Form 943-X:
(Rev. February 2018)
Adjusted Employer’s Annual Federal Tax Return for Agricultural
Employees or Claim for Refund
Department of the Treasury — Internal Revenue Service OMB No. 1545-0035
Employer identification number
(EIN)
—
Name (not your trade name)
Trade Name (if any)
Address
Number Street Suite or room number
City State ZIP code
Foreign country name Foreign province/county Foreign postal code
Return You’re Correcting ...
Enter the calendar year of the return
you’re correcting:
(YYYY)
Enter the date you discovered errors:
/ /
(MM / DD / YYYY)
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. Don’t attach this form to Form 943 unless you’re reclassifying workers; see the
instructions for line 20.
Select ONLY one process. See page 4 for additional guidance.
Part 1:
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’re 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’re 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. Don’t check this box if you’re correcting ANY underreported amounts on this form.
Complete the certifications.Part 2:
3. I certify that I’ve 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’re correcting underreported amounts only, go to Part 3 on page 2 and skip lines 4 and 5. If you’re correcting overreported
amounts, for purposes of the certifications on lines 4 and 5, Medicare tax doesn’t include Additional Medicare Tax. Form 943-X can’t be
used to correct overreported amounts of Additional Medicare Tax unless the amounts weren’t withheld from employee wages.
4. If you checked line 1 because you’re 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 hasn’t claimed (or the claim was rejected) and won’t 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 couldn’t find the affected employees or
each affected employee didn’t give me a written statement that he or she hasn’t claimed (or the claim was rejected) and won’t 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 didn’t withhold from
employee wages.
5. If you checked line 2 because you're 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 hasn’t claimed (or the claim was rejected) and won’t 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 hasn’t claimed (or the claim was rejected) and won’t 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 couldn’t find the affected employees; or each
affected employee didn’t 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 didn’t give me a written statement that he or she hasn’t claimed (or the claim was rejected)
and won’t 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 didn’t withhold from
employee wages.
Next
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For Paperwork Reduction Act Notice, see the separate instructions.
www.irs.gov/Form943X Cat. No. 20332F
Form
943-X (Rev. 2-2018)
