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 2015)

Department of the Treasury — Internal Revenue Service

Employer identification number
(EIN)

OMB No. 1545-0035

Return You Are Correcting ...

—

Enter the calendar year of the return
you are correcting:

Name (not your trade name)

(YYYY)
Trade Name (if any)
Address
Number

Street

Suite or room number

Enter the date you discovered errors:
/

City

Foreign country name

State

Foreign province/county

ZIP code

/

(MM / DD / YYYY)

Foreign postal code

Read the separate instructions before completing this form. 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. Type or print within
the boxes. You MUST complete all three pages. Do not attach this form to Form 943.

Part 1: 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 17, 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 17. 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 943-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 refund 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/form943x

Cat. No. 20332F

Form 943-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 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.

Correcting Calendar Year (YYYY)

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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—

=
=

.

× .124* =

.

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

.

—

=

.

× .029* =

.

.

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

8.

Total wages subject to Additional
Medicare Tax withholding (Form 943,
line 6; only for years beginning after
December 31, 2012)

.

—

=

.

× .009* =

.

.

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

9.

Federal income tax withheld
(Form 943, line 8 (line 6 for years
ending before January 1, 2013))

.

10.

Tax adjustments (Form 943,
line 10 (line 8 for years ending
before January 1, 2013))

.

11.

Special addition to wages for
federal income tax

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12.

Special addition to wages for
social security taxes

.

13.

Special addition to wages for
Medicare taxes

.

14.

Special addition to wages for
Additional Medicare Tax

.

15.

Subtotal. Combine the amounts on lines 6–14 of Column 4

16 a.

COBRA premium assistance payments
(see instructions)

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=

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=

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Total. Combine the amounts on lines 15 and 16a of Column 4

=

.

—

17.

=

.

—

Number of individuals provided COBRA
premium assistance (see instructions)

=

.

—

16b.

=

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Copy Column
3 here ▶

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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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If line 17 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 17 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 943-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.

18.

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 20.

19.

Check here if any corrections involve reclassified workers. Explain on line 20.

20.

You must give us a detailed explanation for how you determined your corrections. See the instructions.

Part 5:

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

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

✗

Print your
name here

Sign your
name here

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

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/

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/

ZIP code
Form 943-X (Rev. 2-2015)

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 17 by the time 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 the adjustment process or the claim
process to correct the overreported amounts.
Choose the adjustment process if you want
the amount shown on line 17 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 17 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 combining
your underreported amounts and overreported
amounts results in a balance due or creates a
credit that you want applied to Form 943.
• File one Form 943-X, and
• Check the box on line 1 and follow the
instructions on line 17.
OR
Choose both the adjustment process and the
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 17 by the time 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 17 by the time 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.

Page 4

Form 943-X (Rev. 2-2015)