Form 943-X:

(Rev. February 2015)

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 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. 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 17, 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 17. 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 overcollected social security tax and Medicare tax for prior years. I have a

written statement from each affected 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 affected 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 tax and Medicare tax for prior years. I have a 

written statement from each affected 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 tax and Medicare tax overcollected in prior years. I also have a written statement from each affected 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 

affected employee did not 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 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.

Next ■▶

For Paperwork Reduction Act Notice, see the separate instructions. IRS.gov/form943x Cat. No. 20332F Form 943-X (Rev. 2-2015)
Name (not your trade name) Employer identification number (EIN) Correcting 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* = .

*Certain wages reported in Column 3 should not be multiplied by .009. See instructions.

9. Federal income tax withheld 

(Form 943, line 8 (line 6 for years 

ending before January 1, 2013)) 

. — . = . Copy Column 

3 here ▶ .

10. Tax adjustments (Form 943, 

line 10 (line 8 for years ending 

before January 1, 2013)) 

. — . = . See 

instructions .

11. Special addition to wages for 

federal income tax . — . = . See 

instructions .

12. Special addition to wages for 

social security taxes . — . = . See 

instructions .

13. Special addition to wages for 

Medicare taxes . — . = . See 

instructions .

14. Special addition to wages for 

Additional Medicare Tax . — . = . See 

instructions .

15. Subtotal. Combine the amounts on lines 6–14 of Column 4 . . . . . . . . . . . . . . . . . . .

16a. COBRA premium assistance payments 

(see instructions) . — . = . See 

instructions .

16b. Number of individuals provided COBRA 

premium assistance (see instructions) — =

17. Total. Combine the amounts on lines 15 and 16a of Column 4 . . . . . . . . . . . . . . . . . .

If line 17 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 17 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. 2-2015)
Name (not your trade name) Employer identification number (EIN) Correcting Calendar Year (YYYY)

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

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 20.

19. Check here if any corrections involve reclassified workers. Explain on line 20.

20. You must give us a detailed explanation for how you determined your corrections. See the 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. 2-2015)
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 17 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 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 17 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 17 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 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 17.

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 17 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 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 17 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. 2-2015)