Form 943

Department of the Treasury 

Internal Revenue Service 

Employer’s Annual Federal Tax Return for Agricultural Employees

▶ Information about Form 943 and its separate instructions is at www.irs.gov/form943.

OMB No. 1545-0035

2015

Type 

or 

Print

Name (as distinguished from trade name) Employer identification number (EIN)

Trade name, if any

Address (number and street)

City or town, state or province, country, and ZIP or foreign postal code

If you do not have to file returns in the future, check here . . . . . . . . . . . . . ▶

If address is 

different from 

prior return, 

check here. ▶

1 Number of agricultural employees employed in the pay period that includes March 12, 2015 ▶ 1 

2 Total wages subject to social security tax . . . . . . . . . . 2 

3 Social security tax (multiply line 2 by 12.4% (.124)) . . . . . . . . . . . . . . . . 3 

4 Total wages subject to Medicare tax . . . . . . . . . . . . 4 

5 Medicare tax (multiply line 4 by 2.9% (.029)) . . . . . . . . . . . . . . . . . . 5 

6 Total wages subject to Additional Medicare Tax withholding . . . . 6

7 Additional Medicare Tax withholding (multiply line 6 by 0.9% (.009)) . . . . . . . . . . 7

8 Federal income tax withheld . . . . . . . . . . . . . . . . . . . . . . . 8

9 Total taxes before adjustments. Add lines 3, 5, 7, and 8 . . . . . . . . . . . . . . 9

10 Current year’s adjustments . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Total taxes after adjustments (line 9 as adjusted by line 10) . . . . . . . . . . . . . 11

12 Total deposits for 2015, including overpayment applied from a prior year and Form 943-X . . . 12

13a Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13a

b Reserved . . . . . . . . . . . . . . . . . . . . . 13b

14 Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Balance due. If line 11 is more than line 12, enter the difference and see the instructions . ▶ 15

16 Overpayment. If line 12 is more than line 11, enter the difference ▶ $ Check one: Apply to next return. Send a refund.

• All filers: If line 11 is less than $2,500, do not complete line 17 or Form 943-A.

• Semiweekly schedule depositors: Complete Form 943-A and check here ▶ • Monthly schedule depositors: Complete line 17 and check here ▶

17 Monthly Summary of Federal Tax Liability. (Do not complete if you were a semiweekly schedule depositor.)

 Tax liability for month 

A January . . .

B February . . .

C March . . .

D April . . . .

E May . . . .

 Tax liability for month 

F June . . . .

G July . . . .

H August . . .

I September . .

J October . . .

 Tax liability for month 

K November . . .

L December . . .

M Total liability for 

year (add lines A 

through L) . .

ThirdParty 

Designee

Do you want to allow another person to discuss this return with the IRS (see separate instructions)? Yes. Complete the following. No.

Designee’s 

name ▶

Phone 

no. ▶

Personal identification 

number (PIN) ▶

Sign 

Here

Under penalties of perjury, I declare that I have examined this return, 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.

Signature ▶

Print Your 

Name and Title ▶ Date ▶

Paid 

Preparer 

Use Only

Print/Type preparer’s name Preparer’s signature Date Check if 

self-employed

PTIN

Firm’s name ▶

Firm’s address ▶

Firm’s EIN ▶

Phone no.

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11252K Form 943 (2015) 
Form 943-V, 

Payment Voucher

Purpose of Form

Complete Form 943-V if you are making a payment with 

Form 943. We will use the completed voucher to credit 

your payment more promptly and accurately, and to 

improve our service to you.

Making Payment With Form 943

To avoid a penalty, make your payment with your 2015 

Form 943 only if:

• Your total taxes after adjustments for the year (Form 

943, line 11) are less than $2,500 and you are paying in 

full with a timely filed return, or

• You are a monthly schedule depositor making a 

payment in accordance with the Accuracy of Deposits 

Rule. See section 7 of Pub. 51 for details. In this case, the 

amount of your payment may be $2,500 or more.

Otherwise, you must make deposits by electronic funds 

transfer. See section 7 of Pub. 51 for deposit instructions. 

Don't use Form 943-V to make federal tax deposits.

▲! CAUTION

Use Form 943-V when making any payment with 

Form 943. However, if you pay an amount with 

Form 943 that should have been deposited, you may be 

subject to a penalty. See Deposit Penalties in section 7 of 

Pub. 51.

Specific Instructions

Box 1—Employer identification number (EIN). If you 

don't have an EIN, you may apply for one online. Go to 

IRS.gov and type “EIN” in the search box. You may also 

apply for an EIN by faxing or mailing Form SS-4 to the 

IRS. If you haven't received your EIN by the due date of 

Form 943, write “Applied For” and the date you applied in 

this entry space.

Box 2—Amount paid. Enter the amount paid with 

Form 943.

Box 3—Name and address. Enter your name and

address as shown on Form 943.

• Enclose your check or money order made payable to 

“United States Treasury.” Be sure to enter your EIN, 

“Form 943,” and “2015” on your check or money order. 

Don't send cash. Don't attach Form 943-V or your 

payment to Form 943 (or to each other).

• Detach Form 943-V and send it with your payment and 

Form 943 to the address provided in the Instructions for 

Form 943.

Note: You must also complete the entity information

above line 1 on Form 943.

✁ ▼ Detach Here and Mail With Your Payment and Form 943. ▼

✃

Form 943-V

Department of the Treasury 

Internal Revenue Service 

Payment Voucher

▶ Don't attach this voucher or your payment to Form 943.

OMB No. 1545-0035

2015

1 Enter your employer identification number (EIN). 2 Enter the amount of your payment . . . ▶

Make your check or money order payable to “United States Treasury”

Dollars Cents

3 Enter your business name (individual name if sole proprietor).

Enter your address.

Enter your city or town, state or province, country, and ZIP or foreign postal code.