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

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943-X:
Adjusted Employer’s Annual Federal Tax Return for Agricultural
Form
Employees or Claim for Refund
(Rev. February 2015)
Department of the Treasury — Internal Revenue Service
OMB No. 1545-0035
Return You Are Correcting ...
Employer identification number
(EIN)
Enter the calendar year of the return
you are correcting:
Name (not your trade name)
(YYYY)
Trade Name (if any)
Address
Number
Street
Suite or room number
Enter the date you discovered errors:
/
/
City
State
ZIP code
(MM / DD / YYYY)
Foreign country name
Foreign province/county
Foreign postal code
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 three pages. Do not attach this form to Form 943.
Select ONLY one process. See page 4 for additional guidance.
Part 1:
1. Adjusted employment tax return. Check this box if you underreported amounts. Also check this box if you overreported amounts and you would like to
use the adjustment process to correct the errors. You must check this box if you are correcting both underreported and overreported amounts on this
form. The amount shown on line 17, if less than zero, may only be applied as a credit to your Form 943 for the tax period in which you are filing this form.
2. Claim. Check this box if you overreported amounts only and you would like to use the claim process to ask for a refund or abatement
of the amount shown on line 17. Do not check this box if you are correcting ANY underreported amounts on this form.
Part 2:
Complete the certifications.
3. I certify that I have 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 are correcting underreported amounts only, go to Part 3 on page 2 and skip lines 4 and 5. If you are correcting overreported
amounts, for purposes of the certifications on lines 4 and 5, Medicare tax does not include Additional Medicare Tax. Form 943-X cannot be
used to correct overreported amounts of Additional Medicare Tax unless the amounts were not withheld from employee wages.
4. If you checked line 1 because you are adjusting overreported amounts, 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 has not claimed (or the claim was rejected) and will not 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 could not find the affected employees or
each affected employee did not give me a written statement that he or she has not claimed (or the claim was rejected) and will not
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 did not withhold from
employee wages.
5. If you checked line 2 because you are claiming a refund or abatement of overreported employment taxes, 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 has not claimed (or the claim was rejected) and will not 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 has not claimed (or the claim was rejected) and will not 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 could not find the affected employees; or each
affected employee did not give me a written consent to file a refund claim for the employee’s share of social security tax and
Medicare tax; or each affected employee did not give me a written statement that he or she has not claimed (or the claim was
rejected) and will not 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 did not withhold from
employee wages.
Next
943-X
For Paperwork Reduction Act Notice, see the separate instructions.
Form
(Rev. 2-2015)
IRS.gov/form943x
Cat. No. 20332F

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