Part 1: Select ONLY one process.

Part 2: Complete the certifications.

Enter the date you discovered errors:

Next ©

943-X:

(Rev. March 2010)

OMB No. 1545-0035

Adjusted Employer’s Annual Federal Tax Return for Agricultural 

Employees or Claim for Refund

Department of the Treasury — Internal Revenue Service

Employer identification number

Name (not your trade name)

Address Number Street Suite or room number

City State ZIP code

Use this form to correct errors you made on Form 943, Employer’s Annual Federal Tax Return 

for Agricultural Employees, for one year only. Please type or print within the boxes. Do not 

attach this form to Form 943.

Return You Are Correcting ...

Form

— (EIN)

Enter the Calendar Year of the return

you are correcting:

/ /

(MM / DD / YYYY)

(YYYY)

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 16, if less than 0, 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 16. Do not check this box if you are correcting ANY underreported amounts on this form.

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. (Check at least one.)

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.

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 refund 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.

5. If you checked line 2 because you are claiming a refund or abatement of overreported employment taxes, check all that apply.

(Check at least one.)

I certify that:

Trade Name (if any)

You MUST complete all three pages. Read the instructions before you complete this form.
—

Part 3: Enter the corrections for this year. If any line does not apply, leave it blank.

Page 2 Form 943-X (Rev. 3-2010)

Name (not your trade name) Employer Identification Number (EIN)

6.

7.

8.

9.

Column 1 Column 2

Total wages subject to social

security tax

(from line 2 of Form 943)

Total wages subject to

Medicare tax

(from line 4 of Form 943)

Federal income tax withheld

(from line 6 of Form 943)

Tax adjustments

(from line 8 of Form 943)

Special addition to wages for

federal income tax

Special addition to wages for

Medicare taxes

13. Subtotal: Combine the amounts in lines 6–12 of Column 4 

—

—

—

=

=

=

If line 16 is more than 0, 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 16.

Total corrected

amount (for ALL

employees)

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

— =

— =

— =

3 .124* =

Special addition to wages for

social security taxes — =

Advance earned income

credit (EIC) payments made

to employees

(from line 10 of Form 943)

16. Total: Combine the amounts in lines 13, 14, and 15a of Column 4 

If line 16 is less than 0:

— = See

instructions

Calendar Year (YYYY)

10.

11.

12.

14.

● 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.

See

instructions

See

instructions

See

instructions

Copy Column 

3 here ©

*If you are correcting your employer share only, use .062. See instructions.

3 .029* =

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

See

instructions

Next ©

. . . .

. . .

. . .

. . .

. . .

. . .

. . .

.

.

.

.

.

.

.

.

.

. . .

Number of individuals

provided COBRA premium

assistance (from line 13b of

Form 943)

— =

COBRA premium assistance

payments (from line 13a of

Form 943)

— = 15a.

15b.

See

. . . instructions .
17.

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 19.

Check here if any corrections involve reclassified workers. Explain on line 19.

Form 943-X (Rev. 3-2010)

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

Preparer’s name

Firm’s name (or yours if

self-employed)

Address

EIN

Phone

ZIP code

Check if you are self-employed 

City State

( ) –

Page 3

Part 4: Explain your corrections for this year.

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.

Sign your

name here

Print your

name here

Date / / Best daytime phone ( ) –

Print your

title here

Name (not your trade name) Employer Identification Number (EIN) Calendar Year (YYYY)

Preparer’s signature

Paid preparer’s use only

Preparer’s

SSN/PTIN

Date / /
Form 943-X: Which process should you use? Type of errors

you are

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 16 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 16 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 16 refunded to you or

abated. 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 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 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 16.

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 16 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.

You must use both the adjustment process and

claim process.

File two separate forms:

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 . . . 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 16 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. 3-2010)