Form 943-X:

(Rev. February 2014)

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 Are Correcting ...

Enter the Calendar Year of the return 

you are correcting:

(YYYY)

Enter the date you discovered errors:

(MM / DD / YYYY)

Read the separate instructions before you complete 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 20, 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 20. 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 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 adjustments of social security tax and Medicare tax are 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, 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 and Medicare tax for 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 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, Medicare tax, or Additional Medicare Tax that I did not withhold from 

employee wages.

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For Paperwork Reduction Act Notice, see the separate instructions. IRS.gov/form943x Cat. No. 20332F Form 943-X (Rev. 2-2014)
Name (not your trade name) Employer identification number (EIN) Calendar Year (YYYY)

Part 3: Enter the corrections for the calendar year you are correcting. If any line does not apply, leave it blank.

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) . — . = . × .124* = .

*If you are correcting a 2011 or 2012 return, use .104. If you are correcting 

your employer share only, use .062. See instructions.

7. Total wages subject to 

Medicare tax (Form 943, line 4) . — . = . × .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 = .

9. Federal income tax withheld 

(Form 943, line 8 (line 6 for years 

ending before January 1, 2013)) 

. — . = . Copy Column 

3 here ▶ .

10a. Number of qualified employees paid 

exempt wages April 1 – December 

31, 2010 (Form 943, line 7a)*

— = *Complete lines 10a 

and 10b only for 

corrections to the 

2010 Form 943. 

10b. Exempt wages paid to qualified 

employees April 1 – December 31, 

2010 (Form 943, line 7b)*

. — . = . × .062 = .

11. Tax adjustments (Form 943, 

line 10 (line 8 for years ending 

before January 1, 2013)) 

. — . = . 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 .

16. Subtotal: Combine the amounts in lines 6–15 of Column 4 . . . . . . . . . . . . . . . . . . . .

17. Advance earned income credit (EIC) 

payments made to employees (Form 

943, line 10; only for years ending before 

January 1, 2011)

. — . = . See 

instructions .

18a. COBRA premium assistance payments 

(Form 943, line 13a for calendar years 

2010 and 2013 (line 11a for calendar 

years 2011 and 2012))

. — . = . See 

instructions .

18b. Number of individuals provided COBRA 

premium assistance (Form 943, line 13b 

for calendar years 2010 and 2013 (line 

11b for calendar years 2011 and 2012))

— =

*Complete lines 18c and 

18d only for corrections 

to the 2010 Form 943.

18c. Number of qualified employees 

paid exempt wages March 19–31, 

2010 (Form 943, line 13c)*

— =

18d. Exempt wages paid to qualified 

employees March 19–31, 2010 

(Form 943, line 13d)* . — . = . × .062 = .

15. Special addition to wages for 

Additional Medicare Tax . — . = . See 

instructions .

19. Total. Combine the amounts in lines 16–18d of Column 4. Continue to next page. . . . . . . . . . . . .

Next ■▶

Page 2 Form 943-X (Rev. 2-2014)
Name (not your trade name) Employer identification number (EIN) Calendar Year (YYYY)

Part 3: Continued

20. Total. Amount from line 19 on page 2 . . . . . . . . . . . . . . . . . . . . . . . . . .

If line 20 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 20 is more than zero, 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 20.

Part 4: Explain your corrections for the calendar year you are correcting.

21. 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 23.

22. Check here if any corrections involve reclassified workers. Explain on line 23.

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

✗ Sign your 

name here

Date

Print your 

name here

Print your 

title here

Best daytime phone

Paid Preparer Use Only Check if you are 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. 2-2014)
Type of errors Form 943-X: Which process should you use? 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 20 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 the adjustment process or the claim 

process to correct the overreported amounts.

Choose the adjustment process if you want

the amount shown on line 20 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 20 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 20.

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 20 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.

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 20 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.

Page 4 Form 943-X (Rev. 2-2014)