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
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,
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))
*Complete lines 10a
10a. Number of qualified employees paid
=
—
and 10b only for
exempt wages April 1 – December
corrections to the
2010 Form 943.
31, 2010 (Form 943, line 7a)*
10b. Exempt wages paid to qualified
=
—
.
.
.
× .062 =
.
employees April 1 – December 31,
2010 (Form 943, line 7b)*
11.
Tax adjustments (Form 943,
=
See
—
.
.
.
.
line 10 (line 8 for years ending
instructions
before January 1, 2013))
Special addition to wages for
=
12.
See
—
.
.
.
.
instructions
federal income tax
Special addition to wages for
13.
=
See
—
.
.
.
.
instructions
social security taxes
Special addition to wages for
=
14.
See
—
.
.
.
.
instructions
Medicare taxes
Special addition to wages for
15.
=
See
—
.
.
.
.
instructions
Additional Medicare Tax
16.
Subtotal: Combine the amounts in lines 6–15 of Column 4 .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Advance earned income credit (EIC)
17.
payments made to employees (Form
=
See
—
.
.
.
.
instructions
943, line 10; only for years ending before
January 1, 2011)
18a. COBRA premium assistance payments
=
—
See
(Form 943, line 13a for calendar years
.
.
.
.
instructions
2010 and 2013 (line 11a for calendar
years 2011 and 2012))
18b. Number of individuals provided COBRA
=
—
premium assistance (Form 943, line 13b
for calendar years 2010 and 2013 (line
11b for calendar years 2011 and 2012))
18c. Number of qualified employees
*Complete lines 18c and
=
—
paid exempt wages March 19–31,
18d only for corrections
to the 2010 Form 943.
2010 (Form 943, line 13c)*
18d. Exempt wages paid to qualified
=
employees March 19–31, 2010
—
× .062 =
.
.
.
.
(Form 943, line 13d)*
19.
Total. Combine the amounts in lines 16–18d of Column 4. Continue to next page.
.
.
.
.
.
.
.
.
.
.
.
.
Next
▶
■
2
943-X
Page
Form
(Rev. 2-2014)

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