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Read the Instructions before completing this form. Use this form to correct errors you made on Form 941. Use a separate Form 941-X for each quarter that needs correction. If a line on Form 941-X doesn't apply to you, leave the line. This system does not support corrections to any COVID-19 related credits. You can e-file adjustments beginning with the first quarter of 2024.

Do not file Form 941-X if your ONLY errors on Form 941 relate to: 1) the number of employees who received wages (line 1), 2) federal tax liabilities reported on Part 2, or 3) federal tax liabilities reported on Schedule B. For corrections to 2 & 3, see the Instructions for Schedule B.

Type of return you are correcting:*

941

941-SS

Calendar year you are correcting:*

Enter the date you discovered errors:*

Employer identification number (EIN):*

Employer name:*

Trade name:

If you have a foreign address, click here:

Address:*

City, State and Zip code:*

Foreign province, postal code and country:

Quarter you are correcting:*

Q1: Jan, Feb, Mar

Q3: Jul, Aug, Sep

Q2: Apr, May, Jun

Q4: Oct, Nov, Dec

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’re correcting both underreported and overreported amounts on this form. The amount shown on line 27, if less than zero, may only be applied as a credit to your Form 941, for the tax period in which you’re 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 27. Don’t check this box if you’re correcting ANY underreported amounts on this form.

3. I certify that I’ve 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’re correcting underreported amounts only, go to Part 3 and skip lines 4 and 5. If you’re correcting overreported amounts, for purposes of the certifications on lines 4 and 5, Medicare tax doesn’t include Additional Medicare Tax. Form 941-X can’t be used to correct overreported amounts of Additional Medicare Tax unless the amounts weren’t withheld from employee wages or an adjustment is being made for the current year.

4. If you checked line 1 because you’re adjusting overreported federal income tax, social security tax, Medicare tax, or Additional Medicare Tax, 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 federal income tax or Additional Medicare Tax for the current year and the overcollected social security tax and Medicare tax for current and prior years. For adjustments of employee social security tax and Medicare tax overcollected in prior years, I have a written statement from each affected employee stating that they haven't claimed (or the claim was rejected) and won’t claim a refund or credit for the overcollection.

b. The adjustments of social security tax and Medicare tax are for the employer’s share only. I couldn’t find the affected employees or each affected employee didn’t give me a written statement that they haven't claimed (or the claim was rejected) and won’t claim a refund or credit for the overcollection.

c. The adjustment is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I didn’t withhold from employee wages.

5. If you checked line 2 because you’re claiming a refund or abatement of overreported federal income tax, social security tax, Medicare tax, or Additional Medicare Tax, check all that apply. You must check at least one box. I certify that:

a. I repaid or reimbursed each affected employee for the overcollected social security tax and Medicare tax. For claims of employee social security tax and Medicare tax overcollected in prior years, I have a written statement from each affected employee stating that they haven't claimed (or the claim was rejected) and won’t claim a refund or credit for the overcollection.

b. I have a written consent from each affected employee stating that I may file this claim for the employee’s share of social security tax and Medicare tax. For refunds of employee social security tax and Medicare tax overcollected in prior years, I also have a written statement from each affected employee stating that they haven't claimed (or the claim was rejected) and won’t 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 couldn’t find the affected employees, or each affected employee didn’t give me a written consent to file a claim for the employee’s share of social security tax and Medicare tax, or each affected employee didn’t give me a written statement that they haven't claimed (or the claim was rejected) and won’t claim a refund or credit for the overcollection.

d. The claim is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I didn’t withhold from employee wages.

Corrected Amount

Originally Reported

Difference

Tax Corrections

6. Wages, tips, and other compensation:

7. Federal income tax withheld from wages, tips, and other compensation:

===>

8. Taxable social security wages:

9. Qualified sick leave wages:

x 0.062 =

10. Qualified family leave wages:

x 0.062 =

11. Taxable social security tips:

12. Taxable Medicare wages and tips:

13. Taxable wages & tips subject to Additional Medicare Tax withholding:

x 0.009 =

14. Section 3121(q) Notice and Demand—Tax due on unreported tips:

===>

15. Tax adjustments:

===>

16. Qualified small business payroll tax credit for increasing research activities (not supported):

x -1.0 =

17. Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021:

x -1.0 =

18a. Nonrefundable portion of employee retention credit:

x -1.0 =

18b. Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021:

x -1.0 =

18c. Nonrefundable portion of COBRA premium assistance credit:

x -1.0 =

18d. Number of individuals provided COBRA premium assistance:

19. Special addition to wages for federal income tax:

20. Special addition to wages for social security taxes:

21. Special addition to wages for Medicare taxes:

22. Special addition to wages for Additional Medicare Tax:

23. Subtotal:

Check here to file an Amended Schedule B with this return.

SCHEDULE B - Amended

Report of Tax Liability for Semiweekly Schedule Depositors

You must complete this form if you’re a semiweekly schedule depositor or became one because your accumulated tax liability during any month was $100,000 or more. Show tax liability here, not deposits, the IRS gets deposit data from electronic funds transfers.

Do not file Schedule B:

If you owe tax and are filing a timely Form 941-X and you were not assessed an FTD penalty caused by an incorrect, incomplete or missing Schedule B.
If your total tax liability on Form 941-X is less than $2,500.

File Schedule B:

If filing late, after the due date of the return for the return period in which you discovered the error. Otherwise, the IRS may assess an “averaged” FTD penalty.
If you were assessed an FTD penalty because of an error on Schedule B and the error won’t change the total liability for the quarter, you may be able to reduce your FTD penalty.
If you were assessed an FTD penalty because of an incorrect, incomplete, or missing Schedule B.
If you were assessed an FTD penalty and have a tax decrease.

Month 1

Day

Amount

Month 2

Day

Amount

Month 3

Day

Amount

24. Reserved for future use:

x -1.0 =

25. Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021:

x -1.0 =

26a. Refundable portion of employee retention credit:

x -1.0 =

26b. Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021:

x -1.0 =

26c. Refundable portion of COBRA premium assistance credit:

x -1.0 =

27. Total:

If line 27 is less than zero:
• If you checked line 1, this is the amount you want applied as a credit to your Form 941 for the tax period in which you're filing this form. (If you're currently filing a Form 944, Employer’s ANNUAL Federal Tax Return, see the instructions.)
• If you checked line 2, this is the amount you want refunded or abated.

If line 27 is more than zero, this is the amount you owe. Check here to pay your balance owed with this return.

FEDERAL DEBIT (limited to a maximum amount of $2,500.00)

Your Federal Debit is limited to an amount no greater than $2500.00. If your employment form shows an amount due greater than $2500.00 your are responsible to make any additional payments.

This Electronic Funds Withdrawal (EFW) payment option cannot be used for making federal tax deposits. Deposits can be submitted using the Electronic Federal Tax Payment System (EFTPS). For more information refer to the tax form Instructions for each respective form.

Entities that do not bank in the United States that need to make a payment cannot pay using EFW or EFTPS. However, payments can be made by check or money order payable to “United States Treasury” and mail to the address shown in the specific form’s instruction.

Once your return is accepted, information pertaining to your payment, such as account information, payment date, or amount, cannot be changed. If changes are needed, the only option is to cancel the payment and choose another payment method. In the event your financial institution is unable to process your payment request, you will be responsible for making other payment arrangements, and for any penalties and interest incurred.

To revoke or cancel an EFW payment, the taxpayer should contact the IRS E-file Payment Inquiry and Cancellation Service at 1-888-353-4537. Wait at least ten (10) days from when the IRS e-file return was accepted before calling. The caller should be prepared to provide the EIN, the exact payment amount (dollars and cents), and bank account number entered in the payment record. Cancellations must be made by 11:59 p.m. ET two business days prior to the scheduled payment date.

BANKING INFORMATION (ALL fields required)

Checking

Savings

28. Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021:

29. Qualified health plan expenses allocable to qualified family leave wages for leave taken before April 1, 2021:

30. Qualified wages for the employee retention credit:

31a. Qualified health plan expenses for the employee retention credit:

31b. Check here if you’re eligible for the employee retention credit in the third or fourth quarter of 2021 solely because your business is a recovery startup business.

32. Credit from Form 5884-C, line 11, for this quarter:

33a. Reserved for future use:

33b. Reserved for future use:

34. Reserved for future use:

Coution: Lines 35–40 apply only to quarters beginning after March 31, 2021.

35. Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021:

36. Qualified health plan expenses allocable to qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021:

37. Amounts under certain collectively bargained agreements allocable to qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021:

38. Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021:

39. Qualified health plan expenses allocable to qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021:

40. Amounts under certain collectively bargained agreements allocable to qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021:

41. 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 43.

42. Check here if any corrections involve reclassified workers. Explain on line 43.

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

Check if you are self-employed:

Name:*

Title:*

Date:*

Best daytime phone:*

Enter a 5 digit PIN as your signature:*

What is a 5 digit signature PIN?

Authorized signature:*

Your cost: $0.00

PERJURY STATEMENT: Under penalties of perjury, I declare that I have an approved role (as identified in the instructions for the employment tax return) within the company listed above and that I've examined a copy of the electronic return and accompanying schedules and statements for the period shown above and to the best of my knowledge and belief, they're true, correct, and complete. I further declare that the amounts in Part I of Form 8879-EMP are the amounts shown on the copy of the electronic return. I consent to allow the electronic return originator (ERO), Tax Me, LLC., to send the return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days before the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I've selected a personal identification number (PIN) as the signature for the electronic return and, if applicable, the consent to electronic funds withdrawal. I Agree

Form 941-X Adjusted Employer’s QUARTERLY Federal Tax Return or Claim for Refund