Form 944-X Adjusted Employer's ANNUAL Federal Tax Return or Claim f

Rev. November 2009 /

944-X:

Form
(January 2010)

Adjusted Employer’s ANNUAL Federal Tax Return or Claim for Refund

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Department of the Treasury — Internal Revenue Service

OMB No. 1545-2007

Return You Are Correcting ...

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Employer identification number (EIN)
Name (not your trade name)

Check the type of return you are
correcting:
944

Trade name (if any)
Address
Number

944-SS

Street

Suite or room number

Enter the calendar year you are
correcting:
(YYYY)

City

State

ZIP code

Enter the date you discovered errors:

Use this form to correct errors made on Form 944 or Form 944-SS for one year only. Type
or print within the boxes. You MUST complete all three pages. Read the instructions before
you complete this form. Do not attach this form to Form 944 or Form 944-SS.

Part 1: Select ONLY one process.

/

/

(MM / DD / YYYY)

1.

Adjusted employment tax return. Check this box if you underreported amounts. Also check this box if you overreported amounts and
you 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 18, if less than 0, may only be applied as a credit to your Form 944,
Form 944-SS, Form 941, or Form 941-SS 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
of the amount shown on line 18. 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 on page 2 and skip lines 4 and 5.
4. If you checked line 1 because you are adjusting overreported amounts, check all that apply. You must check at least one box.
I certify that:
a. I repaid or reimbursed each affected employee for the overcollected social security and Medicare tax for 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.
You must check at least one box.
I certify that:
a. I repaid or reimbursed each affected employee for the 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 claim for the employee’s share of 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, 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.

Next 
For Privacy Act and Paperwork Reduction Act Notice, see the instructions.

Cat. No. 20335M

Form

944-X

(1-2010)

11-2009 /

Name (not your trade name)

Employer identification number (EIN)

Correcting calendar year (YYYY)

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

6. Wages,
tips
and
other
compensation (from line 1 of
Form 944)
7. Income tax withheld from wages,
tips, and other compensation (from
line 2 of Form 944)
8. Taxable social security wages
(from line 4a, Column 1 of Form 944
or Form 944-SS)

Column 1

Column 2

Column 3

Column 4

Total corrected
amount (for ALL
employees)

Amount originally
reported or as
previously corrected
(for ALL employees)

Difference
(If this amount is a
negative number,
use a minus sign.)

Tax correction

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=

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—

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=

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.

—

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=

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=

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Use the amount in Column 1
when you prepare your Forms
W-2 or Forms W-2c.

Copy
Column 3

here

.

.

.124* =

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

9. Taxable social security tips (from
line 4b, Column 1 of Form 944 or
Form 944-SS)

—

.

.

=

.

.124* =

.

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

10.

Taxable Medicare wages and tips
(from line 4c, Column 1 of Form 944
or Form 944-SS)

—

.

.

=

.

.029* =

.

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

11.

12.

13.

14.

15.
16.

Tax adjustments (from line 6 of
Form 944 or Form 944-SS)

.

Special addition to wages for
federal income tax

.

Special addition to wages for
social security taxes

.

Special addition to wages for
Medicare taxes

.

.

=

.

Copy
Column 3

here

.

.

=

.

See
instructions

.

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=

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See
instructions

.

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=

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See
instructions

.

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Subtotal: Combine the amounts on lines 7–14 of Column 4
Advance earned income credit
(EIC) payments made to employees
(from line 8 of Form 944)

17a. COBRA
premium
assistance
payments (from line 11a of Form 944)
17b. Number of individuals provided
COBRA premium assistance (from
line 11b of Form 944)

18.

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—

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—

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=

=

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See
instructions

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See
instructions

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=

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Total: Combine the amounts in lines 15, 16, and 17a of Column 4

If line 18 is less than 0:
● If you checked line 1, this is the amount you want applied as a credit to your Form 944 or Form 944-SS for the tax period in
which you are filing this form. (If you are currently filing a Form 941 or Form 941-SS, Employer’s QUARTERLY Federal Tax Return,
see the instructions.)
● If you checked line 2, this is the amount you want refunded or abated.
If line 18 is more than 0, this is the amount you owe. Pay this amount when you file this return. For information on how to pay,
see Amount You Owe in the instructions.
Next 
Page

2

Form

944-X

(1-2010)

11-2009 /

Name (not your trade name)

Correcting calendar year (YYYY)

Employer identification number (EIN)

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Part 4: Explain your corrections for this year.
19.

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 21.

20.

Check here if any corrections involve reclassified workers. Explain on line 21.

21.

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 944 or Form 944-SS 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

Date

Print your
title here

/

/

Paid preparer’s use only

Preparer’s
SSN/PTIN

Preparer’s signature

Date

Firm’s name (or yours if
self-employed)

EIN

Address

Phone

Page

3

)

–

Check if you are self-employed

Preparer’s name

City

(

Best daytime phone

State

/

(

/

)

–

ZIP code
Form

944-X

(1-2010)

11-2009 /

Type of errors
you are
correcting
Underreported
amounts
ONLY

Overreported
amounts
ONLY

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Form 944-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 18 when you file Form 944-X.

The process you
use depends on
when you file
Form 944-X.

If you are filing Form 944-X
MORE THAN 90 days before the
period of limitations on credit or
refund for Form 944 or Form
944-SS expires . . .

Choose either process to correct the overreported
amounts.
Choose the adjustment process if you want the
amount shown on line 18 credited to your Form 944,
944-SS, 941, or Form 941-SS for the period in which
you file Form 944-X. Check the box on line 1.
OR

Choose the claim process if you want the amount
shown on line 18 refunded to you or abated. Check
the box on line 2.

BOTH
underreported
and
overreported
amounts

The process you
use depends on
when you file
Form 944-X.

If you are filing Form 944-X WITHIN
90 days of the expiration of the
period of limitations on credit or
refund for Form 944 or Form
944-SS . . .

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

If you are filing Form 944-X
MORE THAN 90 days before the
period of limitations on credit or
refund for Form 944 or Form
944-SS expires . . .

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 amounts and overreported amounts
results in a balance due or creates a credit that you
want applied to Form 944, 944-SS, 941, or 941-SS.
● File one Form 944-X, and
● Check the box on line 1 and follow the instructions
on line 18.
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 944-X
to correct the underreported amounts. Check the
box on line 1. Pay the amount you owe from line 18
when you file Form 944-X.
2. For the claim process, file a second Form 944-X to
correct the overreported amounts. Check the box on
line 2.

If you are filing Form 944-X
WITHIN 90 days of the
expiration of the period of
limitations on credit or refund
for Form 944 or Form 944-SS. . .

You must use both the adjustment process and claim
process.
File two separate forms.
1. For the adjustment process, file one Form 944-X
to correct the underreported amounts. Check the
box on line 1. Pay the amount you owe from line 18
when you file Form 944-X.
2. For the claim process, file a second Form 944-X to
correct the overreported amounts. Check the box on
line 2.

11-2009 /

Form

944-X

(1-2009)