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Form 941-X Adjusted Employer’s QUARTERLY Federal Tax Return or Claim for Refund (Use only through Q1 of 2020)

INSTRUCTIONS: This form must be paper filed. No usernames or passwords required. Prepare your form and click the validate button below. ALL PARTS must display Complete. The AutoFill feature is optional and strictly available to TaxMe customers.
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:*
1Q: Jan, Feb, Mar
3Q: Jul, Aug, Sep
2Q: Apr, May, Jun
4Q: 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 21, if less than zero, may only be applied as a credit to your Form 941, Form 941-SS, or Form 944 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 21. 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 on page 2 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 amounts, check all that apply. You must check at least one box. I certify that:
 
a. I repaid or reimbursed each affected employee for the overcollected 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 he or she hasn'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 he or she hasn'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 employment taxes, check all that apply. You must check at least one box. I certify that:
 
a. I repaid or reimbursed each affected employee for the 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 he or she hasn'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 he or she hasn'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 he or she hasn'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:
 
-
=
x 0.124 =
9. Taxable social security tips:
 
-
=
x 0.124 =
10. Taxable Medicare wages and tips:
 
-
=
x 0.029 =
11. Taxable wages & tips subject to Additional Medicare Tax withholding:
 
-
=
x 0.009 =
12. Section 3121(q) Notice and Demand—Tax due on unreported tips:
 
-
=
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13. Tax adjustments:
 
-
=
===>
14. Qualified small business payroll tax credit for increasing research activities:
 
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15. Special addition to wages for federal income tax:
 
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16. Special addition to wages for social security taxes:
 
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=
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17. Special addition to wages for Medicare taxes:
 
-
=
===>
18. Special addition to wages for Additional Medicare Tax:
 
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21. Subtotal:
20a. COBRA premium assistance payments:
 
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=
===>
20b. Number of individuals provided COBRA premium assistance:
 
-
=
21. Total:
If line 21 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 21 is more than zero, this is the amount you owe. Pay this amount by the time you file this return. For information on how to pay, see Amount you owe in the instructions.
22. 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 24.
23. Check here if any corrections involve reclassified workers. Explain on line 24.
 
24. 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:*
 
This return must be paper filed. It is provided free of charge. Read the IRS instructions if you have questions.
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