Form 943-X:

(Rev. February 2021)

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’re Correcting ...

Enter the calendar year of the return 

you’re 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 four pages. Don’t attach this form to Form 943 unless you’re reclassifying workers; see the 

instructions for line 32.

Part 1: Select ONLY one process. See page 5 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’re correcting both underreported and overreported amounts on this 

form. The amount shown on line 25, if less than zero, may only be applied as a credit to your Form 943 for the tax period in which you’re 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 25. Don’t check this box if you’re correcting ANY underreported amounts on this form.

Part 2: Complete the certifications.

3. I certify that I’ve 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’re correcting underreported amounts only, go to Part 3 on page 2 and skip lines 4 and 5. If you’re correcting overreported 

amounts, for purposes of the certifications on lines 4 and 5, Medicare tax doesn’t include Additional Medicare Tax. Form 943-X can’t be 

used to correct overreported amounts of Additional Medicare Tax unless the amounts weren’t withheld from employee wages.

4. If you checked line 1 because you’re adjusting overreported federal income tax withholding, social security tax, Medicare tax, or 

Additional Medicare Tax, 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 hasn’t claimed (or the claim was rejected) and won’t 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 couldn’t find the affected employees or 

each affected employee didn’t give me a written statement that he or she hasn’t claimed (or the claim was rejected) and won’t 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 didn’t withhold from 

employee wages.

5. If you checked line 2 because you’re claiming a refund or abatement of overreported federal income tax withholding, social 

security tax, Medicare tax, or Additional Medicare Tax, 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 hasn’t claimed (or the claim was rejected) and won’t 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 hasn’t claimed (or the claim was rejected) and won’t 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 couldn’t find the affected employees; or each 

affected employee didn’t 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 didn’t give me a written statement that he or she hasn’t claimed (or the claim was rejected) 

and won’t 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 didn’t withhold from 

employee wages.

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For Paperwork Reduction Act Notice, see the separate instructions. www.irs.gov/Form943X Cat. No. 20332F Form 943-X (Rev. 2-2021)
Name (not your trade name) Employer identification number (EIN) Correcting Calendar Year (YYYY)

Part 3: Enter the corrections for the calendar year you’re correcting. If any line doesn’t 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. Wages subject to social 

security tax (Form 943, line 2) . — . = . × 0.124* =

*If you’re correcting your employer share only, use 0.062. See instructions.

.

7. Qualified sick leave wages 

(Form 943, line 2a) . — . = . × 0.062 = .

8. Qualified family leave wages 

(Form 943, line 2b) . — . = . × 0.062 = .

9. Wages subject to Medicare 

tax (Form 943, line 4) . — . = . × 0.029* =

*If you’re correcting your employer share only, use 0.0145. See instructions.

.

10. Wages subject to Additional 

Medicare Tax withholding 

(Form 943, line 6) . — . = . × 0.009* =

*Certain wages reported in Column 3 shouldn’t be multiplied by 0.009. See instructions.

.

11. Federal income tax withheld 

(Form 943, line 8) . — . = . Copy Column 

3 here ▶ .

12. Tax adjustments (Form 943, 

line 10) . — . = . See 

instructions .

13. Qualified small business payroll 

tax credit for increasing research 

activities (Form 943, line 12a; you 

must attach Form 8974)

. — . = . See 

instructions .

14. Nonrefundable portion of 

credit for qualified sick and 

family leave wages (Form 943, 

line 12b)

. — . = . See 

instructions .

15. Nonrefundable portion of 

employee retention credit 

(Form 943, line 12c) . — . = . See 

instructions .

16. Special addition to wages for 

federal income tax . — . = . See 

instructions .

17. Special addition to wages for 

social security taxes . — . = . See 

instructions .

18. Special addition to wages for 

Medicare taxes . — . = . See 

instructions .

19. Special addition to wages for 

Additional Medicare Tax . — . = . See 

instructions .

20. Subtotal. Combine the amounts on lines 6 through 19 of Column 4 . . . . . . . . . . . . . . . . .

21. Deferred amount of the 

employer share of social 

security tax (Form 943, line 

14b)

. — . = . See 

instructions .

Page 2 Form 943-X (Rev. 2-2021)

Next ■▶
Name (not your trade name) Employer identification number (EIN) Correcting Calendar Year (YYYY)

Part 3: Enter the corrections for the calendar year you’re correcting. If any line doesn’t apply, leave it blank. (continued)

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

24. Refundable portion of 

employee retention credit 

(Form 943, line 14e) . — . = . See 

instructions .

25. Total. Combine the amounts on lines 20 through 24 of Column 4 . . . . . . . . . . . . . . . . .

If line 25 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’re filing 

this form.

• If you checked line 2, this is the amount you want refunded or abated.

If line 25 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.

26. Qualified health plan expenses 

allocable to qualified sick leave 

wages (Form 943, line 18)

. — . = .

27. Qualified health plan 

expenses allocable to 

qualified family leave 

wages (Form 943, line 19)

. — . = .

28. Qualified wages for the 

employee retention credit 

(Form 943, line 20)

. — . = .

29. Qualified health plan 

expenses allocable to wages 

reported on Form 943, line 20 

(Form 943, line 21)

. — . = .

30. Credit from Form 5884-C, line 

11, for the year (Form 943, line 

22)

. — . = .

Next ■▶

Page 3 Form 943-X (Rev. 2-2021)

23. Refundable portion of credit 

for qualified sick and family 

leave wages (Form 943, line 

14d)

. — . = . See 

instructions .

22. Deferred amount of the 

employee share of social 

security tax (Form 943, line 

14c)

. — . = . See 

instructions .
Name (not your trade name) Employer identification number (EIN) Correcting Calendar Year (YYYY)

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

31. 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 33.

32. Check here if any corrections involve reclassified workers. Explain on line 33.

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

Part 5: Sign here. You must complete all four 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, 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.

✗ Sign your 

name here

Date / /

Print your 

name here

Print your 

title here

Best daytime phone

Paid Preparer Use Only Check if you’re 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 4 Form 943-X (Rev. 2-2021)
Type of errors Form 943-X: Which process should you use?

you’re 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 25 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’re 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 25 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 25 refunded to you or abated. Check 

the box on line 2.

If you’re 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’re 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 25.

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 25 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’re 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 

the 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 25 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 5 Form 943-X (Rev. 2-2021)