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
For Paperwork Reduction Act Notice, see the separate instructions.
www.irs.gov/Form943X Cat. No. 20332F
Form
943-X (Rev. 2-2018)
Name (not your trade name) Employer identification number (EIN)
Correcting Calendar Year (YYYY)
Enter the corrections for the calendar year you’re correcting. If any line doesn’t apply, leave it blank.Part 3:
Column 1
Total corrected
amount (for ALL
employees)
Column 2
Amount originally reported
or as previously corrected
(for ALL employees)
=
Column 3
Difference (If this amount
is a negative number, use
a minus sign.)
Column 4
Tax correction
6.
Total wages subject to social
security tax (Form 943, line 2)
.
.
=
.
× 0.124* = .
*If you’re correcting your employer share only, use 0.062. See instructions.
7.
Total wages subject to
Medicare tax (Form 943, line 4)
.
.
=
. × 0.029* = .
*If you’re correcting your employer share only, use 0.0145. See instructions.
8. Total wages subject to
Additional Medicare Tax
withholding (Form 943, line 6)
.
.
=
. × 0.009* = .
*Certain wages reported in Column 3 shouldn’t be multiplied by 0.009. See instructions.
9.
Federal income tax withheld
(Form 943, line 8)
.
.
=
.
Copy Column
3 here
.
10.
Tax adjustments (Form 943,
line 10)
.
.
=
.
See
instructions
.
11.
Qualified small business payroll
tax credit for increasing research
activities (Form 943 line 12; you
must attach Form 8974)
.
.
=
.
See
instructions
.
12.
Special addition to wages for
federal income tax
.
.
=
.
See
instructions
.
13.
Special addition to wages for
social security taxes
.
.
=
.
See
instructions
.
14.
Special addition to wages for
Medicare taxes
.
.
=
.
See
instructions
.
15.
Special addition to wages for
Additional Medicare Tax
.
.
=
.
See
instructions
.
16. Subtotal. Combine the amounts on lines 6–15 of Column 4 . . . . . . . . . . . . . . . . . .
.
17a.
COBRA premium assistance
payments (see instructions)
.
.
=
.
See
instructions
.
17b.
Number of individuals
provided COBRA premium
assistance (see instructions)
=
18.
Total. Combine the amounts on lines 16 and 17a of Column 4 . . . . . . . . . . . . . . . . .
.
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’re 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 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. 2-2018)
Name (not your trade name) Employer identification number (EIN)
Correcting Calendar Year (YYYY)
Explain your corrections for the calendar year you’re correcting.Part 4:
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 instructions.
Sign here. You must complete all three pages of this form and sign it.Part 5:
Under penalties of perjury, I declare that I have filed an original Form 943 and that I have examined this adjusted return or claim, including accompanying
schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is
based on all information of which preparer has any knowledge.
Sign your
name here
Date / /
Print your
name here
Print your
title here
Best daytime phone
Paid Preparer Use Only
Check if you’re self-employed . . . . . . . .
Preparer’s name
Preparer’s signature
Firm’s name (or yours if
self-employed)
Address
City State
PTIN
Date / /
EIN
Phone
ZIP code
Page 3 Form 943-X (Rev. 2-2018)
click to sign
signature
click to edit
dd mmm yyyy
dd mmm yyyy
click to sign
signature
click to edit
Form 943-X: Which process should you use?
Type of errors
you’re
correcting
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 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’re 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 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.
If you’re 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.
BOTH
underreported
and
overreported
amounts
The process you
use depends on
when you file
Form 943-X.
If you’re 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 18.
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 18 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’re 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 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. 2-2018)
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