Form 944-X - Adjusted Employer'S Annual Federal Tax Return Or Claim For Refund - 2015
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4944-X:
Adjusted Employer’s ANNUAL Federal Tax Return or Claim for Refund
Form
(Rev. February 2015)
Department of the Treasury — Internal Revenue Service
OMB No. 1545-2007
Return You Are Correcting ...
—
Employer identification number (EIN)
Check the type of return you are
correcting:
Name (not your trade name)
944
Trade name (if any)
944-SS
Enter the calendar year you are
Address
correcting:
Number
Street
Suite or room number
(YYYY)
City
State
ZIP code
Enter the date you discovered errors:
Foreign country name
Foreign province/county
Foreign postal code
/
/
Read the separate instructions before completing this form. Use this form to correct errors
(MM / DD / YYYY)
you made on Form 944 or Form 944-SS. Use a separate Form 944-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 944.
Part 1:
Select ONLY one process. See page 4 for additional guidance.
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 19, if less than zero, may only be applied as a credit to your Form 944,
Form 941, or Form 941-SS 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 19. 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 944-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 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
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944-X
For Paperwork Reduction Act Notice, see the separate instructions.
Form
(Rev. 2-2015)
IRS.gov/form944x
Cat. No. 20335M
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