Form 943-X Adjusted Employer¿s Annual Federal Tax Return for Agricu

Form

943-X:

Adjusted Employer’s Annual Federal Tax Return for Agricultural
Employees or Claim for Refund

(Rev. February 2013)

Department of the Treasury — Internal Revenue Service

Employer identification number
(EIN)

OMB No. 1545-0035

Return You Are Correcting ...

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Enter the Calendar Year of the return
you are correcting:

Name (not your trade name)

(YYYY)
Trade Name (if any)
Address
Number

Street

City

Suite or room number

State

ZIP code

Enter the date you discovered errors:

(MM / DD / YYYY)

Use this form to correct errors you made on Form 943, Employer’s Annual Federal Tax
Return for Agricultural Employees. Use a separate Form 943-X for each year that needs
correction. Please type or print within the boxes. Do not attach this form to Form 943.
You MUST complete all three pages. Read the separate 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
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 zero, 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
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 (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 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.
(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; or each
employee did not give me a written consent to file a refund 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 Paperwork Reduction Act Notice, see the separate instructions.

IRS.gov/form943x

Cat. No. 20332F

Form 943-X (Rev. 2-2013)

Name (not your trade name)

Part 3:

Employer Identification Number (EIN)

Enter the corrections for the calendar year you are correcting. If any line does not apply, leave it blank.
Column 2

Column 3

Column 4

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

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

Tax correction

Column 1
Total corrected
amount (for ALL
employees)

6.

7.

8.

Total wages subject to social
security tax
(Form 943, line 2)

.

Total wages subject to
Medicare tax
(Form 943, line 4)

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Federal income tax withheld
(Form 943, line 6)

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9b. Exempt wages paid to
qualified employees April 1 –
December 31, 2010
(Form 943, line 7b)*

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× .124* =

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=

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× .029* =

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

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=

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11.

Special addition to wages for
federal income tax

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12.

Special addition to wages for
social security taxes

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13.

Special addition to wages for
Medicare taxes

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14.

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

15.

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16c. Number of qualified
employees paid exempt
wages March 19–31, 2010
(Form 943, line 13c)*
.

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× .062 =

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See
instructions

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See
instructions

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See
instructions

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See
instructions

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See
instructions

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See
instructions

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*Complete lines
16c and 16d
only for
corrections to
the 2010
Form 943.

=

Total. Combine the amounts in lines 14–16d of Column 4. Continue to next page.

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*Complete lines
9a and 9b only
for corrections
to the 2010
Form 943.

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Copy Column
3 here ▶

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=

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Tax adjustments
(Form 943, line 8)

16d. Exempt wages paid to
qualified employees March
19–31, 2010 (Form 943,
line 13d)*

=

.

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10.

Advance earned income
credit (EIC) payments made
to employees (Form 943, line
10; only for years ending before
January 1, 2011)
16a. COBRA premium assistance
payments (Form 943, line 11a (line
13a for years ending before
January 1, 2011))
16b. Number of individuals provided
COBRA premium assistance
(Form 943, line 11b (line 13b for years
ending before January 1, 2011))

=

*If you are correcting a 2011 or 2012 return , use .104. If you are correcting
your employer share only, use .062. See instructions.

9a. Number of qualified
employees paid exempt
wages April 1 – December 31,
2010 (Form 943, line 7a)*

17.

Calendar Year (YYYY)

× .062 =

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Next ■▶

Page 2

Form 943-X (Rev. 2-2013)

Name (not your trade name)

Part 3:
18.

Employer Identification Number (EIN)

Calendar Year (YYYY)

Continued

Total. Amount from line 17 on page 2 .

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If line 18 is less than zero:
• 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 18 is more than zero, 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 for line 18.

Part 4:

Explain your corrections for the calendar year you are correcting.

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 for how you determined your corrections. See the separate 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 Use Only

Check if you are self-employed

Preparer’s name

PTIN

Preparer’s signature

Date

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

EIN

Address
City
Page 3

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Phone
State

ZIP code
Form 943-X (Rev. 2-2013)

Type of errors
you are
correcting

Form 943-X: Which process should you use?

Underreported
amounts ONLY

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 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 18 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 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 943-X.

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

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 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 you want to
offset your underreported amounts with your
overreported amounts.
• File one Form 943-X, and
• Check the box on line 1 and follow the
instructions on line 18.
OR
Choose both the adjustment process and
claim process if you want the overreported
amount refunded to you.
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 18 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 18 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 (Rev. 2-2013)