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

Form

944-X:

(Rev. February 2015)

Adjusted Employer’s ANNUAL Federal Tax Return or Claim for Refund
Department of the Treasury — Internal Revenue Service

OMB No. 1545-2007

Return You Are Correcting ...

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Employer identification number (EIN)

Check the type of return you are
correcting:

Name (not your trade name)

944
Trade name (if any)

944-SS

Address
Number

Street

Suite or room number

Enter the calendar year you are
correcting:
(YYYY)

City

State

ZIP code

Enter the date you discovered errors:
Foreign country name

Foreign province/county

Foreign postal code

Read the separate instructions before completing this form. Use this form to correct errors
you made on Form 944 or Form 944-SS. Use a separate Form 944-X for each year that
needs correction. Type or print within the boxes. You MUST complete all three pages. Do
not attach this form to Form 944.

Part 1:

/
/
(MM / DD / YYYY)

Select ONLY one process. See page 4 for additional guidance.

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 19, if less than zero, may only be applied as a credit to your Form 944,
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 19. 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. If you are correcting overreported
amounts, for purposes of the certifications on lines 4 and 5, Medicare tax does not include Additional Medicare Tax. Form 944-X cannot be
used to correct overreported amounts of Additional Medicare Tax unless the amounts were not withheld from employee wages.
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 tax and Medicare tax for prior years. I have a
written statement from each affected 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 adjustments of social security tax and Medicare tax are for the employer’s share only. I could not find the affected employees or
each affected 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, Medicare tax, or Additional 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 overcollected social security tax and Medicare tax for prior years. I have a
written statement from each affected 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 tax
and Medicare tax overcollected in prior years. I also have a written statement from each affected 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
affected employee did not give me a written consent to file a claim for the employee’s share of social security tax and Medicare tax;
or each affected 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, Medicare tax, or Additional Medicare Tax that I did not withhold from
employee wages.
Next ■▶
For Paperwork Reduction Act Notice, see the separate instructions.

IRS.gov/form944x

Cat. No. 20335M

Form 944-X (Rev. 2-2015)

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 1

Column 2

Total corrected
amount (for ALL
employees)

6.

7.

Correcting Calendar Year (YYYY)

Wages,
tips
and
other
compensation (Form 944, line 1)

Federal income tax withheld from
wages,
tips,
and
other
compensation (Form 944, line 2)

.

.

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

=

—

=

.

—

Column 3

Column 4

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

Tax correction

=

.

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

.

Copy
Column 3
▶
here

.

.

8.

Taxable social security wages
—
× .124* =
=
(Form 944 or Form 944-SS, line
.
.
.
.
4a, Column 1)
*If you are correcting a 2011 or 2012 return, use .104. If you are correcting your employer share only, use .062. See instructions.

9.

Taxable social security tips
—
× .124* =
=
(Form 944 or Form 944-SS, line
.
.
.
.
4b, Column 1)
*If you are correcting a 2011 or 2012 return, use .104. If you are correcting your employer share only, use .062. See instructions.

10.

11.

12.

13.

14.

15.

16.

17.

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

.

Taxable wages & tips subject to
Additional Medicare Tax withholding
(Form 944 line 4d, only for years
beginning after December 31, 2012)

.

× .029* =

.

.

—

=

.

× .009* =

.

.

*Certain wages & tips reported in Column 3 should not be multiplied by .009. See instructions.

.

Special addition to wages for
federal income tax

.

Special addition to wages for
social security taxes

.

Special addition to wages for
Medicare taxes

.

Special addition to wages for
Additional Medicare Tax

.

—

.

=

.

—

=

.

—

=

.

—

=

.

—

Subtotal. Combine the amounts on lines 7–16 of Column 4

18b. Number of individuals provided
COBRA premium assistance
(see instructions)

=

.

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

Tax adjustments (Form 944 or
Form 944-SS, line 6)

18a. COBRA premium assistance
payments (see instructions)

19.

—

=

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.

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—

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Copy
Column 3
▶
here

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.

See
instructions

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.

See
instructions

.

.

See
instructions

.

.

See
instructions

.

.

.

.

=

.

—

Total. Combine the amounts on lines 17 and 18a of Column 4 .

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See
instructions

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=

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If line 19 is less than zero:
• If you checked line 1, this is the amount you want applied as a credit to your Form 944 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 19 is more than zero, this is the amount you owe. Pay this amount by the time you file this return. For information on how to pay,
see Amount you owe in the instructions.
Next ■▶
Page 2

Form 944-X (Rev. 2-2015)

Name (not your trade name)

Part 4:

Employer identification number (EIN)

Correcting Calendar Year (YYYY)

Explain your corrections for the calendar year you are correcting.

20.

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 22.

21.

Check here if any corrections involve reclassified workers. Explain on line 22.

22.

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

/

/

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

Phone

City
Page 3

State

/

.

.

/

ZIP code
Form 944-X (Rev. 2-2015)

Type of errors
you are
correcting

Form 944-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 19 by the time you file Form 944-X.

Overreported
amounts
ONLY

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 the adjustment process or the claim
process to correct the overreported amounts.
Choose the adjustment process if you want the
amount shown on line 19 credited to your Form 944,
941, or 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 19 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, 941, or 941-SS.
• File one Form 944-X, and
• Check the box on line 1 and follow the instructions
on line 19.
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 19
by the time 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
the 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 19 by
the time 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.

Page 4

Form 944-X (Rev. 2-2015)