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

Instructions for Form 941-X
(April 2017)

Department of the Treasury
Internal Revenue Service

Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund
Section references are to the Internal Revenue Code
unless otherwise noted.

Future Developments

For the latest information about developments related to
Form 941-X and its instructions, such as legislation
enacted after they were published, go to IRS.gov/
Form941X.

What's New
Employee consents to support a claim for refund.
Rev. Proc. 2017-28, 2017–14 I.R.B. 1061, available at
IRS.gov/irb/2017-14_IRB/ar09.html, provides guidance to
employers on the requirements for employee consents
used by an employer to support a claim for refund of
overcollected social security tax and Medicare tax. The
revenue procedure clarifies the basic requirements for
both a request for employee consent and for the
employee consent, and permits a consent to be
requested, furnished, and retained in an electronic format
as an alternative to a paper format. The revenue
procedure also contains guidance concerning when an
employer may claim a refund of only the employer share
of overcollected social security tax and Medicare tax. The
revenue procedure requires that any request for consent
include an Additional Medicare Tax notice indicating that
any claim on the employee’s behalf won’t include a claim
for overpaid Additional Medicare Tax. Rev. Proc. 2017-28
is effective for requests made on or after June 5, 2017.
For requests made before June 5, 2017, employers may
rely on the proposed revenue procedure set forth in
Notice 2015-15, 2015-9 I.R.B. 687, available at IRS.gov/
irb/2015-9_IRB/ar07.html.
Qualified small business payroll tax credit for increasing research activities For tax years beginning
after December 31, 2015, a qualified small business may
elect to claim up to $250,000 of its credit for increasing
research activities as a payroll tax credit against the
employer’s share of social security tax. The portion of the
credit used against the employer’s share of social security
tax is allowed in the first calendar quarter beginning after
the date that the qualified small business filed its income
tax return. The election and determination of the credit
amount that will be used against the employer’s share of
social security tax is made on Form 6765, Credit for
Increasing Research Activities. The amount from Form
6765, line 44, must then be reported on Form 8974,
Qualified Small Business Payroll Tax Credit for Increasing
Research Activities. Form 8974 is used to determine the
amount of the credit that can be used in the current
quarter. The amount from Form 8974, line 12, is reported
on Form 941 or 941-SS, line 11. Any corrections to Form
941 or 941-SS, line 11, are reported on Form 941-X,
line 14. If you make a correction on Form 941-X, line 14,
you must attach a corrected Form 8974.

Apr 24, 2017

Period of limitations to make certain corrections expired. 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. 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.
The period of limitations to correct social security tax
for 2011 and 2012 expired on April 15, 2015, and April 15,
2016, respectively, for most employers. These
instructions no longer discuss the reduced rate of
employee social security tax that applied in 2011 and
2012. The 2011 and 2012 employee social security tax
rate was 4.2% and the employer social security tax rate
was 6.2% (10.4% total). If the period of limitations for
2011 and 2012 is still open, you can file the April 2017
revision but make sure you use the correct rate when
reporting corrections on lines 8 and 9.

Reminders
Retroactive increase in excludible transit benefits for
2014. The Tax Increase Prevention Act of 2014
increased the monthly transit benefit exclusion from $130
per participating employee to $250 per participating
employee for the period of January 1, 2014, through
December 31, 2014. Employers were provided
instructions on how to correct the social security and
Medicare taxes on the excess transit benefits in Notice
2015-2, 2015-4 I.R.B. 334, available at IRS.gov/irb/
2015-4_IRB/ar06.html.
Retroactive increase in excludible transit benefits for
2015. The Consolidated Appropriations Act, 2016,
increased the monthly transit benefit exclusion from $130
per participating employee to $250 per participating
employee for the period of January 1, 2015, through
December 31, 2015. Employers were provided
instructions on how to correct the social security and
Medicare taxes on the excess transit benefits in Notice
2016-06, 2016-4 I.R.B. 287, available at IRS.gov/irb/
2016-04_IRB/ar07.html.
Claiming the COBRA premium assistance credit. The
COBRA premium assistance credit was available to an
employer for premiums paid on behalf of employees who
were involuntarily terminated from employment between
September 1, 2008, and May 31, 2010. The COBRA
premium assistance credit isn’t available for individuals
who were involuntarily terminated after May 31, 2010.
Therefore, only in rare circumstances, such as instances
where COBRA eligibility was delayed as a result of
employer provided health insurance coverage following
termination, will the credit be available. If you’re eligible to
claim the credit, use Form 941-X, lines 20a and 20b. Form
941-X should be filed after filing your Form 941 or 941-SS.
Filing a Form 941-X before filing a Form 941 or 941-SS for

Cat. No. 20331U

additional wages subject to tax). For more information
about Additional Medicare Tax withholding, see the
Instructions for Form 941 and go to IRS.gov and enter
“Additional Medicare Tax” in the search box. See the
instructions for line 11, later, for more information on the
types of errors that can be corrected and how the
correction is reported on Form 941-X.

the quarter may result in errors or delays in processing
your Form 941-X. For more information, visit IRS.gov and
enter “COBRA” in the search box.
If you’re entitled to claim the COBRA premium

TIP assistance credit, but aren’t otherwise required to

file Form 941 or 941-SS, file a Form 941 or
941-SS with -0- entered on line 14 before filing your Form
941-X to claim the credit.

Correcting the COBRA premium assistance credit.
For tax periods ending before January 1, 2014, employers
who made COBRA premium assistance payments for
assistance eligible individuals were allowed a credit on
their Form 941 or 941-SS. Any errors discovered on a
previously filed Form 941 or 941-SS for this credit are
corrected on Form 941-X, lines 20a and 20b. Effective for
tax periods beginning after December 31, 2013, Form
941-X, is used to both report the total COBRA premium
assistance credit an employer is entitled to claim and
correct any previously reported credit. For more
information, see the instructions for lines 20a and 20b,
later.

Correcting federal income tax withheld. Generally,
you may correct federal income tax withholding errors
only if you discovered the errors in the same calendar
year you paid the wages. In addition, for an overcollection,
you may correct federal income tax withholding only if you
also repaid or reimbursed the employees in the same
year.
For prior years, you may only correct administrative
errors to federal income tax withholding (that is, errors in
which the amount reported on Form 941, line 3, doesn’t
agree with the amount you withheld from an employee’s
wages) and errors for which section 3509 rates apply. See
section 13 of Pub. 15, Employer’s Tax Guide, for more
information about corrections during the calendar year
and about administrative errors. See section 2 of Pub. 15
for more information about section 3509. If section 3509
rates apply, see the instructions for line 15, later.

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CAUTION

Aggregate Form 941. Agents and certified professional
employer organizations (CPEOs) must complete
Schedule R (Form 941), Allocation Schedule for
Aggregate Form 941 Filers, when correcting an aggregate
Form 941. Schedule R (Form 941) is completed only for
those clients and customers who have corrections
reported on Form 941-X. Schedule R (Form 941) is filed
as an attachment to Form 941-X. Aggregate Forms 941
are filed by agents approved by the IRS under section
3504. To request approval to act as an agent for an
employer, the agent files Form 2678, Employer/Payer
Appointment of Agent, with the IRS.
Aggregate Forms 941 are also filed by CPEOs
approved by the IRS under section 7705. CPEOs file
Form 8973, Certified Professional Employer Organization/
Customer Reporting Agreement, to notify the IRS that
they’ve started or ended a service contract with a client or
customer.

Only transposition or math errors involving the
inaccurate reporting of the amount withheld are
“administrative errors”.

You can’t file a Form 941-X to correct federal income
tax withholding for prior years for nonadministrative errors.
In other words, you can’t correct federal income tax
actually withheld from an employee in a prior year if you
discover that you didn’t withhold the right amount. For
example, you can’t correct federal income tax withheld in
a prior year because you used the wrong income tax
withholding table in Pub. 15 or you didn’t treat a payment
correctly as taxable or nontaxable. Similarly, if you paid
federal income tax in a prior year on behalf of your
employee, rather than deducting it from the employee’s
pay (which resulted in additional wages subject to tax),
and in a subsequent year you determine that you
incorrectly calculated the amount of tax, you can’t correct
the federal income tax withholding.

General Instructions:
Understanding Form 941-X
What Is the Purpose of Form 941-X?

The amount actually withheld is reflected on
TIP payroll information or on Form W-2, Wage and
Tax Statement, which can be used by the
employee to claim a credit for withholding for individual
income tax return purposes.

For tax periods beginning after December 31,
2013, Forms 941 and 941-SS will no longer be
CAUTION used to claim the credit for COBRA premium
assistance payments. Instead, use Form 941-X. For more
information, see the instructions for lines 20a and 20b,
later.

Correcting Additional Medicare Tax withholding and
wages and tips subject to Additional Medicare Tax
withholding. Beginning with the first quarter of 2013,
wages and tips subject to Additional Medicare Tax
withholding are reported on Form 941, line 5d. Certain
errors discovered on a previously filed Form 941 are
corrected on Form 941-X, line 11. However, you can’t file
a Form 941-X to correct Additional Medicare Tax actually
withheld from an employee in a prior year, including any
amount you paid on behalf of your employee rather than
deducting it from the employee’s pay (which resulted in

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;
Taxable wages and tips subject to Additional Medicare
Tax withholding;

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Instructions for Form 941-X (Rev. 4-2017)

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 and Forms W-2c, Corrected
Wage and Tax Statements, with the Social Security
Administration (SSA). For corrections of overreported
federal income tax, social security tax, Medicare tax, or
Additional Medicare Tax, you must make any
certifications that apply to your situation.

Qualified small business payroll tax credit for increasing
research activities; and
Credits for COBRA premium assistance payments.
Use Form 843, Claim for Refund and Request for
Abatement, to request a refund or abatement of assessed
interest or penalties. Don’t request a refund or abatement
of assessed interest or penalties on Form 941 or Form
941-X.

Don’t use Form 941-X to correct Form CT-1, 943,
944, or 945. Instead, use the “X” form that
CAUTION corresponds to those forms (Form CT-1 X, 943-X,
944-X, or 945-X).

References to Form 941 on Form 941-X and in
TIP these instructions also apply to Form 941-SS,
Employer's QUARTERLY Federal Tax
Return—American Samoa, Guam, the Commonwealth of
the Northern Mariana Islands, and the U.S. Virgin Islands,
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. See Rev. Rul. 2009-39 for
examples of how the interest-free adjustment and claim
for refund rules apply in 10 different situations. You can
find Rev. Rul. 2009-39, 2009-52, I.R.B. 951 at IRS.gov/irb/
2009-52_IRB/ar14.html.

!

Where Can You Get Help?
For help filing Form 941-X or for questions about federal
employment taxes and tax corrections, you can:
Visit IRS.gov and enter “employment taxes” in the
search box;
See Pub. 15 for correcting Form 941, or Pub. 80,
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; or
Call the IRS Business and Specialty Tax Line at
1-800-829-4933 or 1-800-829-4059 (TDD/TTY for
persons who are deaf, hard of hearing, or have a speech
disability) Monday–Friday from 7:00 a.m. to 7:00 p.m.
local time (Alaska and Hawaii follow Pacific time).

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’re correcting, and
File Form 941-X separately. Don’t file Form 941-X with
Form 941.
If you didn’t file a Form 941 for one or more quarters,
don’t use Form 941-X. Instead, file Form 941 for each of
those quarters. See also When Should You File Form
941-X? below. However, if you didn’t 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 23, later.
Report the correction of underreported and
overreported amounts for the same tax period on a single
Form 941-X, unless you’re requesting a refund or
abatement. If you’re 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.
You’ll use the 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 Form 941 for the period during which you file
Form 941-X. However, see the Caution under Is There a
Deadline for Filing Form 941-X, later, if you’re correcting
overreported amounts during the last 90 days of a period
of limitations. You’ll use the claim process if you
overreported employment taxes and are requesting a
refund or abatement of the overreported amount. Follow
the chart on the back of Form 941-X for help in choosing
whether to use the adjustment process or the claim
process. Be sure to give us a detailed explanation on
line 24 for each correction that you show on Form 941-X.
Continue to report current quarter fractions of cents,
third-party sick pay, tips, and group-term life insurance on
Form 941, lines 7–9.
Instructions for Form 941-X (Rev. 4-2017)

See also How Can You Order Forms, Instructions, and
Publications from the IRS, later.

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 on Form 941, Part 2, or on
Schedule B (Form 941), Report of Tax Liability for
Semiweekly Schedule Depositors, don’t file Form 941-X.
For more information about correcting federal tax liabilities
reported on Form 941, Part 2, or on Schedule B (Form
941), see the Instructions for Schedule B (Form 941).
Due dates. The due date for filing Form 941-X depends
on when you discover an error and if you underreported or
overreported tax. If you underreported tax, see
Underreported tax, later. For overreported amounts, you
may choose to either make an interest-free adjustment or
file a claim for refund or abatement. If you’re correcting
overreported amounts, see Overreported tax—adjustment
process or Overreported tax—claim process, later.
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 don’t follow these guidelines, we will
consider Form 941-X filed when it is actually received.
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or abatement on Form 941-X any time before the period of
limitations on credit or refund expires on Form 941. If you
also 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? next.

See Pub. 15 or Pub. 80 for more information on legal
holidays and IRS-designated private delivery services.
Underreported tax. If you’re 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 by the time you file. Doing so
will generally ensure that your correction is interest free
and not subject to failure-to-pay or failure-to-deposit
(FTD) penalties. See What About Penalties and Interest,
later. For details on how to make a payment, see the
instructions for line 21, later.
If Form 941-X is filed late (after the due date of the
return for the return period in which you discovered the
error), you must attach an amended Schedule B (Form
941) to Form 941-X. Otherwise, the IRS may assess an
“averaged” FTD penalty. The total tax reported on the
“Total liability for the quarter” line of Schedule B (Form
941) must match the corrected tax (Form 941, line 12
(line 10 for quarters ending before January 1, 2017),
combined with any correction entered on Form 941-X,
line 19) for the quarter, less any previous abatements and
interest-free tax assessments.
If you discover an error in . . . .

1.
2.
3.
4.

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

!

CAUTION

You may not file a refund claim to correct federal
income tax or Additional Medicare Tax actually
withheld from employees.

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.

Form 941-X is
due . . . . . . . . . . .

Example. You filed your 2013 fourth quarter Form 941
on January 27, 2014, and payments were timely made.
The IRS treats the return as if it were filed on April 15,
2014. On January 20, 2017, you discovered 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 18, 2017, which is the end of the period of
limitations for Form 941, and use the claim process.

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.

If you file Form 941-X to correct overreported
amounts in the last 90 days of a period of
CAUTION limitations, you must use the claim process. You
can’t use the adjustment process. If you’re also correcting
underreported amounts, you must file another Form 941-X
to correct the underreported amounts using the
adjustment process and pay any tax due.

!

Example—You owe tax. On April 10, 2017, you
discovered that you underreported $10,000 of social
security and Medicare wages on your 2016 first quarter
Form 941. File Form 941-X and pay the amount you owe
by July 31, 2017, because you discovered the error in the
second quarter of 2017, and July 31, 2017, is the due date
for that quarter. If you file Form 941-X before July 31,
2017, pay the amount you owe by the time you file.

Where Should You File Form 941-X?
Send your completed Form 941-X to the address shown
next.

Overreported tax—adjustment process. If you
overreported tax on Form 941 and choose to apply the
credit to Form 941 or Form 944, file an adjusted return on
Form 941-X soon after you discover the error but more
than 90 days before the period of limitations on the credit
or refund for Form 941 expires. See Is There a Deadline
for Filing Form 941-X? below.
If you reduced your deposits during the quarter by
the amount of the COBRA premium assistance
CAUTION credit that will be reflected on your Form 941-X,
don’t use the adjustment process to claim the COBRA
premium assistance credit. Use the claim process. See
the instructions for lines 20a and 20b, later.

!

Overreported tax—claim process. If you overreported
tax on Form 941, you may choose to file a claim for refund
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Instructions for Form 941-X (Rev. 4-2017)

IF you’re in . . . . . . . . . . . .

calendar year of the quarter you’re correcting on the top of
any attachments.

THEN use this address . . . .

Connecticut, Delaware, District of
Columbia, Florida, 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
Alabama, Alaska, Arizona,
Arkansas, California, Colorado,
Hawaii, Idaho, Iowa, Kansas,
Louisiana, Minnesota,
Mississippi, Missouri, Montana,
Nebraska, Nevada, New Mexico,
North Dakota, Oklahoma,
Oregon, South Dakota, Texas,
Utah, Washington, Wyoming
No legal residence or principal
place of business in any state
Special filing addresses for
exempt organizations; federal,
state, and local governmental
entities; and Indian tribal
governmental entities; regardless
of location

Enter the Date You Discovered Errors

You must enter the date you discovered errors. You
discover an error when you have enough information to be
able to correct it. If you’re reporting several errors that you
discovered at different times, enter the earliest date you
discovered them here. Report any subsequent dates and
related errors on line 24.

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

Must You Make an Entry on Each Line?

You must provide all of the information requested at the
top of page 1. You must check one box (but not both) in
Part 1. In Part 2, you must check the box on line 3 and any
applicable boxes on lines 4 and 5. In Part 3, if any line
doesn’t apply, leave it blank. Complete Parts 4 and 5 as
instructed.

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

How Should You Report Negative Amounts?

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

Form 941-X uses negative numbers to show reductions in
tax (credits) and positive numbers to show additional tax
(amounts you owe).

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

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’re
completing the return on your computer and your software
only allows you to use parentheses to report negative
amounts, you may use them.

How Should You Complete Form
941-X?

How Should You Make Entries on Form 941-X?

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. Don’t 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.

Use a Separate Form 941-X for Each Quarter
You’re Correcting

Use a separate Form 941-X for each Form 941 that you’re
correcting. For example, if you found errors on your Forms
941 for the third and fourth quarters of 2016, file one Form
941-X to correct the 2016 third quarter Form 941. File a
second Form 941-X to correct the 2016 fourth quarter
Form 941.

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. Be sure to write your name, EIN,“ Form
941-X,” the calendar quarter you’re correcting (for
example, “Quarter 2”), and the calendar year of the
quarter you’re correcting on the top of any attachments.

What About Penalties and Interest?

Generally, your correction of an underreported amount
won’t be subject to a failure-to-pay penalty, FTD 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 21 by the time 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.

Return You’re Correcting

In the box at the top of page 1, check the type of return
(Form 941 or Form 941-SS) you’re correcting. Check the
appropriate box for the one quarter you’re correcting.
Enter the calendar year of the Form 941 you’re correcting.
Enter the quarter and calendar year on pages 2 and 3. Be
sure to write your name, EIN, “Form 941-X,” the quarter
you’re correcting (for example, “Quarter 2”), and the

Instructions for Form 941-X (Rev. 4-2017)

No correction will be eligible for interest-free treatment
if any of the following apply.
The amounts underreported relate to an issue that was
raised in an examination of a prior period.
You knowingly underreported your employment tax
liability.
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You received a notice and demand for payment.
You received a notice of determination under section
7436.

941-X before December in any year before the expiration
of the period of limitations for the previously filed Form
941. In the year that the period of limitations for the
previously filed Form 941 expires, file Form 941-X at least
90 days before the expiration date.

If you receive a notice about a penalty after you file this
return, reply to the notice with an explanation and we will
determine if you meet the reasonable-cause criteria. Don’t
attach an explanation when you file your return.

Specific Instructions:

Overview of the Process

Part 1: Select ONLY One Process

To correct a previously filed Form 941, use Form 941-X to
file either an adjusted employment tax return or a claim for
refund or abatement. The adjustment process and the
claim process are 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 by the
time you file Form 941-X. For details on how to make a
payment, see the instructions for line 21, later.

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 on either line 1 or
line 2. Don’t check both boxes.

1. Adjusted Employment Tax Return

Check the box on line 1 if you’re correcting underreported
amounts or overreported amounts and you would like to
use the adjustment process to correct the errors.

Example—You underreported employment taxes.
On June 19, 2017, you discover an error that results in
additional tax on your 2016 fourth quarter Form 941. File
Form 941-X by July 31, 2017, and pay the amount you
owe by the time you file. See When Should You File Form
941-X, earlier. Don’t attach Form 941-X to your 2017
second quarter Form 941.
If you overreported the tax. If you overreported the
tax on a previously filed Form 941, you may choose one
of the following options.
Use the adjustment process. Check the box on line 1 to
apply any credit (negative amount) from line 21 to Form
941 for the quarter during which you file Form 941-X.
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 21.

If you’re 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 21 will be applied as a credit (tax deposit) to your
Form 941 or Form 944 for the period in which you’re 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 21 by the
time you file Form 941-X. Generally, you won’t be
charged interest if you file on time, pay on time, enter the
date you discovered the error, and explain the correction
on line 24.
If you have a credit. You overreported employment
taxes (you have a negative amount on line 21) 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 Form 941-X, line 21, 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.

To ensure that the IRS has enough time to

TIP process a credit for an overreporting

adjustment in the quarter during which you file
Form 941-X, you’re 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 under Is There a Deadline for Filing Form
941-X, earlier. This should ensure that the IRS will have
enough time to process Form 941-X so the credit will be
posted before you file Form 941, thus avoiding an
erroneous balance due notice from the IRS. See the
example below.

Don’t check the box on line 1 if you’re either: (a)
correcting overreported amounts and the period of
CAUTION limitations on credit or refund for Form 941 will
expire within 90 days of the date you file Form 941-X, or
(b) claiming a credit for COBRA premium assistance
payments and you reduced your deposits in anticipation
of the credit. Instead, in either case, check the box on
line 2 to file a Form 941-X under the claim process. See Is
There a Deadline for Filing Form 941-X, earlier. Also see
the instructions for lines 20a and 20b, later.

!

Example—You want your overreported tax applied
as a credit to Form 941. On June 19, 2017, you
discover you overreported your tax on your 2016 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 3, 2017, and take the
credit on your third quarter 2017 Form 941.

2. Claim

Check the box on line 2 to use the claim process if you’re
correcting overreported amounts only and you’re
claiming a refund or abatement for the negative amount

If you currently file Form 944 and you’re making a

TIP correction to a previously filed Form 941 that will
be claimed as a credit on Form 944, file Form

-6-

Instructions for Form 941-X (Rev. 4-2017)

written statements from some employees but you couldn’t
locate employees or secure the statements of the
remaining employees, check all applicable boxes. Provide
a summary on line 24 of the amount of the corrections
both for the employees who provided written statements
and for those who didn’t.

(credit) shown on line 21. Don’t check this box if you’re
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,
earlier.

4a. Check the box on line 4a if your overreported amount
includes each affected employee share of overcollected
taxes. You’re certifying that you repaid or reimbursed the
employee share of current and prior year taxes and you
received written statements from the employees stating
that they didn’t and won’t receive a refund or credit for the
prior year taxes. You’re certifying that you adjusted federal
income tax or Additional Medicare Tax withheld from
employees for the current calendar year only. Don’t send
these statements to the IRS. Keep them for your records.
Generally, all employment tax records must be kept for at
least 4 years. Copies must be submitted to the IRS if
requested.

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 Pub.
556, Examination of Returns, Appeal Rights, and Claims
for Refund, for more information.
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 21, plus any interest that
applies.

!

CAUTION

You may not file a refund claim to correct federal
income tax or Additional Medicare Tax actually
withheld from employees.

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 didn’t give you a statement described on
line 4a.

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 ensure
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:
Repay or reimburse your employees for the
overcollection of employee social security and Medicare
taxes, or
Obtain consents from your employees to file a claim on
their behalf. See Rev. Proc. 2017-28 for guidance on the
requirements for both a request for employee consent and
for the employee consent.

4c. Check the box on line 4c to certify that your
overreported amount is only for federal income tax, social
security tax, Medicare tax, or Additional Medicare Tax that
you didn’t withhold from your employees.

5. Certifying Claims

If you’re filing a claim for refund or abatement of
overreported federal income tax, social security tax,
Medicare tax, or Additional 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 couldn’t locate employees or secure the statements
or consents of the remaining employees, check all
applicable boxes. Provide a summary on line 24 of the
amount of the corrections for both the employees who
provided statements or consents and for those who didn’t.

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 with the SSA, as required,
showing your employees' correct wage and tax amounts.
See the General Instructions for Forms W-2 and W-3 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 can’t file a refund claim to correct federal
income tax or Additional Medicare Tax actually
CAUTION withheld from employees in a prior year. If you
request their consent to file a claim for social security tax
or Medicare tax, you must tell your employees that you
can’t claim a refund of any Additional Medicare Tax on
their behalf. See Rev. Proc. 2017-28 for sample language
to use in your request.

!

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 don’t change amounts shown on those forms.
For example, if your only correction to Form 941 involves
misstated tax adjustments (see the instructions for line 13,
later), check the box on line 3 to certify that you already
filed all required Forms W-2 and W-2c with the SSA.

5a. Check the box on line 5a if your overreported tax
includes each affected employee share of social security
and Medicare taxes. You’re certifying that you repaid or
reimbursed to the employees their share of social security
and Medicare taxes. For refunds of employee social
security and Medicare taxes overcollected in prior years,
you’re certifying that you received written statements from
those employees stating that they didn’t and won’t receive
a refund or credit for the prior year taxes. Don’t send these
statements to the IRS. Keep them for your records.
Generally, all employment tax records must be kept for at

4. Certifying Overreporting Adjustments

If you overreported federal income tax, social security tax,
Medicare tax, or Additional 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
Instructions for Form 941-X (Rev. 4-2017)

-7-

Part 3: Enter the Corrections for This
Quarter

least 4 years. Copies must be submitted to the IRS if
requested.
5b. Check the box on line 5b if your overreported tax
includes each affected employee share of social security
and Medicare taxes and you haven’t yet repaid or
reimbursed the employee share of taxes. You’re 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 didn’t and won’t receive a refund or credit for the
prior year taxes.
An employee consent must:
Contain the name, address, and social security number
(or truncated taxpayer identification number, when
appropriate) of the employee;
Contain the name, address, and EIN of the employer;
Contain the tax period(s), type of tax, and the amount of
tax for which the consent is provided;
Affirmatively state that the employee authorizes the
employer to claim a refund for the overpayment of the
employee share of tax;
For amounts collected in a prior year, include the
employee’s written statement certifying that the employee
hasn’t made any previous claims (or the claims were
rejected) and won’t make any future claims for refund or
credit of the amount of the overcollection;
Identify the basis of the claim; and
Be dated and contain the employee’s signature under
penalties of perjury. The penalties of perjury statement
should be located immediately above the required
signature.
Don’t send these statements and consents to the IRS.
Keep them for your records. Generally, all employment
tax records must be kept for at least 4 years. Copies must
be submitted to the IRS if requested.

What Amounts Should You Report in Part 3?

On lines 6–11, columns 1 and 2, show amounts for all of
your employees, not just for those employees whose
amounts you’re correcting.

If a correction that you report in column 4 includes both
underreported and overreported amounts (see the
instructions for line 22, later), give us details for each error
on line 24.
Because special circumstances apply for lines 12–18,
20a, and 20b, read the instructions for each line carefully
before entering amounts in the columns.
If you previously adjusted or amended Form 941
by using Form 941-X or because of an IRS
CAUTION examination change, show amounts in column 2
that include those previously reported corrections.

!

6. Wages, Tips, and Other Compensation

If you’re correcting the wages, tips, and other
compensation you reported on Form 941, line 2, 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 doesn’t apply to Form 941-SS.
If you or the IRS previously corrected the amount
reported on Form 941, line 2, enter in column 2 the
amount after any previous corrections.
line 6 (column 1)
- line 6 (column 2)
line 6 (column 3)

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 don’t check a box on
line 5. Tell us on line 24 that you haven’t repaid or
reimbursed employees or obtained consents at the time
you file the claim. However, you must repay or reimburse
your employees and certify that you’ve done so before the
IRS can allow the claim.

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 2017 first quarter
Form 941. In May of 2017, 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.

5c. Check the box on line 5c to certify that your
overreported tax is only for the employer share of social
security and Medicare taxes. This applies when affected
employees didn’t give you consent to file a claim for
refund for the employee share of social security and
Medicare taxes, they couldn’t be found, or they didn’t give
you a statement described on line 5b.

Column 1 (corrected amount)
Column 2 (Form 941, line 2)
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 2017 first quarter
Form 941. In May of 2017, 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.

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 didn’t withhold from your employees.

-8-

Instructions for Form 941-X (Rev. 4-2017)

Column 1 (corrected amount)
Column 2 (Form 941, line 2)

7,000.00
- 9,000.00

Column 3 (difference)

-2,000.00

You can’t file a Form 941-X to correct federal income tax
withholding for prior years for nonadministrative errors. In
other words, you can’t correct federal income tax actually
withheld from an employee in a prior year if you discover
that you didn’t withhold the right amount. For example,
you can’t correct federal income tax withheld in a prior
year because you used the wrong income tax withholding
table in Pub. 15 or you didn’t treat a payment correctly as
taxable or nontaxable. Similarly, if you paid federal
income tax in a prior year on behalf of your employee,
rather than deducting it from the employee’s pay (which
resulted in additional wages subject to tax), and in a
subsequent year you determine that you incorrectly
calculated the amount of tax, you can’t correct the federal
income tax withholding.

Example—Auto allowance; wages, tips, and other
compensation increased. You paid one of your
employees a $500 monthly auto allowance from October
through December 2016, and didn’t treat the payments as
taxable wages. In February 2017, you realized that the
payments were wages because they weren’t
reimbursements of deductible business expenses that
were substantiated and paid under an accountable plan.
You correct the error by treating the auto allowance as
wages subject to income, social security, and Medicare
taxes. Report the additional $1,500 of wages on lines 6, 8,
and 10.

Example—Failure to withhold federal 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 2016 but you withheld nothing. You
discovered the error on March 16, 2017. You can’t file
Form 941-X to correct federal income tax withheld
reported on your 2016 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 2016.

The amount on line 6, column 1, should be used

TIP on your Forms W-2 or Forms W-2c. This amount

should also be used for any business expense
deduction on your income tax return (or amended return)
for wages paid.

7. Federal Income Tax Withheld from Wages,
Tips, and Other Compensation

Example—Administrative error reporting federal
income tax. You had three employees. In the fourth
quarter of 2016, you withheld $1,000 of federal income tax
from Xavier Black, $2,000 from Sophie Rose, and $6,000
from Leo Wood. The total amount of federal income tax
you withheld was $9,000. You mistakenly reported $6,000
on line 3 of your 2016 fourth quarter Form 941. You
discovered the error on March 13, 2017. This is an
example of an administrative error that may be corrected
in a later calendar year because the amount actually
withheld from the 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.

If you’re correcting the federal income tax withheld from
wages, tips, and other compensation you reported on
Form 941, line 3, 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 doesn’t
apply to Form 941-SS.
line 7 (column 1)
- line 7 (column 2)
line 7 (column 3)

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

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

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

Generally, you may correct federal income tax
withholding errors only if you discovered the
CAUTION errors in the same calendar year you paid the
wages. In addition, for an overcollection, you may correct
federal income tax withholding only if you also repaid or
reimbursed the employees in the same year. For prior
years, you may only correct administrative errors to
federal income tax withholding (that is, errors in which the
amount reported on Form 941, line 3, doesn’t agree with
the amount you withheld from an employee’s wages) and
errors for which section 3509 rates apply. Only
transposition or math errors involving the inaccurate
reporting of the amount withheld are “administrative
errors”. See section 13 of Pub. 15 for more information
about corrections during the calendar year and about
administrative errors. See section 2 of Pub. 15 for more
information about section 3509. If section 3509 rates
apply, see the instructions for line 15, later.

Column 3 (difference)

!

Instructions for Form 941-X (Rev. 4-2017)

9,000.00
- 6,000.00
3,000.00

Report the $3,000 as a tax correction in column 4.
Be sure to explain the reasons for this correction on
line 24.
Example—Nonadministrative error reporting
income tax due to repayment of wages paid in prior
year. You paid Jack Brown $4,000 of wages for 2 months
of work in September 2016. You withheld $400 of federal
income tax at the time you paid Jack. These amounts
were reported on your 2016 third quarter Form 941. Jack
left employment in October 2016 (after only 1 month of
service). After the end of the year, Jack repaid $2,000 to
you. You can’t file Form 941-X to reduce the federal
income tax withheld because you actually withheld the
federal income tax from wages. You also can’t file Form
941-X to reduce wages because the wages were income
-9-

to Jack for the prior year. These amounts were correctly
reported on Form 941.

8. Taxable Social Security Wages

amount you originally reported or as previously corrected.
In column 3, enter the difference between columns 1 and
2.

If you’re correcting the taxable social security wages you
reported on Form 941, line 5a, column 1, 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 8 (column 1)
- line 8 (column 2)
line 8 (column 3)

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

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 0.124 and report
that result in column 4.
line 9 (column 3)
x 0.124
line 9 (column 4)

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

Multiply the amount in column 3 by 0.124 and enter that
result in column 4.
line 8 (column 3)
x 0.124
line 8 (column 4)

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

Note. If you’re correcting only the employer share of tax
on a decrease to social security wages, use 0.062 (6.2%)
when multiplying the amount shown in column 3. If you’re
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 24.
Example—Social security wages decreased.
Following Example—Wages, tips, and other
compensation decreased in 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.
Column 1 (corrected amount)
Column 2 (Form 941, line 5a, column 1)

7,000.00
- 9,000.00

Column 3 (difference)

-2,000.00

Note. If you’re correcting only the employer share of tax
on a decrease to social security tips, use 0.062 (6.2%)
when multiplying the amount shown in column 3. If you’re
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 24.
Example—Social security tips increased.
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.
Column 1 (corrected amount)
Column 2 (Form 941, line 5b, column 1)
Column 3 (difference)

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

-2,000.00
x 0.124
-248.00

Be sure to explain the reasons for this correction on
line 24.

9. Taxable Social Security Tips

1,000.00

Use the difference in column 3 to determine your tax
correction.
Column 3 (difference)
Tax rate (12.4%)
Column 4 (tax correction)

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

10,000.00
- 9,000.00

1,000.00
x 0.124
124.00

Be sure to explain the reasons for this correction on
line 24.

10. Taxable Medicare Wages and Tips

If you’re correcting the taxable Medicare wages and tips
you reported on Form 941, line 5c, column 1, 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 you’re correcting the taxable social security tips you
reported on Form 941, line 5b, column 1, enter the total
corrected amount in column 1. In column 2, enter the
-10-

Instructions for Form 941-X (Rev. 4-2017)

section 3509 rates apply. If section 3509 rates apply, see
the instructions for line 18.

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 0.029 (2.9% tax
rate) and enter that result in column 4.
line 10 (column 3)
x 0.029
line 10 (column 4)

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

Note. If you’re correcting only the employer share of tax
on a decrease to Medicare wages and tips, use 0.0145
(1.45%) when multiplying the amount in column 3. If
you’re 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 24.
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 (Form 941, line 5c, column 1)

7,000.00
- 9,000.00

Column 3 (difference)

-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 0.029
-58.00

Be sure to explain the reasons for this correction on
line 24.

11. Taxable Wages and Tips Subject to
Additional Medicare Tax Withholding

Generally, you may correct errors to Additional Medicare
Tax withholding only if you discovered the errors in the
same calendar year the wages and tips were paid to
employees. However, you may correct errors to Additional
Medicare Tax withholding for prior years if the amount
reported on Form 941, line 5d, column 2, doesn’t agree
with the amount you actually withheld, including any
amount you paid on behalf of your employee rather than
deducting it from the employee’s pay (which resulted in
additional wages subject to tax). This type of error is an
administrative error. You may also correct errors to
Additional Medicare Tax withholding for prior years if

Instructions for Form 941-X (Rev. 4-2017)

If a prior year error was a nonadministrative error, you
may correct only the wages and tips subject to
Additional Medicare Tax withholding that were originally
reported on Form 941, line 5d, column 1, or previously
corrected on Form 941-X. You can’t correct the tax
reported on Form 941, line 5d, column 2.
Errors discovered in the same calendar year or prior
year administrative errors. If you’re correcting the
taxable wages and tips subject to Additional Medicare Tax
withholding that you reported on Form 941, line 5d,
column 1, 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 11 (column 1)
- line 11 (column 2)
line 11 (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 0.009 (0.9% tax
rate) and enter that result in column 4.
line 11 (column 3)
x 0.009
line 11 (column 4)

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

Example—Prior year administrative error
(incorrectly reported amount of Additional Medicare
Tax actually withheld). Xavier Black's wages exceeded
the $200,000 withholding threshold for Additional
Medicare Tax in November 2016. The total wages paid to
Xavier for 2016 were $230,000. You withheld $270
($30,000 x 0.009) from the Xavier's wages. However, on
your fourth quarter 2016 Form 941 you mistakenly
reported $3,000 on line 5d, column 1, and Additional
Medicare Tax withheld of $27 on line 5d, column 2. You
discover the error on March 16, 2017. This is an example
of an administrative error that may be corrected in a later
calendar year because the amount actually withheld
differs from the amount reported on your fourth quarter
2016 Form 941. Use Form 941-X, line 11, to correct the
error as shown below.
Column 1 (corrected amount)
Column 2 (Form 941, line 5d, column 1)

30,000.00
- 3,000.00

Column 3 (difference)

27,000.00

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

-11-

Column 3 (difference)
Tax rate (0.9%)

27,000.00
x 0.009

Column 4 (tax correction)

243.00

Be sure to explain the reasons for this correction on
line 24.
Prior year nonadministrative errors. You may correct
only the taxable wages and tips subject to Additional
Medicare Tax withholding that you reported on Form 941,
line 5d, column 1. 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 11 (column 1)
- line 11 (column 2)
line 11 (column 3)

withheld $270 ($30,000 x 0.009) from Xavier's wages.
However, on your fourth quarter 2016 Form 941 you
mistakenly reported $3,000 on line 5d, column 1, and
Additional Medicare Tax withheld of $27 on line 5d,
column 2. The difference in wages subject to Additional
Medicare Tax related to this administrative error is
$27,000 ($30,000 - $3,000).
Sophie Rose‘s wages exceeded the $200,000
withholding threshold for Additional Medicare Tax in
December 2016. The total wages paid to Sophie for 2016
were $220,000. You were required to withhold $180
($20,000 x 0.009) but you withheld nothing and didn’t
report Sophie's $20,000 in wages subject to Additional
Medicare Tax withholding on line 5d of your fourth quarter
2016 Form 941.
You discover both errors on March 16, 2017. Use Form
941-X, line 11, to correct the errors as shown below.

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

Don’t multiply the amount in column 3 by 0.009 (0.9%
tax rate). Leave column 4 blank and explain the reasons
for this correction on line 24.
Example—Prior year nonadministrative error
(failure to withhold Additional Medicare Tax when
required). Sophie Rose’s wages exceeded the $200,000
withholding threshold for Additional Medicare Tax in
December 2016. The total wages paid to Sophie for 2016
were $220,000. You were required to withhold $180
($20,000 x 0.009) but you withheld nothing and didn’t
report an amount on line 5d of your fourth quarter 2016
Form 941. You discover the error on March 16, 2017. File
Form 941-X to correct wages and tips subject to
Additional Medicare Tax withholding for your 2016 fourth
quarter Form 941, but you may not correct the Additional
Medicare Tax withheld (column 4) because the error
involves a previous year and the amount previously
reported for Sophie represents the actual amount withheld
from Sophie during 2016.
Combination of prior year administrative and nonadministrative errors. If you’re reporting both
administrative errors and nonadministrative errors for the
same quarter of a prior year, 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. However,
multiply only the amount of wages and tips reported in
column 3 that are related to administrative errors by 0.009
(0.9% tax rate). Don’t multiply any wages and tips
reported in column 3 that are related to nonadministrative
errors by 0.009 (0.9% tax rate). Use line 24 to explain in
detail your corrections. The explanation must include the
reasons for the corrections and a breakdown of the
amount reported in column 3 into the amounts related to
administrative errors and nonadministrative errors.
Example—Combination of prior year administrative
and nonadministrative errors. Xavier Black’s wages
exceeded the $200,000 withholding threshold for
Additional Medicare Tax in November 2016. The total
wages paid to Xavier for 2016 were $230,000. You

Column 1 (corrected amount)
Column 2 (Form 941, line 5d, column 1)

50,000.00
- 3,000.00

Column 3 (difference)

47,000.00

Determine the portion of wages and tips reported in
column 3 that is related to the administrative error
($47,000 - $20,000 (nonadministrative error) = $27,000
(administrative error)). Multiply this portion of column 3 by
0.009 (0.9% tax rate) to determine your tax correction.
Difference related to administrative error
Tax rate (0.9%)
Column 4 (tax correction)

27,000.00
x 0.009
243.00

Be sure to explain the reasons for these corrections on
line 24. You must also report that $20,000 of the amount
shown in column 3 was related to the correction of a prior
year nonadministrative error and $27,000 of the amount
shown in column 3 was related to the correction of an
administrative error.

12. Section 3121(q) Notice and Demand—Tax
on Unreported Tips

Enter any corrections, including amounts reported on
Form 941, line 5f, to the tax due from a Section 3121(q)
Notice and Demand on line 12. The IRS issues a Section
3121(q) Notice and Demand to advise an employer of the
amount of tips received by employees who failed to report
or underreported tips to the employer. An employer isn’t
liable for the employer share of the social security and
Medicare taxes on unreported tips until a Section 3121(q)
Notice and Demand for the taxes is made to the employer
by the IRS.

13. Tax Adjustments

Use line 13 to correct any adjustments reported on Form
941, lines 7–9. Enter in column 1 the total corrected
amount for Form 941, lines 7–9.
Enter in column 2 the total originally reported or
previously corrected amounts from Form 941, lines 7–9. In
column 3, enter the difference between columns 1 and 2.

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Instructions for Form 941-X (Rev. 4-2017)

in column 4 or a negative number in column 3 as a
positive number in column 4.

line 13 (column 1)
-line 13 (column 2)

You must attach a corrected Form 8974 and explain
the reasons for this correction on line 24.

line 13 (column 3)

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
Form 941, lines 7–9.
Copy the amount in column 3 to column 4. Include any
minus sign shown in column 3.
On line 24, 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 8 of your 2016 second quarter
Form 941. You didn’t report any amounts on lines 7 and 9.
Your third-party sick pay adjustment should’ve 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 2017. To correct the error, figure the
difference on Form 941-X as shown.
Column 1 (corrected amount)
Column 2 (Form 941, line 8)
Column 3 (difference)

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

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

Column 2
(Form 941, line 8)

Column 3
(difference)

-6,900.00

-2,700.00

Report “-2,700.00” as your correction in column 4.
In this example, you’re claiming a credit for $2,700 in
overreported tax for your 2016 second quarter Form 941.
Always enter the same amount in column 4 (including any
minus sign) that you enter in column 3.
Be sure to explain the reasons for this correction on
line 24.

14. Qualified Small Business Payroll Tax Credit
for Increasing Research Activities

If you’re correcting the qualified small business payroll tax
credit for increasing research activities that you reported
on Form 941, line 11, 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.
Copy the amount in column 3 to column 4. However, to
properly show the amount as a credit or balance due item,
enter a positive number in column 3 as a negative number

Instructions for Form 941-X (Rev. 4-2017)

15–18. Special Additions to Wages for Federal
Income Tax, Social Security Taxes, Medicare
Taxes, and Additional Medicare Tax

Section 3509 provides special rates for the employee
share of income tax, social security tax, Medicare tax, and
Additional Medicare Tax withholding when workers are
reclassified as employees in certain circumstances. The
applicable rate depends on whether you filed required
information returns. An employer can’t recover any tax
paid under this provision from the employees. The full
employer share of social security tax and Medicare tax is
due for all reclassifications.
Note. Section 3509 rates aren’t available if you
intentionally disregarded the requirements to withhold
taxes from the employee, or if you withheld income tax but
didn’t withhold social security and Medicare taxes.
Section 3509 rates are also not available for certain
statutory employees.
On lines 15–18 enter only corrections to wages
resulting from reclassifying certain workers as employees
when section 3509 rates are used to calculate the taxes.
If the employer issued the required information returns,
use the section 3509 rates as follows.
For social security taxes, use the employer rate of 6.2%
plus 20% of the employee rate of 6.2%, for a total rate of
7.44% of wages.
For Medicare taxes, use the employer rate of 1.45%
plus 20% of the employee rate of 1.45%, for a total rate of
1.74% of wages.
For Additional Medicare Tax; 0.18% (20% of the
employee rate of 0.9%) of wages subject to Additional
Medicare Tax.
For income tax withholding, the rate is 1.5% of wages.
If the employer didn’t issue the required information
returns, use the section 3509 rates as follows.
For social security taxes, use the employer rate of 6.2%
plus 40% of the employee rate of 6.2%, for a total rate of
8.68% of wages.
For Medicare taxes, use the employer rate of 1.45%
plus 40% of the employee rate of 1.45%, for a total rate of
2.03% of wages.
For Additional Medicare Tax; 0.36% (40% of the
employee rate of 0.9%) of wages subject to Additional
Medicare Tax.
For income tax withholding, the rate is 3.0% of wages.
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 in column 2
previously reported wages (if any) to reclassified
employees. To get the amount for column 4, use the
applicable section 3509 rates. If you filed the required
information returns for some employees but didn’t file
them for other employees, be sure to use the applicable
rates for each employee when calculating the amounts in
column 4 and show your calculations on line 24. The tax
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correction in column 4 will be a positive number if you
increased the amount of wages you previously reported.
See the instructions for line 23, later, for more information.

19. Subtotal

Combine the amounts from column 4 on lines 7–18.

Example. You entered “1,400.00” in column 4 on
line 7, “-500.00” in column 4 on line 8, and “-100.00” in
column 4 on line 10. Combine these amounts and enter
“800.00” in column 4 on line 19.
Line 7
Line 8
Line 10

1,400.00
-500.00
-100.00

Line 19

800.00

20a. Claiming or Correcting the COBRA
Premium Assistance Credit
The COBRA premium assistance credit was
available to an employer for premiums paid on
CAUTION behalf of employees who were involuntarily
terminated from employment between September 1, 2008
and May 31, 2010. The COBRA premium assistance
credit isn’t available for individuals who were involuntarily
terminated after May 31, 2010. Therefore, only in rare
circumstances, such as instances where COBRA
eligibility was delayed as a result of employer provided
health insurance coverage following termination, will the
credit be available.

!

Enter 65% of the total COBRA premium assistance
payments for all assistance-eligible individuals in column
1. Report the premium assistance payments on this line
only after the assistance-eligible individual's 35% share of
the premium has been paid. For COBRA coverage
provided under a self-insured plan, COBRA premium
assistance is treated as having been made for each
assistance-eligible individual who paid 35% of the
COBRA premium. Don’t include the assistance-eligible
individual's 35% of the premium in the amount entered on
this line.
For tax periods ending before January 1, 2014, enter
any COBRA premium assistance payments previously
claimed on Form 941 or 941-SS, line 12a, in column 2.
For tax periods beginning after December 31, 2013,
enter -0- in column 2, unless you’re correcting a COBRA
premium assistance payment previously reported on a
Form 941-X. If you or the IRS previously corrected the
amount reported, the amount entered in column 2 should
take into account all previous corrections.
Enter the difference between column 1 and 2 in column
3. Copy the amount in column 3 to column 4. However, to
properly show the amount 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.
The COBRA premium assistance credit is treated
as a credit on the first day of the return period
CAUTION (that is, January 1, April 1, July 1, or October 1).
However, because the credit is now claimed on Form

!

941-X filed after submission of the Form 941, an
employer that reduces its required deposits in anticipation
of the credit will receive a system-generated notice
reflecting a balance due and associated penalties and
interest, if applicable. The balance due, including any
related penalties and interest, resulting from the reduction
in deposits in anticipation of the credit will be abated when
the credit is applied. Such abatement will generally occur
without any further action from the employer. Alternatively,
to prevent triggering a system-generated balance due
notice, the employer can make its deposits without a
reduction in anticipation of the COBRA premium
assistance credit and follow these instructions for claiming
the COBRA premium assistance credit.
For more information on the COBRA premium subsidy,
visit IRS.gov and enter “COBRA” in the search box.

20b. Number of Individuals Provided COBRA
Premium Assistance on line 20a

Enter the total number of assistance-eligible individuals
provided COBRA premium assistance in column 1. Count
each assistance-eligible individual who paid a reduced
COBRA premium in the quarter as one individual, whether
or not the reduced premium was for insurance that
covered more than one assistance-eligible individual. For
example, if the reduced COBRA premium was for
coverage for a former employee, spouse, and two
children, you would include one individual in the number
entered on line 20b for the premium assistance entered
on line 20a. Further, each individual is reported only once
per quarter. For example, an assistance-eligible individual
who made monthly premium payments during the quarter
would only be reported as one individual on line 20b for
that quarter.
For tax periods ending before January 1, 2014, enter
the number of assistance-eligible individuals provided
COBRA premium assistance previously reported on Form
941 or 941-SS, line 12b, in column 2. For tax periods
beginning after December 31, 2013, enter -0- in column 2,
unless you’re correcting a previously filed Form 941-X. If
you or the IRS previously corrected the number of
individuals reported, the number entered in column 2
should take into account all previous corrections.

21. Total

Combine the amounts on lines 19 and 20a of column 4
and enter the result on line 21.
Your credit. If the amount entered on line 21 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
Form 941, line 13 (“Total deposits” line), for the quarter
during which you filed Form 941-X or Form 944 “Total
deposits” line, for the year during which you filed Form
941-X. Don’t make any changes to your record of federal
tax liability reported on Form 941, line 16, 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.
If you checked the box on line 2, you’re filing a claim for
refund or abatement of the amount shown.
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Instructions for Form 941-X (Rev. 4-2017)

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.

On line 24, you must explain the reason for both the
$15,000 increase and the $5,000 decrease.

Amount you owe. If the amount on line 21 is a positive
number, you must pay the amount you owe by the time
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, don’t
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). Don’t
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. The total
tax reported on the “Total liability for the quarter” line of
Schedule B (Form 941) must match the corrected tax
(Form 941, line 12 (line 10 for quarters ending before
January 1, 2017), combined with any correction reported
on Form 941-X, line 19) for the quarter, less any previous
abatements and interest-free tax assessments.
Payment methods. You may pay the amount you owe
on line 21 electronically using the Electronic Federal Tax
Payment System (EFTPS), by credit or debit card, or by a
check or money order.
The preferred method of payment is EFTPS. For more
information, visit EFTPS.gov, call EFTPS Customer
Service at 1-800-555-4477 or 1-800-733-4829 (TDD), or
see Pub. 966.
To pay by credit or debit card, visit the IRS website at
IRS.gov/payments.
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,” the calendar
quarter you corrected (for example, “Quarter 2”), and the
calendar year of the quarter you corrected.
You don’t have to pay if the amount you owe is less
than $1.
Previously assessed FTD penalty. If line 21 reflects
overreported tax and the IRS previously assessed an FTD
penalty, you may be able to reduce the penalty. For more
information, see the Instructions for Schedule B (Form
941).

23. Did You Reclassify Any Workers?

Check the box on line 23 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 24, give us a
detailed reason why any worker was reclassified and, if
you used section 3509 rates on lines 15–18, for any
worker reclassified as an employee, explain why section
3509 rates apply and what rates you used.

Return not filed because you didn’t treat any workers
as employees. If you didn’t 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’re entitled to use
section 3509 rates, complete the following steps.
Write “Misclassified Employees” in bold letters
across the top margin of page 1.
Enter a zero on line 12 (line 10 for quarters ending
before January 1, 2017).
Complete the signature area.
Attach a completed Form 941-X (see instructions next).
On each Form 941-X complete the following steps.
Complete the top of Form 941-X, including the date you
discovered the error.
Enter the wage amounts on lines 15–18, column 1.
Enter zeros on lines 15–18, column 2.
Complete columns 3 and 4 as instructed in Part 3.
Provide a detailed statement on line 24.
Complete the signature area.
If you can’t use section 3509 rates (for example,
because the workers you treated as
CAUTION nonemployees were certain statutory employees),
file a Form 941 for each delinquent quarter. Write
“Misclassified Employees” in 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 24.

!

24. Explain Your Corrections

Check the box on line 22 if any corrections you entered on
lines 7-20a, column 3, reflect both underreported and
overreported amounts.

Treasury regulations require you to explain in detail the
grounds and facts relied upon to support each correction.
On line 24, describe in detail each correction you entered
in column 4 on lines 7-18 and 20a. Also use line 24 to
describe corrections made on lines 6 and 20b. If you need
more space, attach additional sheets, but be sure to write
your name, EIN, “Form 941-X,” the quarter you’re
correcting (for example, “Quarter 2”), and the calendar
year of the quarter you’re correcting on the top of each
sheet.

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

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” or “taxes were not withheld” are insufficient

Part 4: Explain Your Corrections for
This Quarter
22. Correction of Both Underreported and
Overreported Amounts

Instructions for Form 941-X (Rev. 4-2017)

-15-

Include your complete address. If you work for a firm,
enter the firm's name and the EIN of the firm. You can
apply for a PTIN online or by filing Form W-12. For more
information about applying for a PTIN online, visit the IRS
website at IRS.gov/PTIN. You can’t use your PTIN in
place of the EIN of the tax preparation firm.

and may delay processing your Form 941-X because the
IRS may need to ask for a more complete explanation.
Provide the following information in your explanation for
each correction.
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.

Generally, you’re not required to complete this section
if you’re filing the return as a reporting agent and have a
valid Form 8655 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.

“The $1,000 difference shown in column 3 on lines 6, 8,
and 10 was discovered on May 15, 2017, 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.”

How Can You Order Forms,
Instructions, and Publications from
the IRS?

For corrections shown on lines 15–18, column 3,
explain why the correction was necessary and attach any
notice you received from the IRS.

Visit the IRS website at IRS.gov/OrderForms.

Part 5. Sign Here
You must complete all three pages of Form 941-X and
sign it on page 3. If you don’t sign, processing of Form
941-X will be delayed.
Who must sign the Form 941-X? The following persons
are authorized to sign the return for each type of business
entity.
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 sign.
Partnership (including an LLC treated as a
partnership) or unincorporated organization—A
responsible and duly authorized member, partner, 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 sign.
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,
2005-28 I.R.B. 82, at IRS.gov/irb/2005-28_IRB/ar16.html.

Paid Preparer Use Only

A paid preparer must sign Form 941-X and provide the
information in the Paid Preparer Use Only section of Part
5 if the preparer was paid to prepare Form 941-X and isn’t
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.

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, including federal income tax
withholding, on wages. 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.
You’re 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.
The time needed to complete and file Form 941-X will
vary depending on individual circumstances. The
estimated average time is:
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 send us comments from IRS.gov/FormComments. Or
you can send your comments to: Tax Forms and
Publications Division, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Don’t send Form 941-X
to this address. Instead, see Where Should You File Form
941-X, earlier.

If you’re a paid preparer, enter your Preparer Tax
Identification Number (PTIN) in the space provided.
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Instructions for Form 941-X (Rev. 4-2017)