form 941 and 941-X instructions.

How to fill out Form SS-16

  1. 1

    Name and EIN

    Enter the full name of the order or subdivision and its EIN. If the order already files Form 941, use the same EIN.

  2. 2

    Address

    For a foreign address, enter the city, province or state, and country, in that order. The form says to follow the country's practice for the postal code and not to abbreviate the country name.

  3. 3

    Effective date

    Enter the first day of the calendar quarter in which the certificate is filed, the quarter after it, or any one of the 20 calendar quarters before it. The form says a missing or incorrect date gets the form returned.

  4. 4

    Sign

    The authorized official signs, enters a title and date, prints or types a name, and enters the best daytime telephone number, including area code.

  5. 5

    Send three copies

    Send Copies A, B and C to the IRS address and keep Copy D. The form says Copy C is returned after the IRS accepts the form.

  6. 6

    Retroactive quarters

    On each Form 941 for a retroactive quarter, write "Form SS-16" and the filing date across the top of page 1 and attach a copy marked "Copy." On Form 941-X, enter them in the Part 4 explanation.

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Where to file, retroactive taxes and help

Where to file

The form lists Department of the Treasury, Internal Revenue Service Center, Ogden, UT 84201-0005.

Retroactive coverage

Coverage for earlier quarters applies only to services by persons who were active members then and are alive on the first day of the quarter the certificate is filed. The order reports and pays both employer and employee taxes for those quarters.

Due dates for retroactive quarters

Forms 941 or 941-X and the tax for retroactive quarters are due April 30, July 31, October 31 or January 31 of next year, for an SS-16 filed in the 1st, 2nd, 3rd or 4th quarter.

Postmark rule

If the effective date is the first day of the 20th quarter before the postmark quarter but the form arrives in a later quarter, the form says the IRS uses the postmark date as the date filed.

Wages

Wages include pay for services and the fair market value of board, lodging, clothing and other benefits. The form says that if the value of the items is less than $100 a month, that amount cannot be included.

Help

The form lists 800-829-4933 (toll free), TTY/TDD 800-829-4059 (toll free), and 267-941-1000 (not toll free) from a foreign country.

Related forms

Who files Form SS-16?

  • Religious orders with a vow of poverty

    The form is for use by religious orders whose members are required to take a vow of poverty, or an autonomous subdivision of such an order.

  • An authorized official of the order

    The form says an authorized official of the order signs it and sends Copies A, B and C to the IRS, with a printed name, title and daytime telephone number.

  • Members the election covers

    The form defines a member as an individual who is subject to a vow of poverty as a member, performs the services usually required of an active member, and is not considered retired because of age or total disability.

  • Orders already filing Form 941

    The form says an order that already files Form 941 shows the same EIN on Form SS-16 that it uses on that return.

  • Members asking about benefits

    The order makes the election for all current and future members. For the effect of the form on members' social security and Medicare benefits, the form says to contact any Social Security Administration office.

A religious order or an autonomous subdivision files it, signed by an authorized official. It goes to the IRS, which forwards Copy B to the Social Security Administration.

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Questions about Form SS-16

Can a Form SS-16 election be revoked?

The form says the certificate is irrevocable and applies to all current and future members of the order.

How far back can coverage start?

The effective date can be the first day of any one of the 20 calendar quarters before the quarter in which the certificate is filed.

What happens if the effective date is wrong?

The form says Form SS-16 will be returned if the effective date is incorrect for the filing date or is missing.

Which copies go to the IRS?

Copies A, B and C. Copy D is kept for the order's records, and Copy C is returned after the IRS accepts the form.

What if the order files Form 944 instead of Form 941?

The form says an order notified to file Form 944 instead of Form 941 can call the IRS for assistance at 800-829-4933.

Are board and lodging counted as wages?

The form says wages include the fair market value of board, lodging, clothing and other benefits, but a value under $100 a month cannot be included.