Form 943-X:

(Rev. February 2022)

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 five pages. Don’t attach this form to Form 943 unless you’re reclassifying workers; see the instructions for line 40.

Part 1: Select ONLY one process. See page 6 for additional guidance, including information on how to treat 

employment tax credits and social security tax deferrals.

1. Adjusted employment tax return. Check this box if you underreported tax amounts. Also check this box if you overreported tax 

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 tax 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 tax 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 tax 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 tax amounts only, go to Part 3 on page 2 and skip lines 4 and 5. If you’re correcting overreported 

tax 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, 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, 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 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. Next ■▶

For Paperwork Reduction Act Notice, see the separate instructions. www.irs.gov/Form943X Cat. No. 20332F Form 943-X (Rev. 2-2022)
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)

*Use line 7 only for qualified sick leave wages paid after March 31, 2020, for leave taken before April 1, 2021.

. — . = . × 0.062 = .

8. Qualified family leave wages* 

(Form 943, line 2b)

*Use line 8 only for qualified family leave wages paid after March 31, 2020, for leave taken before April 1, 2021.

. — . = . × 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 for leave 

taken before April 1, 2021 

(Form 943, line 12b)

. — . = . See 

instructions .

15a. Nonrefundable portion of 

employee retention credit 

(Form 943, line 12c)

. — . = . See 

instructions .

15b. Nonrefundable portion of 

credit for qualified sick and 

family leave wages for leave 

taken after March 31, 2021 

(Form 943, line 12d)

. — . = . See 

instructions .

15c. Nonrefundable portion of 

COBRA premium assistance 

credit (Form 943, line 12e)

. — . = . See 

instructions .

15d. Number of individuals 

provided COBRA premium 

assistance (Form 943, line 12f)

— =

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 . . . . . . . . . . . . . . . . .

Next ■▶

Page 2 Form 943-X (Rev. 2-2022)
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

21. Deferred amount of the 

employer share of social 

security tax* (Form 943, line 14b) * Line 21 can only be used if correcting a 2020 Form 943.

. — . = . See 

instructions .

22. Deferred amount of the 

employee share of social 

security tax* (Form 943, line 14c) * Line 22 can only be used if correcting a 2020 Form 943.

. — . = . See 

instructions .

23. Refundable portion of credit 

for qualified sick and family 

leave wages for leave taken 

before April 1, 2021 (Form 943, 

line 14d)

. — . = . See 

instructions .

24a. Refundable portion of 

employee retention credit 

(Form 943, line 14e)

. — . = . See 

instructions .

24b. Refundable portion of credit 

for qualified sick and family 

leave wages for leave taken 

after March 31, 2021 (Form 

943, line 14f)

. — . = . See 

instructions .

24c. Refundable portion of COBRA 

premium assistance credit 

(Form 943, line 14g)

. — . = . See 

instructions .

25. Total. Combine the amounts on lines 20 through 24c 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 for 

leave take before April 1, 2021 

(Form 943, line 18)

. — . = .

27. Qualified health plan 

expenses allocable to 

qualified family leave wages 

for leave taken before April 1, 

2021 (Form 943, line 19)

. — . = .

28. Qualified wages for the 

employee retention credit 

(Form 943, line 20)

. — . = .

29. Qualified health plan 

expenses for the employee 

retention credit (Form 943, 

line 21)

. — . = .

30. Credit from Form 5884-C, line 

11, for the year* (Form 943, 

line 22) * Line 30 can only be used if correcting a 2020 Form 943.

. — . = .

Next ■▶

Page 3 Form 943-X (Rev. 2-2022)
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.)

Caution: Lines 31–38 don’t apply to years beginning before January 1, 2021.

31. Qualified sick leave wages for 

leave taken after March 31, 

2021 (Form 943, line 22)

. — . = .

32. Qualified health plan 

expenses allocable to 

qualified sick leave wages for 

leave taken after March 31, 

2021 (Form 943, line 23) 

. — . = .

33. Amounts under certain 

collectively bargained 

agreements allocable to 

qualified sick leave wages for 

leave taken after March 31, 

2021 (Form 943, line 24)

. — . = .

34. Qualified family leave wages 

for leave taken after March 31,

2021 (Form 943, line 25)

. — . = .

35. Qualified health plan 

expenses allocable to 

qualified family leave wages 

for leave taken after March 31,

2021 (Form 943, line 26)

. — . = .

36. Amounts under certain 

collectively bargained 

agreements allocable to 

qualified family leave wages 

for leave taken after March 31,

2021 (Form 943, line 27)

. — . = .

37. If you’re eligible for the 

employee retention credit in 

the third quarter of 2021 

solely because your business 

is a recovery startup 

business, enter the total of 

any amounts included on 

Form 943, lines 12c and 14e 

(or, if corrected, Form 943-X, 

lines 15a and 24a), for the 

third quarter of 2021 (Form 

943, line 28)

. — . = .

38. If you’re eligible for the 

employee retention credit in 

the fourth quarter of 2021 

solely because your business 

is a recovery startup 

business, enter the total of 

any amounts included on 

Form 943, lines 12c and 14e 

(or, if corrected, Form 943-X, 

lines 15a and 24a), for the 

fourth quarter of 2021 (Form 

943, line 29)

. — . = .

Next ■▶

Page 4 Form 943-X (Rev. 2-2022)
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.

39. 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 41.

40. Check here if any corrections involve reclassified workers. Explain on line 41.

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

Part 5: Sign here. You must complete all five 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 PTIN

Preparer’s signature Date / /

Firm’s name (or yours

if self-employed) EIN

Address Phone

City State ZIP code

Page 5 Form 943-X (Rev. 2-2022)
Form 943-X: Which process should you use?

Unless otherwise specified in the separate instructions, an underreported employment tax credit or social 

security tax deferral should be treated like an overreported tax amount. An overreported employment tax credit 

or social security tax deferral should be treated like an underreported tax amount. For more information, 

including which process to select on lines 1 and 2, see Correcting an employment tax credit or social security 

tax deferral in the separate instructions.

Type of errors 

you’re correcting

Underreported 

tax amounts 

ONLY

Use the adjustment process to correct underreported tax amounts.

• Check the box on line 1.

• Pay the amount you owe from line 25 by the time you file Form 943-X.

Overreported 

tax 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 tax 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 tax amounts. Check the box on 

line 2.

BOTH 

underreported 

and 

overreported 

tax 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 

tax amounts.

Choose the adjustment process if combining 

your underreported tax amounts and overreported

tax 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 tax 

amount refunded to you or abated.

File two separate forms.

1. For the adjustment process, file one Form 

943-X to correct the underreported tax 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 tax 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 tax 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 tax amounts. 

Check the box on line 2.

Page 6 Form 943-X (Rev. 2-2022)