OMB No. 1545-0256 Supporting Statement To Correct Information Form 941c

(Rev. October 2006)

© File with Forms 941, 941-M, 941-SS, 943, 944, 944(SP), 944-SS, 945, or Form 843.

Page

No.

Department of the Treasury

Internal Revenue Service

Name Employer identification number (EIN)

Telephone number (optional) This form supports adjustments to Form: Check only one box. (see instructions)

941 941-SS

944

Enter the date that you discovered the error(s) reported on this form.

(If you are making more than one correction and the errors were not

discovered at the same time, explain in Part V.) ©

This form is attached to and filed with the return for the

period ending (month, year) ©

Signature and Certification (You must complete this part for the IRS to process your adjustments for

overpayments.) Skip Part I if all of your adjustments are underpayments. (Part I applies to wages only.)

I certify that Forms W-2c, Corrected Wage and Tax Statement, have been filed (as necessary) with the Social Security

Administration, and that (check appropriate boxes):

All overcollected federal income taxes for the current calendar year and all social security and Medicare taxes for the

current and prior calendar years have been repaid to employees. For claims of overcollected employee social security and

Medicare taxes in earlier years, a written statement has been obtained from each employee stating that the employee has

not claimed and will not claim refund or credit for the amount of the overcollection.

All affected employees have given their written consent to the allowance of this credit or refund. For claims of

overcollected employee social security and Medicare taxes in earlier years, a written statement has been obtained from

each employee stating that the employee has not claimed and will not claim refund or credit for the amount of the

overcollection.

The social security tax and Medicare tax adjustments represent the employer’s share only. An attempt was made to

locate the employee(s) affected, but the affected employee(s) could not be located or will not comply with the certification

requirements.

None of this refund or credit was withheld from employee wages.

Sign

Here Signature © Title © Date ©

Federal Income Tax Withholding (Including Backup Withholding) Adjustment

(a)

Period Corrected (For quarterly

returns, enter date quarter ended.

For annual returns, enter year.)

(c)

Correct Withheld

Income Tax for

Period

(b)

Withheld Income Tax

Previously Reported

for Period

(d)

Withheld Income

Tax Adjustment

1

2

3

4

5 Net withheld income tax adjustment. If more than one page, enter total of all columns (d) on first

page only. Enter here and on the appropriate line of the return with which you file this form. © 5

Social Security Tax Adjustment (Use the tax rate in effect during the period(s) corrected. You must also

complete Part IV.)

(f)

Social Security Tax

Adjustment

(e)

Correct Tips for

Period

(d)

Tips Previously

Reported for Period

(c)

Correct Wages for

Period

(b)

Wages Previously

Reported for Period

(a)

Period Corrected (For quarterly

returns, enter date quarter ended.

For annual returns, enter year.)

1

2

3

4

5 Totals. If more than one page,

enter totals on first page only ©

Net social security tax adjustment. If more than one page, enter total of all columns (f) on first

page only. Enter here and on the appropriate line of the return with which you file this form ©

6

6

7 Net wage adjustment. If more than one page, enter total of all lines 7 on first page only. If line 5(c)

is smaller than line 5(b), enter difference in parentheses © 7

8 Net tip adjustment. If more than one page, enter total of all lines 8 on first page only. If line 5(e)

is smaller than line 5(d), enter difference in parentheses © 8

For Paperwork Reduction Act Notice, see page 4. Form 941c (Rev. 10-2006)

Part I

Part II

Part III

Do Not File Separately

A

B C

Cat. No. 11242O

941-M

944(SP)

943

944-SS 945
Form 941c (Rev. 10-2006) Page 2

Medicare Tax Adjustment

(d)

Medicare Tax

Adjustment

(a)

Period Corrected (For quarterly

returns, enter date quarter ended.

For annual returns, enter year.)

(c)

Correct Wages

and Tips for

Period

(b)

Wages and Tips

Previously Reported

for Period

1

2

3

4

5 Totals. If more than one page, enter totals on first page only ©

6 Net Medicare tax adjustment. If more than one page, enter total of all columns (d) on first page

only. Enter here and on the appropriate line of the return with which you file this form © 6

7 Net wage and tip adjustment. If more than one page, enter total of all lines 7 on first page only.

If line 5(c) is smaller than line 5(b), enter difference in parentheses © 7

Part V Explanation of Adjustments

Part IV

Form 941c (Rev. 10-2006)
Form 941c (Rev. 10-2006) Page 3

Specific Instructions

Purpose of form. Use Form 941c to provide

background information and certifications supporting

prior period adjustments to income, social security,

and Medicare taxes reported on Form 941, 941-M,

941-SS, 943, 944, 944(SP), 944-SS, or Form 945. File

it with the tax return on which you are claiming the

adjustment (Form 941, 943, 944, 945, etc.). You may

use Form 941c even though you filed the original

return on magnetic media or electronically.

Complete all applicable columns on the line for each

return period that you are correcting. Show the total

amount paid to all employees, not the amount for each

individual employee. If you need more space, use

additional Forms 941c.

How to use Form 941c. Form 941c is not an

amended return and must never be filed separately.

You must make adjustments on the return (for

example, Form 941) for the period during which you

discovered the error. There is no limit to the number

of adjustments that you can make, and these

adjustments can be for corrections to more than one

prior period. However, if you filed two or more types of

tax returns that need correction (for example, Form

941 and Form 943), use a separate Form 941c for

each type of return. The net adjustment increases or

decreases your tax liability for the period in which the

error was discovered and adjusted.

If your adjustment(s) results in an overpayment, you

may apply for a refund using Form 843, Claim for

Refund and Request for Abatement, instead of making

an adjustment as discussed above. If you choose to

file Form 843, you will receive a refund check (with

interest) instead of reducing your current employment

tax liability (no interest). When filing Form 843, attach

Form 941c or an equivalent statement.

Statute of limitations. Generally, you may make an

adjustment only within three years of the return due

date or the date the return was filed, whichever is later.

For the statute of limitations, the due date of Forms

941, 941-M, 941-SS, 943, 944, 944(SP), 944-SS, and

945 is April 15 of the year after the close of the tax

year. For example, the four quarterly Forms 941 filed

for 2004 are all treated as due on April 15, 2005. If

they were filed on or before April 15, 2005,

adjustments could be made for any of the quarterly

returns for 2004 until April 15, 2008.

Line A. Check the box for the return that you are

adjusting. Check only one box. Use a separate

Form 941c for each type of return (for example,

Form 941 and Form 945).

Line B. Show the return period in which you are

reporting tax adjustment(s). For example, if you are

making an adjustment on Form 941 for the quarter

ending June 30, 2006, enter 06-2006. File Form 941c

with Form 941 for this period. Do not show the return

period(s) being corrected in this entry space.

Line C. Enter the date that you discovered the

error(s). If you are making more than one correction

and the errors were not discovered at the same time,

leave line C blank and explain in Part V. The date that

you discover the error(s) is the date that your tax

liability increases or decreases. Your deposits for this

date must be adjusted accordingly. See your form

instructions for more information.

If you did not file a return for one or more return

periods, do not use Form 941c to report the

information. Instead, file the required returns.

Corrections not required. You are not required to

correct errors previously reported as a monthly or daily

tax liability. For example, do not use Form 941c to

correct amounts reported in line 15 of Form 941, line

13 of Form 944, line 15 of Form 943, or on Schedule B

(Form 941), Form 943-A and Form 945-A. Also, you are

not required to correct amounts previously reported on

lines 1 or 2 of Form 941 or Form 941-M; or line 1 of

Form 941-SS or Form 943.

Federal income tax withholding errors. Generally,

you are not permitted to correct federal income tax

withholding errors made in a prior calendar year.

However, you may make an adjustment to correct an

administrative error in a prior year. Refer to Pub. 15

(Circular E), Employer’s Tax Guide, for more

information on correcting administrative errors.

General Instructions

More information. See Pub. 15 (Circular E), Pub. 51

(Circular A), Agricultural Employer’s Tax Guide, or your

form instructions for more information about

adjustments.

Part I—Signature and certification. Part I applies to

wages only. If any adjustment is for an overpayment, it

cannot be processed unless you check at least one

box in Part I and you sign the certification. If you

obtained written consents or statements from some

employees but you could not locate or secure the

cooperation of the remaining employees, check both

the second and third boxes. Provide a summary in

Part V of the amount of the adjustments for both the

employees who provided statements and for those

who did not.

Do not use Form 941c as a supporting statement for

current period adjustments (for example, adjustment

for uncollected employee share of social security and

Medicare taxes on tips). No supporting statement is

required for the fractions-of-cents, group-term life

insurance, and third-party sick pay adjustments. See

your form instructions.

If you use additional Forms 941c as continuation

pages, be sure that the total and net adjustment lines

on the first form include the totals from the continuation

pages. These lines are line 5 of Part II, lines 5 through 8

of Part III, and lines 5 through 7 of Part IV.

What’s New

Line A. Three new check boxes have been added to

line A on page one for new Forms 944, 944(SP), and

944-SS. These forms are new for calendar year 2006.

Filers of these forms who wish to make adjustments

for prior years should check the appropriate box on

line A and file Form 941c with Form 944, 944(SP), or

944-SS.
Form 941c (Rev. 10-2006) Page 4

Part III—Social Security Tax Adjustment. Use this

part to correct social security wages and tips

information that you reported in an earlier period. You

may make corrections to social security taxes reported

in prior calendar years as long as the statute of

limitations has not expired (see Statute of limitations on

page 3). If you are reducing social security taxes, be

sure to read and check the appropriate boxes in Part I.

Because Form W-2 is used by the Social Security

Administration (SSA) to post an employee’s social

security wages and tips to his or her earnings record,

Part IV—Medicare Tax Adjustment. Use this part to

correct Medicare wages and tips information that you

reported in an earlier period. You may make

corrections to Medicare taxes reported in prior

calendar years as long as the statute of limitations has

not expired (see Statute of limitations on page 3). If

you are reducing Medicare taxes, be sure to read and

check the appropriate boxes in Part I.

You must file a Form W-2c with the SSA and give

copies to the employee for any Medicare correction

made after you filed Form W-2 with the SSA.

Paperwork Reduction Act Notice. We ask for the

information on this form to carry out the Internal

Revenue laws of the United States. You are required to

give us the information. We need it to ensure that you

are complying with these laws and to allow us to figure

and collect the right amount of tax.

The time needed to complete and file this form will

vary depending on individual circumstances. The

estimated average time is 9 hours and 12 minutes.

If you have comments concerning the accuracy of

this time estimate or suggestions for making this form

simpler, we would be happy to hear from you. You can

write to the IRS at the address shown in the Privacy

Act and Paperwork Reduction Act Notice in the

instructions of the tax return with which you file

Form 941c.

You are not required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or

its instructions must be retained as long as their

contents may become material in the administration of

any Internal Revenue law. Generally, tax returns and

return information are confidential, as required by Code

section 6103.

Part II—Federal Income Tax Withholding (Including

Backup Withholding) Adjustment. Use this part to

correct federal income tax withholding (including

backup withholding) information that you previously

reported. Show the total amount of income tax

withheld or required to be withheld.

After the end of the year, you cannot adjust the

amounts reported as income tax withheld (including

backup withholding) unless it is to correct an

administrative error. An administrative error is any error

that does not change the amount of income tax that

was actually withheld. For example, if the total income

tax actually withheld was incorrectly reported due to a

mathematical computation or transposition error, this is

an administrative error.

Except to correct an administrative error, you will not

be allowed a refund or credit for any prior year

overpayment of income tax withheld (including backup

withholding). This is because the amount of

withholding shown on Form W-2, Wage and Tax

Statement, Form W-2G, Certain Gambling Winnings, or

Form 1099, is used as a credit on the employee’s or

income recipient’s income tax return (Form 1040, etc.).

If you are making an administrative error adjustment

for a period during a prior calendar year, provide an

explanation in Part V.

you must file a Form W-2c, Corrected Wage and Tax

Statement, with the SSA and give copies to the

employee for any social security correction made after

you filed his or her Form W-2 with the SSA. Do not

send Form 941c (or a copy) to the SSA with

Form(s) W-2c.

You may make an adjustment for both the employer

and employee shares of social security and Medicare

taxes for those employees who provided the required

written statement. But you may make adjustments for

only the employer’s share for those employees who

did not provide statements.