Form 944-X Adjusted Employer's ANNUAL Federal Tax Return or Claim f

Caution: DRAFT—NOT FOR FILING
This is an early release draft of an IRS tax form, instructions, or
publication, which the IRS is providing for your information as
a courtesy. Do not file draft forms. Also, do not rely on draft
instructions and publications for filing. We generally do not
release drafts of forms until we believe we have incorporated
all changes. However, in some cases unexpected issues arise,
or legislation is passed, necessitating a change to a draft form
we have posted on IRS.gov. Also, forms generally are subject
to OMB approval before they are officially released. Drafts of
instructions and publications are usually subject to at least
some changes before being officially released.
All early releases of draft forms, instructions, and publications
are available at www.IRS.gov/draftforms. All information
about forms, instructions, and publications is accessible from
www.IRS.gov/formspubs.
If you have any comments on this draft, you can submit them to
us on our IRS.gov page titled Comment on Forms and
Publications, where you may make comments anonymously if
you wish. You can also email us at taxforms@irs.gov. Please
include the form or publication number in the subject. We
cannot respond to all comments due to the high volume we
receive, but we will carefully consider each suggestion. Please
note that we may not be able to consider many suggestions
until the subsequent revision of the product.

Form

944-X:

(Rev. February 2013)

Adjusted Employer’s ANNUAL Federal Tax Return or Claim for Refund
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:

DRAFT AS OF
October 4, 2012
DO NOT FILE

Name (not your trade name)

944

Trade name (if any)
Address

Number

944-SS

Street

Suite or room number

Enter the calendar year you are
correcting:
(YYYY)

City

State

ZIP code

Read the instructions before you complete this form. Use this form to correct errors 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:

Enter the date you discovered errors:

(MM / DD / YYYY)

Select ONLY one process.

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 20, 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 20. 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.
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 and Medicare taxes for prior years. I have a
written statement from each 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 adjustment of social security tax and Medicare tax is for the employer’s share only. I could not find the affected employees or
each 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, and 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 social security and Medicare taxes overcollected in prior years. I have a
written statement from each 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
and Medicare taxes overcollected in prior years. I also have a written statement from each 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, each
employee did not give me a written consent to file a claim for the employee’s share of social security and Medicare taxes, or each
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, and Medicare tax that I did not withhold from employee wages.
Next ■▶
For Paperwork Reduction Act Notice, see the separate instructions.

IRS.gov/form944x

Cat. No. 20335M

Form 944-X (Rev. 2-2013)

Name (not your trade name)

Part 3:

Employer identification number (EIN)

Enter the corrections for the calendar year you are correcting. If any line does not apply, leave it blank.
Column 1

Column 2

Total corrected
amount (for ALL
employees)

6.

7.

8.

9.

10.

.

Income tax withheld from wages,
tips, and other compensation
(Form 944, line 2)

.

Taxable social security wages
(Form 944 or Form 944-SS, line
4a, Column 1)

.

Taxable social security tips
(Form 944 or Form 944-SS, line
4b, Column 1)

.

Taxable Medicare wages and
tips (Form 944 or Form 944-SS,
line 4c, Column 1)

.

11b. Exempt wages/tips paid to
qualified employees April 1–
December 31, 2010 (Form 944 or
Form 944-SS, line 5b)*

13.
14.
15.

16.

=

—

=

Column 4

Difference
(If this amount is a
negative number,
use a minus sign.)

Tax correction

—

—

=

.

Copy
Column 3
▶
here

.

.

× .124* =

.

.

—

=

.

× .124* =

.

.

—

=

.

× .029* =

.

.

*If you are correcting your employer share only, use .0145. See instructions.

—

.

.

Special addition to wages for
federal income tax

.

Special addition to wages for
social security tax

.

Special addition to wages for
Medicare taxes

.

.

.

18b. Number of individuals provided
COBRA premium assistance
(Form 944 or Form 944-SS, line 11b,
before 2011 or line 9b after 2010)
18c. Number of qualified employees
paid exempt wages/tips March
19–31, 2010 (Form 944 or Form
944-SS, line 11c)*

.

=

.

—

=

.

—

=

.
.

.

.

.

.

.

.

.

.

.

—

=

Total. Combine the amounts on lines 16–18d of Column 4. Continue to next page .

.

.

Copy
Column 3
▶
here

.

.

See
instructions

.

.

See
instructions

.

.

See
instructions

.

.

.

.

.

.

.

.

See
instructions

.

.

See
instructions

.

*Complete lines 18c
and 18d only for
corrections to the
2010 Form 944 or
Form 944-SS.

=

.

.

.

.

=

=

.

.

=

—

—

.

=

× .062

.

=

.

—

—

=

.

—

—

*Complete lines 11a
and 11b only for
corrections to the
2010 Form 944 or
Form 944-SS.

=

—

Subtotal. Combine the amounts on lines 7–15 of Column 4

18d. Exempt wages/tips paid to
qualified employees March 19–
31, 2010 (Form 944 or Form
944-SS, line 11d)*

=

.

Use the amount in Column 1
when you prepare your Forms
W-2 or Forms W-2c.

.

*If you are correcting a 2011 or 2012 return, use .104. If you are correcting your employer share only, use .062. See instructions.

Tax adjustments (Form 944 or
Form 944-SS, line 6)

Advance earned income credit
(EIC)
payments
made
to
employees (Form 944, line 8,
only for years ending before
January 1, 2011)
COBRA
premium assistance
18a.
payments (Form 944 or Form
944-SS, line 11a, before 2011 or
line 9a after 2010)

.

*If you are correcting a 2011 or 2012 return, use .104. If you are correcting your employer share only, use .062. See instructions.

17.

19.

Amount originally
— reported or as
previously corrected
(for ALL employees)

Column 3

DRAFT AS OF
October 4, 2012
DO NOT FILE

Wages,
tips
and
other
compensation (Form 944, line 1)

11a. Number of qualified employees
paid exempt wages/tips April 1–
December 31, 2010 (Form 944 or
Form 944-SS, line 5a)*

12.

Correcting Calendar Year (YYYY)

.

.

.

.

.

=

× .062

.

.

.

.

.

.

.

.
Next ■▶

Page 2

Form 944-X (Rev. 2-2013)

Name (not your trade name)

Part 3:
20.

Employer identification number (EIN)

Correcting Calendar Year (YYYY)

Continued
Total. Amount from line 19 on page 2 . . . . . . . . . . . . . . . . . . . . . . . .
.
If line 20 is less than zero:
• If you checked line 1, this is the amount you want applied as a credit to your Form 944 for the tax period in which you are filing this form.
(If you are currently filing a Form 941 or Form 941-SS, Employer’s QUARTERLY Federal Tax Return, see the instructions.)

DRAFT AS OF
October 4, 2012
DO NOT FILE

• If you checked line 2, this is the amount you want refunded or abated.
If line 20 is more than zero, this is the amount you owe. Pay this amount when you file this return. For information on how to pay, see
Amount you owe in the instructions.

Part 4:

Explain your corrections for the calendar year you are correcting.

21.

Check here if any corrections you entered on a line include both underreported and overreported amounts.
Explain both your underreported and overreported amounts on line 23.

22.

Check here if any corrections involve reclassified workers. Explain on line 23.

23.

You must give us a detailed explanation of how you determined your corrections. See the instructions.

Part 5:

Sign here. You must complete all three pages of this form and sign it.

Under penalties of perjury, I declare that I have filed an original Form 944 or Form 944-SS and that I have examined this adjusted return or claim
and any schedules or statements that are attached, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration
of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

✗

Print your
name here

Sign your
name here

Print your
title here

Date

Best daytime phone

Paid Preparer Use Only

Check if you are self-employed

Preparer’s name

PTIN

Preparer’s signature

Date

Firm’s name (or yours if
self-employed)

EIN

Address

Phone

City
Page 3

State

ZIP code
Form 944-X (Rev. 2-2013)

Type of errors
you are
correcting

Form 944-X: Which process should you use?

Underreported
amounts
ONLY

Use the adjustment process to correct underreported amounts.
• Check the box on line 1.
• Pay the amount you owe from line 20 when you file Form 944-X.

Overreported
amounts
ONLY

The process you
use depends on
when you file
Form 944-X.

DRAFT AS OF
October 4, 2012
DO NOT FILE
If you are filing Form 944-X
MORE THAN 90 days before the
period of limitations on credit or
refund for Form 944 or Form
944-SS expires . . .

Choose either process to correct the overreported
amounts.
Choose the adjustment process if you want the
amount shown on line 20 credited to your Form 944,
941, or 941-SS, for the period in which you file Form
944-X. Check the box on line 1.
OR

Choose the claim process if you want the amount
shown on line 20 refunded to you or abated. Check
the box on line 2.

BOTH
underreported
and
overreported
amounts

The process you
use depends on
when you file
Form 944-X.

If you are filing Form 944-X
WITHIN 90 days of the expiration
of the period of limitations on
credit or refund for Form 944 or
Form 944-SS . . .

You must use the claim process to correct the
overreported amounts. Check the box on line 2.

If you are filing Form 944-X
MORE THAN 90 days before the
period of limitations on credit or
refund for Form 944 or Form
944-SS expires . . .

Choose either the adjustment process or both the
adjustment process and the claim process when you
correct both underreported and overreported amounts.
Choose the adjustment process if combining your
underreported amounts and overreported amounts
results in a balance due or creates a credit that you
want applied to Form 944, 941, or 941-SS.
• File one Form 944-X, and
• Check the box on line 1 and follow the instructions
on line 20.
OR
Choose both the adjustment process and the
claim process if you want the overreported amount
refunded to you or abated.
File two separate forms.
1. For the adjustment process, file one Form 944-X
to correct the underreported amounts. Check the
box on line 1. Pay the amount you owe from line 20
when you file Form 944-X.
2. For the claim process, file a second Form 944-X
to correct the overreported amounts. Check the
box on line 2.

If you are filing Form 944-X
WITHIN 90 days of the
expiration of the period of
limitations on credit or refund
for Form 944 or Form 944-SS. . .

You must use both the adjustment process and claim
process.
File two separate forms.
1. For the adjustment process, file one Form 944-X
to correct the underreported amounts. Check the
box on line 1. Pay the amount you owe from line 20
when you file Form 944-X.
2. For the claim process, file a second Form 944-X
to correct the overreported amounts. Check the
box on line 2.
Form 944-X (Rev. 2-2013)