Form 941-X - Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund

Instructions for Form 941-X

Department of the Treasury
Internal Revenue Service

(June 2009)
Adjusted Employer’s QUARTERLY Federal Tax Return or Claim for Refund
Section references are to the Internal Revenue Code unless
otherwise noted.

What’s New?
COBRA premium assistance payments credit. Employers
who make COBRA premium assistance payments for
assistance eligible individuals are allowed a credit for the
payments on Form 941. Any errors discovered on previously
filed Forms 941 for this credit are adjusted on Form 941-X. See
17a. COBRA premium assistance payments on page 8.
New form. The Internal Revenue Service (IRS) has developed
Form 941-X, Adjusted Employer’s QUARTERLY Federal Tax
Return or Claim for Refund, to replace Form 941c, Supporting
Statement to Correct Information. Use Form 941-X to make
corrections to previously filed Forms 941. Do not attach Form
941-X to Form 941; file Form 941-X separately.
Form 941-X replaces Form 843, Claim for Refund or
Request for Abatement, for employers to request a refund or
abatement of overreported employment taxes. Continue to use
Form 843 when requesting a refund or abatement of assessed
interest or penalties.
We believe you will find Form 941-X and its instructions
easier to understand and fill out than Form 941c. At the same
time, the new form will enable the IRS to make corrections to
employment taxes more accurately and efficiently. Please read
both the form and these instructions carefully to become
familiar with the many changes.
Background. Treasury Decision 9405 changed the process
for making interest-free adjustments to employment taxes
reported on Form 941, Employer’s QUARTERLY Federal Tax
Return, and for filing a claim for refund of employment taxes.
Treasury Decision 9405, 2008-32 I.R.B. 293, is available at
www.irs.gov/irb/2008-32_irb/ar13.html. You will use the revised
adjustment process if you underreported employment taxes and
are making a payment, or if you overreported employment
taxes and will be applying the credit to the Form 941 period
during which you file Form 941-X. (However, see the CAUTION
on page 2.) You will use the revised claim process if you
overreported employment taxes and are requesting a refund or
abatement of the overreported amount.
References to Form 941 on Form 941-X and in these
instructions also apply to Form 941-SS, Employer’s
QUARTERLY Federal Tax Return, unless otherwise noted. We
use the terms “correct” and “corrections” on Form 941-X and in
these instructions to include interest-free adjustments under
sections 6205 and 6413 and claims for refund and abatement
under sections 6402, 6414, and 6404.
If you have comments or suggestions for improving Form
941-X or these instructions, we would be happy to hear from
you. Write to the address shown in the Privacy Act and
Paperwork Reduction Act Notice on page 10.
New process for correcting employment taxes. After
December 31, 2008, when you discover an error on a
previously filed Form 941, you must:
• correct that error using Form 941-X,
• file a separate Form 941-X for each Form 941 that you are
correcting, and
• file Form 941-X separately. Do not file Form 941-X with Form
941.
Beginning with the first quarter of 2009, Form 941 will no
longer provide adjustment lines (formerly lines 7d through 7g)
for correcting prior quarter errors. However, continue to report

current quarter adjustments for fractions of cents, third-party
sick pay, tips, and group-term life insurance on Form 941 using
lines 7a through 7c.
Report the correction of underreported and overreported
amounts for the same tax period on a single Form 941-X,
unless you are requesting a refund or abatement. If you are
requesting a refund or abatement and are correcting both
underreported and overreported amounts, file one Form 941-X
correcting the underreported amounts only and a second Form
941-X correcting the overreported amounts.
Follow the chart on the back of Form 941-X for help in
choosing whether to use the adjustment process or the claim
process.

General Instructions:
Understanding Form 941-X
What Is the Purpose of Form 941-X?
Use Form 941-X to correct errors on a Form 941 that you
previously filed. Use Form 941-X to correct:
• Wages, tips, and other compensation;
• Income tax withheld from wages, tips, and other
compensation;
• Taxable social security wages;
• Taxable social security tips;
• Taxable Medicare wages and tips;
• Advance earned income credit (EIC) payments made to
employees; and
• Credits for COBRA premium assistance payments.
If you did not file a Form 941 for one or more quarters, do
not use Form 941-X. Instead, file Form 941 for each of those
quarters. See also When Should You File Form 941-X? on
page 2.
However, if you did not file Forms 941 because you
improperly treated workers as independent contractors or
nonemployees and are now reclassifying them as employees,
see the instructions for line 20 on page 8.
You have additional requirements to complete when filing
Form 941-X, such as certifying that you filed (or will file) all
applicable Forms W-2, Wage and Tax Statements, and Forms
W-2c, Corrected Wage and Tax Statements. For corrections of
overreported federal income tax, social security or Medicare
tax, you must make any certifications that apply to your
situation.
Be sure to give us a detailed explanation on line 21 for each
correction that you show on Form 941-X.
Do not use Form 941-X to correct Forms CT-1, 943,
944, 944-SS, or Form 945. Instead, use the “X” form
CAUTION that corresponds to the return you are correcting (Form
CT-1 X, 943-X, 944-X, or Form 945-X).

!

Where Can You Get Help?
For help filing Form 941-X or for questions about federal
employment taxes and tax corrections, you can:
• call the IRS toll-free at 1-800-829-4933 (TTY/TDD for the
hearing impaired at 1-800-829-4059),
• visit the IRS website at www.irs.gov/businesses and click on
“Employment Taxes,” or

Cat. No. 20331U

• get Pub. 15 (Circular E), Employer’s Tax Guide, for correcting

Medicare wages on your 2008 fourth quarter Form 941. File
Form 941-X and pay the amount you owe by April 30, 2009
because you discovered the error in the first quarter of 2009,
and April 30, 2009, is the due date for that quarter. If you file
Form 941-X before April 30, pay the amount you owe when you
file.

Form 941, or Pub. 80 (Circular SS), Federal Tax Guide for
Employers in the U.S. Virgin Islands, Guam, American Samoa,
and the Commonwealth of the Northern Mariana Islands, for
correcting Form 941-SS.
See also How Can You Order Forms and Publications from
the IRS? on page 9.

Overreported tax — credit. If you overreported tax on Form
941 and choose to apply the credit to Form 941 or Form 944,
file Form 941-X soon after you discovered the error but more
than 90 days before the period of limitations on credit or refund
for Form 941 expires. See Is There a Deadline for Filing Form
941-X? below.

When Should You File Form 941-X?
File Form 941-X when you discover an error on a previously
filed Form 941.
However, if your only errors on Form 941 relate to the
number of employees who received wages or to federal tax
liabilities reported in Part 2 of Form 941 or on Schedule B
(Form 941), do not file Form 941-X. For more information about
correcting federal tax liabilities reported in Part 2 of Form 941 or
on Schedule B (Form 941), see the Instructions for Schedule B
(Form 941).
Due dates. The due date for filing Form 941-X to qualify for
interest-free adjustments for underpayments and overpayments
depends on when you discover an error and if you
underreported or overreported tax. If you underreported tax,
see Underreported tax below. For overreported amounts, you
may choose to either make an interest-free adjustment or file a
claim for refund or abatement. If you are correcting
overreported amounts, see Overreported tax — credit or
Overreported tax — claim below. If any due date falls on a
Saturday, Sunday, or legal holiday, you may file Form 941-X on
the next business day. If we receive Form 941-X after the due
date, we will treat Form 941-X as filed on time if the envelope
containing Form 941-X is properly addressed, contains
sufficient postage, and is postmarked by the U.S. Postal
Service on or before the due date, or sent by an
IRS-designated private delivery service on or before the due
date. If you do not follow these guidelines, we will consider
Form 941-X filed when it is actually received. See Pub. 15
(Circular E) or Pub. 80 (Circular SS) for more information on
IRS-designated private delivery services.

Overreported tax — claim. If you overreported tax on Form
941, you may choose to file a claim for refund or abatement on
Form 941-X any time before the period of limitations on credit or
refund expires on Form 941. (If you need to correct any
underreported amounts, you must file another Form 941-X
reporting only corrections to the underreported amounts.) See
Is There a Deadline for Filing Form 941-X? below.
If you discovered an error on or before December 31,

TIP 2008, but did not report it as a line adjustment on Form
941 for any quarter ended before 2009 and did not file a
claim (Form 843), you may use Form 941-X to correct the error.
File Form 941-X for the quarter in which you made the error.

Is There a Deadline for Filing Form
941-X?
Generally, you may correct overreported taxes on a previously
filed Form 941 if you file Form 941-X within 3 years of the date
Form 941 was filed or 2 years from the date you paid the tax
reported on Form 941, whichever is later. You may correct
underreported taxes on a previously filed Form 941 if you file
Form 941-X within 3 years of the date the Form 941 was filed.
We call each of these time frames a “period of limitations.” For
purposes of the period of limitations, Forms 941 for a calendar
year are considered filed on April 15 of the succeeding year if
filed before that date.

Underreported tax. If you are correcting underreported tax,
you must file Form 941-X by the due date of the return for the
return period in which you discovered the error and pay the
amount you owe when you file. Doing so will generally ensure
that your correction is interest free and not subject to
failure-to-pay or failure-to-deposit penalties. See What About
Penalties and Interest on page 3. For details on how to make a
payment, see the instructions for line 18 on page 8.
If you discover an error in . . . . . . .
1.
2.
3.
4.

January, February, March
April, May, June
July, August, September
October, November, December

Example: You filed your 2007 fourth quarter Form 941 on
January 27, 2008, and payments were timely made. The IRS
treats the return as if it were filed on April 15, 2008. On January
20, 2011, you discover that you overreported social security
and Medicare wages on that form by $350. To correct the error
you must file Form 941-X by April 15, 2011, which is the end of
the period of limitations for Form 941, and use the claim
process.

Form 941-X is due . . .

If you file Form 941-X to correct overreported amounts
in the last 90 days of a period of limitations (after
CAUTION January 15, 2011, in the example above), you must use
the claim process. You cannot use the adjustment process. If
you are also correcting underreported amounts, you must use
the adjustment process to file another Form 941-X to correct
the underreported amounts only and pay any tax due.

April 30
July 31
October 31
January 31

!

The dates shown in the table above apply only to corrections of
underreported amounts. If any due date falls on a Saturday,
Sunday, or legal holiday, you may file Form 941-X on the next
business day.

Where Should You File Form 941-X?

Example — You owe tax: On February 11, 2009, you
discover that you underreported $10,000 of social security and

Send your completed Form 941-X to the Internal Revenue
Service Center shown below.

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IF you are in . . . . . . .
Special filing addresses for
exempt organizations; federal,
state, and local governmental
entities; and Indian tribal
governmental entities; regardless
of location

When reporting a negative amount in columns 3 and 4, use
a minus sign instead of parentheses. For example, enter
“-10.59” instead of “(10.59).” However, if you are completing the
return on your computer and your software only allows you to
use parentheses to report negative amounts, you may use
them.

THEN use this address . . .

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0005

How Should You Make Entries on Form 941-X?

Connecticut, Delaware, District of
Columbia, Georgia, Illinois,
Indiana, Kentucky, Maine,
Maryland, Massachusetts,
Michigan, New Hampshire, New
Jersey, New York, North Carolina,
Ohio, Pennsylvania, Rhode
Island, South Carolina,
Tennessee, Vermont, Virginia,
West Virginia, Wisconsin

Department of the Treasury
Internal Revenue Service
Cincinnati, OH 45999-0005

Alabama, Alaska, Arizona,
Arkansas, California, Colorado,
Florida, Hawaii, Idaho, Iowa,
Kansas, Louisiana, Minnesota,
Mississippi, Missouri, Montana,
Nebraska, Nevada, New Mexico,
North Dakota, Oklahoma, Oregon,
South Dakota, Texas, Utah,
Washington, Wyoming

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0005

No legal residence or principal
place of business in any state

Internal Revenue Service
P.O. Box 409101
Ogden, UT 84409

You can help the IRS process Form 941-X timely and
accurately if you follow these guidelines.
• Type or print your entries.
• Use Courier font (if possible) for all typed or
computer-generated entries.
• Omit dollar signs. You may use commas and decimal points,
if desired. Enter dollar amounts to the left of any preprinted
decimal point and cents to the right of it.
• Always show an amount for cents. Do not round entries to
whole dollars.
• Complete all three pages and sign Form 941-X on page 3.
• Staple multiple sheets in the upper-left corner.

What About Penalties and Interest?
Generally, your correction of an underreported amount will not
be subject to a failure-to-pay penalty, failure-to-deposit penalty,
or interest if you:
• file on time (by the due date of the quarter in which you
discover the error),
• pay the amount shown on line 18 when you file Form 941-X,
• enter the date you discovered the error, and
• explain in detail the grounds and facts relied on to support
the correction.
No correction will be eligible for interest-free treatment if (a)
the amounts underreported relate to an issue that was raised in
an examination of a prior period, (b) you knowingly
underreported your employment tax liability, (c) you received a
notice and demand for payment after assessment, or (d) you
received a Notice of Determination of Worker Classification.

How Should You Complete Form 941-X?
Use One Form 941-X for Each Quarter You Are
Correcting.
Use a separate Form 941-X for each Form 941 that you are
correcting. For example, if you found errors on your Forms 941
for the third and fourth quarters of 2008, file one Form 941-X to
correct the 2008 third quarter Form 941. File a second Form
941-X to correct the 2008 fourth quarter Form 941.

Overview of the New Process
The new process for adjusting or filing a claim for Form 941 is
outlined below.
If you underreported the tax. If you underreported the tax
on a previously filed Form 941, check the box on line 1 and pay
any additional amount you owe when you file Form 941-X. For
details on how to make a payment, see the instructions for line
18 on page 8.
Example — You underreported employment taxes: On
June 20, 2009, you discover an error that results in additional
tax on your 2008 fourth quarter Form 941. File Form 941-X by
July 31, 2009 and pay the amount you owe when you file. See
When Should You File Form 941-X? on page 2. Do not attach
Form 941-X to your 2009 second quarter Form 941.
If you overreported the tax. If you overreported the tax on
a previously filed Form 941, you may choose to:
• use the adjustment process. Check the box on line 1 to apply
any credit (negative amount) from line 18 to Form 941 for the
quarter during which you file Form 941-X, or
• use the claim process. Check the box on line 2 to file a claim
on Form 941-X requesting a refund or abatement of the amount
shown on line 18.

EIN, Name, and Address
Enter your EIN, name, and address in the spaces provided.
Also enter your name and EIN on the top of pages 2 and 3, and
on any attachments. If your address has changed since you
filed your Form 941, enter the corrected information and the
IRS will update your address of record.

Return You Are Correcting. . .
In the box at the top of page 1 of Form 941-X, check the type of
return (Form 941 or Form 941-SS) you are correcting. Check
the appropriate box for the one quarter you are correcting.
Enter the calendar year of the Form 941 you are correcting.
Enter the quarter and calendar year on pages 2 and 3, and on
any attachments.

Enter the Date You Discovered Errors
You must enter the date you discovered errors. If you are
reporting several errors that you discovered at different times,
enter the earliest date you discovered them here. On line 21
report any subsequent dates and related errors.

To ensure that the IRS has enough time to process a

TIP credit for an overreporting adjustment in the quarter

Must You Make an Entry on Each Line?

during which you file Form 941-X, you are encouraged
to file Form 941-X correcting the overreported amount in the
first two months of a quarter. For example, if you discover an
overreported amount in March, June, September, or December,
you may want to file Form 941-X in the first two months of the
next quarter (However, there must be 90 days remaining on the
period of limitations when you file Form 941-X. See the Caution
on page 2). This should ensure that the IRS will have enough
time to process the Form 941-X so that the credit will be posted
before you file Form 941, thus avoiding an erroneous balance
due notice from the IRS. See the example below. (If you

You must provide all of the information requested at the top of
page 1 of Form 941-X. You must check one box (but not both)
in Part 1. You must check the box on line 3 and any applicable
boxes on lines 4 and 5. In Part 3, if any line does not apply,
leave it blank. Complete Parts 4 and 5 as instructed.

How Should You Report Negative Amounts?
Form 941-X uses negative numbers to show reductions in tax
(credits) and positive numbers to show additional tax (amounts
you owe).

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currently file Form 944 instead of Form 941 and will claim a
credit on Form 944, file Form 941-X before December in any
year before the expiration of the period of limitations on Form
941. In the year of the expiration of the period of limitations on
Form 941, file Form 941-X at least 90 days before the
expiration date.)
Example — You want your overreported tax applied as a
credit to Form 941: On June 22, 2009, you discover you
overreported your tax on your 2008 fourth quarter Form 941
and want to choose the adjustment process. To allow the IRS
enough time to process the credit, you file Form 941-X on July
1, 2009.

Unless the IRS corrects Form 941-X during processing or
you owe other taxes, penalties, or interest, the IRS will refund
the amount shown on line 18, plus any interest that applies.

Part 2: Complete the Certifications
You must complete all certifications that apply by checking the
appropriate boxes. If all of your corrections relate to
underreported amounts, complete line 3 only; skip lines 4 and 5
and go to Part 3. If your corrections relate to overreported
amounts, you have a duty to assure that your employees’ rights
to recover overpaid employee social security and Medicare
taxes that you withheld are protected. The certifications on lines
4 and 5 address the requirement to (a) repay or reimburse your
employees for the overcollection of employee social security
and Medicare taxes or (b) obtain consents from your employees
to file a claim on their behalf.

Specific Instructions:
Part 1: Select ONLY one process.

3. Filing Forms W-2 or Forms W-2c
Check the box on line 3 to certify that you filed or will file Forms
W-2 or Forms W-2c, as required, showing your employees’
correct wage and tax amounts. See the Instructions for Forms
W-2 and W-3 and the Instructions for Forms W-2c and W-3c for
detailed information about filing requirements. References to
Form W-2 on Form 941-X and in these instructions also apply
to Forms W-2AS, W-2CM, W-2GU, and W-2VI unless otherwise
noted.
You must check the box on line 3 to certify that you filed
Forms W-2 or Forms W-2c even if your corrections on Form
941-X do not change amounts shown on those forms. For
example, if your only correction to Form 941 involves misstated
tax adjustments (see the instructions for line 11), check the box
on line 3 to certify that you already filed all required Forms W-2
and W-2c.

Because Form 941-X may be used to file either an adjusted
employment tax return or a claim for refund or abatement, you
must check one box in either line 1 or line 2. Do not check both
boxes.

1. Adjusted Employment Tax Return
Check the box on line 1 if you are correcting underreported
amounts or overreported amounts and you would like to use the
adjustment process to correct the errors.
If you are correcting both underreported amounts and
overreported amounts on this form, you must check this box. If
you check this box, any negative amount shown on line 18 will
be applied as a credit (tax deposit) to your Form 941 or Form
944 for the period in which you are filing this form. See
Example — You want your overreported tax applied as a credit
to Form 941 above.
If you owe tax. Pay the amount shown on line 18 when you
file Form 941-X. Generally, you will not be charged interest if
you file on time, pay on time, enter the date you discovered the
error, and explain the correction on line 21.
If you have a credit. You overreported employment taxes
(you have a negative amount on line 18) and want the IRS to
apply the credit to Form 941 or Form 944 for the period during
which you filed Form 941-X. The IRS will apply your credit on
the first day of the Form 941 or Form 944 period during which
you filed Form 941-X. However, the credit you show on line 18
of Form 941-X may not be fully available on your Form 941 or
Form 944 if the IRS corrects it during processing or you owe
other taxes, penalties, or interest. The IRS will notify you if your
claimed credit changes or if the amount available as a credit on
Form 941 or Form 944 was reduced because of unpaid taxes,
penalties, or interest.

4. Certifying Overreporting Adjustments
If you overreported federal income tax, social security tax, or
Medicare tax and checked the box on line 1, check the
appropriate box on line 4. You may need to check more than
one box. If you obtained written statements from some
employees but you could not locate or secure the cooperation
of the remaining employees, check all applicable boxes.
Provide a summary in line 21 of the amount of the corrections
for both the employees who provided written statements and for
those who did not.
4a. Check the box on line 4a if your overreported amount
includes each affected employee’s share of overcollected taxes.
You are certifying that you repaid or reimbursed the employee’s
share of current and prior year taxes and you received written
statements from the employees stating that they did not and will
not receive a refund or credit for the prior year taxes. You are
certifying that you adjusted federal income tax withheld from
employees for the current calendar year only.
Example. The following is an example of the written
statement that is required from employees.
Employee name
Employer name
I have received a repayment of $_________ as
overcollected social security and Medicare taxes for 20___. I
have not claimed a refund of or credit for the overcollected
taxes from the IRS, or if I did, that claim has been rejected;
and I will not claim a refund or a credit of the amount.
Employee signature
Date

Do not check the box on line 1 if you are correcting
overreported amounts and the period of limitations on
CAUTION credit or refund for Form 941 will expire within 90 days
of the date you file Form 941-X. Instead, check the box on line
2. See Is There a Deadline for Filing Form 941-X? on page 2.

!

2. Claim
Check the box on line 2 to use the claim process if you are
correcting overreported amounts only and you are claiming a
refund or abatement for the negative amount (credit) shown on
line 18. Do not check this box if you are correcting ANY
underreported amounts on this form.
You must check the box on line 2 if you have a credit and
the period of limitations on credit or refund for Form 941 will
expire within 90 days of the date you file Form 941-X. See Is
There a Deadline for Filing Form 941-X? on page 2.
The IRS usually processes claims shortly after they are filed.
The IRS will notify you if your claim is denied, accepted as filed,
or selected to be examined. See Publication 556, Examination
of Returns, Appeal Rights, and Claims for Refund, for more
information.

Do not send these statements to the IRS. Keep them for
your records.
4b. Check the box on line 4b to certify that your overreported
amount is only for the employer share of taxes on those
employees who you were unable to find or those who would not
(or could not) give you a statement described on line 4a.
4c. Check the box on line 4c to certify that your overreported
amount is only for federal income tax, social security tax, and
Medicare tax that you did not withhold from your employees.

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If a correction that you report in column 4 includes both
underreported and overreported amounts (see the instructions
for line 19), give us details for each error on line 21.

5. Certifying Claims
If you are filing a claim for refund or abatement of overreported
federal income tax, social security tax, or Medicare tax and
checked the box on line 2, check the appropriate box on line 5.
You may need to check more than one box. If you obtained
written statements or consents from some employees but you
could not locate or secure the cooperation of the remaining
employees, check all applicable boxes. Provide a summary in
line 21 of the amount of the corrections for both the employees
who provided statements or consents and for those who did
not. You may not file a refund claim to correct federal income
tax actually withheld from employees.
5a. Check the box on line 5a if your overreported tax includes
each affected employee’s share of social security and Medicare
tax. You are certifying that you repaid or reimbursed to the
employees their share of prior year social security and
Medicare tax and you received written statements from those
employees stating that they did not and will not receive a refund
or credit for the prior year taxes.
5b. Check the box on line 5b if your overreported tax includes
each affected employee’s share of social security and Medicare
tax and you have not yet repaid or reimbursed the employee
share of taxes. You are certifying that you received consent
from each affected employee to file a claim on the employee
share of those taxes and you received written statements from
those employees stating that they did not and will not receive a
refund or credit for the prior year taxes.
Example. The following is an example of the consent and
written statement that is required from employees when you are
filing a claim for refund and have not yet paid or reimbursed the
employee share of taxes.

Because special circumstances apply for lines 11 through 14
and 16 through 17b, read the instructions for each line carefully
before entering amounts in the columns.
If you previously adjusted or amended Form 941 using
Form 941c, Form 941-X, Form 843, an “amended” Form
CAUTION 941, by filing a “supplemental” Form 941, or because of
an IRS examination change, show amounts in column 2 that
include those previously reported corrections.

!

6. Wages, Tips, and Other Compensation
If you are correcting the wages, tips, and other compensation
you reported on line 2 of Form 941, enter the total corrected
amount for ALL employees in column 1. In column 2, enter the
amount you originally reported. In column 3, enter the
difference between columns 1 and 2. This line does not apply to
Form 941-SS.
If you (or the IRS) previously corrected the amount reported
on line 2 of Form 941, enter in column 2 the amount after any
previous corrections.
line 6 (column 1)
-line 6 (column 2)
line 6 (column 3)

If the amount in column 2 is larger than
the amount in column 1, use a minus
sign in column 3.

Example — Wages, tips, and other compensation
increased: You reported $9,000 as total wages, tips, and
other compensation on line 2 of your 2008 third quarter Form
941. In July of 2009, you discovered that you had overlooked
$1,000 in tips for one of your part-time employees. To correct
the error, figure the difference on Form 941-X as shown.

Employee name
Employer name
I give my consent to have my employer (named above) file a
claim on my behalf with the IRS requesting $_________ in
overcollected social security and Medicare taxes for 20___. I
have not claimed a refund of or credit for the overcollected
taxes from the IRS, or if I did, that claim has been rejected;
and I will not claim a refund or a credit of the amount.
Employee signature
Date

Column 1 (corrected amount)
Column 2 (from line 2 of Form 941)
Column 3 (difference)

10,000.00
- 9,000.00
1,000.00

Example — Wages, tips, and other compensation
decreased: You reported $9,000 as wages, tips, and other
compensation on line 2 of your 2008 fourth quarter Form 941.
In December of 2009, you discovered that you included $2,000
in wages for one of your employees twice. To correct the error,
figure the difference on Form 941-X as shown.

Do not send these statements to the IRS. Keep them for
your records.
In certain situations, you may not have repaid or reimbursed
your employees or obtained their consents prior to filing a claim,
such as in cases where the period of limitations on credit or
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 21 that you
“have not repaid or reimbursed employees or obtained
consents.” However, you must certify that you have repaid or
reimbursed your employees or obtained consents before the
IRS can grant the claim.
5c. Check the box on line 5c to certify that your overreported
tax is only for the employer share of social security and
Medicare tax. Affected employees did not give you consent to
file a claim for refund for the employee share of social security
and Medicare tax, they could not be found, or would not (or
could not) give you a statement described on line 5b.
5d. Check the box on line 5d to certify that your overreported
amount is only for federal income tax, social security tax, and
Medicare tax that you did not withhold from your employees.

Column 1 (corrected amount)
Column 2 (from line 2 of Form 941)
Column 3 (difference)

7,000.00
- 9,000.00
- 2,000.00

Example — Auto allowance; wages, tips, and other
compensation increased: You paid one of your employees a
$500 monthly auto allowance from October through December
2008 and did not treat the payments as taxable wages.
However, in February 2009, you realized that the payments
were wages because they were not reimbursements of
deductible business expenses that were substantiated and paid
under an accountable plan. Therefore, you must correct the
error and treat the auto allowance as wages subject to income,
social security, and Medicare taxes. Use Form 941-X to report
the additional $1,500 of wages on line 6 and any underreported
amounts on lines 8 and 10.
For line 6 of Form 941-X only, there is no entry in

TIP column 4. Instead, use the amount in column 1 when
you prepare your Forms W-2 or Forms W-2c.

Part 3: Enter the Corrections for This
Quarter.

7. Income Tax Withheld from Wages, Tips, and
Other Compensation
If you are correcting the federal income tax withheld from
wages, tips, and other compensation you reported on line 3 of
Form 941, enter the total corrected amount in column 1. In
column 2, enter the amount you originally reported or as
previously corrected. In column 3, enter the difference between
columns 1 and 2. This line does not apply to Form 941-SS.

What Amounts Should You Report in Part 3?
In columns 1 and 2 of lines 6 through 10, show amounts for all
of your employees, not just for those employees whose
amounts you are correcting.

-5-

line 7 (column 1)
-line 7 (column 2)
line 7 (column 3)

the instructions for line 6, the wages that you counted twice
were also taxable social security wages. To correct the error,
figure the difference on Form 941-X as shown.

If the amount in column 2 is larger
than the amount in column 1, use a
minus sign in column 3.

Column 1 (corrected amount)
Column 2 (from line 5a of Form 941)
Column 3 (difference)

Copy the amount in column 3 to column 4. Include any minus
sign shown in column 3.

Use the difference in column 3 to determine your tax
correction.

Generally, you may correct federal income tax
withholding errors only if you discovered the errors in
CAUTION the same calendar year you paid the wages. However,
you may correct federal income tax withholding errors for prior
years if the amounts shown on Form 941 do not agree with the
amounts you actually withheld, that is, an administrative error.
See section 13 of Pub. 15 (Circular E) for more information
about corrections during the calendar year and about
administrative errors.
Example — Failure to withhold income tax when
required: You were required to withhold $400 of federal
income tax from an employee’s bonus that was paid in
December of 2008 but you withheld nothing. You discovered
the error on March 15, 2009. You cannot file Form 941-X to
correct your 2008 fourth quarter Form 941 because the error
involves a previous year and the amount previously reported for
the employee represents the actual amount withheld from the
employee during 2008.
Example — Administrative error reporting income tax:
You had three employees. In the fourth quarter of 2008, you
withheld $1,000 of federal income tax from employee A, $2,000
from employee B, and $6,000 from employee C. The total
amount of federal income tax you withheld was $9,000. You
mistakenly reported $6,000 on line 3 of your 2008 fourth quarter
Form 941. You discovered the error on March 16, 2009. This is
an example of an administrative error that may be corrected in
a later calendar year because the amount actually withheld
from employees’ wages differs from the amount reported on
Form 941. Use Form 941-X to correct the error. Enter $9,000 in
column 1 and $6,000 in column 2. Subtract the amount in
column 2 from the amount in column 1.

!

Column 1 (corrected amount)
Column 2 (from line 3 of Form 941)
Column 3 (difference)

7,000.00
- 9,000.00
- 2,000.00

Column 3 (difference)
Tax rate (12.4%)
Column 4 (tax correction)

-2,000.00
x .124
-248.00

Be sure to explain the reasons for this correction on line 21.

9. Taxable Social Security Tips
If you are correcting the taxable social security tips you reported
on line 5b, column 1 of Form 941, enter the total corrected
amount in column 1. In column 2, enter the amount you
originally reported or as previously corrected. In column 3, enter
the difference between columns 1 and 2.
line 9 (column 1)
-line 9 (column 2)
line 9 (column 3)

If the amount in column 2 is larger than the amount
in column 1, use a minus sign in column 3.

Multiply the amount in column 3 by .124 (12.4% tax rate) and
report that result in column 4.
line 9 (column 3)
x .124
line 9 (column 4)

If the amount in column 3 used a minus sign,
also use a minus sign in column 4.

Note. If you are correcting only the employer share of tax on a
decrease to social security tips, use .062 (6.2%) when
multiplying the amount shown in column 3. If you are correcting
both shares of tax for some employees and only the employer
share for other employees, report the properly calculated
amount in column 4. Be sure to show your calculations on line
21.
Following the Example — Wages, tips, and other
compensation increased in the instructions for line 6, the tips
that you overlooked were also taxable social security tips. To
correct the error, figure the difference on Form 941-X as shown.

9,000.00
- 6,000.00
3,000.00

Report the 3,000.00 as a tax correction in column 4.
Be sure to explain the reasons for this correction on line 21.

8. Taxable Social Security Wages

Column 1 (corrected amount)
Column 2 (from line 5b of Form 941)
Column 3 (difference)

10,000.00
- 9,000.00
1,000.00

If you are correcting the taxable social security wages you
reported on line 5a, column 1 of Form 941, enter the total
corrected amount in column 1. In column 2, enter the amount
you originally reported or as previously corrected. In column 3,
enter the difference between columns 1 and 2.

Use the difference in column 3 to determine your tax
correction.

line 8 (column 1)
-line 8 (column 2)
line 8 (column 3)

Column 3 (difference)
Tax rate (12.4%)
Column 4 (tax correction)

If the amount in column 2 is larger
than the amount in column 1, use a
minus sign in column 3.

Be sure to explain the reasons for this correction on line 21.

Multiply the amount in column 3 by .124 (12.4% tax rate) and
enter that result in column 4.
line 8 (column 3)
x .124
line 8 (column 4)

1,000.00
x .124
124.00

10. Taxable Medicare Wages and Tips
If you are correcting the taxable Medicare wages and tips you
reported on line 5c, column 1 of Form 941, enter the total
corrected amount in column 1. In column 2, enter the amount
you originally reported or as previously corrected. In column 3,
enter the difference between columns 1 and 2.

If the amount in column 3 used a minus sign,
also use a minus sign in column 4.

Note. If you are correcting only the employer share of tax on a
decrease to social security wages, use .062 (6.2%) when
multiplying the amount shown in column 3. If you are correcting
both shares of tax for some employees and only the employer
share for other employees, enter the properly calculated
amount in column 4. Be sure to show your calculations on line
21.
Example — Social security wages decreased: Following
Example — Wages, tips and other compensation decreased in

line 10 (column 1)
-line 10 (column 2)
line 10 (column 3)

If the amount in column 2 is larger than the
amount in column 1, use a minus sign in
column 3.

Multiply the amount in column 3 by .029 (2.9% tax rate) and
enter that result in column 4.

-6-

line 10 (column 3)
x .029
line 10 (column 4)

In this example, you are claiming a credit for $2,700 in
overreported tax for your 2008 second quarter Form 941.
Always enter the same amount in column 4 (including any
minus sign) that you enter in column 3.

If the amount in column 3 used a minus sign,
also use a minus sign in column 4.

Note. If you are correcting only the employer share of tax on a
decrease to Medicare wages and tips, use .0145 (1.45%) when
multiplying the amount in column 3. If you are correcting both
shares of tax for some employees and only the employer share
for other employees, enter the properly calculated amount in
column 4. Be sure to explain your calculations on line 21.
Example — Medicare wages and tips decreased:
Following Example — Wages, tips and other compensation
decreased in the instructions for line 6, the wages that you
counted twice were also taxable Medicare wages and tips. To
correct the error, figure the difference on Form 941-X as shown.
Column 1 (corrected amount)
Column 2 (from line 5c of Form 941)
Column 3 (difference)

Be sure to explain the reasons for this correction on line 21.

!

CAUTION

12–14. Special Additions to Wages for Federal
Income Tax, Social Security Tax, and Medicare
Tax
Section 3509 provides special rates for the employee share of
social security and Medicare taxes and income tax withholding
when workers are reclassified as employees in certain
circumstances. The applicable rate depends on whether you
filed required information returns. An employer cannot recover
any tax paid under this provision from the employees. The full
employer share of social security and Medicare tax is due for all
reclassifications.

7,000.00
- 9,000.00
- 2,000.00

Use the difference in column 3 to determine your tax
correction.
Column 3 (difference)
Tax rate (2.9%)
Column 4 (tax correction)

-2,000.00
x .029
-58.00

Note. Section 3509 rates are not available if you intentionally
disregarded the requirements to withhold taxes from the
employee, or if you withheld income tax but did not withhold
social security and Medicare tax. Section 3509 rates are also
not available for certain statutory employees.

Be sure to explain the reasons for this correction on line 21.

11. Tax Adjustments

On lines 12, 13, and 14 enter only corrections to wages
resulting from reclassifying certain workers as employees when
section 3509 rates are used to calculate the taxes.

Do not enter an amount on line 11 unless you need to correct
any adjustments reported on lines 7a through 7c of a previously
filed Form 941.

Unlike other lines on Form 941-X, enter in column 1 only the
corrected wages for workers being reclassified, not the amount
paid to ALL employees. Enter previously reported wages to
reclassified employees (if any) in column 2. To get the amount
for column 4, use the applicable section 3509 rates. The tax
correction in column 4 will be a positive number if you increased
the amount of wages you previously reported. See the
instructions for line 20 for more information.

Use line 11 to correct any adjustments shown on lines 7a
through 7c. Add the corrected amounts on lines 7a through 7c.
Enter that total in column 1.
Add the originally reported or previously corrected amounts
from lines 7a through 7c. Enter that total in column 2. In column
3, enter the difference between columns 1 and 2.
line 11 (column 1)
-line 11 (column 2)
line 11 (column 3)

If you misreported the taxes from worker reclassification

TIP on line 7f or line 7g on a pre-2009 Form 941, you may
correct the amount using lines 12 through 14 of Form
941-X. Be sure to complete all of the columns and provide a
detailed explanation on line 21.

You may need to report negative numbers in any

TIP column. Make sure that the difference you enter in
column 3 accurately represents the change to
adjustments originally reported or previously corrected on lines
7a through 7c of Form 941.
Copy the amount in column 3 to column 4. Include any
minus sign shown in column 3.
On line 21, describe what you misreported on Form 941. Tell
us if your adjustment is for fractions of cents, third-party sick
pay, tips, or group-term life insurance.
Example — Current quarter’s third-party sick pay
underreported: You reported $6,900 (shown as “-6,900.00”)
as a third-party sick pay adjustment (reduction to tax) on line 7b
of your 2008 second quarter Form 941. You did not report any
amounts on lines 7a and 7c. Your third-party sick pay
adjustment should have been $9,600 (shown as “-9,600.00”)
because your third-party sick pay payer withheld that amount of
social security and Medicare taxes from your employees. You
discovered the error in April of 2009. To correct the error, figure
the difference on Form 941-X as shown.
Column 1 (corrected amount)
Column 2 (from line 7b of Form 941)
Column 3 (difference)

15. Subtotal
Combine the amounts on lines 7 through 14 of column 4.
Example: You entered “1,400.00” in column 4 of line 7,
“-500.00” in column 4 of line 8, and “-100.00” in column 4 of line
10. Combine these amounts and enter “800.00” in column 4 of
line 15.
Line 7
Line 8
Line 10
Line 15

If you are correcting the advance earned income credit (EIC)
payments made to your employees that you reported on line 9
of Form 941, enter the total corrected amount for ALL
employees in column 1. In column 2, enter the amount you
originally reported or as previously corrected. In column 3, enter
the difference between columns 1 and 2. This line does not
apply to Form 941-SS.

-9,600.00
- (6,900.00)
-2,700.00

Column 2
(from line 7b, Form 941)
-6,900.00

1,400.00
-500.00
-100.00
800.00

16. Advance Earned Income Credit (EIC)
Payments Made to Employees

Here is how you would enter the numbers on Form 941-X.
Column 1
(corrected amount)
-9,600.00

Do not use line 11 to report corrections to amounts
reported on lines 7d through 7g of pre-2009 Forms 941.

Column 3
(difference)
-2,700.00

line 16 (column 1)
-line 16 (column 2)
line 16 (column 3)

Report “-2,700.00” as your correction in column 4.

-7-

If the amount in column 2 is larger than
the amount in column 1, use a minus sign
in column 3.

• If you checked the box on line 2, you are filing a claim for
refund or abatement of the amount shown.

Copy the amount in column 3 to column 4. However, to
properly show the correction as a credit or balance due
CAUTION item, enter a positive number in column 3 as a negative
number in column 4 or a negative number in column 3 as a
positive number in column 4. Remember, negative amounts in
column 4 represent credits and positive amounts in column 4
represent additional tax.
Examples: If line 16, column 3 shows “560.00,” enter
“-560.00” in column. 4.
If line 16, column 3 shows “-990.00,” enter “990.00” in
column. 4.
Example — Advance EIC payments increased: You filed
your 2008 fourth quarter Form 941 reporting zero (line left
blank) on line 9. On February 17, 2009, you discovered that you
forgot to report the $1,000 in advance EIC payments you made
on behalf of John Smith, one of your employees. You made no
other EIC payments for your other employees. This is an
example of an administrative error. To correct the error, file
Form 941-X showing the following.

!

Column 1 (corrected amount)
Column 2 (from Form 941, line 9)
Column 3 (difference)

-

If your credit is less than $1, we will send a refund or apply it
only if you ask us in writing to do so.
Amount you owe. You must pay the amount you owe when
you file Form 941-X. You may not use any credit that you show
on another Form 941-X to pay the amount you owe, even if you
filed for the amount you owe and the credit at the same time.
If you owe tax and are filing a timely Form 941-X, do not file
an amended Schedule B (Form 941) unless you were assessed
an FTD penalty caused by an incorrect, incomplete, or missing
Schedule B (Form 941). Do not include the tax increase
reported on Form 941-X on any amended Schedule B (Form
941) you file.
If you owe tax and are filing a late Form 941-X, that is, after
the due date for Form 941 for the quarter in which you
discovered the error, you must file an amended Schedule B
(Form 941) with the Form 941-X. Otherwise, the IRS may
assess an “averaged” FTD penalty.

1,000.00
0.00
1,000.00

Payment methods. You may pay the amount you owe on
line 18 electronically using the Electronic Federal Tax Payment
System (EFTPS), by credit card, or by a check or money order.
• The preferred method of payment is EFTPS. For more
information, visit www.eftps.gov, call EFTPS Customer Service
at 1-800-555-4477 toll free, or get Pub. 966, The Secure Way to
Pay Your Federal Taxes.
• To pay by credit card, visit the IRS website at www.irs.gov
and click on the electronic IRS link.
• If you pay by check or money order, make it payable to
“United States Treasury.” On your check or money order, be
sure to write your EIN, “Form 941-X,” and the quarter and year
corrected.

Reverse the mathematical sign of the amount in column 3
and enter your correction in column 4.
Column 4 (tax correction)

-1,000.00

Be sure to explain the reasons for this correction on line 21.
See section 13 of Pub. 15 (Circular E) for more
information about administrative errors and corrections
CAUTION during the calendar year. The same rules that apply to
withheld federal income taxes also apply to advance earned
income credit (EIC) payments made to employees.

!

17a. COBRA premium assistance payments

!

If you are correcting the total COBRA premium assistance
payments reported on line 12a of Form 941, report on this line
the COBRA premium assistance payments you made. Only
report the premium assistance payments you made for the
assistance eligible individuals who have paid their reduced
premiums. This amount should be 65% of the total COBRA
premiums for assistance eligible individuals without regard to
the reduction. Do not include any amounts paid to you by the
COBRA assistance eligible individuals. For COBRA coverage
provided under a self-funded plan, COBRA premium assistance
payments are treated as having been made for each assistance
eligible individual who pays 35% of the COBRA premium.
Copy the amount in column 3 to column 4. However, to
properly show the correction as a credit or balance due item,
enter a positive number in column 3 as a negative number in
column 4 or a negative number in column 3 as a positive
number in column 4. This is the same procedure as the
Advance Earned Income Credit on line 16.

Do not use a federal tax deposit coupon (Form 8109 or
Form 8109-B) to make a payment with Form 941-X.

CAUTION

You do not have to pay if the amount you owe is less than
$1.
Previously assessed FTD penalty. If line 18 reflects
overreported tax and the IRS previously assessed a
failure-to-deposit (FTD) penalty, you may be able to reduce the
penalty. For more information, see the Instructions for Schedule
B (Form 941).

Part 4: Explain Your Corrections for This
Quarter.
19. Correction of Both Underreported and
Overreported Amounts
Check the box on line 19 if any corrections you entered on lines
7 through 14 and line 16 in column 3 reflect both underreported
and overreported amounts.

17b. Number of individuals provided COBRA
premium assistance on line 17a

Example: If you had an increase to social security wages of
$15,000 for employee A and a decrease to social security
wages of $5,000 for employee B, you would enter $10,000 on
line 8, column 3. That $10,000 represents the net change from
corrections.

Enter the total number of individuals provided COBRA premium
assistance payments reported on line 17a.

18. Total deposits and COBRA credit
Combine lines 15, 16, and 17a, and enter the result on line 18.
Your credit. If the amount entered on line 18 is less than zero,
for example, “-115.00,” you have a credit because you
overreported your federal employment taxes.
• If you checked the box on line 1, include this amount on line
11 (“Total deposits”) of Form 941 for the quarter during which
you filed Form 941-X. (If you currently file Form 944 or Form
944-SS because your filing requirement changed, include the
credit on line 10.) Do not make any changes to your record of
federal tax liability reported on line 17 of Form 941 or Schedule
B (Form 941), if your Form 941-X is filed timely. The amounts
reported on the record should reflect your actual tax liability for
the period.

On line 21, you must explain the reason for both the $15,000
increase and the $5,000 decrease.

20. Did You Reclassify Any Workers?
Check the box on line 20 if you reclassified any workers to be
independent contractors or nonemployees. Also check this box
if the IRS (or you) determined that workers you treated as
independent contractors or nonemployees should be classified
as employees. On line 21, give us a detailed reason why any
worker was reclassified and, if you used section 3509 rates on
lines 12 through 14, for any worker reclassified as an employee,
explain why section 3509 rates apply and what rates you used.

-8-

• Partnership (including an LLC treated as a partnership)

Return not filed because you did not treat any workers as
employees. If you did not previously file Form 941 because
you mistakenly treated all workers as independent contractors
or as nonemployees, file a Form 941 for each delinquent
quarter.
On each Form 941 for which you are entitled to use section
3509 rates,
• write “Misclassified Employees” in dark, bold letters across
the top margin of page 1,
• enter a zero on line 10 (“Total taxes after adjustment for
advance EIC”),
• complete the signature area, and
• attach a completed Form 941-X (see instructions below).
On each Form 941-X,
• complete the top of Form 941-X, including the date you
discovered the error,
• enter the wage amounts in column 1 of lines 12 through 14,
• enter zeros in column 2 of lines 12 through 14,
• complete columns 3 and 4 as instructed in Part 3,
• provide a detailed statement on line 21, and
• complete the signature area.

or unincorporated organization — A responsible and duly
authorized member or officer having knowledge of its affairs.
• Single member LLC treated as a disregarded entity for
federal income tax purposes — The owner of the LLC or a
principal officer duly authorized to act.
• Trust or estate — The fiduciary.
Form 941-X may also be signed by a duly authorized agent
of the taxpayer if a valid power of attorney has been filed.
Alternative signature method. Corporate officers or duly
authorized agents may sign Form 941-X by rubber stamp,
mechanical device, or computer software program. For details
and required documentation, see Rev. Proc. 2005-39. You can
find Rev. Proc. 2005-39 on page 82 of Internal Revenue
Bulletin 2005-28 at
www.irs.gov/pub/irs-irbs/irb05-28.pdf.

Paid Preparer’s Use Only
A paid preparer must sign Form 941-X and provide the
information in the Paid preparer’s use only section of Part 5 if
the preparer was paid to prepare Form 941-X and is not an
employee of the filing entity. Paid preparers must sign paper
returns with a manual signature. The preparer must give you a
copy of the return in addition to the copy to be filed with the
IRS.
If you are a paid preparer, write your SSN or your Preparer
Tax Identification Number (PTIN) in the space provided. Include
your complete address. If you work for a firm, write the firm’s
name and the EIN of the firm. You can apply for a PTIN using
Form W-7P, Application for Preparer Tax Identification Number.
You cannot use your PTIN in place of the EIN of the tax
preparation firm.
Generally, you are not required to complete this section if
you are filing the return as a reporting agent and have a valid
Form 8655, Reporting Agent Authorization, on file with the IRS.
However, a reporting agent must complete this section if the
reporting agent offered legal advice, for example, advising the
client on determining whether its workers are employees or
independent contractors for federal tax purposes.

If you cannot use section 3509 rates (for example,
because the workers you treated as nonemployees
CAUTION were certain statutory employees), file a Form 941 for
each delinquent quarter. Write “Misclassified Employees” in
dark, bold letters across the top margin of page 1 of each Form
941. Complete Form 941 using the Instructions for Form 941.
Attach a Form 941-X to each Form 941. Complete the top of
Form 941-X, including the date you discovered the error, and
provide a detailed explanation on line 21.

!

21. Explain Your Corrections
Treasury regulations require you to explain in detail the grounds
and facts relied upon to support each correction. On line 21,
describe in detail each correction you entered in column 4 on
lines 7 through 14 and line 16. If you need more space, attach
additional sheets, but be sure to write your name, EIN, quarter,
and calendar year on the top of each sheet.
You must describe the events that caused the underreported
or overreported amounts. Explanations such as “social security
and Medicare wages were overstated” or “administrative/payroll
errors were discovered” are insufficient and may delay
processing your Form 941-X because the IRS may need to ask
for a more complete explanation.
The following is the information we need in your explanation
for each error you are correcting.
• Form 941-X line number(s) affected
• Date you discovered the error
• Difference (amount of the error)
• Cause of the error
You may report the information in paragraph form. The
following paragraph is an example.
“The $1,000 difference shown in column 3 of lines 6, 8, and
10 was discovered on May 15, 2009, during an internal payroll
audit. We discovered that we included $1,000 of wages for one
of our employees twice. This correction removes the reported
wages that were never paid.”
For corrections shown on lines 12 through 14, explain why
the correction was necessary and attach any notice you
received from the IRS.

How Can You Order Forms and
Publications from the IRS?
Call 1-800-829-3676.

Visit the IRS website at www.irs.gov.

Additional Information
You may find the following products helpful when using Form
941-X.
• Form W-2, Wage and Tax Statement
• Form W-3, Transmittal of Wage and Tax Statements
• Instructions for Forms W-2 and W-3
• Form W-2AS, American Samoa Wage and Tax Statement
• Form W-2CM, Wage and Tax Statement (Northern Mariana
Islands)
• Form W-2GU, Guam Wage and Tax Statement
• Form W-2VI, U.S. Virgin Islands Wage and Tax Statement
• Form W-3SS, Transmittal of Wage and Tax Statements
• Instructions for Forms W-2AS, W-2GU, W-2VI, and Form
W-3SS
• Form W-2c, Corrected Wage and Tax Statement
• Form W-3c, Transmittal of Corrected Wage and Tax
Statements
• Instructions for Forms W-2c and W-3c
• Instructions for Form 843
• Instructions for Form 941

Part 5. Sign Here
You must complete all three pages of Form 941-X and sign it on
page 3. If you do not sign, processing of Form 941-X will be
delayed.
Who must sign the Form 941-X? Form 941-X must be
signed by one of the following:
• Sole proprietorship — The individual who owns the
business.
• Corporation (including a limited liability company (LLC)
treated as a corporation) — The president, vice president, or
other principal officer duly authorized to act.

-9-

•
•
•
•
•

Instructions for Schedule B (Form 941)
Instructions for Form 941-SS
Pub. 15 (Circular E)
Pub. 80 (Circular SS)
Pub. 966, The Secure Way to Pay Your Federal Taxes

your tax return to others as described in the Code. For
example, we may disclose your information to the Department
of Justice for civil and criminal litigation, and to cities, states, the
District of Columbia, and U.S. commonwealths and
possessions for use in administering their tax laws. We may
also disclose this information to other countries under a tax
treaty, to federal and state agencies to enforce federal nontax
criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism.
The time needed to complete and file Form 941-X will vary
depending on individual circumstances. The estimated average
time is:

Privacy Act and Paperwork Reduction Act Notice We ask
for the information on Form 941-X to carry out the Internal
Revenue laws of the United States. We need it to figure and
collect the right amount of tax. Subtitle C, Employment Taxes,
of the Internal Revenue Code imposes employment taxes on
wages, including income tax withholding. This form is used to
determine the amount of taxes that you owe. Section 6011
requires you to provide the requested information if the tax is
applicable to you. Section 6109 requires filers and paid
preparers to provide their identifying number. If you fail to
provide this information in a timely manner, you may be subject
to penalties and interest.
You are not required to provide the information requested on
a form that is subject to the Paperwork Reduction Act unless
the form displays a valid OMB control number. Books and
records relating to a form or instructions must be retained as
long as their contents may become material in the
administration of any Internal Revenue law.
Generally, tax returns and return information are confidential,
as required by section 6103. However, section 6103 allows or
requires the IRS to disclose or give the information shown on

Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . .
Learning about the law or the form . . . . . . . . . . . . .
Preparing and sending the form to the IRS . . . . . . . .

16 hr., 15 min.
30 min.
47 min.

If you have comments concerning the accuracy of these time
estimates or suggestions for making Form 941-X simpler, we
would be happy to hear from you. You can write to: Internal
Revenue Service, Tax Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send Form 941-X to this
address. Instead, see Where Should You File? on page 2.

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