Form 943-X (PR)

Form 943-X:
(January 2009)

This form will be translated into
Spanish. The Form number will
Draft 10: 11/11/08
Adjusted Employer’s
be - FormAnnual
943-XFederal
(PR) Tax Return for Agricultural Employees or Claim for Refund

Department of the Treasury — Internal Revenue Service

OMB No. 1545-0035

Return You Are Correcting …
Employer Identification Number (EIN)

–

Enter the calendar year of the return you
are correcting:

Name (not your trade name)

(YYYY)

Trade name (if any)
Address

Enter the date you discovered errors:
Number

Street

Suite or room number

/
City

State

ZIP code

/

(MM / DD / YYYY)

Use this form to correct errors made on Form 943, Employer’s Annual Federal Tax Return for Agricultural Employees, for one year only.
Please type or print within the boxes. Do not attach this form to Form 943.
You MUST complete all three pages. Read the instructions before you complete this form.
Part 1: Select ONLY one process.

1. Adjusted employment tax return. Check this box if you underreported amounts. Also check this box if you overreported amounts and would
like to use the adjustment process to correct the errors. You must check this box if you are correcting both underreported and overreported
amounts on this form. The amount shown on line 15, if less than 0, may only be applied as a credit to your Form 943 for the tax period in
which you are filing this form.
2. Claim. Check this box if you overreported amounts only and you would like to use the claim process to ask for a refund or abatement for the
amount shown on line 15. Do not check this box if you are correcting ANY underreported amounts on this form.
Part 2: Complete the certifications.

3. I certify that I have filed or will file Forms W-2, Wage and Tax Statement, or Forms W-2c, Corrected Wage and Tax Statement, as
required.
Note: If you are correcting underreported amounts only, go to Part 3 (Skip lines 4 and 5).
4. If you checked line 1 because you are adjusting overreported amounts, check all that apply. (Check at least one.)
I certify that:
a. I repaid or reimbursed each affected employee for the overcollected federal income tax for the current year and the

overcollected social security and Medicare tax for current and prior years. For adjustments of employee social security
and Medicare tax overcollected in prior years, I have a written statement from each employee stating that he or she has
not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.
b. the adjustment of social security tax and Medicare tax is for the employer’s share only. I could not find the affected

employees or each employee did not give me a written statement that he or she has not claimed (or the claim was
rejected) and will not claim a refund or credit for the overcollection.
c. the adjustment is for federal income tax, social security tax, and Medicare tax that I did not withhold from employee wages.
5. If you checked line 2 because you are claiming a refund or abatement of overreported employment taxes, check all that apply.
(Check at least one.)
I certify that:
a. I repaid or reimbursed each affected employee for the overcollected social security and Medicare tax. For claims of

employee social security and Medicare tax overcollected in prior years, I have a written statement from each employee
stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.
b. I have a written consent from each affected employee stating that I may file this refund claim for the employee’s share

of social security and Medicare tax. For refunds of employee social security and Medicare tax overcollected in prior
years, I also have a written statement from each employee stating that he or she has not claimed (or the claim was
rejected) and will not claim a refund or credit for the overcollection.
c. the claim for social security tax and Medicare tax is for the employer’s share only. I could not find the affected

employees; or each employee did not give me a written consent to file a claim for the employee’s share of social
security and Medicare tax; or each employee did not give me a written statement that he or she has not claimed (or the
claim was rejected) and will not claim a refund or credit for the overcollection.
d. the claim is for federal income tax, social security tax, and Medicare tax that I did not withhold from employee wages.
For Paperwork Reduction Act Notice, see the instructions.

Cat. No. 20332F

Form 943-X (1-2009)

Next ·

Name (not your trade name)

Employer Identification Number (EIN)

Calendar Year (YYYY)

Part 3: Enter the corrections for this year. If any line does not apply, leave it blank.

Draft
6. Total wages subject to social
security tax
(from line 2 of Form 943)

Column 1

Column 2

Total corrected
amount
(For ALL employees)

.

–

Column 3

Column 4

Amount originally
Difference
reported or as previously
= (If this amount is a
corrected
negative number, use a
(For ALL employees)
minus sign.)

–

.

=

.

Tax correction

.

X .124* =

*If you are correcting your employer share only, use .062. See instructions.

7. Total wages subject to Medicare tax
(from line 4 of Form 943)

.

–

.

=

.

X .029* =

.

*If you are correcting your employer share only, use .0145. See instructions.

8. Federal income tax withheld
(from line 6 of Form 943)

.
9. Tax adjustments
(from line 8 of Form 943)
10. Special addition to wages for
federal income tax

.

–

–

.

.

=

=

.

.

Copy
Column 3
here ff

.

See
instructions

.

=

.

See
instructions

.

=

.

See
instructions

.

=

.

See
instructions

.

13. Subtotal: Combine the amounts in lines 6–12 of Column 4..................................................................................................................

.

11. Special addition to wages for
social security taxes
12. Special addition to wages for
Medicare taxes

14. Advance earned income credit
(EIC) payments made to employees
(from line 10 of Form 943)

.
.
.

.

–

–

–

–

.
.
.

.

=

.

See
instructions

.

15. Total: Combine the amounts in lines 13 and 14 of Column 4................................................................................................................

.

If line 15 is less than 0…
• If you checked line 1, this is the amount you want applied as a credit to your Form 943 for the tax period in which you are filing this form.
• If you checked line 2, this is the amount you want refunded or abated.

If line 15 is more than 0, this is the amount you owe. Pay this amount when you file this return. Go to Amount You Owe on page X of the instructions.
Next ·
Page 2

Form 943-X (1-2009)

Name (not your trade name)

Employer Identification Number (EIN)

Calendar Year (YYYY)

Part 4: Explain your corrections for this year.

16. Check here if any corrections you entered on a line include both underreported and overreported amounts. Explain both your
underreported and overreported amounts on line 18.
17. Check here if any corrections involve reclassified workers. Explain on line 18.
18. You must give us a detailed explanation of how you determined your corrections. (See the instructions.)

Part 5: Sign here. You must complete all three pages of this form and sign it.

Under penalties of perjury, I declare that I have filed an original Form 943 and that I have examined this adjusted return or claim and any schedules or
statements that are attached, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than
taxpayer) is based on all information of which preparer has any knowledge.



Print your
name here

Sign your
name here

Print your
title here

Date

/

/

Best daytime phone

(

)

--

Paid preparer’s use only

Check if you are self employed ....................................

Preparer’s name

Preparer’s SSN/PTIN

Preparer’s signature

Date

Firm’s name (or yours
if self-employed

EIN

Address

Phone

City
Page 3

State

/

(

/

)

--

ZIP code
Form 943-X (1-2009)

Type of errors
you are
correcting

Underreported
amounts
ONLY

Form 943-X: Which process should you use?

Use the adjustment process to correct underreported amounts.
• Check the box on line 1.
• Pay the amount you owe from line 15 when you file Form 943-X.

Overreported
amounts
ONLY

The process you
use depends on
when you file
Form 943-X.

If you are filing Form 943-X
MORE THAN 90 days before
the period of limitations on
credit or refund for Form 943
expires …

Choose either process to correct the overreported amounts.
Choose the adjustment process if you want the amount
shown on line 15 credited to your Form 943 for the period in
which you file Form 943-X. Check the box on line 1.
OR
Choose the claim process if you want the amount shown on
line 15 refunded to you or abated. Check the box on line 2.

If you are filing Form 943-X
WITHIN 90 DAYS of the
expiration of the period of
limitations on credit or refund
for Form 943 …

BOTH
underreported
and
overreported
amounts

The process you
use depends on
when you file
Form 943-X.

If you are filing Form 943-X
MORE THAN 90 days before
the period of limitations on
credit or refund for Form 943
expires …

You must use the claim process to correct the overreported
amounts. Check the box on line 2.

Choose either the adjustment process or both the adjustment
process and the claim process when you correct both
underreported and overreported amounts.

Choose the adjustment process if combining your
underreported and overreported amounts results in a balance
due or creates a credit that you want applied to Form 943.
• File one Form 943-X, and
• Check the box on line 1 and follow the instructions on
line 15.
OR
Choose both the adjustment process and the claim
process if you want the overreported amount refunded to you
or abated.
File two separate forms.
1. For the adjustment process, file one Form 943-X to

correct the underreported amounts. Check the box on line
1. Pay the amount you owe from line 15 when you file
Form 943-X.
2. For the claim process, file a second Form 943-X to

correct the overreported amounts. Check the box on
line 2.
If you are filing Form 943-X
WITHIN 90 DAYS of the
expiration of the period of
limitations on credit or refund
for Form 943 …

You must use both the adjustment process and claim process.
File two separate forms.
1. For the adjustment process, file one Form 943-X to correct

the underreported amounts. Check the box on line 1. Pay the
amount you owe from line 15 when you file Form 943-X.
2. For the claim process, file a second Form 943-X to correct

the overreported amounts. Check the box on line 2.
Form 943-X (1-2009)