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)
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
Amount originally
Difference
=
Total corrected
reported or as
(If this amount is a
—
amount (for ALL
previously corrected
negative number, use
employees)
(for ALL employees)
a minus sign.)
Tax correction
Total wages subject to social
6.
=
—
× .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.
Total wages subject to
7.
=
—
Medicare tax
× .029* =
.
.
.
.
(Form 943, line 4)
*If you are correcting your employer share only, use .0145. See
instructions.
8.
Federal income tax withheld
=
Copy Column
—
.
.
.
.
3 here
▶
(Form 943, line 6)
*Complete lines
9a. Number of qualified
=
—
9a and 9b only
employees paid exempt
for corrections
wages April 1 – December 31,
to the 2010
Form 943.
2010 (Form 943, line 7a)*
9b. Exempt wages paid to
=
—
.
.
.
× .062 =
.
qualified employees April 1 –
December 31, 2010
(Form 943, line 7b)*
Tax adjustments
=
10.
—
See
.
.
.
.
instructions
(Form 943, line 8)
Special addition to wages for
11.
=
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.
Subtotal: Combine the amounts in lines 6–13 of Column 4 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
15.
Advance earned income
=
See
—
credit (EIC) payments made
.
.
.
.
instructions
to employees (Form 943, line
10; only for years ending before
January 1, 2011)
16a. COBRA premium assistance
=
—
See
payments (Form 943, line 11a (line
.
.
.
.
instructions
13a for years ending before
January 1, 2011))
16b. Number of individuals provided
=
—
*Complete lines
COBRA premium assistance
16c and 16d
(Form 943, line 11b (line 13b for years
only for
corrections to
ending before January 1, 2011))
the 2010
16c. Number of qualified
Form 943.
=
—
employees paid exempt
wages March 19–31, 2010
(Form 943, line 13c)*
16d. Exempt wages paid to
=
—
.
.
.
× .062 =
.
qualified employees March
19–31, 2010 (Form 943,
line 13d)*
17.
Total. Combine the amounts in lines 14–16d of Column 4. Continue to next page.
.
.
.
.
.
.
.
.
.
.
.
.
Next
▶
■
2
943-X
Page
Form
(Rev. 2-2013)

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