Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund

Instructions for Form 941-X
(April 2013)

Department of the Treasury
Internal Revenue Service

Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund
Section references are to the Internal Revenue Code unless
otherwise noted.

Future Developments

For the latest information about developments related to Form
941-X and its instructions, such as legislation enacted after they
were published, go to www.irs.gov/form941x.

What's New
Correcting wages and tips subject to Additional Medicare
Tax withholding. Beginning with the first quarter of 2013,
wages and tips subject to Additional Medicare Tax withholding
are reported on Form 941, line 5d. Any errors discovered on a
previously filed Form 941 are corrected on Form 941-X, line 11.
For more information about Additional Medicare Tax
withholding, see the Instructions for Form 941 and go to IRS.gov
and enter “Additional Medicare Tax” in the search box. See the
instructions for line 11 for more information on the types of errors
that can be corrected and how the correction is reported on
Form 941-X.
Social security tax rate for 2013. The employee social
security tax rate is 6.2% and the employer social security tax
rate is 6.2% (12.4% total). In 2011 and 2012, the employee
social security tax rate was 4.2% and the employer social
security tax rate was 6.2% (10.4% total). Be sure to use the
correct rate when reporting correct amounts on lines 8 and 9.
Retroactive increase in excludible transit benefits. The
American Taxpayer Relief Act (ATRA) increased the monthly
transit benefit exclusion from $125 per participating employee to
$240 per participating employee for the period of January 1,
2012, through December 31, 2012. Employers were provided
instructions on how to correct the social security and Medicare
taxes on the excess transit benefits in Notice 2013-8, 2013-7
I.R.B. 486, available at www.irs.gov/irb/2013-07_IRB/ar08.html.

Reminders
Aggregate Form 941. Agents must complete Schedule R
(Form 941), Allocation Schedule for Aggregate Form 941 Filers,
when correcting an aggregate Form 941. Schedule R (Form
941) is completed only for those clients who have corrections
reported on Form 941-X. Schedule R (Form 941) is filed as an
attachment to Form 941-X. Aggregate Forms 941 are filed by
agents approved by the IRS under section 3504. To request
approval to act as an agent for an employer, the agent files Form
2678, Employer/Payer Appointment of Agent, with the IRS.
Section 3121(q) Notice and Demand—Tax due on unreported tips. An employer enters the amount of social security and
Medicare taxes on unreported tips shown on the Section
3121(q) Notice and Demand on line 5f (line 5e for quarters
ending before January 1, 2013) of the employer's Form 941 for
the calendar quarter corresponding to the “Date of Notice and
Demand.” Any errors discovered on a previously filed Form 941
for these taxes are corrected on Form 941-X, line 12. In addition,
any errors relating to Section 3121(q) Notice and Demand
amounts reported on Form 941, line 7c (for quarters ending
before January 1, 2011) should be corrected on Form 941-X,
line 12.
Qualified employer's social security tax exemption expired. The qualified employer's exemption for their share
Mar 26, 2013

(6.2%) of social security tax on wages/tips paid to qualified
employees expired on December 31, 2010. Any errors
discovered on a previously filed Form 941 (for quarters ending
after March 31, 2010, and before January 1, 2011) for this
exemption are corrected on Form 941-X, lines 13a–13c.
Qualified employer's social security tax credit. Qualified
employers were allowed a credit for their share (6.2%) of social
security tax on wages/tips paid to qualified employees after
March 18, 2010, and before April 1, 2010. Any errors discovered
on a previously filed Form 941 for the second quarter of 2010 for
this credit are corrected on Form 941-X, lines 20c and 20d.
Advance payment of earned income credit (EIC). The
option of receiving advance payroll payments of EIC expired on
December 31, 2010. Any errors discovered on a previously filed
Form 941 for this credit are corrected on Form 941-X, line 19.
COBRA premium assistance payments. Employers who
make COBRA premium assistance payments for assistance
eligible individuals are allowed a credit for the payments on
Form 941. Any errors discovered on a previously filed Form 941
for this credit are corrected on Form 941-X, lines 20a and 20b.
See COBRA Premium Assistance Payments, later.

General Instructions:
Understanding Form 941-X
What Is the Purpose of Form 941-X?
Use Form 941-X to correct errors on a Form 941 that you
previously filed. Use Form 941-X to correct:
Wages, tips, and other compensation;
Income tax withheld from wages, tips, and other
compensation;
Taxable social security wages;
Taxable social security tips;
Taxable Medicare wages and tips;
Taxable wages and tips subject to Additional Medicare Tax
withholding;
Advance earned income credit (EIC) payments made to
employees (for quarters ending before January 1, 2011);
Credits for COBRA premium assistance payments;
Credits for qualified employer's share of social security tax on
wages/tips paid to qualified employees March 19–31, 2010
(second quarter 2010 only); and
Exemptions for qualified employer's share of social security
tax on wages/tips paid to qualified employees (for quarters
ending after March 31, 2010, and before January 1, 2011).
Use Form 843, Claim for Refund and Request for Abatement,
to request a refund or abatement of assessed interest or
penalties. Do not request abatement of assessed interest or
penalties on Form 941 or Form 941-X.
References to Form 941 on Form 941-X and in these
instructions also apply to Form 941-SS, Employer's
QUARTERLY Federal Tax Return—American Samoa,
Guam, the Commonwealth of the Northern Mariana Islands, and
the U.S. Virgin Islands, unless otherwise noted. We use the
terms “correct” and “corrections” on Form 941-X and in these
instructions to include interest-free adjustments under sections
6205 and 6413 and claims for refund and abatement under

TIP

Cat. No. 20331U

sections 6402, 6414, and 6404. See Rev. Rul. 2009-39 for
examples of how the interest-free adjustment and claim for
refund rules apply in 10 different situations. You can find Rev.
Rul. 2009-39, 2009-52, I.R.B. 951 at www.irs.gov/irb/
2009-52_IRB/ar14.html.

See Pub. 15 (Circular E), Employer's Tax Guide, for correcting
Form 941, or Pub. 80 (Circular SS), Federal Tax Guide for
Employers in the U.S. Virgin Islands, Guam, American Samoa,
and the Commonwealth of the Northern Mariana Islands, for
correcting Form 941-SS.

When you discover an error on a previously filed Form 941,
you must:
Correct that error using Form 941-X,
File a separate Form 941-X for each Form 941 that you are
correcting, and
File Form 941-X separately. Do not file Form 941-X with
Form 941.

See also How Can You Order Forms, Instructions, and
Publications from the IRS, later.

When Should You File Form 941-X?
File Form 941-X when you discover an error on a previously filed
Form 941.
However, if your only errors on Form 941 relate to the number
of employees who received wages or to federal tax liabilities
reported on Form 941, Part 2, or on Schedule B (Form 941), do
not file Form 941-X. For more information about correcting
federal tax liabilities reported on Form 941, Part 2, or on
Schedule B (Form 941), Report of Tax Liability for Semiweekly
Schedule Depositors, see the Instructions for Schedule B (Form
941).

If you did not file a Form 941 for one or more quarters, do not
use Form 941-X. Instead, file Form 941 for each of those
quarters. See also When Should You File Form 941-X below.
However, if you did not file Forms 941 because you improperly
treated workers as independent contractors or nonemployees
and are now reclassifying them as employees, see the
instructions for line 24, later.
Report the correction of underreported and overreported
amounts for the same tax period on a single Form 941-X, unless
you are requesting a refund or abatement. If you are requesting
a refund or abatement and are correcting both underreported
and overreported amounts, file one Form 941-X correcting the
underreported amounts only and a second Form 941-X
correcting the overreported amounts.

Due dates. The due date for filing Form 941-X depends on
when you discover an error and if you underreported or
overreported tax. If you underreported tax, see Underreported
tax next. For overreported amounts, you may choose to either
make an interest-free adjustment or file a claim for refund or
abatement. If you are correcting overreported amounts, see
Overreported tax—credit or Overreported tax—claim, later.
If any due date falls on a Saturday, Sunday, or legal holiday,
you may file Form 941-X on the next business day. If we receive
Form 941-X after the due date, we will treat Form 941-X as filed
on time if the envelope containing Form 941-X is properly
addressed, contains sufficient postage, and is postmarked by
the U.S. Postal Service on or before the due date, or sent by an
IRS-designated private delivery service on or before the due
date. If you do not follow these guidelines, we will consider Form
941-X filed when it is actually received. See Pub. 15 (Circular E)
or Pub. 80 (Circular SS) for more information on legal holidays
and IRS-designated private delivery services.

You will use the adjustment process if you underreported
employment taxes and are making a payment, or if you
overreported employment taxes and will be applying the credit to
Form 941 for the period during which you file Form 941-X.
However, see the Caution under Is There a Deadline for Filing
Form 941-X, later, if you are correcting overreported amounts
during the last 90 days of a period of limitations. You will use the
claim process if you overreported employment taxes and are
requesting a refund or abatement of the overreported amount.
Follow the chart on the back of Form 941-X for help in choosing
whether to use the adjustment process or the claim process. Be
sure to give us a detailed explanation on line 25 for each
correction that you show on Form 941-X.

Underreported tax. If you are correcting underreported tax,
you must file Form 941-X by the due date of the return for the
return period in which you discovered the error and pay the
amount you owe by the time you file. Doing so will generally
ensure that your correction is interest free and not subject to
failure-to-pay or failure-to-deposit penalties. See What About
Penalties and Interest, later. For details on how to make a
payment, see the instructions for lines 21–22, later.
If Form 941-X is filed late (after the due date of the return for
the return period in which you discovered the error), you must
attach an amended Schedule B (Form 941) to Form 941-X.
Otherwise, the IRS may assess an “averaged” failure-to-deposit
penalty. The total tax reported on the “Total liability for the
quarter” line of Schedule B (Form 941) must match the corrected
tax (Form 941, line 10, combined with any correction entered on
Form 941-X, line 18, minus any advance EIC reported on Form
941-X, line 19) for the quarter, less any previous abatements
and interest-free tax assessments.

Continue to report current quarter fractions of cents,
third-party sick pay, tips, and group-term life insurance on Form
941, lines 7–9.
You have additional requirements to complete when filing
Form 941-X, such as certifying that you filed (or will file) all
applicable Forms W-2, Wage and Tax Statements, and Forms
W-2c, Corrected Wage and Tax Statements, with the Social
Security Administration (SSA). For corrections of overreported
federal income tax, social security tax, Medicare tax, or
Additional Medicare Tax, you must make any certifications that
apply to your situation.
Do not use Form 941-X to correct Form CT-1, 943, 944,
944-SS, or 945. Instead, use the “X” form that
CAUTION
corresponds to those forms (Form CT-1 X, 943-X,
944-X, or 945-X).

!

Where Can You Get Help?

If you discover an error in

For help filing Form 941-X or for questions about federal
employment taxes and tax corrections, you can:
Call the IRS Business and Specialty Tax Line toll-free at
1-800-829-4933 or 1-800-829-4059 (TDD/TTY for persons who
are deaf, hard of hearing, or have a speech disability) Monday–
Friday from 7 a.m. to 7 p.m. local time (Alaska and Hawaii follow
Pacific time),
Visit the IRS website at www.irs.gov/businesses and click on
the Employment Taxes link under Businesses Topics, or

1.
2.
3.
4.

. . . . . .

January, February, March
April, May, June
July, August, September
October, November, December

Form 941-X is due

. .

April 30
July 31
October 31
January 31

The dates shown in the table above apply only to corrections of
underreported amounts. If any due date falls on a Saturday, Sunday,
or legal holiday, you may file Form 941-X on the next business day.

-2-

Instructions for Form 941-X (Rev. 4-2013)

Example—You owe tax. On February 11, 2013, you
discover that you underreported $10,000 of social security and
Medicare wages on your 2012 fourth quarter Form 941. File
Form 941-X and pay the amount you owe by April 30, 2013,
because you discovered the error in the first quarter of 2013, and
April 30, 2013, is the due date for that quarter. If you file Form
941-X before April 30, pay the amount you owe by the time you
file.

IF you are in

Overreported tax—credit. If you overreported tax on Form
941 and choose to apply the credit to Form 941 or Form 944, file
Form 941-X soon after you discovered the error but more than
90 days before the period of limitations on the credit or refund for
Form 941 expires. See Is There a Deadline for Filing Form
941-X? below.
Overreported tax—claim. If you overreported tax on Form
941, you may choose to file a claim for refund or abatement on
Form 941-X any time before the period of limitations on credit or
refund expires on Form 941. If you also need to correct any
underreported amounts, you must file another Form 941-X
reporting only corrections to the underreported amounts. See Is
There a Deadline for Filing Form 941-X? next.

!

CAUTION

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0005

Internal Revenue Service
P.O. Box 409101
Ogden, UT 84409

Use a separate Form 941-X for each Form 941 that you are
correcting. For example, if you found errors on your Forms 941
for the third and fourth quarters of 2010, file one Form 941-X to
correct the 2010 third quarter Form 941. File a second Form
941-X to correct the 2010 fourth quarter Form 941.

EIN, Name, and Address

Enter your EIN, name, and address in the spaces provided. Also
enter your name and EIN on the top of pages 2 and 3, and on
any attachments. If your address has changed since you filed
your Form 941, enter the corrected information and the IRS will
update your address of record.

Example. You filed your 2010 fourth quarter Form 941 on
January 27, 2011, and payments were timely made. The IRS
treats the return as if it were filed on April 15, 2011. On January
22, 2013, you discover that you overreported social security and
Medicare wages on that form by $350. To correct the error you
must file Form 941-X by April 15, 2014, which is the end of the
period of limitations for Form 941, and use the claim process.

Return You Are Correcting

In the box at the top of page 1, check the type of return (Form
941 or Form 941-SS) you are correcting. Check the appropriate
box for the one quarter you are correcting. Enter the calendar
year of the Form 941 you are correcting. Enter the quarter and
calendar year on pages 2 and 3. Be sure to write your name,
EIN, Form 941-X, the quarter, and calendar year on the top of
any attachments.

If you file Form 941-X to correct overreported amounts
in the last 90 days of a period of limitations (after
CAUTION
January 15, 2014, in the example above), you must use
the claim process. You cannot use the adjustment process. If
you are also correcting underreported amounts, you must file
another Form 941-X to correct the underreported amounts using
the adjustment process and pay any tax due.

!

Enter the Date You Discovered Errors

You must enter the date you discovered errors. You discover an
error when you have enough information to be able to correct it.
If you are reporting several errors that you discovered at different
times, enter the earliest date you discovered them here. Report
any subsequent dates and related errors on line 25.

Where Should You File Form 941-X?

Must You Make an Entry on Each Line?

Send your completed Form 941-X to the address shown next.

Special filing addresses for exempt
organizations; federal, state, and local
governmental entities; and Indian
tribal governmental entities;
regardless of location

Alabama, Alaska, Arizona, Arkansas,
California, Colorado, Hawaii, Idaho,
Iowa, Kansas, Louisiana, Minnesota,
Mississippi, Missouri, Montana,
Nebraska, Nevada, New Mexico,
North Dakota, Oklahoma, Oregon,
South Dakota, Texas, Utah,
Washington, Wyoming

Use a Separate Form 941-X for Each Quarter
You Are Correcting

Generally, you may correct overreported taxes on a previously
filed Form 941 if you file Form 941-X within 3 years of the date
Form 941 was filed or 2 years from the date you paid the tax
reported on Form 941, whichever is later. You may correct
underreported taxes on a previously filed Form 941 if you file
Form 941-X within 3 years of the date the Form 941 was filed.
We call each of these time frames a “period of limitations.” For
purposes of the period of limitations, Forms 941 for a calendar
year are considered filed on April 15 of the succeeding year if
filed before that date.

THEN use this address

. . . . .

How Should You Complete Form
941-X?

Is There a Deadline for Filing Form
941-X?

. . . . . . . . . . . .

THEN use this address

Department of the Treasury
Internal Revenue Service
Cincinnati, OH 45999-0005

No legal residence or principal place
of business in any state

You may not file a refund claim to correct federal
income tax or Additional Medicare Tax actually withheld
from employees.

IF you are in

. . . . . . . . . . . .

Connecticut, Delaware, District of
Columbia, Florida, Georgia, Illinois,
Indiana, Kentucky, Maine, Maryland,
Massachusetts, Michigan, New
Hampshire, New Jersey, New York,
North Carolina, Ohio, Pennsylvania,
Rhode Island, South Carolina,
Tennessee, Vermont, Virginia, West
Virginia, Wisconsin

You must provide all of the information requested at the top of
page 1. You must check one box (but not both) in Part 1. In Part
2, you must check the box on line 3 and any applicable boxes on
lines 4 and 5. In Part 3, if any line does not apply, leave it blank.
Complete Parts 4 and 5 as instructed.

. . . . .

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0005

How Should You Report Negative Amounts?

Form 941-X uses negative numbers to show reductions in tax
(credits) and positive numbers to show additional tax (amounts
you owe).
Instructions for Form 941-X (Rev. 4-2013)

-3-

When reporting a negative amount in columns 3 and 4, use a
minus sign instead of parentheses. For example, enter “-10.59”
instead of “(10.59).” However, if you are completing the return on
your computer and your software only allows you to use
parentheses to report negative amounts, you may use them.

Use the claim process. Check the box on line 2 to file a claim
on Form 941-X requesting a refund or abatement of the amount
shown on line 22.
To ensure that the IRS has enough time to process a
credit for an overreporting adjustment in the quarter
during which you file Form 941-X, you are encouraged
to file Form 941-X correcting the overreported amount in the first
two months of a quarter. For example, if you discover an
overreported amount in March, June, September, or December,
you may want to file Form 941-X in the first two months of the
next quarter. However, there must be 90 days remaining on the
period of limitations when you file Form 941-X. See the Caution
under Is There a Deadline for Filing Form 941-X, earlier. This
should ensure that the IRS will have enough time to process
Form 941-X so the credit will be posted before you file Form 941,
thus avoiding an erroneous balance due notice from the IRS.
See the example below.

TIP

How Should You Make Entries on Form 941-X?

You can help the IRS process Form 941-X timely and accurately
if you follow these guidelines.
Type or print your entries.
Use Courier font (if possible) for all typed or
computer-generated entries.
Omit dollar signs. You may use commas and decimal points, if
desired. Enter dollar amounts to the left of any preprinted
decimal point and cents to the right of it.
Always show an amount for cents. Do not round entries to
whole dollars.
Complete all three pages and sign Form 941-X on page 3.
Staple multiple sheets in the upper-left corner.

If you currently file Form 944 instead of Form 941 and will claim
a credit on Form 944, file Form 941-X before December in any
year before the expiration of the period of limitations on Form
941. In the year of the expiration of the period of limitations on
Form 941, file Form 941-X at least 90 days before the expiration
date.

What About Penalties and Interest?

Generally, your correction of an underreported amount will not
be subject to a failure-to-pay penalty, failure-to-deposit penalty,
or interest if you:
File on time (by the due date of the quarter in which you
discover the error),
Pay the amount shown on line 22 by the time you file
Form 941-X,
Enter the date you discovered the error, and
Explain in detail the grounds and facts relied on to support the
correction.

Example—You want your overreported tax applied as a
credit to Form 941. On June 21, 2013, you discover you
overreported your tax on your 2012 fourth quarter Form 941 and
want to choose the adjustment process. To allow the IRS
enough time to process the credit, you file Form 941-X on July 1,
2013, and take the credit on your third quarter 2013 Form 941.

Specific Instructions:

No correction will be eligible for interest-free treatment if any
of the following apply.
The amounts underreported relate to an issue that was raised
in an examination of a prior period.
You knowingly underreported your employment tax liability.
You received a notice and demand for payment.
You received a Notice of Determination of Worker
Classification.

Part 1: Select ONLY One Process
Because Form 941-X may be used to file either an adjusted
employment tax return or a claim for refund or abatement, you
must check one box on either line 1 or line 2. Do not check both
boxes.

1. Adjusted Employment Tax Return

If you receive a notice about a penalty after you file this
return, reply to the notice with an explanation and we will
determine if you meet the reasonable-cause criteria. Do not
attach an explanation when you file your return.

Check the box on line 1 if you are correcting underreported
amounts or overreported amounts and you would like to use the
adjustment process to correct the errors.
If you are correcting both underreported amounts and
overreported amounts on this form, you must check this box. If
you check this box, any negative amount shown on line 22 will
be applied as a credit (tax deposit) to your Form 941 or Form
944 for the period in which you are filing this form. See
Example—You want your overreported tax applied as a credit to
Form 941 above.

Overview of the Process
The process to correct a previously filed Form 941 or file a claim
is outlined below.
If you underreported the tax. If you underreported the tax
on a previously filed Form 941, check the box on line 1 and pay
any additional amount you owe by the time you file Form 941-X.
For details on how to make a payment, see the instructions for
lines 21–22, later.

If you owe tax. Pay the amount shown on line 22 by the time
you file Form 941-X. Generally, you will not be charged interest if
you file on time, pay on time, enter the date you discovered the
error, and explain the correction on line 25.

Example—You underreported employment taxes. On
June 20, 2013, you discover an error that results in additional tax
on your 2012 fourth quarter Form 941. File Form 941-X by July
31, 2013, and pay the amount you owe by the time you file. See
When Should You File Form 941-X, earlier. Do not attach Form
941-X to your 2013 second quarter Form 941.
If you overreported the tax. If you overreported the tax on a
previously filed Form 941, you may choose one of the following
options.
Use the adjustment process. Check the box on line 1 to apply
any credit (negative amount) from line 22 to Form 941 for the
quarter during which you file Form 941-X.

If you have a credit. You overreported employment taxes (you
have a negative amount on line 22) and want the IRS to apply
the credit to Form 941 or Form 944 for the period during which
you filed Form 941-X. The IRS will apply your credit on the first
day of the Form 941 or Form 944 period during which you filed
Form 941-X. However, the credit you show on Form 941-X,
line 22, may not be fully available on your Form 941 or Form 944
if the IRS corrects it during processing or you owe other taxes,
penalties, or interest. The IRS will notify you if your claimed
credit changes or if the amount available as a credit on Form 941
or Form 944 was reduced because of unpaid taxes, penalties, or
interest.
-4-

Instructions for Form 941-X (Rev. 4-2013)

boxes. Provide a summary on line 25 of the amount of the
corrections both for the employees who provided written
statements and for those who did not.

Do not check the box on line 1 if you are correcting
overreported amounts and the period of limitations on
CAUTION
credit or refund for Form 941 will expire within 90 days
of the date you file Form 941-X. Instead, check the box on line 2.
See Is There a Deadline for Filing Form 941-X, earlier.

!

4a. Check the box on line 4a if your overreported amount
includes each affected employee's share of overcollected taxes.
You are certifying that you repaid or reimbursed the employee's
share of current and prior year taxes and you received written
statements from the employees stating that they did not and will
not receive a refund or credit for the prior year taxes. You are
certifying that you adjusted federal income tax or Additional
Medicare Tax withheld from employees for the current calendar
year only.

2. Claim

Check the box on line 2 to use the claim process if you are
correcting overreported amounts only and you are claiming a
refund or abatement for the negative amount (credit) shown on
line 22. Do not check this box if you are correcting any
underreported amounts on this form.

Example. The following is an example of the written
statement that is required from employees.
Employee name
Employer name
I have received a repayment of $_________ as
overcollected social security and Medicare taxes for 20___. I
have not claimed a refund of or credit for the overcollected
taxes from the IRS, or if I did, that claim has been rejected;
and I will not claim a refund or a credit of the amount.
Employee signature
Date
Do not send these statements to the IRS. Keep them for your
records. Generally, all employment tax records must be kept for
at least 4 years.

You must check the box on line 2 if you have a credit and the
period of limitations on credit or refund for Form 941 will expire
within 90 days of the date you file Form 941-X. See Is There a
Deadline for Filing Form 941-X, earlier.
The IRS usually processes claims shortly after they are filed.
The IRS will notify you if your claim is denied, accepted as filed,
or selected to be examined. See Pub. 556, Examination of
Returns, Appeal Rights, and Claims for Refund, for more
information.
Unless the IRS corrects Form 941-X during processing or you
owe other taxes, penalties, or interest, the IRS will refund the
amount shown on line 22, plus any interest that applies.

!

CAUTION

You may not file a refund claim to correct federal
income tax or Additional Medicare Tax actually withheld
from employees.

4b. Check the box on line 4b to certify that your overreported
amount is only for the employer share of taxes on those
employees who you were unable to find or those who would not
(or could not) give you a statement described on line 4a.

Part 2: Complete the Certifications

4c. Check the box on line 4c to certify that your overreported
amount is only for federal income tax, social security tax,
Medicare tax, or Additional Medicare Tax that you did not
withhold from your employees.

You must complete all certifications that apply by checking the
appropriate boxes. If all of your corrections relate to
underreported amounts, complete line 3 only; skip lines 4 and 5
and go to Part 3. If your corrections relate to overreported
amounts, you have a duty to ensure that your employees' rights
to recover overpaid employee social security and Medicare
taxes that you withheld are protected. The certifications on lines
4 and 5 address the requirement to:
Repay or reimburse your employees for the overcollection of
employee social security and Medicare taxes, or
Obtain consents from your employees to file a claim on their
behalf.

5. Certifying Claims

If you are filing a claim for refund or abatement of overreported
federal income tax, social security tax, Medicare tax, or
Additional Medicare Tax and checked the box on line 2, check
the appropriate box on line 5. You may need to check more than
one box. If you obtained written statements or consents from
some employees but you could not locate or secure the
cooperation of the remaining employees, check all applicable
boxes. Provide a summary on line 25 of the amount of the
corrections for both the employees who provided statements or
consents and for those who did not. You may not file a refund
claim to correct federal income tax or Additional Medicare Tax
actually withheld from employees.

3. Filing Forms W-2 or Forms W-2c

Check the box on line 3 to certify that you filed or will file Forms
W-2 or Forms W-2c with the SSA, as required, showing your
employees' correct wage and tax amounts. See the General
Instructions for Forms W-2 and W-3 for detailed information
about filing requirements. References to Form W-2 on Form
941-X and in these instructions also apply to Forms W-2AS,
W-2CM, W-2GU, and W-2VI unless otherwise noted.

5a. Check the box on line 5a if your overreported tax includes
each affected employee's share of social security and Medicare
taxes. You are certifying that you repaid or reimbursed to the
employees their share of social security and Medicare taxes. For
refunds of employee social security and Medicare taxes
overcollected in prior years, you are certifying that you received
written statements from those employees stating that they did
not and will not receive a refund or credit for the prior year taxes.

You must check the box on line 3 to certify that you filed
Forms W-2 or Forms W-2c even if your corrections on Form
941-X do not change amounts shown on those forms. For
example, if your only correction to Form 941 involves misstated
tax adjustments (see the instructions for line 14, later), check the
box on line 3 to certify that you already filed all required Forms
W-2 and W-2c with the SSA.

5b. Check the box on line 5b if your overreported tax includes
each affected employee's share of social security and Medicare
taxes and you have not yet repaid or reimbursed the employee
share of taxes. You are certifying that you received consent from
each affected employee to file a claim on the employee share of
those taxes and you received written statements from those
employees stating that they did not and will not receive a refund
or credit for the prior year taxes.

4. Certifying Overreporting Adjustments

If you overreported federal income tax, social security tax,
Medicare tax, or Additional Medicare Tax and checked the box
on line 1, check the appropriate box on line 4. You may need to
check more than one box. If you obtained written statements
from some employees but you could not locate or secure the
cooperation of the remaining employees, check all applicable
Instructions for Form 941-X (Rev. 4-2013)

Example. The following is an example of the consent and
written statement that is required from employees when you are
-5-

filing a claim for refund and have not yet paid or reimbursed the
employee share of taxes.
Employee name
Employer name
I give my consent to have my employer (named above) file a
claim on my behalf with the IRS requesting $_________ in
overcollected social security and Medicare taxes for 20___. I
have not claimed a refund of or credit for the overcollected
taxes from the IRS, or if I did, that claim has been rejected;
and I will not claim a refund or a credit of the amount.
Employee signature
Date
Do not send these statements to the IRS. Keep them for your
records. Generally, all employment tax records must be kept for
at least 4 years.

line 6 (column 1)
- line 6 (column 2)
line 6 (column 3)

If the amount in column 2 is larger than the
amount in column 1, use a minus sign in column 3.

Example —Wages, tips, and other compensation
increased. You reported $9,000 as total wages, tips, and other
compensation on line 2 of your 2013 first quarter Form 941. In
May of 2013, you discovered that you had overlooked $1,000 in
tips for one of your part-time employees. To correct the error,
figure the difference on Form 941-X as shown.
Column 1 (corrected amount)
Column 2 (Form 941, line 2)
Column 3 (difference)

In certain situations, you may not have repaid or reimbursed
your employees or obtained their consents prior to filing a claim,
such as in cases where the period of limitations on credit or
refund is about to expire. In those situations, file Form 941-X, but
do not check a box on line 5. Tell us on line 25 that you have not
repaid or reimbursed employees or obtained consents.
However, you must certify that you have repaid or reimbursed
your employees or obtained consents before the IRS can grant
the claim.

10,000.00
- 9,000.00
1,000.00

Example —Wages, tips, and other compensation
decreased. You reported $9,000 as wages, tips, and other
compensation on line 2 of your 2013 first quarter Form 941. In
May of 2013, you discovered that you included $2,000 in wages
for one of your employees twice. To correct the error, figure the
difference on Form 941-X as shown.

5c. Check the box on line 5c to certify that your overreported tax
is only for the employer share of social security and Medicare
taxes. Affected employees did not give you consent to file a
claim for refund for the employee share of social security and
Medicare taxes, they could not be found, or would not (or could
not) give you a statement described on line 5b.

Column 1 (corrected amount)
Column 2 (Form 941, line 2)

7,000.00
- 9,000.00

Column 3 (difference)

-2,000.00

Example—Auto allowance; wages, tips, and other
compensation increased. You paid one of your employees a
$500 monthly auto allowance from October through December
2012, and did not treat the payments as taxable wages. In
February 2013, you realized that the payments were wages
because they were not reimbursements of deductible business
expenses that were substantiated and paid under an
accountable plan. You correct the error by treating the auto
allowance as wages subject to income, social security, and
Medicare taxes. Report the additional $1,500 of wages on lines
6, 8, and 10.

5d. Check the box on line 5d to certify that your overreported
amount is only for federal income tax, social security tax,
Medicare tax, or Additional Medicare Tax that you did not
withhold from your employees.

Part 3: Enter the Corrections for This
Quarter

TIP

What Amounts Should You Report in Part 3?

On lines 6–11, columns 1 and 2, show amounts for all of your
employees, not just for those employees whose amounts you
are correcting.

Use the amount on line 6, column 1, when you prepare
your Forms W-2 or Forms W-2c.

7. Income Tax Withheld from Wages, Tips, and
Other Compensation

If you are correcting the federal income tax withheld from wages,
tips, and other compensation you reported on Form 941, line 3,
enter the total corrected amount in column 1. In column 2, enter
the amount you originally reported or as previously corrected. In
column 3, enter the difference between columns 1 and 2. This
line does not apply to Form 941-SS.

If a correction that you report in column 4 includes both
underreported and overreported amounts (see the instructions
for lines 21–22, later), give us details for each error on line 25.
Because special circumstances apply for lines 12–17 and 19–
20d, read the instructions for each line carefully before entering
amounts in the columns.

line 7 (column 1)
- line 7 (column 2)

If you previously adjusted or amended Form 941 by
using Form 941-X or because of an IRS examination
CAUTION
change, show amounts in column 2 that include those
previously reported corrections.

!

line 7 (column 3)

If the amount in column 2 is larger than the
amount in column 1, use a minus sign in column 3.

Copy the amount in column 3 to column 4. Include any minus
sign shown in column 3.

6. Wages, Tips, and Other Compensation

If you are correcting the wages, tips, and other compensation
you reported on Form 941, line 2, enter the total corrected
amount for ALL employees in column 1. In column 2, enter the
amount you originally reported. In column 3, enter the difference
between columns 1 and 2. This line does not apply to Form
941-SS.

Generally, you may correct federal income tax
withholding errors only if you discovered the errors in
CAUTION
the same calendar year you paid the wages. However,
you may correct federal income tax withholding errors for prior
years if the amounts shown on Form 941 do not agree with the
amounts you actually withheld, that is, an administrative error or
if section 3509 rates apply. See section 13 of Pub. 15 (Circular
E) for more information about corrections during the calendar

!

If you or the IRS previously corrected the amount reported on
Form 941, line 2, enter in column 2 the amount after any
previous corrections.
-6-

Instructions for Form 941-X (Rev. 4-2013)

multiplying the amount shown in column 3. If you are correcting
both shares of tax for some employees and only the employer
share for other employees, enter the properly calculated amount
in column 4. Be sure to show your calculations on line 25.

year and about administrative errors. See section 2 of Pub. 15
(Circular E) for more information about section 3509.
Example—Failure to withhold income tax when
required. You were required to withhold $400 of federal income
tax from an employee's bonus that was paid in December of
2012 but you withheld nothing. You discovered the error on
March 15, 2013. You cannot file Form 941-X to correct your
2012 fourth quarter Form 941 because the error involves a
previous year and the amount previously reported for the
employee represents the actual amount withheld from the
employee during 2012.

Example—Social security wages decreased. Following
Example—Wages, tips, and other compensation decreased in
the instructions for line 6, the wages that you counted twice were
also taxable social security wages. To correct the error, figure
the difference on Form 941-X as shown.

Example—Administrative error reporting income tax.
You had three employees. In the fourth quarter of 2012, you
withheld $1,000 of federal income tax from employee A, $2,000
from employee B, and $6,000 from employee C. The total
amount of federal income tax you withheld was $9,000. You
mistakenly reported $6,000 on line 3 of your 2012 fourth quarter
Form 941. You discovered the error on March 15, 2013. This is
an example of an administrative error that may be corrected in a
later calendar year because the amount actually withheld from
employees' wages differs from the amount reported on Form
941. Use Form 941-X to correct the error. Enter $9,000 in
column 1 and $6,000 in column 2. Subtract the amount in
column 2 from the amount in column 1.
Column 1 (corrected amount)
Column 2 (Form 941, line 3)
Column 3 (difference)

9,000.00
- 6,000.00

9. Taxable Social Security Tips

3,000.00

!

CAUTION

The 2011 and 2012 employee tax rate for social
security is 4.2%. The employer tax rate for social
security is 6.2%.

If you are correcting the taxable social security tips you reported
on Form 941, line 5b, column 1, enter the total corrected amount
in column 1. In column 2, enter the amount you originally
reported or as previously corrected. In column 3, enter the
difference between columns 1 and 2.
line 9 (column 1)
- line 9 (column 2)
line 9 (column 3)

If the amount in column 2 is larger than the
amount in column 1, use a minus sign in column 3.

Multiply the amount in column 3 by .124 (.104 for corrections
to a 2011 or 2012 return) and report that result in column 4.
line 9 (column 3)
x .124

If the amount in column 2 is larger than the
amount in column 1, use a minus sign in column 3.

line 9 (column 4)

Multiply the amount in column 3 by .124 (.104 for corrections
to a 2011 or 2012 return) and enter that result in column 4.

(Use .104 for corrections to a 2011 or 2012 return.)
If the amount in column 3 used a minus sign, also
use a minus sign in column 4.

Note. If you are correcting only the employer share of tax on a
decrease to social security tips, use .062 (6.2%) when
multiplying the amount shown in column 3. If you are correcting
both shares of tax for some employees and only the employer
share for other employees, report the properly calculated
amount in column 4. Be sure to show your calculations on
line 25.

(Use .104 for corrections to a 2011 or 2012 return.)
If the amount in column 3 used a minus sign, also
use a minus sign in column 4.

Note. If you are correcting only the employer share of tax on a
decrease to social security wages, use .062 (6.2%) when

Instructions for Form 941-X (Rev. 4-2013)

-248.00

Note. If the example above was for a correction to a 2011 or
2012 return, the amount in column 3 would be multiplied by .104.

line 8 (column 1)
- line 8 (column 2)

line 8 (column 4)

-2,000.00
x .124

Be sure to explain the reasons for this correction on line 25.

If you are correcting the taxable social security wages you
reported on Form 941, line 5a, column 1, enter the total
corrected amount in column 1. In column 2, enter the amount
you originally reported or as previously corrected. In column 3,
enter the difference between columns 1 and 2.

line 8 (column 3)
x .124

-2,000.00

Column 4 (tax correction)

The 2011 and 2012 employee tax rate for social
security is 4.2%. The employer tax rate for social
security is 6.2%.

line 8 (column 3)

Column 3 (difference)

Column 3 (difference)
Tax rate (12.4%)

8. Taxable Social Security Wages

CAUTION

7,000.00
- 9,000.00

Use the difference in column 3 to determine your tax
correction.

Report the $3,000 as a tax correction in column 4.
Be sure to explain the reasons for this correction on line 25.

!

Column 1 (corrected amount)
Column 2 (Form 941, line 5a, column 1)

-7-

Following the Example—Wages, tips, and other
compensation increased in the instructions for line 6, the tips
that you overlooked were also taxable social security tips. To
correct the error, figure the difference on Form 941-X as shown.
Column 1 (corrected amount)
Column 2 (Form 941, line 5b, column 1)

Be sure to explain the reasons for this correction on line 25.

11. Taxable Wages and Tips Subject to
Additional Medicare Tax Withholding

If you are correcting the taxable wages and tips subject to
Additional Medicare Tax withholding that you reported on Form
941, line 5d, column 1, enter the total corrected amount in
column 1. In column 2, enter the amount you originally reported
or as previously corrected. In column 3, enter the difference
between columns 1 and 2.

10,000.00
- 9,000.00

Column 3 (difference)

1,000.00

Use the difference in column 3 to determine your tax
correction.
Column 3 (difference)
Tax rate (12.4%)

line 11 (column 1)
- line 11 (column 2)

1,000.00
x .124

Column 4 (tax correction)

line 11 (column 3)

124.00

Be sure to explain the reasons for this correction on line 25.

Multiply the amount in column 3 by .009 (0.9% tax rate) and
enter that result in column 4.

Note. If the example above was for a correction to a 2011 or
2012 return, the amount in column 3 would be multiplied by .104.

line 11 (column 3)
x .009

10. Taxable Medicare Wages and Tips

line 11 (column 4)

If you are correcting the taxable Medicare wages and tips you
reported on Form 941, line 5c, column 1, enter the total
corrected amount in column 1. In column 2, enter the amount
you originally reported or as previously corrected. In column 3,
enter the difference between columns 1 and 2.

Generally, you may correct errors to wages and tips
subject to Additional Medicare Tax withholding only if
CAUTION
you discovered the errors in the same calendar year the
wages and tips were paid to employees. However, you may
correct errors to wages and tips subject to Additional Medicare
Tax withholding for prior years if the amounts shown on Form
941 do not agree with the amounts you actually withheld, that is,
an administrative error or if section 3509 rates apply.

If the amount in column 2 is larger than the
amount in column 1, use a minus sign in column 3.

Multiply the amount in column 3 by .029 (2.9% tax rate) and
enter that result in column 4.

Example—Failure to withhold Additional Medicare Tax
when required. Employee A's wages exceeded the $200,000
withholding threshold for Additional Medicare Tax in November
2013. The total wages paid to Employee A for 2013 were
$225,000. You were required to withhold $225 ($25,000 x .009)
but you withheld nothing and did not report an amount on line 5d
of your fourth quarter 2013 Form 941. You discover the error on
March 14, 2014. You cannot file Form 941-X to correct your
2013 fourth quarter Form 941 because the error involves a
previous year and the amount previously reported for the
employee represents the actual amount withheld from the
employee during 2013.
Example—Administrative error reporting Additional
Medicare Tax withheld. Employee B's wages exceeded the
$200,000 withholding threshold for Additional Medicare Tax in
November 2013. The total wages paid to Employee B for 2013
were $225,000. You withheld $225 ($25,000 x .009) from the
employee's wages. However, on your fourth quarter 2013 Form
941 you mistakenly reported $2,500 on line 5d, column 1, and
Additional Medicare Tax withheld of $22.50 on line 5d, column 2.
You discover the error on March 14, 2014. This is an example of
an administrative error that may be corrected in a later calendar
year because the amount actually withheld differs from the
amount reported on Form 941. Use Form 941-X, line 11, to
correct the error as shown below.

line 10 (column 3)
x .029
line 10 (column 4)

If the amount in column 3 used a minus sign, also
use a minus sign in column 4.

Note. If you are correcting only the employer share of tax on a
decrease to Medicare wages and tips, use .0145 (1.45%) when
multiplying the amount in column 3. If you are correcting both
shares of tax for some employees and only the employer share
for other employees, enter the properly calculated amount in
column 4. Be sure to explain your calculations on line 25.
Example—Medicare wages and tips decreased.
Following Example—Wages, tips, and other compensation
decreased in the instructions for line 6, the wages that you
counted twice were also taxable Medicare wages and tips. To
correct the error, figure the difference on Form 941-X as shown.
Column 1 (corrected amount)
Column 2 (Form 941, line 5c, column 1)

7,000.00
- 9,000.00

Column 3 (difference)

-2,000.00

Use the difference in column 3 to determine your tax
correction.
Column 3 (difference)
Tax rate (2.9%)
Column 4 (tax correction)

If the amount in column 3 used a minus sign, also
use a minus sign in column 4.

!

line 10 (column 1)
- line 10 (column 2)
line 10 (column 3)

If the amount in column 2 is larger than the
amount in column 1, use a minus sign in column 3.

-2,000.00
x .029

Column 1 (corrected amount)
Column 2 (Form 941, line 5d, column 1)

25,000.00
- 2,500.00

Column 3 (difference)

22,500.00

-58.00

-8-

Instructions for Form 941-X (Rev. 4-2013)

capital and profits interest. If you are an estate or trust, see
section 51(i)(1) and section 152(d)(2) for more details.
Exempt wages/tips are the wages/tips paid to qualified
employees for which the employer is exempt from paying the
employer's 6.2% share of social security tax.

Use the difference in column 3 to determine your tax
correction.
Column 3 (difference)
Tax rate (0.9%)
Column 4 (tax correction)

22,500.00
x .009
202.50

!

Be sure to explain the reasons for this correction on line 25.

CAUTION

12. Section 3121(q) Notice and Demand—Tax
on Unreported Tips

13b. Number of qualified employees paid exempt wages/
tips this quarter. Enter on line 13b (column 1) the total
corrected number of qualified employees paid exempt wages/
tips to which you applied the social security tax exemption in the
quarter you are correcting. Enter on line 13b (column 2) the total
number of qualified employees originally reported on Form 941,
line 6b. If you are not correcting Form 941, line 6b, and are
making a correction on line 13a, enter on line 13b the amount
from Form 941, line 6b. See the instructions for line 13a for
definitions of qualified employee and exempt wages/tips.

Enter any corrections, including amounts reported on line 7c (for
quarters ending before 2011), amounts reported on line 5e (for
quarters ending after 2010 but before 2013), and amounts
reported on line 5f (for quarters ending after 2012), to the tax due
from a Section 3121(q) Notice and Demand on line 12. The IRS
issues a Section 3121(q) Notice and Demand to advise an
employer of the amount of tips received by employees who
failed to report or underreported tips to the employer. An
employer is not liable for the employer share of the social
security and Medicare taxes on unreported tips until a Section
3121(q) Notice and Demand for the taxes is made to the
employer by the IRS.

!

!

13c. Exempt wages/tips paid to qualified employees this
quarter. Enter the amount of exempt wages/tips paid in the
quarter you are correcting to all qualified employees. Enter the
corrected amount from Form 941, line 6c. Enter the corrected
amount in column 1. In column 2, enter the amount you originally
reported or as previously corrected. In column 3, enter the
difference between columns 1 and 2. If the amount in column 2
is larger than the amount in column 1, use a minus sign in
column 3. Multiply the amount in column 3 by .062 and enter the
result in column 4. However, to properly show the correction as a
credit or balance due item, enter a positive number in column 3
as a negative number in column 4 or a negative number in
column 3 as a positive number in column 4. See the instructions
for line 13a for definitions of qualified employee and exempt
wages/tips.

Lines 13a–13c apply only for corrections to quarters
ending after March 31, 2010, and before January 1,
2011.

Complete lines 13a–13c to correct the payroll tax exemption for
the employer's share (6.2%) of social security tax on exempt
wages/tips paid to one or more qualified employees from April 1–
December 31, 2010.
An employer must be a qualified employer to qualify for the
employer's social security tax exemption. A qualified employer
is any employer other than Federal, State, and any related
government entities. All public institutions of higher education
and Indian tribal governments are also qualified employers.

14. Tax Adjustments

Use line 14 to correct any adjustments reported on Form 941,
lines 7–9 (lines 7a–7c for quarters ending before 2011). Enter in
column 1 the total corrected amount for Form 941, lines 7–9
(lines 7a–7c for quarters ending before 2011).

For more information regarding the employer's social security
tax exemption visit IRS.gov and enter “HIRE Act” in the search
box.
13a. Number of qualified employees first paid exempt
wages/tips this quarter. Enter on line 13a (column 2) the
number of qualified employees originally reported on Form 941,
line 6a. If you are not correcting Form 941, line 6a, and are
making a correction on line 13b, enter the amount from Form
941, line 6a, on line 13a.
A qualified employee is an employee who:
Began employment with you after February 3, 2010, and
before January 1, 2011;
Certified by signed affidavit (Form W-11, Hiring Incentives to
Restore Employment (HIRE) Act Employee Affidavit, or similar
statement) under penalties of perjury that he or she has not been
employed for more than 40 hours during the 60-day period
(including 2009) ending on the date the employee begins
employment with you;
Was not employed by you to replace another employee
unless the other employee separated from employment
voluntarily or for cause (including downsizing); and
Was not related to you. An employee is related to you if he or
she is your child or a descendant of your child, your sibling or
stepsibling, your parent or ancestor of your parent, your
stepparent, your niece or nephew, your aunt or uncle, or your
in-law. An employee is also related to you if he or she is related
to anyone who owns more than 50% of your outstanding stock or
capital and profits interest or is your dependent or a dependent
of anyone who owns more than 50% of your outstanding stock or
Instructions for Form 941-X (Rev. 4-2013)

If you make a correction on line 13b, then you must
complete line 13a.

CAUTION

13. Employer's Social Security Tax Exemption

CAUTION

If you make a correction on line 13a, then you must
complete line 13b.

Enter in column 2 the total originally reported or previously
corrected amounts from Form 941, lines 7–9 (lines 7a–7c for
quarters ending before 2011). In column 3, enter the difference
between columns 1 and 2.
line 14 (column 1)
-line 14 (column 2)
line 14 (column 3)

You may need to report negative numbers in any
column. Make sure that the difference you enter in
column 3 accurately represents the change to
adjustments originally reported or previously corrected on Form
941, lines 7–9 (lines 7a–7c for quarters ending before 2011).

TIP

Copy the amount in column 3 to column 4. Include any minus
sign shown in column 3.
On line 25, describe what you misreported on Form 941. Tell
us if your adjustment is for fractions of cents, third-party sick pay,
tips, or group-term life insurance.
Example—Current quarter's third-party sick pay
underreported. You reported $6,900 (shown as “-6,900.00”) as
a third-party sick pay adjustment (reduction to tax) on line 8 of
your 2012 second quarter Form 941. You did not report any
-9-

amounts on lines 7 and 9. Your third-party sick pay adjustment
should have been $9,600 (shown as “-9,600.00”) because your
third-party sick pay payer withheld that amount of social security
and Medicare taxes from your employees. You discovered the
error in April of 2013. To correct the error, figure the difference
on Form 941-X as shown.
Column 1 (corrected amount)
Column 2 (Form 941, line 8)
Column 3 (difference)

For Additional Medicare Tax; 40% of the employee rate of
0.9%.
For income tax withholding, the rate is 3.0% of wages.
Unlike other lines on Form 941-X, enter in column 1 only the
corrected wages for workers being reclassified, not the amount
paid to ALL employees. Enter previously reported wages to
reclassified employees (if any) in column 2. To get the amount
for column 4, use the applicable section 3509 rates. The tax
correction in column 4 will be a positive number if you increased
the amount of wages you previously reported. See the
instructions for line 24 for more information.

-9,600.00
- (6,900.00)
-2,700.00

Here is how you would enter the numbers on Form 941-X.
Column 1
Column 2
(corrected amount) (Form 941, line 8)
-9,600.00
-6,900.00

18. Subtotal

Column 3
(difference)
-2,700.00

Combine the amounts from column 4 on lines 7–17.
Example. You entered “1,400.00” in column 4 on line 7,
“-500.00” in column 4 on line 8, and “-100.00” in column 4 on
line 10. Combine these amounts and enter “800.00” in column 4
on line 18.

Report “-2,700.00” as your correction in column 4.
In this example, you are claiming a credit for $2,700 in
overreported tax for your 2012 second quarter Form 941. Always
enter the same amount in column 4 (including any minus sign)
that you enter in column 3.
Be sure to explain the reasons for this correction on line 25.

Line 7
Line 8
Line 10

1,400.00
-500.00
-1,000.00

Line 18

800.00

Note. If the example above was for a correction to a quarter
ending before 2011, the references to line 8 change to line 7b.

19. Advance EIC Payments Made to Employees

15–17. Special Additions to Wages for Federal
Income Tax, Social Security Tax, Medicare Tax,
and Additional Medicare Tax

The option of receiving advance payroll payments of
EIC expired on December 31, 2010. Corrections to
CAUTION
advance EIC can be made only for quarters ending
before January 1, 2011.

!

Section 3509 provides special rates for the employee share of
income tax, social security tax, Medicare tax, and Additional
Medicare Tax withholding when workers are reclassified as
employees in certain circumstances. The applicable rate
depends on whether you filed required information returns. An
employer cannot recover any tax paid under this provision from
the employees. The full employer share of social security tax and
Medicare tax is due for all reclassifications.

If you are correcting the advance EIC payments made to your
employees that you reported on Form 941, line 9 (only for
quarters ending before January 1, 2011), enter the total
corrected amount for ALL employees in column 1. In column 2,
enter the amount you originally reported or as previously
corrected. In column 3, enter the difference between columns 1
and 2. This line does not apply to Form 941-SS.

Note. Section 3509 rates are not available if you intentionally
disregarded the requirements to withhold taxes from the
employee, or if you withheld income tax but did not withhold
social security and Medicare taxes. Section 3509 rates are also
not available for certain statutory employees.

line 19 (column 1)
- line 19 (column 2)
line 19 (column 3)

If the amount in column 2 is larger than the
amount in column 1, use a minus sign in column 3.

Copy the amount in column 3 to column 4. However, to
properly show the correction as a credit or balance due
CAUTION
item, enter a positive number in column 3 as a negative
number in column 4 or a negative number in column 3 as a
positive number in column 4. Remember, negative amounts in
column 4 represent credits and positive amounts in column 4
represent additional tax.

On lines 15–17 enter only corrections to wages resulting from
reclassifying certain workers as employees when section 3509
rates are used to calculate the taxes.

!

If the employer issued the required information returns, use
the section 3509 rates as follows.
For social security taxes, use the employer rate of 6.2% plus
20% of the employee rate of 6.2% (4.2% for 2011 and 2012), for
a total rate of 7.44% (7.04% for 2011 and 2012) of wages.
For Medicare taxes, use the employer rate of 1.45% plus 20%
of the employee rate of 1.45%, for a total rate of 1.74% of
wages.
For Additional Medicare Tax; 20% of the employee rate of
0.9%.
For income tax withholding, the rate is 1.5% of wages.

Examples. If line 19, column 3 shows “560.00,” enter
“-560.00” in column 4.
If line 19, column 3 shows “-990.00,” enter “990.00” in
column 4.
Example—Advance EIC payments increased. You filed
your 2010 fourth quarter Form 941 reporting zero (or line left
blank) on line 9. On February 17, 2011, you discovered that you
forgot to report the $1,000 in advance EIC payments you made
on behalf of John Smith, one of your employees. You made no
other EIC payments for your other employees. This is an
example of an administrative error. To correct the error, file Form
941-X showing the following.

If the employer did not issue the required information returns,
use the section 3509 rates as follows.
For social security taxes, use the employer rate of 6.2% plus
40% of the employee rate of 6.2% (4.2% for 2011 and 2012), for
a total rate of 8.68% (7.88% for 2011 and 2012) of wages.
For Medicare taxes, use the employer rate of 1.45% plus 40%
of the employee rate of 1.45%, for a total rate of 2.03% of
wages.
-10-

Instructions for Form 941-X (Rev. 4-2013)

Column 1 (corrected amount)
Column 2 (Form 941, line 9)

1,000.00
- 0.00

Column 3 (difference)

1,000.00

20c. Number of Qualified Employees Paid
Exempt Wages/Tips March 19–31

Complete this line when correcting Form 941 for the second
quarter of 2010 only. Enter on line 20c, column 1, the corrected
number of qualified employees paid exempt wages/tips from
March 19, 2010, through March 31, 2010. Include only qualified
employees for whom you are claiming the exemption. Enter on
line 20c, column 2, the number of qualified employees originally
reported on line 12c of the second quarter 2010 Form 941. If you
are not correcting line 12c of the second quarter 2010 Form 941
but you are making a correction on line 20d, enter the amount
from line 12c of the second quarter 2010 Form 941 on line 20c.
For the definition of qualified employee, see the instructions for
line 13a.

Reverse the mathematical sign of the amount in column 3
and enter your correction in column 4.
Column 4 (tax correction)

-1,000.00

Be sure to explain the reasons for this correction on line 25.
See section 13 of Pub. 15 (Circular E) for more
information about administrative errors and corrections
CAUTION
during the calendar year. The same rules that apply to
withheld federal income taxes also apply to advance EIC
payments made to employees.

!

20d. Exempt Wages/Tips Paid to Qualified
Employees March 19-31

20a. COBRA Premium Assistance Payments

Complete this line when correcting Form 941 for the second
quarter of 2010 only. Enter on line 20d the amount of exempt
wages/tips paid to qualified employees from March 19, 2010,
through March 31, 2010. For the definition of exempt wages/tips,
see the instructions for line 13a. Enter the corrected amount in
column 1. In column 2, enter the amount you originally reported
or as previously corrected. In column 3, enter the difference
between columns 1 and 2. If the amount in column 2 is larger
than the amount in column 1, use a minus sign in column 3.
Multiply the amount in column 3 by .062 and enter the result in
column 4. However, to properly show the correction as a credit
or balance due item, enter a positive number in column 3 as a
negative number in column 4 or a negative number in column 3
as a positive number in column 4.

If you are correcting the total COBRA premium assistance
payments reported on Form 941, line 12a, report on this
line 65% of the COBRA premiums for assistance eligible
individuals. Report the premium assistance credit on this line
only after the assistance eligible individual's 35% share of the
premium has been paid. For COBRA coverage provided under a
self-insured plan, COBRA premium assistance is treated as
having been made for each assistance eligible individual who
pays 35% of the COBRA premium.
Do not include the assistance eligible individual's 35% of the
premium in the amount entered on this line. For more information
on the COBRA premium subsidy, visit IRS.gov and enter
“COBRA” in the search box.
Copy the amount in column 3 to column 4. However, to
properly show the correction as a credit or balance due item,
enter a positive number in column 3 as a negative number in
column 4 or a negative number in column 3 as a positive number
in column 4. This is the same procedure as the advance EIC on
line 19.

21–22. Total

Combine lines 18–20d of column 4 and enter the result on
line 21. Copy the amount from line 21 on page 2 to line 22 on
page 3.
Your credit. If the amount entered on line 22 is less than zero,
for example, “-115.00,” you have a credit because you
overreported your federal employment taxes.
If you checked the box on line 1, include this amount on Form
941, line 11 (“Total deposits” line), for the quarter during which
you filed Form 941-X or Form 944, line 8 (“Total deposits” line),
for the year during which you filed Form 941-X. Do not make any
changes to your record of federal tax liability reported on Form
941, line 17, or Schedule B (Form 941), if your Form 941-X is
filed timely. The amounts reported on the record should reflect
your actual tax liability for the period.
If you checked the box on line 2, you are filing a claim for
refund or abatement of the amount shown.
If your credit is less than $1, we will send a refund or apply it
only if you ask us in writing to do so.

20b. Number of Individuals Provided COBRA
Premium Assistance on line 20a

Complete this line only if you are correcting Form 941, line 12b.
Enter on line 20b, column 1, the corrected number of assistance
eligible individuals provided COBRA premium assistance. Count
each assistance eligible individual who paid a reduced COBRA
premium in the quarter as one individual, whether or not the
reduced premium was for insurance that covered more than one
assistance eligible individual. For example, if the reduced
COBRA premium was for coverage for a former employee,
spouse, and two children, you would include one individual in
the number entered on line 20b for the premium assistance
entered on line 20a. Further, each individual is reported only
once per quarter. For example, an assistance eligible individual
who made monthly premium payments during the quarter would
only be reported as one individual on line 20b for that quarter.

Amount you owe. If the amount on line 22 is a positive
number, you must pay the amount you owe by the time you file
Form 941-X. You may not use any credit that you show on
another Form 941-X to pay the amount you owe, even if you filed
for the amount you owe and the credit at the same time.
If you owe tax and are filing a timely Form 941-X, do not file
an amended Schedule B (Form 941) unless you were assessed
an FTD penalty caused by an incorrect, incomplete, or missing
Schedule B (Form 941). Do not include the tax increase reported
on Form 941-X on any amended Schedule B (Form 941) you file.
If you owe tax and are filing a late Form 941-X, that is, after
the due date for Form 941 for the quarter in which you
discovered the error, you must file an amended Schedule B
(Form 941) with the Form 941-X. Otherwise, the IRS may assess
an “averaged” FTD penalty. The total tax reported on the “Total

Enter on line 20b, column 2, the number of assistance eligible
individuals provided COBRA premium assistance originally
reported on Form 941, line 12b.
Lines 20c and 20d apply only to the second quarter of
2010. These lines are used to report the number of
CAUTION
qualified employees, amount of exempt wages/tips, and
amount of employer social security tax exemption as if the
exemption were allowed for the first quarter of 2010.

!

Instructions for Form 941-X (Rev. 4-2013)

-11-

liability for the quarter” line of Schedule B (Form 941), must
match the corrected tax (Form 941, line 10, combined with any
correction reported on Form 941-X, line 18, minus any advance
EIC reported on Form 941-X, line 19), less any previous
abatements and interest-free tax assessments.
Payment methods. You may pay the amount you owe on
line 22 electronically using the Electronic Federal Tax Payment
System (EFTPS), by credit or debit card, or by a check or money
order.
The preferred method of payment is EFTPS. For more
information, visit www.eftps.gov, call EFTPS Customer Service
at 1-800-555-4477 toll free, or see Pub. 966, Electronic Federal
Tax Payment System: A Guide To Getting Started.
To pay by credit or debit card, visit the IRS website at
www.irs.gov/e-pay.
If you pay by check or money order, make it payable to
“United States Treasury.” On your check or money order, be
sure to write your EIN, “Form 941-X,” and the quarter and year
corrected.
You do not have to pay if the amount you owe is less than $1.
Previously assessed FTD penalty. If line 22 reflects
overreported tax and the IRS previously assessed a
failure-to-deposit (FTD) penalty, you may be able to reduce the
penalty. For more information, see the Instructions for
Schedule B (Form 941).

Enter the wage amounts on lines 15–17, column 1.
Enter zeros on lines 15–17, column 2.
Complete columns 3 and 4 as instructed in Part 3.
Provide a detailed statement on line 25.
Complete the signature area.
If you cannot use section 3509 rates (for example,
because the workers you treated as nonemployees
CAUTION
were certain statutory employees), file a Form 941 for
each delinquent quarter. Write “Misclassified Employees” in
dark, bold letters across the top margin of page 1 of each Form
941. Complete Form 941 using the Instructions for Form 941.
Attach a Form 941-X to each Form 941. Complete the top of
Form 941-X, including the date you discovered the error, and
provide a detailed explanation on line 25.

!

25. Explain Your Corrections

Treasury regulations require you to explain in detail the grounds
and facts relied upon to support each correction. On line 25,
describe in detail each correction you entered on lines 6–20d,
column 3. If you need more space, attach additional sheets, but
be sure to write your name, EIN, Form 941-X, quarter, and
calendar year on the top of each sheet.
You must describe the events that caused the underreported
or overreported amounts. Explanations such as “social security
and Medicare wages were overstated” or “administrative/payroll
errors were discovered” are insufficient and may delay
processing your Form 941-X because the IRS may need to ask
for a more complete explanation.

Part 4: Explain Your Corrections for
This Quarter
23. Correction of Both Underreported and
Overreported Amounts

Provide the following information in your explanation for each
correction.
Form 941-X line number(s) affected.
Date you discovered the error.
Difference (amount of the error).
Cause of the error.
You may report the information in paragraph form. The following
paragraph is an example.

Check the box on line 23 if any corrections you entered on lines
6–20d, column 3, reflect both underreported and overreported
amounts.
Example. If you had an increase to social security wages of
$15,000 for employee A and a decrease to social security wages
of $5,000 for employee B, you would enter $10,000 on line 8,
column 3. That $10,000 represents the net change from
corrections.
On line 25, you must explain the reason for both the $15,000
increase and the $5,000 decrease.

“The $1,000 difference shown in column 3 on lines 6, 8, and
10 was discovered on May 16, 2013, during an internal payroll
audit. We discovered that we included $1,000 of wages for one
of our employees twice. This correction removes the reported
wages that were never paid.”
For corrections shown on lines 15–17, column 3, explain why
the correction was necessary and attach any notice you
received from the IRS.

24. Did You Reclassify Any Workers?

Check the box on line 24 if you reclassified any workers to be
independent contractors or nonemployees. Also check this box if
the IRS (or you) determined that workers you treated as
independent contractors or nonemployees should be classified
as employees. On line 25, give us a detailed reason why any
worker was reclassified and, if you used section 3509 rates on
lines 15–17, for any worker reclassified as an employee, explain
why section 3509 rates apply and what rates you used.

Part 5. Sign Here
You must complete all three pages of Form 941-X and sign it on
page 3. If you do not sign, processing of Form 941-X will be
delayed.
Who must sign the Form 941-X? Form 941-X must be signed
by one of the following.
Sole proprietorship—The individual who owns the business.
Corporation (including a limited liability company (LLC)
treated as a corporation)—The president, vice president, or
other principal officer duly authorized to sign.
Partnership (including an LLC treated as a partnership)
or unincorporated organization—A responsible and duly
authorized member, partner, or officer having knowledge of its
affairs.
Single member LLC treated as a disregarded entity for
federal income tax purposes—The owner of the LLC or a
principal officer duly authorized to sign.
Trust or estate—The fiduciary.
Form 941-X may also be signed by a duly authorized agent of
the taxpayer if a valid power of attorney has been filed.

Return not filed because you did not treat any workers as
employees. If you did not previously file Form 941 because you
mistakenly treated all workers as independent contractors or as
nonemployees, file a Form 941 for each delinquent quarter.
On each Form 941 for which you are entitled to use section
3509 rates, complete the following steps.
Write “Misclassified Employees” in dark, bold letters across
the top margin of page 1.
Enter a zero on line 10 (“Total taxes after adjustments”).
Complete the signature area.
Attach a completed Form 941-X (see instructions next).
On each Form 941-X complete the following steps.
Complete the top of Form 941-X, including the date you
discovered the error.
-12-

Instructions for Form 941-X (Rev. 4-2013)

Form W-2GU, Guam Wage and Tax Statement
Form W-2VI, U.S. Virgin Islands Wage and Tax Statement
Form W-3SS, Transmittal of Wage and Tax Statements
Form W-2c, Corrected Wage and Tax Statement
Form W-3c, Transmittal of Corrected Wage and Tax
Statements
Form W-11, Hiring Incentives to Restore Employment (HIRE)
Act Employee Affidavit
Instructions for Form 843
Instructions for Form 941
Instructions for Schedule B (Form 941)
Instructions for Form 941-SS
Pub. 15 (Circular E), Employer's Tax Guide
Pub. 80 (Circular SS), Federal Tax Guide for Employers in the
U.S. Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands
Pub. 966, Electronic Federal Tax Payment System: A Guide
To Getting Started

Alternative signature method. Corporate officers or duly
authorized agents may sign Form 941-X by rubber stamp,
mechanical device, or computer software program. For details
and required documentation, see Rev. Proc. 2005-39. You can
find Rev. Proc. 2005-39, 2005-28 I.R.B. 82, at www.irs.gov/irb/
2005-28_IRB/ar16.html.

Paid Preparer Use Only

A paid preparer must sign Form 941-X and provide the
information in the Paid Preparer Use Only section of Part 5 if the
preparer was paid to prepare Form 941-X and is not an
employee of the filing entity. Paid preparers must sign paper
returns with a manual signature. The preparer must give you a
copy of the return in addition to the copy to be filed with the IRS.
If you are a paid preparer, enter your Preparer Tax
Identification Number (PTIN) in the space provided. Include your
complete address. If you work for a firm, enter the firm's name
and the EIN of the firm. You can apply for a PTIN online or by
filing Form W-12, IRS Paid Preparer Tax Identification Number
(PTIN) Application and Renewal. For more information about
applying for a PTIN online, visit the IRS website at www.irs.gov/
ptin. You cannot use your PTIN in place of the EIN of the tax
preparation firm.
Generally, you are not required to complete this section if you
are filing the return as a reporting agent and have a valid Form
8655, Reporting Agent Authorization, on file with the IRS.
However, a reporting agent must complete this section if the
reporting agent offered legal advice, for example, advising the
client on determining whether its workers are employees or
independent contractors for federal tax purposes.

Paperwork Reduction Act Notice We ask for the information
on Form 941-X to carry out the Internal Revenue laws of the
United States. We need it to figure and collect the right amount
of tax. Subtitle C, Employment Taxes, of the Internal Revenue
Code imposes employment taxes on wages, including income
tax withholding. This form is used to determine the amount of
taxes that you owe. Section 6011 requires you to provide the
requested information if the tax is applicable to you.
You are not required to provide the information requested on
a form that is subject to the Paperwork Reduction Act unless the
form displays a valid OMB control number. Books and records
relating to a form or instructions must be retained as long as their
contents may become material in the administration of any
Internal Revenue law.

How Can You Order Forms,
Instructions, and Publications from
the IRS?

The time needed to complete and file Form 941-X will vary
depending on individual circumstances. The estimated average
time is:

Visit the IRS website at www.irs.gov/formspubs.

Recordkeeping . . . . . . . . . . . . . . . . . . . . . . .
Learning about the law or the form
. . . . . . . . . . . .
Preparing and sending the form to the IRS . . . . . . . .

Call 1-800-TAX-FORM (1-800-829-3676).

If you have comments concerning the accuracy of these time
estimates or suggestions for making Form 941-X simpler, we
would be happy to hear from you. You can email us at:
[email protected]. Enter "Form 941-X" on the subject line. Or
write to: Internal Revenue Service, Tax Products Coordinating
Committee, SE:W:CAR:MP:T:MS, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Do not send Form 941-X to
this address. Instead, see Where Should You File Form 941-X,
earlier.

Additional Information
You may find the following products helpful when using Form
941-X.
Form W-2, Wage and Tax Statement
Form W-3, Transmittal of Wage and Tax Statements
General Instructions for Forms W-2 and W-3
Form W-2AS, American Samoa Wage and Tax Statement
Form W-2CM, Wage and Tax Statement (Northern Mariana
Islands)

Instructions for Form 941-X (Rev. 4-2013)

16 hr., 15 min.
30 min.
47 min.

-13-