Form 943-X - Adjusted Employer'S Annual Federal Tax Return For Agricultural Employees Or Claim For Refund Page 2

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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 2
Column 3
Column 4
Column 1
Total corrected
Amount originally reported
Difference (If this amount
=
—
amount (for ALL
or as previously corrected
is a negative number, use
employees)
(for ALL employees)
a minus sign.)
Tax correction
6.
Total wages subject to social
=
—
× .124* =
.
.
.
.
security tax (Form 943, line 2)
*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
=
—
× .029* =
.
.
.
.
Medicare tax (Form 943, line 4)
*If you are correcting your employer share only, use .0145. See instructions.
8.
Total wages subject to Additional
=
—
× .009* =
.
.
.
.
Medicare Tax withholding (Form 943,
*Certain wages reported in Column 3 should not be multiplied by .009. See instructions.
line 6; only for years beginning after
December 31, 2012)
9.
Federal income tax withheld
=
Copy Column
—
.
.
.
.
(Form 943, line 8 (line 6 for years
3 here
▶
ending before January 1, 2013))
10.
Tax adjustments (Form 943,
=
See
—
.
.
.
.
line 10 (line 8 for years ending
instructions
before January 1, 2013))
11.
Special addition to wages for
=
See
—
.
.
.
.
instructions
federal income tax
Special addition to wages for
12.
=
See
—
.
.
.
.
instructions
social security taxes
Special addition to wages for
13.
=
See
—
.
.
.
.
instructions
Medicare taxes
14.
Special addition to wages for
=
See
—
.
.
.
.
instructions
Additional Medicare Tax
15.
Subtotal. Combine the amounts on lines 6–14 of Column 4
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
16 a. COBRA premium assistance payments
=
See
—
(see instructions)
.
.
.
.
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
▶
■
2
943-X
Page
Form
(Rev. 2-2015)

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