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Part 3: Enter the Corrections for This

for your records. Generally, all employment tax records must be

kept for at least 4 years.

Quarter

4b. Check the box on line 4b to certify that your overreported

amount is only for the employer share of taxes on those

What Amounts Should You Report in Part 3?

employees who you were unable to find or those who did not

give you a statement described on line 4a.

On lines 6–11, columns 1 and 2, show amounts for all of your

employees, not just for those employees whose amounts you

4c. Check the box on line 4c to certify that your overreported

are correcting.

amount is only for federal income tax, social security tax,

Medicare tax, or Additional Medicare Tax that you did not

If a correction that you report in column 4 includes both

withhold from your employees.

underreported and overreported amounts (see the instructions

for line 21, later), give us details for each error on line 23.

5. Certifying Claims

Because special circumstances apply for lines 12–17, 19a,

If you are filing a claim for refund or abatement of overreported

and 19b, read the instructions for each line carefully before

federal income tax, social security tax, Medicare tax, or

entering amounts in the columns.

Additional Medicare Tax and checked the box on line 2, check

If you previously adjusted or amended Form 941 by

the appropriate box on line 5. You may need to check more than

using Form 941-X or because of an IRS examination

one box. If you obtained written statements or consents from

change, show amounts in column 2 that include those

some employees but you could not locate employees or secure

CAUTION

previously reported corrections.

the statements or consents of the remaining employees, check

all applicable boxes. Provide a summary on line 23 of the

amount of the corrections for both the employees who provided

6. Wages, Tips, and Other Compensation

statements or consents and for those who did not.

If you are correcting the wages, tips, and other compensation

you reported on Form 941, line 2, enter the total corrected

You cannot file a refund claim to correct federal income

amount for ALL employees in column 1. In column 2, enter the

tax or Additional Medicare Tax actually withheld from

amount you originally reported. In column 3, enter the difference

employees in a prior year.

CAUTION

between columns 1 and 2. This line does not apply to Form

5a. Check the box on line 5a if your overreported tax includes

941-SS.

each affected employee share of social security and Medicare

If you or the IRS previously corrected the amount reported on

taxes. You are certifying that you repaid or reimbursed to the

Form 941, line 2, enter in column 2 the amount after any

employees their share of social security and Medicare taxes. For

previous corrections.

refunds of employee social security and Medicare taxes

overcollected in prior years, you are certifying that you received

line 6 (column 1)

written statements from those employees stating that they did

- line 6 (column 2)

not and will not receive a refund or credit for the prior year taxes.

line 6 (column 3)

If the amount in column 2 is larger than the

5b. Check the box on line 5b if your overreported tax includes

amount in column 1, use a minus sign in column 3.

each affected employee share of social security and Medicare

taxes and you have not yet repaid or reimbursed the employee

share of taxes. You are certifying that you received consent from

Example —Wages, tips, and other compensation

each affected employee to file a claim on the employee share of

increased. You reported $9,000 as total wages, tips, and other

those taxes and you received written statements from those

compensation on line 2 of your 2015 first quarter Form 941. In

employees stating that they did not and will not receive a refund

May of 2015, you discovered that you had overlooked $1,000 in

or credit for the prior year taxes. Do not send these statements

tips for one of your part-time employees. To correct the error,

and consents to the IRS. Keep them for your records. Generally,

figure the difference on Form 941-X as shown.

all employment tax records must be kept for at least 4 years.

In certain situations, you may not have repaid or reimbursed

Column 1 (corrected amount)

10,000.00

your employees or obtained their consents prior to filing a claim,

Column 2 (Form 941, line 2)

- 9,000.00

such as in cases where the period of limitations on credit or

Column 3 (difference)

1,000.00

refund is about to expire. In those situations, file Form 941-X, but

do not check a box on line 5. Tell us on line 23 that you have not

repaid or reimbursed employees or obtained consents at the

Example —Wages, tips, and other compensation

time you file the claim. However, you must repay or reimburse

decreased. You reported $9,000 as wages, tips, and other

your employees and certify that you have done so before the

compensation on line 2 of your 2015 first quarter Form 941. In

IRS can allow the claim.

May of 2015, you discovered that you included $2,000 in wages

5c. Check the box on line 5c to certify that your overreported tax

for one of your employees twice. To correct the error, figure the

is only for the employer share of social security and Medicare

difference on Form 941-X as shown.

taxes. This applies when affected employees did not give you

consent to file a claim for refund for the employee share of social

Column 1 (corrected amount)

7,000.00

security and Medicare taxes, they could not be found, or they did

Column 2 (Form 941, line 2)

- 9,000.00

not give you a statement described on line 5b.

Column 3 (difference)

-2,000.00

5d. Check the box on line 5d to certify that your overreported

amount is only for federal income tax, social security tax,

Medicare tax, or Additional Medicare Tax that you did not

Example—Auto allowance; wages, tips, and other

withhold from your employees.

compensation increased. You paid one of your employees a

$500 monthly auto allowance from October through December

2014, and did not treat the payments as taxable wages. In

February 2015, you realized that the payments were wages

-6-

Instructions for Form 941-X (Rev. 4-2015)

Instructions For Form 941-X - Adjusted Employer'S Quarterly Federal Tax Return Or Claim For Refund - 2017 Page 6

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