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

2012

Type 

or 

Print

Name (as distinguished from trade name) Calendar year

Trade name, if any Employer identification number (EIN)

Address (number and street) City, state, and ZIP 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, 2012 ▶ 1 

For 2012, the employee social security tax rate is 4.2% and the Medicare tax rate is 1.45%. The employer social security tax rate 

is 6.2% and the Medicare tax rate is 1.45%.

2 Total wages subject to social security tax (see separate instructions) 2 

3 Social security tax (multiply line 2 by 10.4% (.104)) . . . . . . . . . . . . . . . . 3 

4 Total wages subject to Medicare tax (see separate instructions) . . . 4 

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

6 Federal income tax withheld (see separate instructions) . . . . . . . . . . . . . . 6 

7 Total taxes before adjustments. Add lines 3, 5, and 6 . . . . . . . . . . . . . . . 7

8 Current year’s adjustments (see separate instructions) . . . . . . . . . . . . . . . 8 

9 Total taxes after adjustments (line 7 as adjusted by line 8) . . . . . . . . . . . . . . 9 

10 Total deposits for 2012, including overpayment applied from a prior year and Form 943-X . . . 10

11a COBRA premium assistance payments (see separate instructions) . . . . . . . . . . . 11a

11b Number of individuals provided COBRA premium assistance . . . . 11b

12 Add lines 10 and 11a . . . . . . . . . . . . . . . . . . . . . . . . . . 12 

13 Balance due. If line 9 is more than 12, enter the difference and see the instructions . . . ▶ 13 

14 Overpayment. If line 12 is more than line 9, enter the difference ▶ $ Check one: Appy to next return. Send a refund.

• All filers: If line 9 is less than $2,500, do not complete line 15 or Form 943-A.

• Semiweekly schedule depositors: Complete Form 943-A and check here ▶ • Monthly schedule depositors: Complete line 15 and check here ▶

15 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 (2012) 
Form 943-V, 

Payment Voucher

Purpose of Form

Complete Form 943-V, Payment Voucher, if you are 

making a payment with Form 943, Employer’s Annual 

Federal Tax Return for Agricultural Employees. 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 2012 

Form 943 only if:

• Your total taxes after adjustments for the year (Form 

943, line 9) 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 (Circular A), Agricultural 

Employer’s Tax Guide, 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 (Circular A) for deposit 

instructions. Do not 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 

(Circular A).

Specific Instructions

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

not have an EIN, you may apply for one online. Go to 

IRS.gov and click on the Apply for an EIN Online link 

under “Tools.” You may also apply for an EIN by calling 

1-800-829-4933, or you can fax or mail Form SS-4, 

Application for Employer Identification Number. If you 

have not 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 

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

“Form 943,” and “2012” on your check or money order. 

Do not send cash. Do not 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

▶ Do not attach this voucher or your payment to Form 943.

OMB No. 1545-0035

2012

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, state, and ZIP code.