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

What Is Form 941-X?

IRS Form 941-X, Adjusted Employer's Quarterly Federal Tax Return or Claim for Refund is a form used to correct mistakes on previously filed IRS Forms 941 or 941-SS. This form can be used to make Form 941 corrections for under-reported or over-reported amounts.

IRS Form 941-X is used to correct the following: 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, qualified small business payroll tax credit for increasing research activities; and credits for COBRA premium assistance payments.

The most recent version of the document was issued by the Internal Revenue Service (IRS) in April 2017. A fillable version of the form is available for download below.

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

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941-X:
Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund
Form
Department of the Treasury — Internal Revenue Service
(Rev. April 2017)
OMB No. 1545-0029
Employer identification number
Return You're Correcting ...
(EIN)
Check the type of return you're correcting.
941
Name (not your trade name)
941-SS
Trade name (if any)
Check the ONE quarter you're correcting.
Address
1: January, February, March
Number
Street
Suite or room number
2: April, May, June
City
State
ZIP code
3: July, August, September
4: October, November, December
Foreign country name
Foreign province/county
Foreign postal code
Enter the calendar year of the
Read the separate instructions before completing this form. Use this form to correct
quarter you're correcting.
errors you made on Form 941 or 941-SS. Use a separate Form 941-X for each quarter
that needs correction. Type or print within the boxes. You MUST complete all three
(YYYY)
pages. Don't attach this form to Form 941 or 941-SS.
Part 1:
Select ONLY one process. See page 4 for additional guidance.
Enter the date you discovered errors.
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
(MM / DD / YYYY)
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.
Part 2:
Complete the certifications.
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.
Next
941-X
For Paperwork Reduction Act Notice, see the instructions.
Form
(Rev. 4-2017)
www.irs.gov/Form941X
Cat. No. 17025J
941-X:
Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund
Form
Department of the Treasury — Internal Revenue Service
(Rev. April 2017)
OMB No. 1545-0029
Employer identification number
Return You're Correcting ...
(EIN)
Check the type of return you're correcting.
941
Name (not your trade name)
941-SS
Trade name (if any)
Check the ONE quarter you're correcting.
Address
1: January, February, March
Number
Street
Suite or room number
2: April, May, June
City
State
ZIP code
3: July, August, September
4: October, November, December
Foreign country name
Foreign province/county
Foreign postal code
Enter the calendar year of the
Read the separate instructions before completing this form. Use this form to correct
quarter you're correcting.
errors you made on Form 941 or 941-SS. Use a separate Form 941-X for each quarter
that needs correction. Type or print within the boxes. You MUST complete all three
(YYYY)
pages. Don't attach this form to Form 941 or 941-SS.
Part 1:
Select ONLY one process. See page 4 for additional guidance.
Enter the date you discovered errors.
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
(MM / DD / YYYY)
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.
Part 2:
Complete the certifications.
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.
Next
941-X
For Paperwork Reduction Act Notice, see the instructions.
Form
(Rev. 4-2017)
www.irs.gov/Form941X
Cat. No. 17025J
Name (not your trade name)
Employer identification number (EIN)
Correcting quarter
(1, 2, 3, 4)
Correcting calendar year (YYYY)
Part 3:
Enter the corrections for this quarter. If any line doesn't apply, leave it blank.
Column 2
Column 3
Column 4
Column 1
Amount originally
Difference
Total corrected
reported or as
(If this amount is a
amount (for ALL
Tax correction
previously corrected
negative number,
employees)
=
(for ALL employees)
use a minus sign.)
6.
Wages, tips and other
Use the amount in Column 1 when you
=
.
.
.
compensation (Form 941, line 2)
prepare your Forms W-2 or Forms W-2c.
7.
Federal income tax withheld
Copy Column
=
from wages, tips, and other
.
.
.
.
3 here
compensation (Form 941, line 3)
8.
Taxable social security wages
=
(Form 941 or 941-SS, line 5a,
.
.
.
.
× 0.124* =
Column 1)
*If you're correcting your employer share only, use 0.062. See instructions.
9.
Taxable social security tips (Form
=
941 or 941-SS, line 5b, Column 1)
.
.
.
.
× 0.124* =
*If you're correcting your employer share only, use 0.062. See instructions.
10.
Taxable Medicare wages and tips
=
(Form 941 or 941-SS, line 5c, Column 1)
.
.
.
.
× 0.029* =
*If you're correcting your employer share only, use 0.0145. See instructions.
11.
Taxable wages & tips subject to
=
Additional Medicare Tax
.
.
.
.
× 0.009* =
withholding (Form 941 or
*Certain wages and tips reported in Column 3 shouldn't be multiplied by 0.009. See instructions.
941-SS, line 5d)
12.
Section 3121(q) Notice and
=
Copy Column
.
.
.
.
Demand—Tax due on
3 here
unreported tips
(Form 941 or 941-SS, line 5f)
13.
Tax adjustments (Form 941 or
=
Copy Column
.
.
.
.
941-SS, lines 7–9)
3 here
14.
Qualified small business payroll
=
See
.
.
.
.
tax credit for increasing
instructions
research activities (Form 941 or
941-SS, line 11; you must attach
Form 8974)
15.
Special addition to wages for
=
See
.
.
.
.
federal income tax
instructions
16.
Special addition to wages for
=
See
.
.
.
.
social security taxes
instructions
17.
Special addition to wages for
=
See
.
.
.
.
Medicare taxes
instructions
18.
Special addition to wages for
=
See
.
.
.
.
Additional Medicare Tax
instructions
.
19.
Combine the amounts on lines 7–18 of Column 4
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
20a.
COBRA premium assistance
=
See
.
.
.
.
payments (see instructions)
instructions
20b.
Number of individuals provided
=
COBRA premium assistance
(see instructions)
21.
Total. Combine the amounts on lines 19 and 20a of Column 4
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
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.
Next
2
941-X
Page
Form
(Rev. 4-2017)
Name (not your trade name)
Employer identification number (EIN)
Correcting quarter
(1, 2, 3, 4)
Correcting calendar year (YYYY)
Part 4:
Explain your corrections for this quarter.
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.
Part 5:
Sign here. You must complete all three pages of this form and sign it.
Under penalties of perjury, I declare that I have filed an original Form 941 or Form 941-SS and that I have examined this adjusted return or claim, including
accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than
taxpayer) is based on all information of which preparer has any knowledge.
Print your
name here
Sign your
Print your
name here
title here
Date
/
/
Best daytime phone
Check if you're self-employed .
.
.
Paid Preparer Use Only
Preparer’s name
PTIN
Preparer’s signature
Date
/
/
Firm’s name (or yours
EIN
if self-employed)
Address
Phone
City
State
ZIP code
3
941-X
Page
Form
(Rev. 4-2017)
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When Is 941-X Due?

Over-reported taxes can be corrected within 2 years from the date when the over-reported taxes were paid or within 3 years from filing the form. Under-reported taxes should be corrected before the form due date for that quarter and the tax must be paid by the time the form is filed.

If the document is filed on time, under-reported taxes are paid by the time of filing, the grounds for corrections are explained in details and the date of error discovery is provided, the employer will not be subject to failure-to-pay penalties.

Where to File 941-X?

The mailing address for the form depends on the location of the person filing this form. The complete list of mailing addresses can be found in the IRS-issued instructions for IRS Form 941-X.

Form 941-X Instructions

  1. Part 1. The desired process.
  2. Part 2. Certifications.
  3. Part 3. Corrections for the quarter.
    • Lines 6-14 are self-explanatory;
    • Lines 15-18 apply only if you reclassified any workers to independent contractors or nonemployees. Enter additions to wages only for reclassified workers, not all employees. Enter the correct amount of additions to wages in Column 1 and the originally reported amounts in Column 2. Enter the difference between the amounts in Column 3. Use Section 3509 for rates and calculation the number for Column 4;
    • Line 19. Add amounts provided in Column 4 of Lines 7-18 and enter the resulting number;
    • Line 20a, COBRA premium assistance payments. Enter 65% if the total COBRA premium assistance payments for all eligible individuals. For tax periods ending before January 2014, enter any COBRA payments in Column 2. For tax periods beginning after December 2013, enter 0, unless you are correcting a previously filed IRS Form 941-X. Enter the difference between Columns 1 and 2 in Columns 3 and 4;
    • Line 20b, Number of individuals provided COBRA premium assistance. Enter the number of eligible individuals, who paid the reduces premium in the reported quarter in Column 1. If you are making a correction for a tax period beginning December 2013, enter 0 in Column 2. 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 21, Total. Add amounts entered in Column 4 in Lines 19 and 20a.
  4. Part 4. Explanations for corrections.
    • Line 22. Check the box if any of your corrections contain both under-reported and over-reported amounts;
    • Line 23. Check the box, if any of your corrections involve reclassified workers;
    • Line 24. Provide a detailed explanation of how you determined your corrections. If you checked the box in the previous item, explain this as well.
  5. Part 5. Signature field.
  6. Print your name and title, enter your best daytime phone number and sign the form. If you are a paid preparer, fill the Paid Preparer Use Only part. Check the box, if you are self-employed, provide your name, your firm's name, address, Preparer Tax Identification Number (PTIN), EIN and phone number.

The following people have authority to sign IRS Form 941-X: the owner of the business, president, vice president, other authorized principal officer, a responsible and authorized member, partner, or an officer having knowledge of partnership affairs, the owner of a limited liability company (LLC) or an authorized principal officer and fiduciary of a trust.

To request a refund or abatement of arrested interest or penalties, the employer should use IRS Form 843, Claim for Refund and Request for Abatement. IRS Form 941-X cannot be used for these purposes.

How to Correct Form 941-X?

If you discovered a mistake on your form, file another one, correcting the same form and mail it before the due date.

IRS 941-X Related Forms

  • IRS Form 941, Employer's Quarterly Federal Tax Return is a form used to report Medicare, social security and income taxes withheld from the employee's paychecks and pay the employer's share of Medicare and social security taxes. This form is filed four times a year.
  • IRS 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 is a form used for the same purpose as IRS Form 941, but is used by employers, located in the above-mentioned territories.
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