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                                                                                                       Department of the Treasury
                                                                                                       Internal Revenue Service
Instructions for Form 941-X

(Rev. April 2023)
Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund

Section references are to the Internal Revenue Code                         the information included in the Instructions for Form 941. 
unless otherwise noted.                                                     For example, these instructions don't discuss who is 
                                                                            eligible to claim the credit for qualified sick and family 
Contents                                                           Page
                                                                            leave wages, the employee retention credit, or the 
General Instructions: Understanding Form 941-X                 . . . .   4
                                                                            COBRA premium assistance credit. Prior revisions of the 
What Is the Purpose of Form 941-X?                 . . . . . . . . . .   4  Instructions for Form 941 are available at IRS.gov/
Where Can You Get Help?              . . . . . . . . . . . . . . . . .   5  Form941 (select the link for “All Form 941 Revisions” 
When Should You File Form 941-X?                   . . . . . . . . . .   5  under “Other Items You May Find Useful”).
Is There a Deadline for Filing Form 941-X? . . . . . .                   6
Where Should You File Form 941-X? . . . . . . . . . .                    6
                                                                            What's New
How Should You Complete Form 941-X? . . . . . . .                        6
Overview of the Process          . . . . . . . . . . . . . . . . . . .   7  Qualified small business payroll tax credit for in-
Specific Instructions: . . . . . . . . . . . . . . . . . . . . . . . . . 8  creasing research activities. For tax years beginning 
Part 1: Select ONLY One Process                . . . . . . . . . . . .   8  before January 1, 2023, a qualified small business may 
                                                                            elect to claim up to $250,000 of its credit for increasing 
Part 2: Complete the Certifications . . . . . . . . . . . .              8
                                                                            research activities as a payroll tax credit. The Inflation 
Part 3: Enter the Corrections for This Quarter                 . . .     10 Reduction Act of 2022 (the IRA) increases the election 
Part 4: Explain Your Corrections for This                                   amount to $500,000 for tax years beginning after 
    Quarter  . . . . . . . . . . . . . . . . . . . . . . . . . . . .     25 December 31, 2022. The payroll tax credit election must 
Part 5: Sign Here      . . . . . . . . . . . . . . . . . . . . . . .     26 be made on or before the due date of the originally filed 
Worksheet 1. Adjusted Credit for Qualified Sick                             income tax return (including extensions). The portion of 
and Family Leave Wages for Leave Taken                                      the credit used against payroll taxes is allowed in the first 
After March 31, 2020, and Before April 1,                                   calendar quarter beginning after the date that the qualified 
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     27 small business filed its income tax return. The election 
Worksheet 2. Adjusted Employee Retention Credit                             and determination of the credit amount that will be used 
for Qualified Wages Paid After March 12, 2020,                              against the employer's payroll taxes are made on Form 
and Before July 1, 2021          . . . . . . . . . . . . . . . . . .     28 6765, Credit for Increasing Research Activities. The 
Worksheet 3. Adjusted Credit for Qualified Sick                             amount from Form 6765, line 44, must then be reported 
and Family Leave Wages for Leave Taken                                      on Form 8974, Qualified Small Business Payroll Tax 
After March 31, 2021, and Before October 1,                                 Credit for Increasing Research Activities.
2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     29 For quarters beginning before January 1, 2023, the 
Worksheet 4. Adjusted Employee Retention Credit                             payroll tax credit can be used only against the employer 
for Qualified Wages Paid After June 30, 2021,                               share of social security tax for the quarter and any 
and Before January 1, 2022           . . . . . . . . . . . . . . . .     30 remaining credit is carried forward to the next quarter. 
Worksheet 5. Adjusted COBRA Premium                                         Starting in the first quarter of 2023, the payroll tax credit is 
Assistance Credit . . . . . . . . . . . . . . . . . . . . . . .          31 first used to reduce the employer share of social security 
How Can You Get Forms, Instructions, and                                    tax up to $250,000 per quarter and any remaining credit 
Publications From the IRS? . . . . . . . . . . . . . . . .               31 reduces the employer share of Medicare tax for the 
                                                                            quarter. Any remaining credit, after reducing the employer 
                                                                            share of social security tax and the employer share of 
Future Developments                                                         Medicare tax, is then carried forward to the next quarter. 
For the latest information about developments related to                    Form 8974 is used to determine the amount of the credit 
Form 941-X and its instructions, such as legislation                        that can be used in the current quarter. Corrections to this 
enacted after they were published, go to IRS.gov/                           credit are made on Form 941-X, line 16. If you make a 
Form941X.                                                                   correction to Form 941-X, line 16, you must attach a 
                                                                            corrected Form 8974. For more information, see the 
    These instructions have been updated for                                Instructions for Form 8974 and go to IRS.gov/
TIP changes to the qualified small business payroll tax                     ResearchPayrollTC.
    credit for increasing research activities reported 
on Form 8974. You may use these instructions and the                        Reminders
April 2023 revision of Form 941-X for all years for which 
                                                                                  If a line on Form 941-X doesn't apply to you, leave 
the statute of limitations on corrections hasn't expired. 
                                                                            TIP   it blank. If you're correcting a quarter that began 
Before you proceed with these instructions and 
                                                                                  before April 1, 2020, you must leave blank lines 9, 
completing Form 941-X, you'll need a copy of the 
                                                                            10, 17, 18a, 24, 25, 26a, 28, 29, 30, 31a, 32, 33a, and 34. 
Instructions for Form 941 for the quarter that you're 
                                                                            If you're correcting a quarter that began before July 1, 
correcting because these instructions don't repeat all of 

May 18, 2023                                                       Cat. No. 20331U

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2020, you must leave blank line 33b. If you're correcting a employee retention credit solely because your business is 
quarter that began before April 1, 2021, you must leave     a recovery startup business.
blank lines 18b, 18c, 18d, 26b, 26c, 35, 36, 37, 38, 39, 
                                                            Credit for COBRA premium assistance payments is 
and 40. If you're correcting a quarter that began before 
                                                            limited to periods of coverage beginning on or after 
July 1, 2021, you must leave blank line 31b. If you're 
                                                            April 1, 2021, through periods of coverage beginning 
correcting a quarter that began after December 31, 2021, 
                                                            on or before September 30, 2021.      Section 9501 of the 
you must leave blank lines 18a, 26a, 30, 31a, and 31b.
                                                            ARP provides for COBRA premium assistance in the form 
                                                            of a full reduction in the premium otherwise payable by 
The COVID-19 related credit for qualified sick and 
                                                            certain individuals and their families who elect COBRA 
family leave wages is limited to leave taken after 
                                                            continuation coverage due to a loss of coverage as the 
March 31, 2020, and before October 1, 2021. The 
                                                            result of a reduction in hours or an involuntary termination 
credit for qualified sick and family leave wages, as 
                                                            of employment (assistance eligible individuals). This 
enacted under the Families First Coronavirus Response 
                                                            COBRA premium assistance was available for periods of 
Act (FFCRA) and amended and extended by the 
                                                            coverage beginning on or after April 1, 2021, through 
COVID-related Tax Relief Act of 2020, is for leave taken 
                                                            periods of coverage beginning on or before September 
after March 31, 2020, and before April 1, 2021, and the 
credit for qualified sick and family leave wages under      30, 2021. A premium payee was entitled to the COBRA 
sections 3131, 3132, and 3133 of the Internal Revenue       premium assistance credit at the time an eligible individual 
                                                            elects coverage. Therefore, other than in rare 
Code, as enacted under the American Rescue Plan Act of 
                                                            circumstances, due to the COBRA notice and election 
2021 (the ARP), is for leave taken after March 31, 2021, 
                                                            period requirements (generally, employers have 60 days 
and before October 1, 2021. For more information about 
                                                            to provide notice and assistance eligible individuals have 
the credit for qualified sick and family leave wages, go to 
                                                            60 days to elect coverage), the first quarter of 2022 was 
IRS.gov/PLC.
                                                            the last quarter in which employers may have been 
Corrections to amounts reported on Form 941, lines          eligible to claim the COBRA premium assistance credit on 
5a(i), 5a(ii), 11b, 13c, 19, and 20, for the credit for     Form 941. Employers eligible to claim the COBRA 
qualified sick and family leave wages for leave taken after premium assistance credit after March 31, 2022, must file 
March 31, 2020, and before April 1, 2021, are reported on   Form 941-X to claim the credit.
Form 941-X, lines 9, 10, 17, 25, 28, and 29, respectively.
                                                                For more information on COBRA premium assistance 
Corrections to amounts reported on Form 941, lines          payments and the credit, see Notice 2021-31, 2021-23 
11d, 13e, 23, 24, 25, 26, 27, and 28, for the credit for    I.R.B. 1173, available at IRS.gov/irb/
qualified sick and family leave wages for leave taken after 2021-23_IRB#NOT-2021-31; and Notice 2021-46, 
March 31, 2021, and before October 1, 2021, are reported    2021-33 I.R.B. 303, available at IRS.gov/irb/
on Form 941-X, lines 18b, 26b, 35, 36, 37, 38, 39, and 40,  2021-33_IRB#NOT-2021-46.
respectively.
                                                                Corrections to amounts reported on Form 941, lines 
The COVID-19 related employee retention credit has          11e, 11f, and 13f, for the COBRA premium assistance 
expired. The employee retention credit enacted under        credit are reported on Form 941-X, lines 18c, 18d, and 
the Coronavirus Aid, Relief, and Economic Security          26c, respectively.
(CARES) Act and amended and extended by the 
                                                                        If you claimed the credit for qualified sick and 
Taxpayer Certainty and Disaster Tax Relief Act of 2020 
                                                                        family leave wages for leave taken after March 31, 
was limited to qualified wages paid after March 12, 2020,       CAUTION!
                                                                        2020, and before April 1, 2021, and you make any 
and before July 1, 2021. The employee retention credit 
                                                            corrections on Form 941 X to amounts used to figure this 
under section 3134 of the Internal Revenue Code, as                           ‐
                                                            credit, you'll need to refigure the amount of this credit 
enacted by the ARP and amended by the Infrastructure 
                                                            using Worksheet 1. You'll also use this worksheet to figure 
Investment and Jobs Act, was limited to qualified wages 
                                                            this credit if you’re claiming it for the first time on Form 
paid after June 30, 2021, and before October 1, 2021, 
unless the employer was a recovery startup business. An     941-X. If you claimed the credit for qualified sick and 
                                                            family leave wages for leave taken after March 31, 2021, 
employer that was a recovery startup business could also 
claim the employee retention credit for qualified wages     and before October 1, 2021, and you make any 
                                                            corrections on Form 941 X to amounts used to figure this 
paid after September 30, 2021, and before January 1,                          ‐
2022. For more information about the employee retention     credit, you'll need to refigure the amount of this credit 
                                                            using 
credit, including the dates for which the credit may be           Worksheet 3. You'll also use this worksheet to figure 
                                                            this credit if you’re claiming it for the first time on Form 
claimed, go to IRS.gov/ERC.
                                                            941-X. If you claimed the employee retention credit for 
Corrections to amounts reported on Form 941, lines          wages paid after March 12, 2020, and before July 1, 
11c, 13d, 21, and 22, for the employee retention credit are 2021, and you make any corrections on Form 941 X to ‐
reported on Form 941-X, lines 18a, 26a, 30, and 31a,        amounts used to figure this credit, you'll need to refigure 
respectively. However, how you figure the employee          the amount of this credit using Worksheet 2. You'll also 
retention credit for qualified wages paid after March 12,   use this worksheet to figure this credit if you’re claiming it 
2020, and before July 1, 2021, is different from how you    for the first time on Form 941-X. If you claimed the 
figure the credit for qualified wages paid after June 30,   employee retention credit for wages paid after June 30, 
2021, and before January 1, 2022. Also, for corrections to  2021, and before January 1, 2022, and you make any 
qualified wages paid after June 30, 2021, you may need      corrections on Form 941 X to amounts used to figure this ‐
to complete line 31b to tell us if you're eligible for the  credit, you'll need to refigure the amount of this credit 

                                                            -2-               Instructions for Form 941-X (Rev. 4-2023)

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using Worksheet 4. You'll also use this worksheet to figure 13 of Pub. 15, Employer’s Tax Guide, for more information
this credit if you’re claiming it for the first time on Form about corrections during the calendar year and about
941-X. If you claimed the COBRA premium assistance administrative errors. See section 2 of Pub. 15 for more
credit and you make any corrections on Form 941 X to ‐ information about section 3509. If section 3509 rates
amounts used to figure this credit, you'll need to refigure apply, see the instructions for lines 19–22, later.
the amount of this credit using Worksheet 5. You'll also
Only transposition or math errors involving the
use this worksheet to figure this credit if you’re claiming it
inaccurate reporting of the amount withheld are
for the first time on Form 941-X. CAUTION!
administrative errors.
Form 941-X is filed to correct Form 941 or Form You can’t file a Form 941-X to correct federal income
941-SS. References to Form 941 on Form 941-X and in tax withholding for prior years for nonadministrative errors.
these instructions also apply to Form 941-SS, Employer's In other words, you can’t correct federal income tax
QUARTERLY Federal Tax Return (American Samoa, actually withheld from an employee in a prior year if you
Guam, the Commonwealth of the Northern Mariana discover that you didn’t withhold the right amount. For
Islands, and the U.S. Virgin Islands), unless otherwise example, you can’t correct federal income tax withheld in
noted. a prior year because you used the wrong income tax
Payroll tax credit for certain tax-exempt organiza- withholding table or you didn’t treat a payment correctly as
tions affected by qualified disasters. Section 303(d) of taxable or nontaxable. Similarly, if you paid federal
the Taxpayer Certainty and Disaster Tax Relief Act of income tax in a prior year on behalf of your employee,
2020 allows for a payroll tax credit for certain tax-exempt rather than deducting it from the employee’s pay (which
organizations affected by certain qualified disasters not resulted in additional wages subject to tax), and in a
related to COVID-19. This credit is claimed on Form subsequent year you determine that you incorrectly
5884-D. Form 5884-D is filed after the Form 941 for the calculated the amount of tax, you can’t correct the federal
quarter for which the credit is being claimed has been income tax withholding. However, you must still correct
filed. If applicable to the quarter that you're correcting, the amount of wages you reported on Form 941 and Form
you'll enter the credit claimed on Form 5884-D on W-2, Wage and Tax Statement, for a prior year by filing
Worksheet 1 to figure your credit for qualified sick and Form 941-X and Form W-2c, Corrected Wage and Tax
family leave wages for leave taken before April 1, 2021, or Statement, respectively. You'll report the correct wages
Worksheet 2 to figure the employee retention credit for on Form 941-X, line 6, column 1.
wages paid after March 12, 2020, and before July 1, The amount actually withheld is reflected on
2021. For more information about this credit, go to TIP payroll information or on Form W-2, which can be
IRS.gov/Form5884D. used by the employee to claim a credit for
Employee consents to support a claim for refund. withholding for individual income tax return purposes.
Rev. Proc. 2017-28, 2017-14 I.R.B. 1061, available at
Correcting Additional Medicare Tax withholding and
IRS.gov/irb/2017-14_IRB#RP-2017-28, provides
wages and tips subject to Additional Medicare Tax
guidance to employers on the requirements for employee
withholding. Wages and tips subject to Additional
consents used by an employer to support a claim for
Medicare Tax withholding are reported on Form 941,
refund of overcollected social security tax and Medicare
line 5d. Certain errors discovered on a previously filed
tax. The revenue procedure clarifies the basic
Form 941 are corrected on Form 941-X, line 13. However,
requirements for both a request for employee consent and
you can’t file a Form 941-X to correct the wrong amount of
for the employee consent, and permits a consent to be
Additional Medicare Tax actually withheld from an
requested, furnished, and retained in an electronic format
employee in a prior year, including any amount you paid
as an alternative to a paper format. The revenue
on behalf of your employee rather than deducting it from
procedure also contains guidance concerning when an
the employee’s pay (which resulted in additional wages
employer may claim a refund of only the employer share
subject to tax). See the instructions for line 13, later, for
of overcollected social security tax and Medicare tax. The
more information on the types of errors that can be
revenue procedure requires that any request for consent
corrected and how the correction is reported on Form
include an Additional Medicare Tax notice indicating that
941-X. For more information about Additional Medicare
any claim on the employee’s behalf won’t include a claim
Tax withholding, see the Instructions for Form 941 or go to
for overpaid Additional Medicare Tax.
IRS.gov/ADMTfaqs.
Correcting federal income tax withheld. Generally,
You may need to attach Schedule R (Form 941) to
you may correct federal income tax withholding errors
your Form 941-X. If you were required to file Schedule R
only if you discovered the errors in the same calendar
(Form 941), Allocation Schedule for Aggregate Form 941
year you paid the wages. In addition, for an overcollection,
Filers, when you filed Form 941, you must complete
you may correct federal income tax withholding only if you
Schedule R (Form 941) when correcting an aggregate
also repaid or reimbursed the employees in the same
Form 941. Schedule R (Form 941) is completed only for
year.
those clients and customers who have corrections
For prior years, you may only correct administrative reported on Form 941-X. Schedule R (Form 941) is filed
errors to federal income tax withholding (that is, errors in as an attachment to Form 941-X.
which the amount reported on Form 941, line 3, isn't the
Approved section 3504 agents and certified
amount you actually withheld from an employee’s wages)
professional employer organizations (CPEOs) must
and errors for which section 3509 rates apply. See section

Instructions for Form 941-X (Rev. 4-2023) -3-

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complete and file Schedule R (Form 941) when filing an         adjustments to Form 941, lines 11d, 13e, 23, 24, 25, 26, 
aggregate Form 941. Aggregate Forms 941 are filed by           27, and 28;
agents approved by the IRS under section 3504. To                  • Amounts reported on Form 941 for the employee 
request approval to act as an agent for an employer, the       retention credit, including adjustments to Form 941, lines 
agent files Form 2678 with the IRS. Aggregate Forms 941        11c, 13d, 21, and 22, (for the second quarter of 2020, also 
are also filed by CPEOs approved by the IRS under              Form 941, lines 24 and 25); and
section 7705. To become a CPEO, the organization must              • Amounts reported on Form 941 for the COBRA 
apply through the IRS Online Registration System at            premium assistance credit, for periods of coverage 
IRS.gov/CPEO. CPEOs file Form 8973, Certified                  beginning on or after April 1, 2021, through periods of 
Professional Employer Organization/Customer Reporting          coverage beginning on or before September 30, 2021, 
Agreement, to notify the IRS that they started or ended a      including adjustments to Form 941, lines 11e, 11f, and 
service contract with a customer.                              13f.
  Other third-party payers that file aggregate Forms 941, 
                                                                     Use Form 843, Claim for Refund and Request for 
such as non-certified PEOs, must complete and file 
                                                               Abatement, to request a refund or abatement of assessed 
Schedule R (Form 941) if they have clients that are 
                                                               interest or penalties. Don’t request a refund or abatement 
claiming the qualified small business payroll tax credit for 
                                                               of assessed interest or penalties on Form 941 or Form 
increasing research activities, the credit for qualified sick 
                                                               941-X.
and family leave wages, the employee retention credit, 
and/or the COBRA premium assistance credit, or clients                 We use the terms “correct” and “corrections” on 
deferring the employer or the employee share of social             TIP Form 941-X and in these instructions to include 
security tax. If you're an other third-party payer that didn't         interest-free adjustments under sections 6205 and 
file Schedule R (Form 941) with Form 941 because you           6413 and claims for refund and abatement under sections 
didn't meet these requirements, but are now filing Form        6402, 6414, and 6404. See Rev. Rul. 2009-39 for 
941-X to report these credits or the deferral of the           examples of how the interest-free adjustment and claim 
employer or the employee share of social security tax for      for refund rules apply in 10 different situations. You can 
your clients, then you must now file Schedule R (Form          find Rev. Rul. 2009-39, 2009-52 I.R.B. 951, at IRS.gov/irb/
941) and attach it to Form 941-X.                              2009-52_IRB#RR-2009-39.
  See the March 2022 revision of the Instructions for 
Form 941 for information about when a third party is                 When you discover an error on a previously filed Form 
considered the person to whom COBRA premium                    941, you must:
assistance payments are payable.                                   • Correct that error using Form 941-X;
                                                                   • File a separate Form 941-X for each Form 941 that 
                                                               you’re correcting; and
General Instructions:                                              • Generally, file Form 941-X separately. Don't file Form 
Understanding Form 941-X                                       941-X with Form 941. However, if you didn't previously file 
                                                               Form 941 because you mistakenly treated your 
What Is the Purpose of Form 941-X?                             employees as nonemployees, you may have to file Form 
                                                               941-X with Form 941. See the instructions for line 42, 
Use Form 941-X to correct errors on a Form 941 that you        later.
previously filed. Use Form 941-X to correct:
• Wages, tips, and other compensation;                               If you didn’t file a Form 941 for one or more quarters, 
• Income tax withheld from wages, tips, and other              don’t use Form 941-X. Instead, file Form 941 for each of 
compensation;                                                  those quarters. Also, see When Should You File Form 
• Taxable social security wages;                               941-X, later. However, if you didn’t file Forms 941 
• Taxable social security tips;                                because you improperly treated workers as independent 
• Taxable Medicare wages and tips;                             contractors or nonemployees and are now reclassifying 
• Taxable wages and tips subject to Additional Medicare        them as employees, see the instructions for line 42, later.
Tax withholding;                                                       Unless otherwise specified in these instructions, 
• Deferred amount of the employer share of social                  TIP an underreported employment tax credit or social 
security tax;                                                          security tax deferral should be treated like an 
• Deferred amount of the employee share of social              overreported tax amount. An overreported employment 
security tax;                                                  tax credit or social security tax deferral should be treated 
• Qualified small business payroll tax credit for increasing   like an underreported tax amount. For more information, 
research activities;                                           including which process to select on lines 1 and 2, see 
• Amounts reported on Form 941 for the credit for              Correcting an employment tax credit or social security tax 
qualified sick and family leave wages for leave taken after    deferral, later.
March 31, 2020, and before April 1, 2021, including 
adjustments to Form 941, lines 5a(i), 5a(ii), 11b, 13c, 19, 
and 20;                                                              Report the correction of underreported and 
• Amounts reported on Form 941 for the credit for              overreported tax amounts for the same tax period on a 
qualified sick and family leave wages for leave taken after    single Form 941-X, unless you’re requesting a refund or 
March 31, 2021, and before October 1, 2021, including          abatement. If you’re requesting a refund or abatement and 
                                                               are correcting both underreported and overreported tax 
                                                               amounts, file one Form 941-X correcting the 

                                                               -4-             Instructions for Form 941-X (Rev. 4-2023)

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underreported tax amounts only and a second Form federal tax liabilities reported on Form 941, Part 2, or on
941-X correcting the overreported tax amounts. Schedule B (Form 941), see the Instructions for
Schedule B (Form 941).
You’ll use the adjustment process if you underreported
employment taxes and are making a payment, or if you Due dates. The due date for filing Form 941-X depends
overreported employment taxes and will be applying the on when you discover an error and if you underreported or
credit to Form 941 for the period during which you file overreported tax. If you underreported tax, see
Form 941-X. However, see the Caution under Is There a Underreported tax, later. For overreported tax amounts,
Deadline for Filing Form 941-X, later, if you’re correcting you may choose to either make an interest-free
overreported tax amounts during the last 90 days of a adjustment or file a claim for refund or abatement. If you’re
period of limitations. You’ll use the claim process if you correcting overreported tax amounts, see Overreported
overreported employment taxes and are requesting a tax—Adjustment process or Overreported tax—Claim
refund or abatement of the overreported tax amount. process, later.
Follow the chart on page 6 of Form 941-X for help in If any due date falls on a Saturday, Sunday, or legal
choosing whether to use the adjustment process or the holiday, you may file Form 941-X on the next business
claim process. Be sure to give us a detailed explanation day. If we receive Form 941-X after the due date, we will
on line 43 for each correction that you show on Form treat Form 941-X as filed on time if the envelope
941-X. containing Form 941-X is properly addressed, contains
sufficient postage, and is postmarked by the U.S. Postal
Continue to report current quarter fractions of cents,
Service on or before the due date, or sent by an
third-party sick pay, tips, and group-term life insurance on
IRS-designated private delivery service (PDS) on or
Form 941, lines 7–9.
before the due date. If you don’t follow these guidelines,
You have additional requirements to complete when we will consider Form 941-X filed when it is actually
filing Form 941-X, such as certifying that you filed (or will received. See Pub. 15 or Pub. 80 for more information on
file) all applicable Forms W-2 and Forms W-2c with the legal holidays. For more information about PDSs, see
Social Security Administration (SSA). For corrections of Where Should You File Form 941-X, later.
overreported federal income tax, social security tax,
Medicare tax, or Additional Medicare Tax, you must make Underreported tax. If you’re correcting underreported
any certifications that apply to your situation. 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
Don’t use Form 941-X to correct Form CT-1, 943, pay the amount you owe by the time you file. Doing so
! 944, or 945. Instead, use the “X” form that will generally ensure that your correction is interest free
CAUTION corresponds to those forms (Form CT-1 X, 943-X, and not subject to failure-to-pay (FTP) or failure-to-deposit
944-X, or 945-X). (FTD) penalties. See What About Penalties and Interest,
later. For details on how to make a payment, see the
Where Can You Get Help? instructions for line 27, later.
For help filing Form 941-X or for questions about federal If Form 941-X is filed late (after the due date of the
employment taxes and tax corrections, you can: return for the return period in which you discovered the
• Go to IRS.gov/EmploymentTaxes and IRS.gov/ error), you must attach an amended Schedule B (Form
CorrectingEmploymentTaxes; 941) to Form 941-X. Otherwise, the IRS may assess an
• See Pub. 15 for correcting Form 941, or Pub. 80, “averaged” FTD penalty. See “Averaged” FTD penalty in
Federal Tax Guide for Employers in the U.S. Virgin section 11 of Pub. 15 or section 8 of Pub. 80 for more
Islands, Guam, American Samoa, and the Commonwealth information about “averaged” FTD penalties. The total tax
of the Northern Mariana Islands, for correcting Form reported on the “Total liability for the quarter” line of
941-SS; or Schedule B (Form 941) must match the corrected tax
• Call the IRS Business and Specialty Tax Line at (Form 941, line 12, combined with any correction entered
800-829-4933 or 800-829-4059 (TDD/TTY for persons on Form 941-X, line 23) for the quarter, less any previous
who are deaf, hard of hearing, or have a speech abatements and interest-free tax assessments.
disability), Monday–Friday from 7:00 a.m. to 7:00 p.m.
If you discover an error in . . . Form 941-X is due . . .
local time (Alaska and Hawaii follow Pacific time).
1. January, February, March April 30
See also How Can You Get Forms, Instructions, and 2. April, May, June July 31
Publications From the IRS, later. 3. July, August, September October 31
4. October, November, January 31
When Should You File Form 941-X? December
File Form 941-X when you discover an error on a
previously filed Form 941. The dates shown in the table above apply only to corrections of
underreported amounts. If any due date falls on a Saturday,
However, if your only errors on Form 941 relate to the Sunday, or legal holiday, you may file Form 941-X on the next
number of employees who received wages (Form 941, business day.
line 1) 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 Example—You owe tax. On July 7, 2023, you
Form 941-X. For more information about correcting discover that you underreported $10,000 of social security

Instructions for Form 941-X (Rev. 4-2023) -5-

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and Medicare wages on your 2023 first quarter Form 941. If you file Form 941-X to correct overreported tax
File Form 941-X and pay the amount you owe by October ! amounts in the last 90 days of a period of
31, 2023, because you discovered the error in the third CAUTION limitations, you must use the claim process. You
quarter of 2023, and October 31, 2023, is the due date for can’t use the adjustment process. If you’re also correcting
that quarter. If you file Form 941-X before October 31, underreported tax amounts, you must file another Form
2023, pay the amount you owe by the time you file. 941-X to correct the underreported tax amounts using the
adjustment process and pay any tax due.
The due date for filing the adjusted return is
TIP determined by the type of return (Form 941 or
Form 944) being corrected, without regard to your Where Should You File Form 941-X?
current filing requirements. Therefore, if you're currently
Send your completed Form 941-X to the address shown
filing Form 941 and you're correcting a previously filed
next.
Form 944, you must file Form 944-X by January 31 of the
year following the year you discover the error. IF you’re in . . . THEN use this address . . .
Overreported tax—Adjustment process. If you Connecticut, Delaware, District of
overreported tax on Form 941 and choose to apply the Columbia, Florida, Georgia,
Illinois, Indiana, Kentucky, Maine,
credit to Form 941 or Form 944, file an adjusted return on Maryland, Massachusetts,
Department of the Treasury
Form 941-X soon after you discover the error but more Michigan, New Hampshire, New
Internal Revenue Service
than 90 days before the period of limitations on the credit Jersey, New York, North Carolina,
Cincinnati, OH 45999-0005
or refund for Form 941 expires. See Is There a Deadline Ohio, Pennsylvania, Rhode
for Filing Form 941-X, later. Island, South Carolina,
Tennessee, Vermont, Virginia,
Overreported tax—Claim process. If you overreported West Virginia, Wisconsin
tax on Form 941, you may choose to file a claim for refund
or abatement on Form 941-X any time before the period of Alabama, Alaska, Arizona,
Arkansas, California, Colorado,
limitations on credit or refund expires on Form 941. If you Hawaii, Idaho, Iowa, Kansas,
also need to correct any underreported tax amounts, you Louisiana, Minnesota, Department of the Treasury
must file another Form 941-X reporting only corrections to Mississippi, Missouri, Montana, Internal Revenue Service
the underreported amounts. See Is There a Deadline for Nebraska, Nevada, New Mexico, Ogden, UT 84201-0005
Filing Form 941-X? next. North Dakota, Oklahoma,
Oregon, South Dakota, Texas,
You may not file a refund claim to correct federal Utah, Washington, Wyoming
! income tax or Additional Medicare Tax actually No legal residence or principal Internal Revenue Service
CAUTION withheld from employees.
place of business in any state P.O. Box 409101
Ogden, UT 84409
Is There a Deadline for Filing Form
Special filing address for
941-X? exempt organizations; federal,
Department of the Treasury
state, and local governmental
Internal Revenue Service
Generally, you may correct overreported taxes on a entities; and Indian tribal
Ogden, UT 84201-0005
previously filed Form 941 if you file Form 941-X within 3 governmental entities, regardless
years of the date Form 941 was filed or 2 years from the of location
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 PDSs can't deliver to P.O. boxes. You must use the
years of the date the Form 941 was filed. We call each of U.S. Postal Service to mail an item to a P.O. box address.
these time frames a period of limitations. For purposes of Go to IRS.gov/PDS for the current list of PDSs. If you file
the period of limitations, Forms 941 for a calendar year Form 941-X using a PDS, send it to the following address.
are considered filed on April 15 of the succeeding year if
filed before that date. Ogden - Internal Revenue Submission Processing
Example. You filed your 2020 fourth quarter Form 941 Center
on January 26, 2021, and payments were timely made. 1973 Rulon White Blvd.
The IRS treats the return as if it were filed on April 15, Ogden, UT 84201
2021. On January 24, 2024, you discover that you
overreported social security and Medicare wages on that Use this address even if your business is located in a
form by $350. To correct the error, you must file Form state that files in Cincinnati.

941-X by April 15, 2024, which is the end of the period of How Should You Complete Form
limitations for Form 941, and use the claim process.
941-X?

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

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941 for the third and fourth quarters of 2022, file one Form • Complete all five pages and sign Form 941-X on
941-X to correct the 2022 third quarter Form 941 and file a page 5.
second Form 941-X to correct the 2022 fourth quarter • Staple multiple sheets in the upper-left corner.
Form 941.
What About Penalties and Interest?
Employer Identification Number (EIN), Name, Generally, your correction of an underreported tax amount
and Address won’t be subject to an FTP penalty, an FTD penalty, or
Enter your EIN, name, and address in the spaces interest if you:
provided. Also enter your name and EIN on the top of • File on time (by the due date of Form 941 for the quarter
pages 2, 3, 4, and 5, and on any attachments. If your in which you discover the error),
address has changed since you filed your Form 941, enter • Pay the amount shown on line 27 by the time you file
the corrected information and the IRS will update your Form 941-X,
address of record. Be sure to write your name, EIN, “Form • Enter the date you discovered the error, and
941-X,” the calendar quarter you’re correcting (for • Explain in detail the grounds and facts relied on to
example, “Quarter 2”), and the calendar year of the support the correction.
quarter you’re correcting on the top of any attachments.
No correction will be eligible for interest-free treatment
Return You’re Correcting if any of the following apply.
• The amounts underreported relate to an issue that was
In the box at the top of page 1, check the type of return
raised in an examination of a prior period.
(Form 941 or Form 941-SS) you’re correcting. Check the
• You knowingly underreported your employment tax
appropriate box for the one quarter you’re correcting.
liability.
Enter the calendar year of the Form 941 you’re correcting.
• You received a notice and demand for payment.
Enter the quarter and calendar year on pages 2, 3, 4, and
• You received a notice of determination under section
5.
7436.
Enter the Date You Discovered Errors If you receive a notice about a penalty after you file this
You must enter the date you discovered errors. You return, reply to the notice with an explanation and we will
discover an error when you have enough information to be determine if you meet the reasonable-cause criteria. Don’t
able to correct it. If you’re reporting several errors that you attach an explanation when you file your return.
discovered at different times, enter the earliest date you
discovered them here. Report any subsequent dates and Overview of the Process
related errors on line 43.
To correct a previously filed Form 941, use Form 941-X to
Must You Make an Entry on Each Line? file either an adjusted employment tax return or a claim for
refund or abatement. The adjustment process and the
You must provide all of the information requested at the
claim process are outlined below.
top of page 1 of Form 941-X. You must check one box
(but not both) in Part 1. In Part 2, you must check the box If you underreported the tax. If you underreported
on line 3 and any applicable boxes on lines 4 and 5. In the tax on a previously filed Form 941, check the box on
Part 3, if any line doesn’t apply, leave it blank. Complete line 1 and pay any additional amount you owe by the
Parts 4 and 5 as instructed. time you file Form 941-X. For details on how to make a
payment, see the instructions for line 27, later.
How Should You Report Negative Amounts? Example—You underreported employment taxes.
Form 941-X uses negative numbers to show reductions in On July 7, 2023, you discover an error that results in
tax (credits) and positive numbers to show additional tax additional tax on your 2022 third quarter Form 941. File
(amounts you owe). Form 941-X by October 31, 2023, and pay the amount
you owe by the time you file. See When Should You File
When reporting a negative amount in columns 3 and 4,
Form 941-X, earlier. Don’t attach Form 941-X to your 2023
use a minus sign instead of parentheses. For example,
third quarter Form 941.
enter “-10.59” instead of “(10.59).” However, if you’re
completing the return on your computer and your software If you overreported the tax. If you overreported the
only allows you to use parentheses to report negative tax on a previously filed Form 941, you may choose one
amounts, you may use them. of the following options.
• Use the adjustment process. Check the box on line 1 to
How Should You Make Entries on Form 941-X? apply any credit (negative amount) from line 27 to Form
941 for the quarter during which you file Form 941-X.
You can help the IRS process Form 941-X timely and
accurately if you follow these guidelines. • Use the claim process. Check the box on line 2 to file a
claim on Form 941-X requesting a refund or abatement of
• Type or print your entries.
the amount shown on line 27.
• Use Courier font (if possible) for all typed or
computer-generated entries. To ensure that the IRS has enough time to
• Omit dollar signs. You may use commas and decimal TIP process a credit for an overreporting tax
points, if desired. Enter dollar amounts to the left of any adjustment in the quarter during which you file
preprinted decimal point and cents to the right of it. Form 941-X, you’re encouraged to file Form 941-X
• Always show an amount for cents, even if it is zero. correcting the overreported tax amount in the first 2
Don’t round entries to whole dollars. months of a quarter. For example, if you discover an

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overreported tax amount in March, June, September, or date you discovered the error, and explain the correction
December, you may want to file Form 941-X in the first 2 on line 43.
months of the next quarter. However, there must be 90
If you have a credit. You overreported employment
days remaining on the period of limitations when you file
taxes (you have a negative amount on line 27) and want
Form 941-X. See the Caution under Is There a Deadline
the IRS to apply the credit to Form 941 or Form 944 for the
for Filing Form 941-X, earlier. This should ensure that the
period during which you filed Form 941-X. The IRS will
IRS will have enough time to process Form 941-X so the
apply your credit on the first day of the Form 941 or Form
credit will be posted before you file Form 941, thus
944 period during which you filed Form 941-X. However,
avoiding an erroneous balance due notice from the IRS.
the credit you show on Form 941-X, line 27, may not be
See the example below.
fully available on your Form 941 or Form 944 if the IRS
corrects it during processing or you owe other taxes,
Example—You want your overreported tax applied penalties, or interest. The IRS will notify you if your
as a credit to Form 941. On September 18, 2023, you claimed credit changes or if the amount available as a
discover you overreported your tax on your 2022 fourth credit on Form 941 or Form 944 was reduced because of
quarter Form 941 and want to choose the adjustment unpaid taxes, penalties, or interest.
process. To allow the IRS enough time to process the
credit, you file Form 941-X on October 2, 2023, and take Don’t check the box on line 1 if you’re correcting
the credit on your fourth quarter 2023 Form 941. ! overreported tax amounts and the period of
CAUTION limitations on credit or refund for Form 941 will
If you currently file Form 944 and you’re making a expire within 90 days of the date you file Form 941-X. See
TIP correction to a previously filed Form 941 that will Is There a Deadline for Filing Form 941-X, earlier.
be claimed as a credit on Form 944, file Form
941-X before December in any year before the expiration
of the period of limitations for the previously filed Form 2. Claim
941. In the year that the period of limitations for the Check the box on line 2 to use the claim process if you’re
previously filed Form 941 expires, file Form 941-X at least correcting overreported tax amounts only and you’re
90 days before the expiration date. claiming a refund or abatement for the negative amount
(credit) shown on line 27. Don’t check this box if you’re
correcting any underreported tax amounts on this form.
Specific Instructions: You must check the box on line 2 if you have a credit (a
negative amount on line 27) and the period of limitations
Part 1: Select ONLY One Process 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
Because Form 941-X may be used to file either an
for Filing Form 941-X, earlier.
adjusted employment tax return or a claim for refund or
abatement, you must check one box on either line 1 or The IRS usually processes claims shortly after they are
line 2. Don’t check both boxes. filed. The IRS will notify you if your claim is denied,
accepted as filed, or selected to be examined. See Pub.
Correcting an employment tax credit or social securi-
556, Examination of Returns, Appeal Rights, and Claims
ty tax deferral. For lines 1 and 2, if you underreported an
for Refund, for more information.
employment tax credit or the amount of social security tax
deferred, treat it like you overreported a tax amount. If you Unless the IRS corrects Form 941-X during processing
overreported an employment tax credit or the amount of or you owe other taxes, penalties, or interest, the IRS will
social security tax deferred, treat it like you underreported refund the amount shown on line 27, plus any interest that
a tax amount. If you're filing Form 941-X to adjust only an applies.
employment tax credit and/or the amount of social You may not file a refund claim to correct federal
security tax deferred and you're not correcting any ! income tax or Additional Medicare Tax actually
overreported taxes on Form 941-X, lines 6–13, skip lines 4 CAUTION withheld from employees.
and 5.
1. Adjusted Employment Tax Return Part 2: Complete the Certifications
Check the box on line 1 if you’re correcting underreported You must complete all certifications that apply by
tax amounts or overreported tax amounts and you would checking the appropriate boxes. If all of your corrections
like to use the adjustment process to correct the errors. relate to underreported tax amounts, complete line 3 only;
skip lines 4 and 5 and go to Part 3. If your corrections
If you’re correcting both underreported tax amounts
relate to overreported tax amounts, other than corrections
and overreported tax amounts on this form, you must
related to underreported employment tax credits and
check this box. If you check this box, any negative amount
social security tax deferrals, you have a duty to ensure
shown on line 27 will be applied as a credit (tax deposit) to
that your employees' rights to recover overpaid employee
your Form 941 or Form 944 for the period in which you’re
social security and Medicare taxes that you withheld are
filing this form. See Example—You want your
protected. The certifications on lines 4 and 5 address the
overreported tax applied as a credit to Form 941, earlier.
requirement to:
If you owe tax. Pay the amount shown on line 27 by the • Repay or reimburse your employees for the
time you file Form 941-X. Generally, you won’t be overcollection of employee social security and Medicare
charged interest if you file on time, pay on time, enter the taxes, or

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• Obtain consents from your employees to file a claim on security tax, Medicare tax, or Additional Medicare Tax that
their behalf. See Rev. Proc. 2017-28 for guidance on the you didn’t withhold from your employees.
requirements for both a request for employee consent and
for the employee consent. 5. Certifying Claims
If you’re filing a claim for refund or abatement of
3. Filing Forms W-2 or Forms W-2c overreported federal income tax, social security tax,
Check the box on line 3 to certify that you filed or will file Medicare tax, or Additional Medicare Tax and checked
Forms W-2 or Forms W-2c with the SSA, as required, the box on line 2, check the appropriate box on line 5. You
showing your employees' correct wage and tax amounts. may need to check more than one box. If you obtained
See the General Instructions for Forms W-2 and W-3 for written statements or consents from some employees but
detailed information about filing requirements. References you couldn’t locate employees or secure the statements
to Form W-2 on Form 941-X and in these instructions also or consents of the remaining employees, check all
apply to Forms W-2AS, W-2CM, W-2GU, and W-2VI, applicable boxes. Provide a summary on line 43 of the
unless otherwise noted. amount of the corrections for both the employees who
You must check the box on line 3 to certify that you filed provided statements or consents and for those who didn’t.
Forms W-2 or Forms W-2c even if your corrections on You can’t file a refund claim to correct the
Form 941-X don’t change amounts shown on those forms. ! incorrect amount of federal income tax or
For example, if your only correction to Form 941 involves CAUTION Additional Medicare Tax actually withheld from
misstated tax adjustments, which don't impact the employees in a prior year. If you request their consent to
amounts reported on your employees’ Forms W-2 (see file a claim for social security tax or Medicare tax, you
the instructions for line 15, later), check the box on line 3 must tell your employees that you can’t claim a refund of
to certify that you already filed all required Forms W-2 and any Additional Medicare Tax on their behalf. See Rev.
W-2c with the SSA. In this situation, you're certifying that Proc. 2017-28 for sample language to use in your request.
you don't need to file Form W-2c because you already
filed a correct Form W-2. 5a. Check the box on line 5a if your overreported tax
includes each affected employee share of social security
4. Certifying Overreporting Adjustments and Medicare taxes. You’re certifying that you repaid or
If you overreported federal income tax, social security tax, reimbursed to the employees their share of social security
Medicare tax, or Additional Medicare Tax and checked and Medicare taxes. For refunds of employee social
the box on line 1, check the appropriate box on line 4. You security and Medicare taxes overcollected in prior years,
may need to check more than one box. If you obtained you’re certifying that you received written statements from
written statements from some employees but you couldn’t those employees stating that they didn’t and won’t receive
locate employees or secure the statements of the a refund or credit for the prior year taxes. Don’t send these
remaining employees, check all applicable boxes. Provide statements to the IRS. Keep them for your records.
a summary on line 43 of the amount of the corrections Generally, all employment tax records must be kept for at
both for the employees who provided written statements least 4 years. Records related to qualified sick leave
and for those who didn’t. wages and qualified family leave wages for leave taken
after March 31, 2021, and before October 1, 2021, and
4a. Check the box on line 4a if your overreported amount records related to qualified wages for the employee
includes each affected employee share of overcollected retention credit paid after June 30, 2021, should be kept
taxes. You’re certifying that you repaid or reimbursed the for at least 6 years. Copies must be submitted to the IRS if
employee share of current and prior year taxes and you requested.
received written statements from the employees stating
that they didn’t and won’t receive a refund or credit for the 5b. Check the box on line 5b if your overreported tax
prior year taxes. You’re certifying that you adjusted federal includes each affected employee share of social security
income tax or Additional Medicare Tax withheld from and Medicare taxes and you haven’t yet repaid or
employees for the current calendar year only. Don’t send reimbursed the employee share of taxes. You’re certifying
these statements to the IRS. Keep them for your records. that you received consent from each affected employee to
Generally, all employment tax records must be kept for at file a claim on the employee share of those taxes and you
least 4 years. Records related to qualified sick leave received written statements from those employees stating
wages and qualified family leave wages for leave taken that they didn’t and won’t receive a refund or credit for the
after March 31, 2021, and before October 1, 2021, and prior year taxes.
records related to qualified wages for the employee An employee consent must:
retention credit paid after June 30, 2021, should be kept • Contain the name, address, and social security number
for at least 6 years. Copies must be submitted to the IRS if (or truncated taxpayer identification number, when
requested. appropriate) of the employee;
4b. Check the box on line 4b to certify that your • Contain the name, address, and EIN of the employer;
overreported amount is only for the employer share of • Contain the tax period(s), the type of tax, and the
taxes on those employees who you were unable to find or amount of tax for which the consent is provided;
those who didn’t give you a statement described on • Affirmatively state that the employee authorizes the
line 4a. employer to claim a refund for the overpayment of the
employee share of tax;
4c. Check the box on line 4c to certify that your
overreported amount is only for federal income tax, social

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• For amounts collected in a prior year, include the If you previously adjusted or amended Form 941
employee’s written statement certifying that the employee ! by using Form 941-X or because of an IRS
hasn’t made any previous claims (or the claims were CAUTION examination change, show amounts in column 2
rejected) and won’t make any future claims for refund or that include those previously reported corrections.
credit of the amount of the overcollection;
• Identify the basis of the claim; and 6. Wages, Tips, and Other Compensation
• Be dated and contain the employee’s signature under
If you’re correcting the wages, tips, and other
penalties of perjury. The penalties of perjury statement
compensation you reported on Form 941, line 2, enter the
should be located immediately above the required
total corrected amount for all employees in column 1. In
signature.
column 2, enter the amount you originally reported or as
Don’t send these statements and consents to the IRS. previously corrected. In column 3, enter the difference
Keep them for your records. Generally, all employment between columns 1 and 2. This line doesn’t apply to Form
tax records must be kept for at least 4 years. Records 941-SS.
related to qualified sick leave wages and qualified family
leave wages for leave taken after March 31, 2021, and If you or the IRS previously corrected the amount
before October 1, 2021, and records related to qualified reported on Form 941, line 2, enter in column 2 the
wages for the employee retention credit paid after June amount after any previous corrections.
30, 2021, should be kept for at least 6 years. Copies must
be submitted to the IRS if requested. line 6 (column 1)
- line 6 (column 2)
In certain situations, you may not have repaid or line 6 (column 3) If the amount in column 2 is larger than the
reimbursed your employees or obtained their consents amount in column 1, use a minus sign in
prior to filing a claim, such as in cases where the period of column 3.
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 43 that you haven’t repaid or Example—Wages, tips, and other compensation
reimbursed employees or obtained consents at the time increased. You reported $9,000 as total wages, tips, and
you file the claim. However, you must repay or reimburse other compensation on line 2 of your 2023 first quarter
your employees and certify that you’ve done so before the Form 941. In May of 2023, you discovered that you had
IRS can allow the claim. overlooked $1,000 in tips for one of your employees. To
5c. Check the box on line 5c to certify that your correct the error, figure the difference on Form 941-X as
overreported tax is only for the employer share of social shown.
security and Medicare taxes. This applies when affected
employees didn’t give you consent to file a claim for Column 1 (corrected amount) 10,000.00
refund for the employee share of social security and Column 2 (Form 941, line 2) - 9,000.00
Medicare taxes, they couldn’t be found, or they didn’t give Column 3 (difference) 1,000.00
you a statement described on line 5b.
5d. Check the box on line 5d to certify that your
overreported amount is only for federal income tax, social Example—Wages, tips, and other compensation
security tax, Medicare tax, or Additional Medicare Tax that decreased. You reported $9,000 as wages, tips, and
you didn’t withhold from your employees. other compensation on line 2 of your 2023 first quarter
Form 941. In May of 2023, you discovered that you
Part 3: Enter the Corrections for This included $2,000 in wages for one of your employees
twice. To correct the error, figure the difference on Form
Quarter 941-X as shown.
What Amounts Should You Report in Part 3?
Column 1 (corrected amount) 7,000.00
On lines 6–13, columns 1 and 2, for each line you're Column 2 (Form 941, line 2) - 9,000.00
correcting, show amounts for all of your employees, not
just for those employees whose amounts you’re Column 3 (difference) -2,000.00
correcting.
If a correction that you report in column 4 includes both Example—Auto allowance; wages, tips, and other
underreported and overreported amounts (see the compensation increased. You paid one of your
instructions for line 41, later), give us details for each error employees a $500 monthly auto allowance from October
on line 43. through December 2022, and didn’t treat the payments as
Because special circumstances apply for lines 14–22, taxable wages. In February 2023, you realized that the
24–26c, and 28–40, read the instructions for each line payments were wages because they weren’t
carefully before entering amounts in the columns. reimbursements of deductible business expenses that
were substantiated and paid under an accountable plan.
If any line doesn't apply to you, leave it blank. 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 Form
941-X, lines 6, 8, 12, and, if applicable, 13.

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Be sure to explain the reasons for the corrections on Example—Prior year nonadministrative error
line 43. (failure to withhold federal income tax when
required). You were required to withhold $400 of federal
The quarterly amount on line 6, column 1, should
income tax from an employee's bonus that was paid in
TIP be used to figure the annual amount to report on
December of 2022 but you withheld nothing. You
your Forms W-2 or Forms W-2c. This amount
discovered the error on March 13, 2023. You can’t file
should also generally be used for any business expense
Form 941-X to correct federal income tax withheld
deduction on your income tax return (or amended return)
reported on your 2022 fourth quarter Form 941 because
for wages paid.
the error involves a previous year and the amount
previously reported for the employee represents the
7. Federal Income Tax Withheld From Wages, actual amount withheld from the employee during 2022.
Tips, and Other Compensation
Example—Prior year administrative error
If you’re correcting the federal income tax withheld from (incorrectly reported amount of federal income tax
wages, tips, and other compensation you reported on actually withheld). You had three employees. In the
Form 941, line 3, enter the total corrected amount in fourth quarter of 2022, you withheld $1,000 of federal
column 1. In column 2, enter the amount you originally income tax from Xavier Black, $2,000 from Sophie Rose,
reported or as previously corrected. In column 3, enter the and $6,000 from Leo Wood. The total amount of federal
difference between columns 1 and 2. This line doesn’t income tax you withheld was $9,000. You mistakenly
apply to Form 941-SS. reported $6,000 on line 3 of your 2022 fourth quarter Form
941. You discovered the error on March 10, 2023. This is
line 7 (column 1) an example of an administrative error that may be
- line 7 (column 2) corrected in a later calendar year because the amount
line 7 (column 3) If the amount in column 2 is larger than the actually withheld from the employees' wages isn’t the
amount in column 1, use a minus sign in amount reported on Form 941. Use Form 941-X to correct
column 3. 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.
Copy the amount in column 3 to column 4. Include any
minus sign shown in column 3.
Column 1 (corrected amount) 9,000.00
Generally, you may correct federal income tax Column 2 (Form 941, line 3) - 6,000.00
! withholding errors only if you discovered the Column 3 (difference) 3,000.00
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 Report the $3,000 as a tax correction in column 4.
reimbursed the employees in the same year. For prior Be sure to explain the reasons for this correction on
years, you may only correct administrative errors to line 43.
federal income tax withholding (that is, errors in which the
amount reported on Form 941, line 3, isn't the amount you Example—Nonadministrative error reporting
actually withheld from an employee’s wages) and errors federal income tax because of repayment of wages
for which section 3509 rates apply. Only transposition or paid in prior year. You prepaid Jack Brown $4,000 of
math errors involving the inaccurate reporting of the wages for 2 months of work in September 2022. You
amount withheld are administrative errors. See section 13 withheld $400 of federal income tax at the time you paid
of Pub. 15 for more information about corrections during Jack. These amounts were reported on your 2022 third
the calendar year and about administrative errors. See quarter Form 941. Jack left employment in October 2022
section 2 of Pub. 15 for more information about section (after only 1 month of service). In January 2023, Jack
3509. If section 3509 rates apply, see the instructions for repaid $2,000 to you for the 1 month Jack didn't work. You
lines 19–22, later. 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
You can’t file a Form 941-X to correct federal income wages because the wages were income to Jack for the
tax withholding for prior years for nonadministrative errors. prior year. These amounts were correctly reported on
In other words, you can’t correct federal income tax Form 941.
actually withheld from an employee in a prior year if you
discover that you didn’t withhold the right amount. For 8. Taxable Social Security Wages
example, you can’t correct federal income tax withheld in
a prior year because you used the wrong income tax Qualified sick leave wages and qualified family
withholding table or you didn’t treat a payment correctly as TIP leave wages for leave taken after March 31, 2021,
taxable or nontaxable. Similarly, if you paid federal and before October 1, 2021, were included on
income tax in a prior year on behalf of your employee, Form 941, line 5a, column 1, and can be adjusted only on
rather than deducting it from the employee’s pay (which Form 941-X, line 8.
resulted in additional wages subject to tax), and in a If you’re correcting the taxable social security wages
subsequent year you determine that you incorrectly you reported on Form 941, line 5a, column 1, enter the
calculated the amount of tax, you can’t correct the federal total corrected amount in column 1. In column 2, enter the
income tax withholding. amount you originally reported or as previously corrected.

Instructions for Form 941-X (Rev. 4-2023) -11-

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In column 3, enter the difference between columns 1 and             reported on Form 941 X, line 25. Adjustments to qualified ‐
2.                                                                  health plan expenses allocable to qualified sick leave 
                                                                    wages and to qualified family leave wages for leave taken 
    line 8 (column 1)                                               after March 31, 2020, and before April 1, 2021, are 
   - line 8 (column 2)                                              reported on Form 941 X, lines 28 and 29, respectively. If ‐
   line 8 (column 3)   If the amount in column 2 is larger than the you claimed the credit for qualified sick and family leave 
                       amount in column 1, use a minus sign in      wages for leave taken after March 31, 2020, and before 
                       column 3.                                    April 1, 2021, on your original Form 941 for the quarter, 
                                                                    and you make any corrections on Form 941 X for the ‐
                                                                    quarter to amounts used to figure this credit, you'll need to 
   Multiply the amount in column 3 by 0.124 and enter that          refigure the amount of this credit using Worksheet 1. You'll 
result in column 4.                                                 also use this worksheet to figure this credit if you’re 
                                                                    claiming the credit for the first time on Form 941-X. For 
                                                                    more information about the credit for qualified sick and 
   line 8 (column 3)
                                                                    family leave wages, go to IRS.gov/PLC.
          x 0.124
   line 8 (column 4)   If the amount in column 3 used a minus sign,      Qualified sick leave wages paid with respect to leave 
                       also use a minus sign in column 4.           taken after March 31, 2020, and before April 1, 2021, 
                                                                    aren't subject to the employer share of social security tax; 
                                                                    therefore, the tax rate on these wages is 6.2% (0.062). For 
                                                                    more information about qualified sick leave wages, see 
Note. If you checked the box on Form 941-X, line 4b or              Definition of qualified sick and family leave wages for 
line 5c, because you’re correcting only the employer                leave taken after March 31, 2020, and before April 1, 
share of tax on a decrease to social security wages, use            2021, later, and go to IRS.gov/PLC. If you’re correcting 
0.062 (6.2%) when multiplying the amount shown in                   the qualified sick leave wages you reported on Form 941, 
column 3. If you’re correcting both shares of tax for some          line 5a(i), column 1, enter the total corrected amount in 
employees and only the employer share for other                     column 1. In column 2, enter the amount you originally 
employees, enter the properly calculated amount in                  reported or as previously corrected. In column 3, enter the 
column 4. Be sure to show your calculations on line 43.             difference between columns 1 and 2.
   Example—Social security wages decreased. 
Following Example—Wages, tips, and other                                  line 9 (column 1)
compensation decreased in the instructions for line 6, the               - line 9 (column 2)
wages that you counted twice were also taxable social                    line 9 (column 3)  If the amount in column 2 is larger than the 
security wages. To correct the error, figure the difference                                 amount in column 1, use a minus sign in 
on Form 941-X as shown.                                                                     column 3.

Column 1 (corrected amount)            7,000.00
Column 2 (Form 941, line 5a, column 1) - 9,000.00                        Multiply the amount in column 3 by 0.062 and enter that 
Column 3 (difference)                  -2,000.00                    result in column 4.

                                                                         line 9 (column 3)
   Use the difference in column 3 to determine your tax                   x 0.062
correction.                                                              line 9 (column 4)  If the amount in column 3 used a minus sign, 
                                                                                            also use a minus sign in column 4.
Column 3 (difference)                  -2,000.00
Tax rate (12.4%)                         x 0.124
Column 4 (tax correction)               -248.00
                                                                    Note. If you erroneously reported qualified sick leave 
                                                                    wages for leave taken after March 31, 2020, and before 
                                                                    April 1, 2021, on Form 941, line 5a, instead of on 
   Be sure to explain the reasons for this correction on            line 5a(i), you'll need to make a correction on Form 941-X, 
line 43.                                                            lines 8 and 9, and enter the properly calculated amount in 
                                                                    column 4 for each line.
9. Qualified Sick Leave Wages (For Leave Taken 
                                                                         Example—Qualified sick leave wages increased. 
After March 31, 2020, and Before April 1, 2021)
                                                                    You paid $2,000 of qualified sick leave wages to only one 
         Adjustments to the social security tax on qualified        of your employees in the second quarter of 2020. In 
TIP      sick leave wages and qualified family leave wages          March 2023, you discovered that you only reported 
         for leave taken after March 31, 2020, and before           $1,000 of qualified sick leave wages on Form 941 for the 
April 1, 2021, are reported on Form 941 X, lines 9 and 10, ‐        second quarter. To correct the error, figure the difference 
respectively. Adjustments to the nonrefundable portion of           on Form 941 X as shown.‐
the credit for qualified sick and family leave wages for 
leave taken after March 31, 2020, and before April 1, 
2021, are reported on Form 941 X, line 17, and ‐
adjustments to the refundable portion of the credit are 

                                                                    -12-                    Instructions for Form 941-X (Rev. 4-2023)

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Column 1 (corrected amount) 2,000.00 wages on Form 941 for the second quarter. To correct the
Column 2 (Form 941, line 5a(i), column 1) - 1,000.00 error, figure the difference on Form 941 X as shown.‐
Column 3 (difference) 1,000.00
Column 1 (corrected amount) 1,000.00
Column 2 (Form 941, line 5a(ii), column 1) - 3,000.00
Use the difference in column 3 to determine your tax Column 3 (difference) -2,000.00
correction.

Column 3 (difference) 1,000.00 Use the difference in column 3 to determine your tax
Tax rate (6.2%) x 0.062 correction.
Column 4 (tax correction) 62.00
Column 3 (difference) -2,000.00
Tax rate (6.2%) x 0.062
Column 4 (tax correction) -124.00
Be sure to explain the reasons for this correction on
line 43.
10. Qualified Family Leave Wages (For Leave Be sure to explain the reasons for this correction on
Taken After March 31, 2020, and Before April 1, line 43.

2021) 11. Taxable Social Security Tips
Qualified family leave wages paid with respect to leave If you’re correcting the taxable social security tips you
taken after March 31, 2020, and before April 1, 2021, reported on Form 941, line 5b, column 1, enter the total
aren't subject to the employer share of social security tax; corrected amount in column 1. In column 2, enter the
therefore, the tax rate on these wages is 6.2% (0.062). For amount you originally reported or as previously corrected.
more information about qualified family leave wages, see In column 3, enter the difference between columns 1 and
Definition of qualified sick and family leave wages for 2.
leave taken after March 31, 2020, and before April 1,
2021, later, and go to IRS.gov/PLC. If you’re correcting line 11 (column 1)
the qualified family leave wages you reported on Form - line 11 (column 2)
941, line 5a(ii), column 1, enter the total corrected amount
in column 1. In column 2, enter the amount you originally line 11 (column 3) If the amount in column 2 is larger than the
amount in column 1, use a minus sign in
reported or as previously corrected. In column 3, enter the column 3.
difference between columns 1 and 2.

line 10 (column 1)
Multiply the amount in column 3 by 0.124 and report
- line 10 (column 2)
that result in column 4.
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. line 11 (column 3)
x 0.124
line 11 (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 0.062 and enter that
result in column 4.
line 10 (column 3) Note. If you checked the box on Form 941-X, line 4b or
x 0.062 line 5c, because you’re correcting only the employer
share of tax on a decrease to social security tips, use
line 10 (column 4) If the amount in column 3 used a minus sign,
also use a minus sign in column 4. 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
Note. If you erroneously reported qualified family leave column 4. Be sure to show your calculations on line 43.
wages for leave taken after March 31, 2020, and before Example—Social security tips increased.
April 1, 2021, on Form 941, line 5a, instead of on Following Example—Wages, tips, and other
line 5a(ii), you'll need to make a correction on Form compensation increased in the instructions for line 6, the
941-X, lines 8 and 10, and enter the properly calculated tips that you overlooked were also taxable social security
amount in column 4 for each line. tips. To correct the error, figure the difference on Form
Example—Qualified family leave wages 941-X as shown.
decreased. You paid $1,000 of qualified family leave
wages to only one of your employees in the second
quarter of 2020. In March 2023, you discovered that you
erroneously reported $3,000 of qualified family leave

Instructions for Form 941-X (Rev. 4-2023) -13-

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Column 1 (corrected amount) 10,000.00 Use the difference in column 3 to determine your tax
Column 2 (Form 941, line 5b, column 1) - 9,000.00 correction.
Column 3 (difference) 1,000.00
Column 3 (difference) -2,000.00
Tax rate (2.9%) x 0.029
Use the difference in column 3 to determine your tax Column 4 (tax correction) -58.00
correction.

Column 3 (difference) 1,000.00 Be sure to explain the reasons for this correction on
Tax rate (12.4%) x 0.124 line 43.

Column 4 (tax correction) 124.00 13. Taxable Wages & Tips Subject to Additional
Medicare Tax Withholding
Generally, you may correct errors to Additional Medicare
Be sure to explain the reasons for this correction on
Tax withholding only if you discovered the errors in the
line 43.
same calendar year the wages and tips were paid to
12. Taxable Medicare Wages & Tips employees. However, you may correct errors to Additional
Medicare Tax withholding for prior years if the amount
If you’re correcting the taxable Medicare wages and tips
reported on Form 941, line 5d, column 2, isn’t the amount
you reported on Form 941, line 5c, column 1, enter the
you actually withheld, including any amount you paid on
total corrected amount in column 1. In column 2, enter the
behalf of your employee rather than deducting it from the
amount you originally reported or as previously corrected.
employee’s pay (which resulted in additional wages
In column 3, enter the difference between columns 1 and
subject to tax). This type of error is an administrative error.
2.
The administrative error adjustment corrects the amount
reported on Form 941 to agree with the amount actually
line 12 (column 1) withheld from employees.
- line 12 (column 2)
line 12 (column 3) If the amount in column 2 is larger than the You may also correct errors to Additional Medicare Tax
amount in column 1, use a minus sign in withholding for prior years if section 3509 rates apply. If
column 3. section 3509 rates apply, see the instructions for lines 19–
22, later.

Multiply the amount in column 3 by 0.029 (2.9% tax If a prior year error was a nonadministrative error, you
rate) and enter that result in column 4. may correct only the wages and tips subject to
Additional Medicare Tax withholding that were originally
line 12 (column 3) reported on Form 941, line 5d, column 1, or previously
x 0.029 corrected on Form 941-X. You can’t correct the tax
reported on Form 941, line 5d, column 2.
line 12 (column 4) If the amount in column 3 used a minus sign,
also use a minus sign in column 4. 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,
Note. If you checked the box on Form 941-X, line 4b or
column 1, enter the total corrected amount in column 1. In
line 5c, because you’re correcting only the employer
column 2, enter the amount you originally reported or as
share of tax on a decrease to Medicare wages and tips,
previously corrected. In column 3, enter the difference
use 0.0145 (1.45%) when multiplying the amount in
between columns 1 and 2.
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 line 13 (column 1)
column 4. Be sure to explain your calculations on line 43. - line 13 (column 2)
line 13 (column 3) If the amount in column 2 is larger than the
Example—Medicare wages and tips decreased. amount in column 1, use a minus sign in
Following Example—Wages, tips, and other column 3.
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 Multiply the amount in column 3 by 0.009 (0.9% tax
on Form 941-X as shown. rate) and enter that result in column 4.

Column 1 (corrected amount) 7,000.00 line 13 (column 3)
Column 2 (Form 941, line 5c, column 1) - 9,000.00 x 0.009
Column 3 (difference) -2,000.00 line 13 (column 4) If the amount in column 3 used a minus sign,
also use a minus sign in column 4.

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Example—Prior year administrative error Medicare Tax withheld (column 4) because the error
(incorrectly reported amount of Additional Medicare involves a previous year and the amount previously
Tax actually withheld). Xavier Black's wages exceeded reported for Sophie represents the actual amount withheld
the $200,000 withholding threshold for Additional from Sophie during 2022.
Medicare Tax in November 2022. The total wages paid to
Combination of prior year administrative and nonad-
Xavier for 2022 were $230,000. You withheld $270
ministrative errors. If you’re reporting both
($30,000 x 0.009) from Xavier's wages. However, on your
administrative errors and nonadministrative errors for the
fourth quarter 2022 Form 941, you mistakenly reported
same quarter of a prior year, enter the total corrected
$3,000 on line 5d, column 1, and Additional Medicare Tax
amount in column 1. In column 2, enter the amount you
withheld of $27 on line 5d, column 2. You discover the
originally reported or as previously corrected. In column 3,
error on March 13, 2023. This is an example of an
enter the difference between columns 1 and 2. However,
administrative error that may be corrected in a later
multiply only the amount of wages and tips reported in
calendar year because the amount actually withheld isn’t
column 3 that are related to administrative errors by 0.009
the amount reported on your fourth quarter 2022 Form
(0.9% tax rate). Don’t multiply any wages and tips
941. Use Form 941-X, line 13, to correct the error as
reported in column 3 that are related to nonadministrative
shown below.
errors by 0.009 (0.9% tax rate). Use line 43 to explain in
detail your corrections. The explanation must include the
Column 1 (corrected amount) 30,000.00 reasons for the corrections and a breakdown of the
Column 2 (Form 941, line 5d, column 1) - 3,000.00 amount reported in column 3 into the amounts related to
Column 3 (difference) 27,000.00 administrative errors and nonadministrative errors.
Example—Combination of prior year administrative
and nonadministrative errors. Xavier Black’s wages
Use the difference in column 3 to determine your tax exceeded the $200,000 withholding threshold for
correction. Additional Medicare Tax in November 2022. The total
wages paid to Xavier for 2022 were $230,000. You
Column 3 (difference) 27,000.00 withheld $270 ($30,000 x 0.009) from Xavier's wages.
Tax rate (0.9%) x 0.009 However, on your fourth quarter 2022 Form 941, you
Column 4 (tax correction) 243.00 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
Be sure to explain the reasons for this correction on Medicare Tax related to this administrative error is
line 43. $27,000 ($30,000 - $3,000).
Prior year nonadministrative errors. You may correct Sophie Rose’s wages exceeded the $200,000
only the taxable wages and tips subject to Additional withholding threshold for Additional Medicare Tax in
Medicare Tax withholding that you reported on Form 941, December 2022. The total wages paid to Sophie for 2022
line 5d, column 1. Enter the total corrected amount in were $220,000. You were required to withhold $180
column 1. In column 2, enter the amount you originally ($20,000 x 0.009) but you withheld nothing and didn’t
reported or as previously corrected. In column 3, enter the report Sophie's $20,000 in wages subject to Additional
difference between columns 1 and 2. Medicare Tax withholding on line 5d of your fourth quarter
2022 Form 941.
line 13 (column 1) You discover both errors on March 13, 2023. Use Form
- line 13 (column 2) 941-X, line 13, to correct the errors as shown below.
line 13 (column 3) If the amount in column 2 is larger than the
amount in column 1, use a minus sign in Column 1 (corrected amount) 50,000.00
column 3. Column 2 (Form 941, line 5d, column 1) - 3,000.00
Column 3 (difference) 47,000.00
Don’t multiply the amount in column 3 by 0.009 (0.9%
tax rate). Leave column 4 blank and explain the reasons Determine the portion of wages and tips reported in
for this correction on line 43. column 3 that is related to the administrative error
Example—Prior year nonadministrative error ($47,000 - $20,000 (nonadministrative error) = $27,000
(failure to withhold Additional Medicare Tax when (administrative error)). Multiply this portion of column 3 by
required). Sophie Rose’s wages exceeded the $200,000 0.009 (0.9% tax rate) to determine your tax correction.
withholding threshold for Additional Medicare Tax in
December 2022. The total wages paid to Sophie for 2022 Difference related to administrative error 27,000.00
were $220,000. You were required to withhold $180 Tax rate (0.9%) x 0.009
($20,000 x 0.009) but you withheld nothing and didn’t
Column 4 (tax correction) 243.00
report an amount on line 5d of your fourth quarter 2022
Form 941. You discover the error on March 13, 2023. File
Form 941-X to correct wages and tips subject to
Be sure to explain the reasons for these corrections on
Additional Medicare Tax withholding for your 2022 fourth
line 43. You must also report that $20,000 of the amount
quarter Form 941, but you may not correct the Additional
shown in column 3 was related to the correction of a prior

Instructions for Form 941-X (Rev. 4-2023) -15-

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year nonadministrative error and $27,000 of the amount Column 1 (corrected amount) -9,600.00
shown in column 3 was related to the correction of an Column 2 (Form 941, line 8) - (6,900.00)
administrative error. Column 3 (difference) -2,700.00
14. Section 3121(q) Notice and Demand—Tax
on Unreported Tips Here is how you would enter the numbers on Form
Enter on line 14 any corrections to amounts reported on 941-X.
Form 941, line 5f, for the tax due from a Section 3121(q)
Notice and Demand. The IRS issues a Section 3121(q) Column 1 Column 2 Column 3
Notice and Demand to advise an employer of the amount (corrected (Form 941, line 8) (difference)
of tips received by employees who failed to report or amount)
underreported tips to the employer. An employer isn’t -9,600.00 -6,900.00 -2,700.00
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 Report “-2,700.00” as your correction in column 4.
by the IRS.
In this example, you’re claiming a credit for $2,700 in
Be sure to explain the reasons for any corrections on overreported tax for your 2022 second quarter Form 941.
line 43. Always enter the same amount in column 4 (including any
minus sign) that you enter in column 3.
15. Tax Adjustments Be sure to explain the reasons for this correction on
For purposes of these instructions, all references line 43.
TIP to “sick pay” mean ordinary sick pay, not “qualified
sick leave wages.” 16. Qualified Small Business Payroll Tax Credit
for Increasing Research Activities
Use line 15 to correct any adjustments reported on
Form 941, lines 7–9. Enter in column 1 the total corrected The payroll tax credit election must be made on or
amount for Form 941, lines 7–9. ! before the due date of the originally filed income
CAUTION tax return (including extensions). Any election to
Enter in column 2 the total originally reported or take the payroll tax credit may be revoked only with the
previously corrected amounts from Form 941, lines 7–9. In consent of the IRS.
column 3, enter the difference between columns 1 and 2.
If you’re correcting the qualified small business payroll
line 15 (column 1) tax credit for increasing research activities that you
-line 15 (column 2) reported on Form 941, line 11a (line 11 for quarters
beginning before April 1, 2020), enter the total corrected
line 15 (column 3)
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.
You may need to report negative numbers in any
TIP column. Make sure that the difference you enter in Copy the amount in column 3 to column 4. However, to
column 3 accurately represents the change to properly show the amount as a credit or balance due item,
adjustments originally reported or previously corrected on enter a positive number in column 3 as a negative number
Form 941, lines 7–9. in column 4 or a negative number in column 3 as a
positive number in column 4.
Copy the amount in column 3 to column 4. Include any You must attach a corrected Form 8974 and explain
minus sign shown in column 3. the reasons for this correction on line 43.

On line 43, describe what you misreported on Form 17. Nonrefundable Portion of Credit for
941. Tell us if your adjustment is for fractions of cents,
Qualified Sick and Family Leave Wages for
third-party sick pay, tips, or group-term life insurance.
Leave Taken After March 31, 2020, and Before
Example—Current quarter's third-party sick pay
April 1, 2021
underreported. You reported $6,900 (shown as
“-6,900.00”) as a third-party sick pay adjustment Form 941-X and these instructions use the terms
(reduction to tax) on line 8 of your 2022 second quarter TIP “nonrefundable” and “refundable” when
Form 941. You didn’t report any amounts on lines 7 and 9. discussing credits. The term “nonrefundable”
Your third-party sick pay adjustment should’ve been means the portion of the credit which is limited by law to
$9,600 (shown as “-9,600.00”) because your third-party certain taxes. The term “refundable” means the portion of
sick pay payer withheld that amount of social security and the credit which is in excess of those taxes.
Medicare taxes from your employees. You discovered the For corrections to Form 941, line 11b, the credit for
error in April of 2023. To correct the error, figure the qualified sick and family leave wages is only available for
difference on Form 941-X as shown. wages paid with respect to leave taken after March 31,
2020, and before April 1, 2021. Don't enter an amount on
line 17 if you're correcting a quarter that began before
April 1, 2020.

-16- Instructions for Form 941-X (Rev. 4-2023)

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If you’re correcting the nonrefundable portion of the             increased in the instructions for line 9, you originally 
credit for qualified sick and family leave wages for leave        reported a $1,000 nonrefundable portion of the credit for 
taken after March 31, 2020, and before April 1, 2021, that        qualified sick and family leave wages on Form 941, 
you reported on Form 941, line 11b, enter the total               line 11b, for the second quarter of 2020. You use 
corrected amount from Worksheet 1, Step 2, line 2j, in            Worksheet 1 to refigure the correct nonrefundable portion 
column 1. In column 2, enter the amount you originally            of the credit for qualified sick and family leave wages and 
reported or as previously corrected. In column 3, enter the       you determine that the correct credit is now $2,000. To 
difference between columns 1 and 2. For more                      correct the error, figure the difference on Form 941 X as ‐
information about the credit for qualified sick and family        shown.
leave wages, go to IRS.gov/PLC.
                                                                  Column 1 (corrected amount)                2,000.00
Copy the amount in column 3 to column 4. However, to              Column 2 (Form 941, line 11b)              - 1,000.00
properly show the amount as a credit or balance due item, 
                                                                  Column 3 (difference)                      1,000.00
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.
                                                                  To properly show the credit increase as a reduction to 
Definition of qualified sick and family leave wages               your tax balance, enter the positive number in column 3 as 
for leave taken after March 31, 2020, and before April            a negative number in column 4. Here is how you would 
1, 2021. For purposes of the credit for qualified sick and        enter the numbers on Form 941 X, line 17.‐
family leave wages, qualified sick and family leave wages 
are wages for social security and Medicare tax purposes,          Column 1   Column 2           Column 3     Column 4
determined without regard to the exclusions from the              (corrected (Form 941,         (difference) (tax correction)
definition of employment under sections 3121(b)(1)–(22),          amount)    line 11b)
that an employer pays that otherwise meet the                      2,000.00  1,000.00           1,000.00     -1,000.00
requirements of the Emergency Paid Sick Leave Act 
(EPSLA) or the Emergency Family and Medical Leave 
Expansion Act (Expanded FMLA), as enacted under the               Be sure to explain the reasons for this correction on 
FFCRA and amended by the COVID-related Tax Relief                 line 43.
Act of 2020. However, don't include any wages otherwise 
excluded under sections 3121(b)(1)–(22) when reporting            18a. Nonrefundable Portion of Employee 
qualified sick and family leave wages on your employment          Retention Credit
tax return and when figuring the credit on Worksheet 1,           Use line 18a only for corrections to quarters beginning 
Step 2, lines 2a and 2a(i), and on Step 2, lines 2e and           after March 31, 2020, and before January 1, 2022.
2e(i). Instead, include qualified sick leave wages and 
qualified family leave wages excluded from the definition                 Section 206(c) of the Taxpayer Certainty and 
of employment under sections 3121(b)(1)–(22) separately           TIP     Disaster Tax Relief Act of 2020 removed the 
in Step 2, line 2a(iii) and/or line 2e(iii), respectively, before         restriction on an employer who has received a 
you figure your total credit in Step 2, line 2d (credit for       Small Business Interruption Loan under the Paycheck 
qualified sick leave wages), or Step 2, line 2h (credit for       Protection Program (PPP) from claiming the employee 
qualified family leave wages).                                    retention credit. The eligible employer can claim the 
                                                                  employee retention credit on any qualified wages that 
The April 2020 revision and July 2020 revision of the 
                                                                  aren't counted as payroll costs in obtaining PPP loan 
Instructions for Form 941 were released before the 
                                                                  forgiveness. Any wages that could count toward eligibility 
COVID-related Tax Relief Act of 2020 was enacted on 
                                                                  for the employee retention credit or PPP loan forgiveness 
December 27, 2020; therefore, Worksheet 1, in those 
                                                                  can be applied to either of these two programs, but not 
Instructions for Form 941, didn't include lines to add the 
                                                                  both. If your Form 941 didn't claim the correct amount for 
wages that meet an exclusion under sections 3121(b)(1)–
                                                                  the employee retention credit because you received a 
(22) when figuring the credits for qualified sick and family 
                                                                  Small Business Interruption Loan under the PPP, you may 
leave wages. If your Form 941 for the second, third, or 
                                                                  file Form 941-X and complete Worksheet 2 to claim the 
fourth quarter of 2020 didn't claim the correct amount of 
                                                                  correct amount of the credit. For more information, see 
the credit for qualified sick and family leave wages 
                                                                  Notice 2021-20, 2021-11 I.R.B. 922, available at 
because you paid qualified sick leave wages and/or 
                                                                  IRS.gov/irb/2021-11_IRB#NOT-2021-20; and Rev. Proc. 
qualified family leave wages that meet an exclusion under 
                                                                  2021-33, 2021-34 I.R.B. 327, available at IRS.gov/irb/
sections 3121(b)(1)–(22), you may file Form 941-X and 
                                                                  2021-34_IRB#REV-PROC-2021-33.
complete Worksheet 1 to claim the correct amount of the 
credit. You'll also include on Form 941-X, lines 28 and 29, 
and on Worksheet 1 any qualified health plan expenses             Instructions for Qualified Wages Paid After March 
allocable to those wages. The appropriate lines related to        12, 2020, and Before July 1, 2021
the exclusions under sections 3121(b)(1)–(22) were 
added to Worksheet 1 in the first quarter 2021 Instructions       If you’re correcting the nonrefundable portion of the 
for Form 941 (Revised March 2021).                                employee retention credit for qualified wages paid after 
Example—Nonrefundable portion of credit for                       March 12, 2020, and before July 1, 2021, that you 
qualified sick and family leave wages increased.                  reported on Form 941, line 11c, enter the total corrected 
Following Example—Qualified sick leave wages                      amount from Worksheet 2, Step 2, line 2j, in column 1. In 

Instructions for Form 941-X (Rev. 4-2023)                    -17-

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column 2, enter the amount you originally reported or as quarter of 2021 to employers that are recovery startup
previously corrected. In column 3, enter the difference businesses, as defined in section 3134(c)(5). Thus, for
between columns 1 and 2. wages paid after September 30, 2021, and before
January 1, 2022, only the wages paid by recovery startup
Copy the amount in column 3 to column 4. However, to businesses can be qualified wages. See the December
properly show the amount as a credit or balance due item, 2021 revision of the Instructions for Form 941 for more
enter a positive number in column 3 as a negative number information about a recovery startup business.
in column 4 or a negative number in column 3 as a
positive number in column 4. For an example of how to
If you're correcting the nonrefundable portion of the
report amounts in columns 1–4 for an employment tax
employee retention credit for qualified wages paid after
credit, see the instructions for line 17, earlier.
June 30, 2021, and before January 1, 2022, that you
reported on Form 941, line 11c, enter the total corrected
For more information about the employee retention amount from Worksheet 4, Step 2, line 2h, in column 1. In
credit for qualified wages paid after March 12, 2020, and column 2, enter the amount you originally reported or as
before January 1, 2021, see Notice 2021-20. See Notice previously corrected. In column 3, enter the difference
2021-23, 2021-16 I.R.B. 1113, available at IRS.gov/irb/ between columns 1 and 2.
2021-16_IRB#NOT-2021-23, for more information about
the employee retention credit for qualified wages paid
Copy the amount in column 3 to column 4. However, to
after December 31, 2020, and before July 1, 2021. Also
properly show the amount as a credit or balance due item,
see section IV of Notice 2021-49, 2021-34 I.R.B. 316,
enter a positive number in column 3 as a negative number
available at IRS.gov/irb/2021-34_IRB#NOT-2021-49; and
in column 4 or a negative number in column 3 as a
Rev. Proc. 2021-33.
positive number in column 4. For an example of how to
report amounts in columns 1–4 for an employment tax
Be sure to explain the reasons for this correction on
credit, see the instructions for line 17, earlier.
line 43.
Adjustments to the nonrefundable portion of the For more information about the employee retention
TIP employee retention credit for qualified wages paid credit for qualified wages paid after June 30, 2021, and
after March 12, 2020, and before July 1, 2021, are before January 1, 2022, see Notice 2021-49 and Rev.
reported on Form 941-X, line 18a, and adjustments to the Proc. 2021-33. See Notice 2021-65, 2021-51 I.R.B. 880,
refundable portion of the credit are reported on Form available at IRS.gov/irb/2021-51_IRB#NOT-2021-65, for
941-X, line 26a. Adjustments to qualified wages for the modifications to Notice 2021-49.
employee retention credit are reported on Form 941-X,
line 30. Adjustments to qualified health plan expenses Be sure to explain the reasons for this correction on
allocable to the employee retention credit are reported on line 43.
Form 941-X, line 31a. Adjustments to qualified wages
paid March 13, 2020, through March 31, 2020, for the Adjustments to the nonrefundable portion of the
employee retention credit are reported on Form 941-X, TIP employee retention credit for qualified wages paid
line 33a, and adjustments to qualified health plan after June 30, 2021, and before January 1, 2022,
expenses allocable to these wages are reported on Form are reported on Form 941-X, line 18a, and adjustments to
941-X, line 34. The employee retention credit may only be the refundable portion of the credit are reported on Form
claimed on Form 941 filed for quarters beginning after 941-X, line 26a. Adjustments to qualified wages for the
March 31, 2020. The employee retention credit for wages employee retention credit are reported on Form 941-X,
paid March 13, 2020, through March 31, 2020, is claimed line 30. Adjustments to qualified health plan expenses
on Form 941 for the second quarter of 2020; therefore, allocable to the employee retention credit are reported on
any corrections to the employee retention credit for the Form 941-X, line 31a. If you claimed the employee
period from March 13, 2020, through March 31, 2020, retention credit on your original Form 941 for the quarter,
should be reported on Form 941 X filed for the second ‐ and you make any corrections on Form 941-X for the
quarter of 2020. Don’t file Form 941 X for the first quarter ‐ quarter to amounts used to figure this credit, you'll need to
of 2020 to report these amounts. If you claimed the refigure the amount of the credit using Worksheet 4. You'll
employee retention credit on your original Form 941 for also use this worksheet to figure this credit if you’re
the quarter, and you make any corrections on Form 941 X ‐ claiming the credit for the first time on Form 941-X.
for the quarter to amounts used to figure this credit, you'll
need to refigure the amount of the credit using Worksheet 18b. Nonrefundable Portion of Credit for
2. You'll also use this worksheet to figure this credit if Qualified Sick and Family Leave Wages for
you’re claiming the credit for the first time on Form 941-X. Leave Taken After March 31, 2021, and Before
October 1, 2021
Instructions for Qualified Wages Paid After June For corrections to Form 941, line 11d, the credit for
30, 2021, and Before January 1, 2022 qualified sick and family leave wages is only available for
wages paid with respect to leave taken after March 31,
The Infrastructure Investment and Jobs Act 2021, and before October 1, 2021. Don't enter an amount
! amends section 3134 of the Internal Revenue on line 18b if you're correcting a quarter that began before
CAUTION Code, as enacted under the ARP, to limit the
April 1, 2021.
availability of the employee retention credit in the fourth

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If you’re correcting the nonrefundable portion of the If you’re correcting the nonrefundable portion of the
credit for qualified sick and family leave wages for leave COBRA premium assistance credit that you reported on
taken after March 31, 2021, and before October 1, 2021, Form 941, line 11e, enter the total corrected amount from
that you reported on Form 941, line 11d, enter the total Worksheet 5, Step 2, line 2g, in column 1. In column 2,
corrected amount from Worksheet 3, Step 2, line 2r, in enter the amount you originally reported or as previously
column 1. In column 2, enter the amount you originally corrected. In column 3, enter the difference between
reported or as previously corrected. In column 3, enter the columns 1 and 2.
difference between columns 1 and 2. For more
information about the credit for qualified sick and family Copy the amount in column 3 to column 4. However, to
leave wages, go to IRS.gov/PLC. properly show the amount as a credit or balance due item,
enter a positive number in column 3 as a negative number
Copy the amount in column 3 to column 4. However, to in column 4 or a negative number in column 3 as a
properly show the amount as a credit or balance due item, positive number in column 4. For an example of how to
enter a positive number in column 3 as a negative number report amounts in columns 1–4 for an employment tax
in column 4 or a negative number in column 3 as a credit, see the instructions for line 17, earlier.
positive number in column 4. For an example of how to
report amounts in columns 1–4 for an employment tax Be sure to explain the reasons for this correction on
credit, see the instructions for line 17, earlier. line 43.

Definition of qualified sick and family leave wages 18d. Number of Individuals Provided COBRA
for leave taken after March 31, 2021, and before Oc- Premium Assistance
tober 1, 2021. For purposes of this credit, qualified sick Use line 18d only for corrections to quarters beginning
leave wages and qualified family leave wages are wages after March 31, 2021.
for social security and Medicare tax purposes, determined
without regard to the exclusions from the definition of If you’re correcting the number of individuals provided
employment under sections 3121(b)(1)–(22), that an COBRA premium assistance that you reported on Form
employer pays that otherwise meet the requirements of 941, line 11f, enter the total corrected amount in column 1.
the EPSLA or Expanded FMLA, as enacted under the In column 2, enter the amount you originally reported or as
FFCRA and amended for purposes of the ARP. Taxable previously corrected. In column 3, enter the difference
qualified sick leave wages and qualified family leave between columns 1 and 2.
wages for leave taken after March 31, 2021, and before
Be sure to explain the reasons for this correction on
October 1, 2021, were included on Form 941, line 5a,
line 43.
column 1, and can be adjusted only on Form 941-X,
line 8. Total qualified sick and family leave wages for 19–22. Special Additions to Wages for Federal
leave taken after March 31, 2021, and before October 1,
Income Tax, Social Security Taxes, Medicare
2021, including any qualified leave wages that were
above the social security wage base and any qualified Taxes, and Additional Medicare Tax
leave wages excluded from the definition of employment Section 3509 provides special rates for the employee
under sections 3121(b)(1)–(22), were included on Form share of federal income tax, social security tax, Medicare
941, lines 23 and 26, respectively, and can be adjusted tax, and Additional Medicare Tax withholding when
only on Form 941-X, lines 35 and 38, respectively. Use workers are reclassified as employees in certain
Worksheet 3 to figure your credit. circumstances. The applicable rate depends on whether
Be sure to explain the reasons for this correction on you filed required information returns. An employer can’t
line 43. recover any tax paid under this provision from the
employees. The full employer share of social security tax
18c. Nonrefundable Portion of COBRA Premium and Medicare tax is due for all reclassifications.

Assistance Credit Note. Section 3509 rates aren’t available if you
The COBRA premium assistance was available for intentionally disregarded the requirements to withhold
periods of coverage beginning on or after April 1, 2021, taxes from the employee, or if you withheld federal income
through periods of coverage beginning on or before tax but didn’t withhold social security and Medicare taxes.
September 30, 2021. For more information, see Credit for Section 3509 rates are also not available for certain
COBRA premium assistance payments is limited to statutory employees.
periods of coverage beginning on or after April 1, 2021,
through periods of coverage beginning on or before On lines 19–22, enter only corrections to wages
September 30, 2021 under Reminders, earlier. Use resulting from reclassifying certain workers as employees
line 18c only for corrections to quarters beginning after when section 3509 rates are used to calculate the taxes.
March 31, 2021. If the employer issued the required information returns,
Premium payees that receive an election from an use the section 3509 rates as follows.
TIP assistance eligible individual are entitled to the • For social security taxes, use the employer rate of 6.2%
COBRA premium assistance credit for premiums plus 20% of the employee rate of 6.2%, for a total rate of
not paid during the quarter in which the election is 7.44% of wages.
received. See Notice 2021-31 for more information. • 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.

Instructions for Form 941-X (Rev. 4-2023) -19-

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• For Additional Medicare Tax, 0.18% (20% of the defers the payment due, to properly show the amount as a
employee rate of 0.9%) of wages subject to Additional deferral of payment, enter a positive number in column 3
Medicare Tax. as a negative number in column 4. A decrease to the
• For federal income tax withholding, the rate is 1.5% of deferred amount of the employer and/or the employee
wages. share of social security tax decreases the payment you
If the employer didn’t issue the required information can defer and must be shown as a balance due item;
returns, use the section 3509 rates as follows. therefore, to properly show the amount as a balance due
• For social security taxes, use the employer rate of 6.2% item, enter a negative number in column 3 as a positive
plus 40% of the employee rate of 6.2%, for a total rate of number in column 4. If you make any corrections to the
8.68% of wages. deferred amount of the employee share of social security
• For Medicare taxes, use the employer rate of 1.45% tax on Form 941-X, line 24, you may also need to make a
plus 40% of the employee rate of 1.45%, for a total rate of correction on Form 941-X, line 33b.
2.03% of wages. Be sure to explain the reasons for any corrections on
• For Additional Medicare Tax, 0.36% (40% of the line 43.
employee rate of 0.9%) of wages subject to Additional
Deferred amount of the employer share of social se-
Medicare Tax.
curity tax. If you’re filing Form 941-X to increase the
• For federal income tax withholding, the rate is 3.0% of
amount of social security wages paid on or after March
wages.
27, 2020, and before January 1, 2021, so that there is an
Unlike some other lines on Form 941-X, enter in additional amount of social security tax that hasn’t yet
column 1 only the corrected wages for workers being been paid, and hasn’t yet been deferred, then you may
reclassified, not the amount paid to all employees. Enter use Form 941-X to increase the amount of the deferred
in column 2 previously reported wages (if any) to employer share of social security tax originally reported on
reclassified employees. To get the amount for column 4, Form 941, line 13b. If you’re filing Form 941-X to decrease
use the applicable section 3509 rates. If you filed the the amount of social security wages paid on or after
required information returns for some employees but March 27, 2020, and before January 1, 2021, so that there
didn’t file them for other employees, be sure to use the is a decrease in the amount of social security tax that is
applicable rates for each employee when calculating the eligible for deferral, then you must use Form 941-X to
amounts in column 4 and show your calculations on decrease the amount of the deferred employer share of
line 43. The tax correction in column 4 will be a positive social security tax originally reported on Form 941,
number if you increased the amount of wages you line 13b, if the decrease in wages causes the amount you
previously reported. See the instructions for line 42, later, originally deferred to exceed the amount that is now
for more information. eligible for deferral. Otherwise, you may only correct the
amount of the deferred employer share of social security
23. Subtotal tax if the amount originally reported on Form 941, line 13b,
Combine the amounts from column 4 on lines 7–22 and isn’t the amount you actually deferred (for example, you
enter the result on line 23. incorrectly reported the amount that you actually
Example. You entered “1,400.00” in column 4 on deferred). If you already paid the correct amount of the
line 7, “-500.00” in column 4 on line 8, and “-100.00” in employer’s share of social security tax for a calendar
column 4 on line 12. Combine these amounts and enter quarter during the payroll tax deferral period, you may not
“800.00” in column 4 on line 23. subsequently defer the payment by filing Form 941-X. See
IRS.gov/ETD for more information about the interaction of
Line 7 1,400.00 credits and the deferral of employment tax deposits and
Line 8 (500.00) payments.
Line 12 + (100.00) The deferred amount of the employer share of social
Line 23 800.00 security tax was only available for deposits and payments
due on or after March 27, 2020, and before January 1,
2021, as well as deposits and payments due after January
1, 2021, that were required for wages paid during the
24. Deferred Amount of Social Security Tax quarter ending on December 31, 2020. One-half of the
Use Form 941-X, line 24, if you need to correct the deferred amount of the employer share of social security
deferred amount of the employer share of social security tax was due by December 31, 2021, and the remainder
tax for the second, third, or fourth quarter of 2020, and/or was due by December 31, 2022. Because both December
the deferred amount of the employee share of social 31, 2021, and December 31, 2022, were nonbusiness
security tax for the third or fourth quarter of 2020, that you days, payments made on the next business day were
reported on Form 941, line 13b. Enter the total corrected considered timely. Any payments or deposits you made
amount in column 1. In column 2, enter the amount you before December 31, 2021, were first applied against your
originally reported or as previously corrected by you or the payment due on December 31, 2021, and then applied
IRS. In column 3, enter the difference between columns 1 against your payment due on December 31, 2022. For
and 2. more information about the deferral of employment tax
Copy the amount in column 3 to column 4. However, deposits, go to IRS.gov/ETD and see the Instructions for
because an increase to the deferred amount of the Form 941, available at IRS.gov/Form941.
employer and/or the employee share of social security tax

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Deferred amount of the employee share of social se- 26a. Refundable Portion of Employee Retention
curity tax. You may only correct the amount of the Credit
deferred employee share of social security tax if the Use line 26a only for corrections to quarters beginning
amount originally reported on Form 941, line 13b, isn’t the after March 31, 2020, and before January 1, 2022.
amount you actually deferred (for example, you incorrectly
reported the amount that you actually deferred). If you Instructions for Qualified Wages Paid After March
already paid the correct amount of the employee’s share
of social security tax, you may not subsequently defer the 12, 2020, and Before July 1, 2021
payment by filing Form 941-X.
If you’re correcting the refundable portion of the employee
The deferred amount of the employee share of social retention credit that you reported on Form 941, line 13d,
security tax was only available for social security wages of for qualified wages paid after March 12, 2020, and before
less than $4,000 paid to an employee in any biweekly pay July 1, 2021, enter the total corrected amount from
period (or the equivalent threshold amount for other pay Worksheet 2, Step 2, line 2k, in column 1. In column 2,
periods) paid on a pay date during the period beginning enter the amount you originally reported or as previously
on September 1, 2020, and ending on December 31, corrected. In column 3, enter the difference between
2020. The due date for withholding and payment of the columns 1 and 2. For more information about the
deferred employee share of social security tax was employee retention credit for qualified wages paid after
postponed until the period beginning on January 1, 2021, March 12, 2020, and before January 1, 2021, see Notice
and ending on December 31, 2021. The employer was 2021-20. See Notice 2021-23 for more information about
liable to pay the deferred employee share of social the employee retention credit for qualified wages paid
security tax to the IRS and was required to do so before after December 31, 2020, and before July 1, 2021. Also
January 1, 2022, to avoid interest, penalties, and see section IV of Notice 2021-49, and Rev. Proc.
additions to tax on those amounts. Because January 1, 2021-33.
2022, was a nonbusiness day, payments made on
January 3, 2022, were considered timely. For more
Copy the amount in column 3 to column 4. However, to
information about the deferral of the employee share of
properly show the amount as a credit or balance due item,
social security tax, see Notice 2020-65, 2020-38 I.R.B.
enter a positive number in column 3 as a negative number
567, available at IRS.gov/irb/2020-38_IRB#NOT-2020-65;
in column 4 or a negative number in column 3 as a
and Notice 2021-11, 2021-06 I.R.B. 827, available at
positive number in column 4. For an example of how to
IRS.gov/irb/2021-06_IRB#NOT-2021-11.
report amounts in columns 1–4 for an employment tax
25. Refundable Portion of Credit for Qualified credit, see the instructions for line 17, earlier.
Sick and Family Leave Wages for Leave Taken
Be sure to explain the reasons for this correction on
After March 31, 2020, and Before April 1, 2021 line 43.
For corrections to Form 941, line 13c, the credit for
qualified sick and family leave wages is only available for Instructions for Qualified Wages Paid After June
wages paid with respect to leave taken after March 31,
30, 2021, and Before January 1, 2022
2020, and before April 1, 2021. Don't enter an amount on
line 25 if you're correcting a quarter that began before
April 1, 2020. If you're correcting the refundable portion of the employee
retention credit that you reported on Form 941, line 13d,
If you’re correcting the refundable portion of the credit for qualified wages paid after June 30, 2021, and before
for qualified sick and family leave wages for leave taken January 1, 2022, enter the total corrected amount from
after March 31, 2020, and before April 1, 2021, that you Worksheet 4, Step 2, line 2i, in column 1. In column 2,
reported on Form 941, line 13c, enter the total corrected enter the amount you originally reported or as previously
amount from Worksheet 1, Step 2, line 2k, in column 1. In corrected. In column 3, enter the difference between
column 2, enter the amount you originally reported or as columns 1 and 2. For more information about the
previously corrected. In column 3, enter the difference employee retention credit for qualified wages paid after
between columns 1 and 2. For more information about the June 30, 2021, and before January 1, 2022, see Notice
credit for qualified sick and family leave wages, go to 2021-49 and Rev. Proc. 2021-33. See Notice 2021-65 for
IRS.gov/PLC. modifications to Notice 2021-49.
Copy the amount in column 3 to column 4. However, to
properly show the amount as a credit or balance due item, Copy the amount in column 3 to column 4. However, to
enter a positive number in column 3 as a negative number properly show the amount as a credit or balance due item,
in column 4 or a negative number in column 3 as a enter a positive number in column 3 as a negative number
positive number in column 4. For an example of how to in column 4 or a negative number in column 3 as a
report amounts in columns 1–4 for an employment tax positive number in column 4. For an example of how to
credit, see the instructions for line 17, earlier. report amounts in columns 1–4 for an employment tax
credit, see the instructions for line 17, earlier.
Be sure to explain the reasons for this correction on
line 43. Be sure to explain the reasons for this correction on
line 43.

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Corrections to Form 941, Line 13f (For Quarters COBRA premium assistance payments is limited to
Beginning After March 31, 2020, and Ending periods of coverage beginning on or after April 1, 2021,
Before April 1, 2021) or Line 13h (For Quarters through periods of coverage beginning on or before
September 30, 2021 under Reminders, earlier. Use
Beginning After March 31, 2021, and Ending line 26c only for corrections to quarters beginning after
Before January 1, 2022) March 31, 2021.
Form 941-X doesn't include a line to correct amounts
reported on Form 941, line 13f (13h), for the total If you’re correcting the refundable portion of the
advances received from filing Form(s) 7200 for the COBRA premium assistance credit that you reported on
quarter. If a discrepancy exists between the amount Form 941, line 13f, enter the total corrected amount from
reported on Form 941 and the amount of advance Worksheet 5, Step 2, line 2h, in column 1. In column 2,
payments issued, the IRS will generally correct the enter the amount you originally reported or as previously
amount reported on Form 941, line 13f (13h), to match the corrected. In column 3, enter the difference between
amount of advance payments issued. However, columns 1 and 2.
aggregate filers may need to correct the amount reported Copy the amount in column 3 to column 4. However, to
on Form 941, line 13f (13h), to reflect the correct advance properly show the amount as a credit or balance due item,
payments received by their clients or customers. If you’re enter a positive number in column 3 as a negative number
an aggregate filer that needs to correct the amount in column 4 or a negative number in column 3 as a
reported on Form 941, line 13f (13h), include any increase positive number in column 4. For an example of how to
or decrease to the amount in the “Total” reported on Form report amounts in columns 1–4 for an employment tax
941-X, line 27; write “Correction to line 13f” or "Correction credit, see the instructions for line 17, earlier.
to line 13h," as applicable, on the dotted line to the left of
the entry box on line 27; explain your correction on line 43; Be sure to explain the reasons for this correction on
and attach Schedule R (Form 941) to Form 941-X to show line 43.
corrections for your clients or customers.
27. Total
26b. Refundable Portion of Credit for Qualified Combine the amounts from column 4 on lines 23–26c and
Sick and Family Leave Wages for Leave Taken enter the result on line 27.
After March 31, 2021, and Before October 1,
Your credit. If the amount entered on line 27 is less than
2021 zero, for example, “-115.00,” you have a credit because
For corrections to Form 941, line 13e, the credit for you overreported your federal employment taxes.
qualified sick and family leave wages is only available for • If you checked the box on line 1, include this amount on
wages paid with respect to leave taken after March 31, the "Total deposits" line of Form 941 for the quarter during
2021, and before October 1, 2021. Don't enter an amount which you filed Form 941-X. If you currently file Form 944
on line 26b if you're correcting a quarter that began before because your filing requirement changed, include this
April 1, 2021. amount on the "Total deposits" line of Form 944 for the
If you’re correcting the refundable portion of the credit year during which you filed Form 941-X. Don’t make any
for qualified sick and family leave wages for leave taken changes to your record of federal tax liability reported on
after March 31, 2021, and before October 1, 2021, that Form 941, line 16, or Schedule B (Form 941) if your Form
you reported on Form 941, line 13e, enter the total 941-X is filed timely. The amounts reported on the record
corrected amount from Worksheet 3, Step 2, line 2s, in should reflect your actual tax liability for the period.
column 1. In column 2, enter the amount you originally • If you checked the box on line 2, you’re filing a claim for
reported or as previously corrected. In column 3, enter the refund or abatement of the amount shown.
difference between columns 1 and 2. For more If your credit is less than $1, we will send a refund or
information about the credit for qualified sick and family apply it only if you ask us in writing to do so.
leave wages, go to IRS.gov/PLC. Amount you owe. If the amount on line 27 is a positive
Copy the amount in column 3 to column 4. However, to number, you must pay the amount you owe by the time
properly show the amount as a credit or balance due item, you file Form 941-X. You may not use any credit that you
enter a positive number in column 3 as a negative number show on another Form 941-X to pay the amount you owe,
in column 4 or a negative number in column 3 as a even if you filed for the amount you owe and the credit at
positive number in column 4. For an example of how to the same time.
report amounts in columns 1–4 for an employment tax If you owe tax and are filing a timely Form 941-X, don’t
credit, see the instructions for line 17, earlier. file an amended Schedule B (Form 941) unless you were
Be sure to explain the reasons for this correction on assessed an FTD penalty caused by an incorrect,
line 43. incomplete, or missing Schedule B (Form 941). Don’t
include the tax increase reported on Form 941-X on any
26c. Refundable Portion of COBRA Premium amended Schedule B (Form 941) you file.
Assistance Credit If you owe tax and are filing a late Form 941-X, that is,
The COBRA premium assistance was available for after the due date for Form 941 for the quarter in which
periods of coverage beginning on or after April 1, 2021, you discovered the error, you must file an amended
through periods of coverage beginning on or before Schedule B (Form 941) with the Form 941-X. Otherwise,
September 30, 2021. For more information, see Credit for the IRS may assess an “averaged” FTD penalty. The total

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tax reported on the “Total liability for the quarter” line of 29. Qualified Health Plan Expenses Allocable to
Schedule B (Form 941) must match the corrected tax Qualified Family Leave Wages for Leave Taken
(Form 941, line 12, combined with any correction reported After March 31, 2020, and Before April 1, 2021
on Form 941-X, line 23) for the quarter, less any previous
abatements and interest-free tax assessments. If you’re correcting the qualified health plan expenses
Payment methods. You may pay the amount you owe allocable to qualified family leave wages for leave taken
on line 27 electronically using the Electronic Federal Tax after March 31, 2020, and before April 1, 2021, that you
Payment System (EFTPS), by credit or debit card, or by a reported on Form 941, line 20, enter the total corrected
check or money order. amount for all employees in column 1. In column 2, enter
• The preferred method of payment is EFTPS. For more the amount you originally reported or as previously
information, go to EFTPS.gov or call 800-555-4477. To corrected. In column 3, enter the difference between
contact EFTPS using Telecommunications Relay columns 1 and 2. Enter the corrected amount from column
Services (TRS) for people who are deaf, hard of hearing, 1 on Worksheet 1, Step 2, line 2f.

or have a speech disability, dial 711 and then provide the 30. Qualified Wages for the Employee Retention
TRS assistant the 800-555-4477 number above or
800-733-4829. Additional information about EFTPS is Credit
also available in Pub. 966. Use line 30 only for corrections to quarters beginning after
• To pay by credit or debit card, go to IRS.gov/ March 31, 2020, and before January 1, 2022.
PayByCard. Your payment will be processed by a
payment processor who will charge a processing fee. If you’re correcting the qualified wages for the
• If you pay by check or money order, make it payable to employee retention credit that you reported on Form 941,
“United States Treasury.” On your check or money order, line 21, enter the total corrected amount for all employees
be sure to write your EIN, “Form 941-X,” the calendar in column 1. In column 2, enter the amount you originally
quarter you corrected (for example, “Quarter 2”), and the reported or as previously corrected. In column 3, enter the
calendar year of the quarter you corrected. difference between columns 1 and 2. Enter the corrected
amount from column 1 on Worksheet 2, Step 2, line 2a, for
You don’t have to pay if the amount you owe is less qualified wages paid after March 12, 2020, and before
than $1. July 1, 2021. Enter the corrected amount from column 1
Previously assessed FTD penalty. If line 27 reflects on Worksheet 4, Step 2, line 2a, for qualified wages paid
overreported tax and the IRS previously assessed an FTD after June 30, 2021, and before January 1, 2022.
penalty, you may be able to reduce the penalty. For more
information, see the Instructions for Schedule B (Form 31a. Qualified Health Plan Expenses for the
941). Employee Retention Credit
Lines 28–40 Use line 31a only for corrections to quarters beginning
after March 31, 2020, and before January 1, 2022.
For lines 28–31a and lines 32–40, you'll only enter
amounts in columns 1, 2, and 3. These lines don’t have an If you’re correcting the qualified health plan expenses
entry space for column 4 because these adjustments allocable to wages reported on Form 941, line 21, that you
don’t directly result in an increase or decrease to your tax. reported on Form 941, line 22, enter the total corrected
The amounts entered on lines 28–31a and lines 32–40 are amount for all employees in column 1. In column 2, enter
amounts that you use in Worksheets 1–5, as applicable, to the amount you originally reported or as previously
figure your credits. If you reported an incorrect amount on corrected. In column 3, enter the difference between
lines 19–28 on your original Form 941, then you'll use columns 1 and 2. Enter the corrected amount from column
lines 28–31a and lines 32–40 of Form 941 X to report the ‐ 1 on Worksheet 2, Step 2, line 2b, for qualified health plan
correction. Use Worksheets 1–5, as applicable, to refigure expenses allocable to qualified wages paid after March
your credits based on the corrected amounts reported in 12, 2020, and before July 1, 2021. Enter the corrected
column 1. For details on how to complete line 31b, see the amount from column 1 on Worksheet 4, Step 2, line 2b, for
instructions for line 31b, later. Be sure to explain the qualified health plan expenses allocable to qualified
reasons for your corrections on line 43. wages paid after June 30, 2021, and before January 1,
2022.
28. Qualified Health Plan Expenses Allocable to
Qualified Sick Leave Wages for Leave Taken 31b. Recovery Startup Business Checkbox
After March 31, 2020, and Before April 1, 2021 For the fourth quarter of 2021, only a recovery
If you’re correcting the qualified health plan expenses ! startup business may claim the employee
allocable to qualified sick leave wages for leave taken CAUTION retention credit.
after March 31, 2020, and before April 1, 2021, that you
reported on Form 941, line 19, enter the total corrected Whether you check the box on line 31b to tell us if
amount for all employees in column 1. In column 2, enter you're eligible for the employee retention credit in the third
the amount you originally reported or as previously or fourth quarter of 2021 solely because your business is
corrected. In column 3, enter the difference between a recovery startup business depends on its applicability
columns 1 and 2. Enter the corrected amount from column and how you originally answered the question on Form
1 on Worksheet 1, Step 2, line 2b. 941, line 18b.
• If you checked the box on line 18b on your originally
filed Form 941 and you still qualify for the employee

Instructions for Form 941-X (Rev. 4-2023) -23-

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retention credit solely because your business is a for qualified wages paid after March 12, 2020, and before
recovery startup business, check the box on line 31b. July 1, 2021, enter the corrected amount from column 1
• If you checked the box on line 18b on your originally on Worksheet 2, Step 1, line 1k, unless you also
filed Form 941 but that response is no longer accurate, completed Worksheet 1 and you're bringing the amount
don't check the box on line 31b. However, explain in detail from Worksheet 1, Step 1, line 1l, forward to Worksheet 2,
on line 43 why you no longer think that you're a recovery Step 1, line 1a. Reporting a correction on this line doesn't
startup business and, if correcting the third quarter of correct the credit claimed on Form 5884-C.
2021, the reasons that you still qualify for the employee
retention credit. 33a. Qualified Wages Paid March 13 Through
• If you didn't check the box on line 18b on your originally March 31, 2020, for the Employee Retention
filed Form 941 and this question still doesn't apply, don't Credit
check the box on line 31b. Use line 33a only for corrections to the second quarter of
• If you didn't check the box on line 18b on your originally 2020.
filed Form 941 but you're now claiming the employee
retention credit as a recovery startup business, check the If you’re correcting the qualified wages paid March 13,
box on line 31b. 2020, through March 31, 2020, for the employee retention
Recovery startup business. For the third quarter of credit that you reported on Form 941, line 24, for the
2021, a recovery startup business is an employer that: second quarter of 2020, enter the total corrected amount
• Began carrying on a trade or business after February for all employees in column 1. In column 2, enter the
15, 2020; amount you originally reported or as previously corrected.
• Had average annual gross receipts of $1 million or less In column 3, enter the difference between columns 1 and
for the 3 tax years ending with the tax year before the 2. Enter the corrected amount from column 1 on
calendar quarter in which the employee retention credit is Worksheet 2, Step 2, line 2c.
claimed; and
• Isn't otherwise eligible for the employee retention credit 33b. Deferred Amount of the Employee Share of
because business operations aren't fully or partially Social Security Tax Included on Form 941,
suspended due to a governmental order or because gross Line 13b
receipts (within the meaning of section 448(c) or, if you're Use line 33b only for corrections to the third and fourth
a tax-exempt organization, section 6033) aren't less than quarters of 2020.
80% of the gross receipts for the same calendar quarter in
calendar year 2019. The employee retention credit isn't If you're correcting the deferred amount of the
available in the second quarter of 2021 on the basis of employee share of social security tax (for the third and
being a recovery startup business. fourth quarters of 2020) that you reported on Form 941,
For the fourth quarter of 2021, a recovery startup line 24, enter the total corrected amount for all employees
business is an employer that began carrying on a trade or in column 1. In column 2, enter the amount you originally
business after February 15, 2020, and had average reported or as previously corrected. In column 3, enter the
annual gross receipts of $1 million or less for the 3 tax difference between columns 1 and 2.
years ending with the tax year before the calendar quarter
34. Qualified Health Plan Expenses Allocable to
in which the employee retention credit is claimed.
Wages Reported on Form 941, Line 24
Recovery startup businesses are limited to a Use line 34 only for corrections to the second quarter of
! maximum employee retention credit of $50,000 2020.
CAUTION per quarter. If you check the box on line 31b, don't
enter more than $50,000 per quarter in total on lines 18a If you’re correcting the qualified health plan expenses
and 26a. allocable to wages reported on Form 941, line 24, that you
reported on Form 941, line 25, for the second quarter of
32. Credit From Form 5884 C, Line 11, for This ‐ 2020, enter the total corrected amount for all employees in
Quarter column 1. In column 2, enter the amount you originally
reported or as previously corrected. In column 3, enter the
Use line 32 only for corrections to quarters beginning after
difference between columns 1 and 2. Enter the corrected
March 31, 2020, and before April 1, 2021.
amount from column 1 on Worksheet 2, Step 2, line 2d.
If you’re correcting the credit from Form 5884 C, ‐
line 11, for the second, third, or fourth quarter of 2020, or 35. Qualified Sick Leave Wages for Leave Taken
the first quarter of 2021, that you reported on Form 941, After March 31, 2021, and Before October 1,
line 23, enter the total corrected amount in column 1. In 2021
column 2, enter the amount you originally reported or as If you’re correcting the qualified sick leave wages for leave
previously corrected. In column 3, enter the difference taken after March 31, 2021, and before October 1, 2021,
between columns 1 and 2. Enter the corrected amount that you reported on Form 941, line 23, enter the total
from column 1 on Worksheet 1, Step 1, line 1j. Entering an corrected amount in column 1. In column 2, enter the
amount here is strictly for purposes of figuring the credit amount you originally reported or as previously corrected.
for qualified sick and family wages for leave taken after In column 3, enter the difference between columns 1 and
March 31, 2020, and before April 1, 2021, on Worksheet 2. Enter the corrected amount from column 1 on
1. For purposes of figuring the employee retention credit Worksheet 3, Step 2, line 2a.

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Be sure to explain the reasons for this correction on between columns 1 and 2. Enter the corrected amount
line 43. from column 1 on Worksheet 3, Step 2, line 2h.
36. Qualified Health Plan Expenses Allocable to Be sure to explain the reasons for this correction on
line 43.
Qualified Sick Leave Wages for Leave Taken
After March 31, 2021, and Before October 1, 40. Amounts Under Certain Collectively
2021 Bargained Agreements Allocable to Qualified
If you’re correcting the qualified health plan expenses Family Leave Wages for Leave Taken After
allocable to qualified sick leave wages for leave taken March 31, 2021, and Before October 1, 2021
after March 31, 2021, and before October 1, 2021, that
If you’re correcting the amounts under certain collectively
you reported on Form 941, line 24, enter the total
bargained agreements allocable to qualified family leave
corrected amount for all employees in column 1. In
wages for leave taken after March 31, 2021, and before
column 2, enter the amount you originally reported or as
October 1, 2021, that you reported on Form 941, line 28,
previously corrected. In column 3, enter the difference
enter the total corrected amount for all employees in
between columns 1 and 2. Enter the corrected amount
column 1. In column 2, enter the amount you originally
from column 1 on Worksheet 3, Step 2, line 2b.
reported or as previously corrected. In column 3, enter the
Be sure to explain the reasons for this correction on difference between columns 1 and 2. Enter the corrected
line 43. amount from column 1 on Worksheet 3, Step 2, line 2i.
Be sure to explain the reasons for this correction on
37. Amounts Under Certain Collectively
line 43.
Bargained Agreements Allocable to Qualified
Sick Leave Wages for Leave Taken After March Part 4: Explain Your Corrections for
31, 2021, and Before October 1, 2021 This Quarter
If you’re correcting the amounts under certain collectively
bargained agreements allocable to qualified sick leave 41. Corrections of Both Underreported and
wages for leave taken after March 31, 2021, and before Overreported Amounts
October 1, 2021, that you reported on Form 941, line 25,
Check the box on line 41 if any corrections you entered on
enter the total corrected amount for all employees in
lines 7–26c, or lines 28–31a, or lines 32–40, column 3,
column 1. In column 2, enter the amount you originally
reflect both underreported and overreported amounts.
reported or as previously corrected. In column 3, enter the
difference between columns 1 and 2. Enter the corrected Example. If you had an increase to social security
amount from column 1 on Worksheet 3, Step 2, line 2c. wages of $15,000 for Xavier Black and a decrease to
social security wages of $5,000 for Sophie Rose, you
Be sure to explain the reasons for this correction on would enter $10,000 on line 8, column 3. That $10,000
line 43. represents the net change from corrections.
38. Qualified Family Leave Wages for Leave On line 43, you must explain the reason for both the
$15,000 increase and the $5,000 decrease.
Taken After March 31, 2021, and Before October
1, 2021 42. Did You Reclassify Any Workers?
If you’re correcting the qualified family leave wages for Check the box on line 42 if you reclassified any workers to
leave taken after March 31, 2021, and before October 1, be independent contractors or nonemployees. Also check
2021, that you reported on Form 941, line 26, enter the this box if the IRS (or you) determined that workers you
total corrected amount in column 1. In column 2, enter the treated as independent contractors or nonemployees
amount you originally reported or as previously corrected. should be classified as employees. On line 43, give us a
In column 3, enter the difference between columns 1 and detailed reason why any worker was reclassified and, if
2. Enter the corrected amount from column 1 on you used section 3509 rates on lines 19–22 for any worker
Worksheet 3, Step 2, line 2g. reclassified as an employee, explain why section 3509
Be sure to explain the reasons for this correction on rates apply and what rates you used.
line 43. Return not filed because you didn’t treat any workers
as employees. If you didn’t previously file Form 941
39. Qualified Health Plan Expenses Allocable to because you mistakenly treated all workers as
Qualified Family Leave Wages for Leave Taken independent contractors or as nonemployees, file a Form
After March 31, 2021, and Before October 1, 941 for each delinquent quarter.
2021 On each Form 941 for which you’re entitled to use
If you’re correcting the qualified health plan expenses section 3509 rates, complete the following steps.
allocable to qualified family leave wages for leave taken • Write “Misclassified Employees” in bold letters
after March 31, 2021, and before October 1, 2021, that across the top margin of page 1.
you reported on Form 941, line 27, enter the total • Enter a zero on line 12.
corrected amount for all employees in column 1. In • Complete the signature area.
column 2, enter the amount you originally reported or as • Attach a completed Form 941-X (see instructions next).
previously corrected. In column 3, enter the difference On each Form 941-X, complete the following steps.

Instructions for Form 941-X (Rev. 4-2023) -25-

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• Complete the top of Form 941-X, including the date you Who must sign the Form 941-X? The following persons
discovered the error. are authorized to sign the return for each type of business
• Enter the wage amounts on lines 19–22, column 1. entity.
• Enter zeros on lines 19–22, column 2. • Sole proprietorship—The individual who owns the
• Complete columns 3 and 4 as instructed in Part 3. business.
• Provide a detailed statement on line 43. • Corporation (including a limited liability company
• Complete the signature area. (LLC) treated as a corporation)—The president, vice
If you can’t use section 3509 rates (for example, president, or other principal officer duly authorized to sign.
• Partnership (including an LLC treated as a
CAUTION nonemployees were certain statutory employees),
! because the workers you treated as partnership) or unincorporated organization—A
file a Form 941 for each delinquent quarter. Write responsible and duly authorized member, partner, or
“Misclassified Employees” in bold letters across the top officer having knowledge of its affairs.
margin of page 1 of each Form 941. Complete Form 941 • Single-member LLC treated as a disregarded entity
using the Instructions for Form 941. Attach a Form 941-X for federal income tax purposes—The owner of the
to each Form 941. Complete the top of Form 941-X, LLC or a principal officer duly authorized to sign.
including the date you discovered the error, and provide a • Trust or estate—The fiduciary.
detailed explanation on line 43. Form 941-X may also be signed by a duly authorized
agent of the taxpayer if a valid power of attorney has been
43. Explain Your Corrections filed.
Treasury regulations require you to explain in detail the Alternative signature method. Corporate officers or
grounds and facts relied upon to support each correction. duly authorized agents may sign Form 941-X by rubber
On line 43, describe in detail each correction you entered stamp, mechanical device, or computer software
in column 4 on lines 7–22, and lines 24–26c. Also use program. For details and required documentation, see
line 43 to describe corrections made on line 6 and lines Rev. Proc. 2005-39. You can find Rev. Proc. 2005-39,
28–40. If you need more space, attach additional sheets, 2005-28 I.R.B. 82, at IRS.gov/irb/
but be sure to write your name, EIN, “Form 941-X,” the 2005-28_IRB#RP-2005-39.
quarter you’re correcting (for example, “Quarter 2”), and
the calendar year of the quarter you’re correcting on the Paid Preparer Use Only
top of each sheet. A paid preparer must sign Form 941-X and provide the
You must describe the events that caused the information in the Paid Preparer Use Only section of Part
underreported or overreported amounts. Explanations 5 if the preparer was paid to prepare Form 941-X and isn’t
such as “social security and Medicare wages were an employee of the filing entity. Paid preparers must sign
overstated” or “administrative/payroll errors were paper returns with a manual signature. The preparer must
discovered” or “taxes were not withheld” are insufficient give you a copy of the return in addition to the copy to be
and may delay processing your Form 941-X because the filed with the IRS.
IRS may need to ask for a more complete explanation. If you’re a paid preparer, enter your Preparer Tax
Provide the following information in your explanation for Identification Number (PTIN) in the space provided.
each correction. Include your complete address. If you work for a firm,
• Form 941-X line number(s) affected. enter the firm's name and the EIN of the firm. You can
• Date you discovered the error. apply for a PTIN online or by filing Form W-12. For more
• Difference (amount of the error). information about applying for a PTIN online, go to the IRS
• Cause of the error. website at IRS.gov/PTIN. You can’t use your PTIN in
You may report the information in paragraph form. The place of the EIN of the tax preparation firm.
following paragraph is an example.
Generally, you’re not required to complete this section
“The $1,000 difference shown in column 3 on lines 6, 8, if you’re filing the return as a reporting agent and have a
and 12 was discovered on May 15, 2023, during an valid Form 8655 on file with the IRS. However, a reporting
internal payroll audit. We discovered that we included agent must complete this section if the reporting agent
$1,000 of wages for one of our employees twice. This offered legal advice, for example, advising the client on
correction removes the reported wages that were never determining whether its workers are employees or
paid.” independent contractors for federal tax purposes.
For corrections shown on lines 19–22, explain why the
correction was necessary and attach any notice you
received from the IRS.

Part 5: Sign Here
You must complete all five pages of Form 941-X and sign
it on page 5. If you don’t sign, processing of Form 941-X
will be delayed.

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Worksheet 1. Adjusted Credit for Qualified Sick and Family Leave 
Wages for Leave Taken After March 31, 2020, and Before April 1, 
2021                                                                                                                                          Keep for Your Records
You must use this worksheet if you claimed the credit for qualified sick and family leave wages for leave taken after March 31, 2020, and 
before April 1, 2021, on your original Form 941 and you correct any amounts used to figure the credit for qualified sick and family leave 
wages for leave taken after March 31, 2020, and before April 1, 2021. You'll also use this worksheet to figure this credit if you're claiming it 
for the first time on Form 941-X. If you're a third-party payer, you must complete this worksheet for each client for which it is applicable, on a 
client-by-client basis. 
Step 1.       Determine the corrected employer share of social security tax this quarter after it is reduced by any credit 
              claimed on Form 8974, Form 5884-C, and/or Form 5884-D
        1a    Enter the amount of social security wages from Form 941, Part 1, line 5a, column 1, 
              or, if corrected, the amount from Form 941-X, line 8, column 1 . . . . . . . . . . . . . . . . .                             1a       
        1b    Enter the amount of social security tips from Form 941, Part 1, line 5b, column 1, or, 
              if corrected, the amount from Form 941-X, line 11, column 1 . . . . . . . . . . . . . . . . . . .                            1b       
        1c    Add lines 1a and 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      1c       
        1d    Multiply line 1c by 6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           1d       
        1e    If you're a third-party payer of sick pay that isn't an agent and you're claiming credits 
              for amounts paid to your employees, enter the employer share of social security tax 
              included on Form 941, Part 1, line 8, or, if corrected, the amount of the employer 
              share of social security tax on sick pay that you included on Form 941-X, line 15, 
              column 1 (enter as a negative number) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    1e       
        1f    Employer share of social security tax included on Form 941-X, line 20, 
              column 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1f       
        1g    If you received a Section 3121(q) Notice and Demand during the quarter, enter the 
              amount of the employer share of social security tax from the notice  . . . . . . . . . . . . .                               1g       
        1h    Employer share of social security tax. Combine lines 1d, 1e, 1f, and 1g . . . . . . .                                                 1h              
        1i    Enter the amount from Form 8974, line 12 (including any amended Form 8974 
              attached to Form 941-X) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          1i       
        1j    Enter the amount from Form 5884-C, line 11, for this quarter (for quarters ending 
              before April 1, 2021, this amount was also included on Form 941, Part 3, line 23, or, 
              if corrected, the amount from Form 941-X, line 32, column 1) . . . . . . . . . . . . . . . . . .                             1j       
        1j(i) Enter the amount from Form 5884-D, line 12, for this quarter  . . . . . . . . . . . . . . . . . .                            1j(i)    
        1k    Total nonrefundable credits already used against the employer share of 
              social security tax. Add lines 1i, 1j, and 1j(i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          1k  
        1l    Employer share of social security tax remaining. Subtract line 1k 
              from line 1h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          1l  

Step 2.       Figure the sick and family leave credit
        2a    Qualified sick leave wages reported on Form 941, Part 1, line 5a(i), column 1, or, if 
              corrected, the amount from Form 941-X, line 9, column 1 . . . . . . . . . . . . . . . . . . . . .                            2a       
        2a(i) Qualified sick leave wages included on Form 941, Part 1, line 5c, or, if corrected, the 
              amount from Form 941-X, line 12, column 1, but not included on Form 941, Part 1, 
              line 5a(i), column 1, or Form 941-X, line 9, column 1, because the wages reported 
              on that line were limited by the social security wage base . . . . . . . . . . . . . . . . . . . . .                         2a(i)    
        2a(ii)  Total qualified sick leave wages. Add lines 2a and 2a(i) . . . . . . . . . . . . . . . . . . . . . .                       2a(ii)   
        2a(iii) Qualified sick leave wages excluded from the definition of employment under 
              sections 3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         2a(iii)  
        2b    Qualified health plan expenses allocable to qualified sick leave wages (Form 941, 
              Part 3, line 19, or, if corrected, Form 941-X, line 28, column 1) . . . . . . . . . . . . . . . . .                          2b       
        2c    Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 
              1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     2c       
        2d    Credit for qualified sick leave wages. Add lines 2a(ii), 2a(iii), 2b, and 2c . . . . . . .                                            2d  
        2e    Qualified family leave wages reported on Form 941, Part 1, line 5a(ii), column 1, or, 
              if corrected, the amount from Form 941-X, line 10, column 1 . . . . . . . . . . . . . . . . . . .                            2e       
        2e(i)  Qualified family leave wages included on Form 941, Part 1, line 5c, or, if corrected, 
              the amount from Form 941-X, line 12, column 1, but not included on Form 941, Part 
              1, line 5a(ii), column 1, or Form 941-X, line 10, column 1, because the wages 
              reported on that line were limited by the social security wage base . . . . . . . . . . . . . .                              2e(i)    
        2e(ii) Total qualified family leave wages. Add lines 2e and 2e(i) . . . . . . . . . . . . . . . . . . . . .                        2e(ii)   
        2e(iii) Qualified family leave wages excluded from the definition of employment under 
              sections 3121(b)(1)–(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         2e(iii)  
        2f    Qualified health plan expenses allocable to qualified family leave wages (Form 941, 
              Part 3, line 20, or, if corrected, Form 941-X, line 29, column 1) . . . . . . . . . . . . . . . . .                          2f       
        2g    Employer share of Medicare tax on qualified family leave wages. Multiply line 2e(ii) 
              by 1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      2g       
        2h    Credit for qualified family leave wages. Add lines 2e(ii), 2e(iii), 2f, and 2g . . . . .                                              2h  
        2i    Credit for qualified sick and family leave wages. Add lines 2d and 2h . . . . . . . .                                                 2i  
        2j    Nonrefundable portion of credit for qualified sick and family leave wages for 
              leave taken after March 31, 2020, and before April 1, 2021. Enter the smaller of 
              line 1l or line 2i. Enter this amount on Form 941-X, line 17, column 1 . . . . . . . . . . . .                                        2j
        2k    Refundable portion of credit for qualified sick and family leave wages for 
              leave taken after March 31, 2020, and before April 1, 2021. Subtract line 2j from 
              line 2i and enter this amount on Form 941-X, line 25, column 1 . . . . . . . . . . . . . . . . .                                      2k

Instructions for Form 941-X (Rev. 4-2023)             -27-

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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Worksheet 2. Adjusted Employee Retention Credit for Qualified 
Wages Paid After March 12, 2020, and Before July 1, 2021                                                                                     Keep for Your Records
You must use this worksheet if you claimed the employee retention credit for qualified wages paid after March 12, 2020, and before July 1, 
2021, on your original Form 941 and you correct any amounts used to figure the employee retention credit for qualified wages paid after 
March 12, 2020, and before July 1, 2021. You'll also use this worksheet to figure this credit if you're claiming it for the first time on Form 
941-X. If you're a third-party payer, you must complete this worksheet for each client for which it is applicable, on a client-by-client basis. 
Step 1.    Determine the corrected employer share of social security tax this quarter after it is reduced by any credit 
           claimed on Form 8974, Form 5884-C, and/or Form 5884-D
        1a If you completed Worksheet 1 to claim a credit for qualified sick and family leave 
           wages for leave taken after March 31, 2020, and before April 1, 2021, for a quarter 
           in which you're also claiming the employee retention credit, enter the amount from 
           Worksheet 1, Step 1, line 1l, and go to Step 2. Otherwise, complete lines 1b–1n 
           below and then go to Step 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  1a                   
        1b Enter the amount of social security wages from Form 941, Part 1, line 5a, column 1, 
           or, if corrected, the amount from Form 941-X, line 8, column 1 . . . . . . . . . . . . . . . . .                               1b  
        1c Enter the amount of social security tips from Form 941, Part 1, line 5b, column 1, or, 
           if corrected, the amount from Form 941-X, line 11, column 1 . . . . . . . . . . . . . . . . . . .                              1c  
        1d Add lines 1b and 1c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        1d  
        1e Multiply line 1d by 6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             1e  
        1f If you're a third-party payer of sick pay that isn't an agent and you're claiming credits 
           for amounts paid to your employees, enter the employer share of social security tax 
           included on Form 941, Part 1, line 8, or, if corrected, the amount of the employer 
           share of social security tax on sick pay that you included on Form 941-X, line 15, 
           column 1 (enter as a negative number) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                      1f  
        1g Employer share of social security tax included on Form 941-X, line 20, 
           column 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   1g  
        1h If you received a Section 3121(q) Notice and Demand during the quarter, enter the 
           amount of the employer share of social security tax from the notice  . . . . . . . . . . . . .                                 1h  
        1i Employer share of social security tax. Combine lines 1e, 1f, 1g, and 1h . . . . . . .                                              1i                   
        1j Enter the amount from Form 941, Part 1, line 11a, or, if corrected, the amount from 
           Form 941-X, line 16, column 1 (credit from Form 8974) . . . . . . . . . . . . . . . . . . . . . . .                            1j  
        1k Enter the amount from Form 5884-C, line 11, for this quarter (for quarters ending 
           before April 1, 2021, this amount was also included on Form 941, Part 3, line 23, or, 
           if corrected, the amount from Form 941-X, line 32, column 1) . . . . . . . . . . . . . . . . . .                               1k  
        1l Enter the amount from Form 5884-D, line 12, for this quarter  . . . . . . . . . . . . . . . . . .                              1l  
        1m Total nonrefundable credits already used against the employer share of 
           social security tax. Add lines 1j, 1k, and 1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        1m  
        1n Employer share of social security tax remaining. Subtract line 1m 
           from line 1i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     1n  

Step 2.    Figure the employee retention credit
           Caution: For qualified wages paid before January 1, 2021, the cumulative total for 
           all quarters of 2020 that can be claimed on lines 2a, 2b, 2c, and 2d can't exceed 
           $10,000 per employee. For qualified wages paid after December 31, 2020, the total 
           amount included on lines 2a and 2b can't exceed $10,000 per employee each 
           quarter.
        2a Qualified wages (excluding qualified health plan expenses) for the employee 
           retention credit (Form 941, Part 3, line 21, or, if corrected, Form 941-X, line 30, 
           column 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2a  
        2b Qualified health plan expenses allocable to qualified wages for the employee 
           retention credit (Form 941, Part 3, line 22, or, if corrected, Form 941-X, line 31a, 
           column 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2b  
        2c Qualified wages (excluding qualified health plan expenses) paid March 13, 2020, 
           through March 31, 2020, for the employee retention credit (Form 941, Part 3, 
           line 24, or, if corrected, Form 941-X, line 33a, column 1). Enter an amount here only 
           if filing a Form 941-X to correct the second quarter of 2020 . . . . . . . . . . . . . . . . . . . .                           2c  
        2d Qualified health plan expenses allocable to qualified wages paid March 13, 2020, 
           through March 31, 2020, for the employee retention credit (Form 941, Part 3, 
           line 25, or, if corrected, Form 941-X, line 34, column 1). Enter an amount here only if 
           filing a Form 941-X to correct the second quarter of 2020 . . . . . . . . . . . . . . . . . . . . .                            2d  
        2e Add lines 2a, 2b, 2c, and 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           2e  
        2f Retention credit. If you're correcting the second, third, or fourth quarter of 2020, 
           multiply line 2e by 50% (0.50). If you're correcting the first or second quarter of 
           2021, multiply line 2e by 70% (0.70) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                     2f  
        2g Enter the amount of the employer share of social security tax from Step 1, line 1a, 
           or, if applicable, Step 1, line 1n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           2g  
        2h Enter the amount of the nonrefundable portion of the credit for qualified sick and 
           family leave wages for leave taken after March 31, 2020, and before April 1, 2021 
           (this amount may come from Worksheet 1, Step 2, line 2j, in these instructions if 
           you're correcting that credit for the quarter or you may need to enter the credit 
           claimed on your original Form 941 for the quarter) . . . . . . . . . . . . . . . . . . . . . . . . . .                         2h  
        2i Subtract line 2h from line 2g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          2i  
        2j Nonrefundable portion of employee retention credit. Enter the smaller of line 2f 
           or line 2i. Enter this amount on Form 941-X, line 18a, column 1 . . . . . . . . . . . . . . . .                                    2j
        2k Refundable portion of employee retention credit. Subtract line 2j from line 2f 
           and enter this amount on Form 941-X, line 26a, column 1 . . . . . . . . . . . . . . . . . . . . .                                  2k

                                                              -28-                      Instructions for Form 941-X (Rev. 4-2023)

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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Worksheet 3. Adjusted Credit for Qualified Sick and Family Leave 
Wages for Leave Taken After March 31, 2021, and Before October 1, 
2021                                                                                                                                                 Keep for Your Records
You must use this worksheet if you claimed the credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before October 1, 2021, on 
your original Form 941 and you correct any amounts used to figure the credit for qualified sick and family leave wages for leave taken after March 31, 2021, and before 
October 1, 2021. You'll also use this worksheet to figure this credit if you're claiming it for the first time on Form 941-X. If you're a third-party payer, you must complete 
this worksheet for each client for which it is applicable, on a client-by-client basis. 
Step 1.         Determine the corrected employer share of Medicare tax
        1a      Enter the amount of Medicare wages from Form 941, Part 1, line 5c, column 1, or, if corrected, the                                        
                amount from Form 941-X, line 12, column 1 .             . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   1a
        1b      Multiply line 1a by 1.45% (0.0145) .        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   1b      
        1c      If you're a third-party payer of sick pay that isn't an agent and you're claiming credits for amounts 
                paid to your employees, enter the employer share of Medicare tax included on Form 941, Part 1, 
                line 8, or, if corrected, the amount of the employer share of Medicare tax on sick pay that you                                           
                included on Form 941-X, line 15, column 1 (enter as a negative number) .                      . . . . . . . . . . . . . . . . .   1c
        1d      Employer share of Medicare tax included on Form 941-X, line 21, column 4                        . . . . . . . . . . . . . . . .   1d      
        1e      If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount of the                                           
                employer share of Medicare tax from the notice              . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   1e
        1f      Employer share of Medicare tax. Combine lines 1b, 1c, 1d, and 1e .                        . . . . . . . . . . . . . . . . . . .           1f                    
        1g      For corrections to quarters beginning after December 31, 2022, only, enter the amount from Form                                           
                8974, line 16 (including any amended Form 8974 attached to Form 941-X) .                        . . . . . . . . . . . . . . . .   1g
        1h      Employer share of Medicare tax remaining. Subtract line 1g from line 1f .                         . . . . . . . . . . . . . . .           1h                    
Step 2.         Figure the sick and family leave credit
        2a      Qualified sick leave wages for leave taken after March 31, 2021, and before October 1, 2021, 
                reported on Form 941, Part 3, line 23, or, if corrected, the amount from Form 941-X, line 35,                                             
                column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2a
        2a(i)   Qualified sick leave wages included on Form 941, Part 3, line 23, or, if corrected, the amount from 
                Form 941-X, line 35, column 1, that were not included as wages reported on Form 941, Part 1, lines 
                5a and 5c, or, if corrected, the amount from Form 941-X, lines 8 and 12, column 1, because the 
                qualified sick leave wages were excluded from the definition of employment under sections 3121(b)                                         
                (1)–(22)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(i)
        2a(ii)  Subtract line 2a(i) from line 2a .    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2a(ii)  
        2a(iii) Qualified sick leave wages included on Form 941, Part 3, line 23, or, if corrected, the amount from 
                Form 941-X, line 35, column 1, that were not included as wages reported on Form 941, Part 1, 
                line 5a, or, if corrected, the amount from Form 941-X, line 8, column 1, because the qualified sick                                       
                leave wages were limited by the social security wage base .                 . . . . . . . . . . . . . . . . . . . . . . . . . .   2a(iii)
        2a(iv)  Subtract line 2a(iii) from line 2a(ii)    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2a(iv)  
        2b      Qualified health plan expenses allocable to qualified sick leave wages for leave taken after March 31, 
                2021, and before October 1, 2021, reported on Form 941, Part 3, line 24, or, if corrected, the amount                                     
                from Form 941-X, line 36, column 1          . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2b
        2c      Amounts under certain collectively bargained agreements allocable to qualified sick leave wages for 
                leave taken after March 31, 2021, and before October 1, 2021, reported on Form 941, Part 3, line 25,                                      
                or, if corrected, the amount from Form 941-X, line 37, column 1 .                 . . . . . . . . . . . . . . . . . . . . . . .   2c
        2d      Employer share of social security tax on qualified sick leave wages. Multiply line 2a(iv) by 6.2%                                         
                (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d
        2e      Employer share of Medicare tax on qualified sick leave wages. Multiply line 2a(ii) by 1.45%                                               
                (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2e
        2f      Credit for qualified sick leave wages. Add lines 2a, 2b, 2c, 2d, and 2e .                     . . . . . . . . . . . . . . . . .           2f  
        2g      Qualified family leave wages for leave taken after March 31, 2021, and before October 1, 2021, 
                reported on Form 941, Part 3, line 26, or, if corrected, the amount from Form 941-X, line 38,                                             
                column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2g
        2g(i)   Qualified family leave wages included on Form 941, Part 3, line 26, or, if corrected, the amount from 
                Form 941-X, line 38, column 1, that were not included as wages reported on Form 941, Part 1, lines 
                5a and 5c, or, if corrected, the amount from Form 941-X, lines 8 and 12, column 1, because the 
                qualified family leave wages were excluded from the definition of employment under sections 3121(b)                                       
                (1)–(22)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g(i)
        2g(ii)  Subtract line 2g(i) from line 2g .    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2g(ii)  
        2g(iii) Qualified family leave wages included on Form 941, Part 3, line 26, or, if corrected, the amount from 
                Form 941-X, line 38, column 1, that were not included as wages reported on Form 941, Part 1, 
                line 5a, or, if corrected, the amount from Form 941-X, line 8, column 1, because the qualified family                                     
                leave wages were limited by the social security wage base .                 . . . . . . . . . . . . . . . . . . . . . . . . . .   2g(iii)
        2g(iv)  Subtract line 2g(iii) from line 2g(ii)    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2g(iv)  
        2h      Qualified health plan expenses allocable to qualified family leave wages for leave taken after March 
                31, 2021, and before October 1, 2021, reported on Form 941, Part 3, line 27, or, if corrected, the                                        
                amount from Form 941-X, line 39, column 1 .             . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2h
        2i      Amounts under certain collectively bargained agreements allocable to qualified family leave wages 
                for leave taken after March 31, 2021, and before October 1, 2021, reported on Form 941, Part 3,                                           
                line 28, or, if corrected, the amount from Form 941-X, line 40, column 1 .                  . . . . . . . . . . . . . . . . . .   2i
        2j      Employer share of social security tax on qualified family leave wages. Multiply line 2g(iv) by 6.2%                                       
                (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2j
        2k      Employer share of Medicare tax on qualified family leave wages. Multiply line 2g(ii) by 1.45%                                             
                (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2k
        2l      Credit for qualified family leave wages. Add lines 2g, 2h, 2i, 2j, and 2k                     . . . . . . . . . . . . . . . . .           2l  
        2m      Credit for qualified sick and family leave wages. Add lines 2f and 2l                       . . . . . . . . . . . . . . . . . .           2m  
        2n      For second quarter of 2021 only, enter any employee retention credit claimed under section 2301 
                of the CARES Act (this amount may come from Worksheet 2, Step 2, line 2f, in these instructions if 
                you're correcting that credit for the second quarter of 2021 or you may need to enter the credit 
                claimed on your original Form 941 for the second quarter of 2021) with respect to any wages taken                                         
                into account for the credit for qualified sick and family leave wages for the quarter                   . . . . . . . . . . . .   2n
        2o      Enter any credit claimed under section 41 for increasing research activities with respect to any                                          
                wages taken into account for the credit for qualified sick and family leave wages .                     . . . . . . . . . . . .   2o
        2p      Add lines 2n and 2o     . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2p      
        2q      Credit for qualified sick and family leave wages after adjusting for other credits. Subtract                                                  
                line 2p from line 2m .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           2q
        2r      Nonrefundable portion of credit for qualified sick and family leave wages for leave taken 
                after March 31, 2021, and before October 1, 2021. Enter the smaller of line 1h or line 2q. Enter 
                this amount on Form 941-X, line 18b, column 1 .             . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           2r
        2s      Refundable portion of credit for qualified sick and family leave wages for leave taken after 
                March 31, 2021, and before October 1, 2021. Subtract line 2r from line 2q and enter this amount 
                on Form 941-X, line 26b, column 1 .         . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           2s
Instructions for Form 941-X (Rev. 4-2023)                                                     -29-

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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Worksheet 4. Adjusted Employee Retention Credit for Qualified 
Wages Paid After June 30, 2021, and Before January 1, 2022                                                                                Keep for Your Records
You must use this worksheet if you claimed the employee retention credit for qualified wages paid after June 30, 2021, and before January 
1, 2022, on your original Form 941 and you correct any amounts used to figure the employee retention credit for qualified wages paid after 
June 30, 2021, and before January 1, 2022. You'll also use this worksheet to figure this credit if you're claiming it for the first time on Form 
941-X. If you're a third-party payer, you must complete this worksheet for each client for which it is applicable, on a client-by-client basis. 
Step 1.    Determine the corrected employer share of Medicare tax
        1a If you completed Worksheet 3 to claim a credit for qualified sick and family leave 
           wages for leave taken after March 31, 2021, and before October 1, 2021, for a 
           quarter in which you're also claiming the employee retention credit, enter the 
           amount from Worksheet 3, Step 1, line 1h, and go to Step 2. Otherwise, complete 
           lines 1b–1g below and then go to Step 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                       1a                   
        1b Enter the amount of Medicare wages from Form 941, Part 1, line 5c, column 1, or, if 
           corrected, the amount from Form 941-X, line 12, column 1 . . . . . . . . . . . . . . . . . . .                              1b  
        1c Multiply line 1b by 1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              1c  
        1d If you're a third-party payer of sick pay that isn't an agent and you're claiming credits 
           for amounts paid to your employees, enter the employer share of Medicare tax 
           included on Form 941, Part 1, line 8, or, if corrected, the amount of the employer 
           share of Medicare tax on sick pay that you included on Form 941-X, line 15, column 
           1 (enter as a negative number) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              1d  
        1e Employer share of Medicare tax included on Form 941-X, line 21, column 4 . . . . .                                          1e  
        1f If you received a Section 3121(q) Notice and Demand during the quarter, enter the 
           amount of the employer share of Medicare tax from the notice . . . . . . . . . . . . . . . .                                1f  
        1g Employer share of Medicare tax. Combine lines 1c, 1d, 1e, and 1f . . . . . . . . . . .                                          1g                   

Step 2.    Figure the employee retention credit
           Caution: You must be a recovery startup business to claim the employee retention 
           credit for qualified wages paid after September 30, 2021, and before January 1, 
           2022 (fourth quarter 2021). The total amount included on lines 2a and 2b can't 
           exceed $10,000 per employee each quarter. 
        2a Qualified wages (excluding qualified health plan expenses) for the employee 
           retention credit (Form 941, Part 3, line 21, or, if corrected, Form 941-X, line 30, 
           column 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a  
        2b Qualified health plan expenses allocable to qualified wages for the employee 
           retention credit (Form 941, Part 3, line 22, or, if corrected, Form 941-X, line 31a, 
           column 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b  
        2c Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       2c  
        2d Retention credit. Multiply line 2c by 70% (0.70). If you qualify for the employee 
           retention credit solely because your business is a recovery startup business, don't 
           enter more than $50,000 per quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                     2d  
        2e Enter the amount of the employer share of Medicare tax from Step 1, line 1a, or, if 
           applicable, Step 1, line 1g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         2e  
        2f Enter the amount of the nonrefundable portion of the credit for qualified sick and 
           family leave wages for leave taken after March 31, 2021, and before October 1, 
           2021 (this amount may come from Worksheet 3, Step 2, line 2r, in these instructions 
           if you're correcting that credit or you may need to enter the credit claimed on your 
           original Form 941) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      2f  
        2g Subtract line 2f from line 2e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         2g  
        2h Nonrefundable portion of employee retention credit. Enter the smaller of 
           line 2d or line 2g. Enter this amount on Form 941-X, line 18a, column 1 . . . . . . . . .                                       2h
        2i Refundable portion of employee retention credit. Subtract line 2h from line 2d 
           and enter this amount on Form 941-X, line 26a, column 1 . . . . . . . . . . . . . . . . . . . .                                 2i

                                                     -30-                                 Instructions for Form 941-X (Rev. 4-2023)

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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Worksheet 5. Adjusted COBRA Premium Assistance Credit                                                                                        Keep for Your Records
You must use this worksheet if you claimed the COBRA premium assistance credit on your original Form 941 and you correct any amounts used to figure 
the COBRA premium assistance credit. You'll also use this worksheet to figure this credit if you're claiming it for the first time on Form 941-X. If you're a 
third-party payer, you must complete this worksheet for each client for which it is applicable, on a client-by-client basis. 
Step 1.    Determine the corrected employer share of Medicare tax
        1a If you completed Worksheet 3 or Worksheet 4 for a quarter in which you're also claiming the 
           COBRA premium assistance credit, enter the amount listed on Worksheet 3, line 1h, or 
           Worksheet 4, line 1a or 1g (as applicable). Otherwise, complete lines 1b–1g below and then 
           go to Step 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         1a                 
        1b Enter the amount of Medicare wages from Form 941, Part 1, line 5c, column 1, or, if corrected, 
           the amount from Form 941-X, line 12, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    1b  
        1c Multiply line 1b by 1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           1c  
        1d If you're a third-party payer of sick pay that isn't an agent and you're claiming credits for 
           amounts paid to your employees, enter the employer share of Medicare tax included on Form 
           941, Part 1, line 8, or, if corrected, the amount of the employer share of Medicare tax on sick 
           pay that you included on Form 941-X, line 15, column 1 (enter as a negative 
           number) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1d  
        1e Employer share of Medicare tax included on Form 941-X, line 21, column 4 . . . . . . . . . . . .                               1e  
        1f If you received a Section 3121(q) Notice and Demand during the quarter, enter the amount of 
           the employer share of Medicare tax from the notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   1f  
        1g Employer share of Medicare tax. Combine lines 1c, 1d, 1e, and 1f        . . . . . . . . . . . . . . . .                              1g                 
Step 2.    Figure the COBRA premium assistance credit
        2a Enter the COBRA premium assistance that you provided this quarter       . . . . . . . . . . . . . . . .                        2a  
        2b Enter the amount of the employer share of Medicare tax from Step 1, line 1a, or, if applicable, 
           Step 1, line 1g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    2b  
        2c Enter the amount of the nonrefundable portion of the credit for qualified sick and family leave 
           wages for leave taken after March 31, 2021, and before October 1, 2021 (this amount may 
           come from Worksheet 3, Step 2, line 2r, in these instructions if you're correcting that credit for 
           the quarter or you may need to enter the credit claimed on your original Form 941 for the 
           quarter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c  
        2d Enter the amount of the nonrefundable portion of the employee retention credit (this amount 
           may come from Worksheet 4, Step 2, line 2h, in these instructions if you're correcting that 
           credit for the quarter or you may need to enter the credit claimed on your original Form 941 for 
           the quarter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2d  
        2e Other nonrefundable credits used against the employer share of Medicare tax. Add 
           lines 2c and 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    2e  
        2f Subtract line 2e from line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        2f  
        2g Nonrefundable portion of the COBRA premium assistance credit. Enter the smaller of 
           line 2a or line 2f. Enter this amount on Form 941-X, line 18c, column 1 . . . . . . . . . . . . . . .                                2g
        2h Refundable portion of the COBRA premium assistance credit. Subtract line 2g from 
           line 2a and enter this amount on Form 941-X, line 26c, column 1 . . . . . . . . . . . . . . . . . . .                                2h

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        You can view, download, or print most of the                       The time needed to complete and file Form 941-X will 
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Paperwork Reduction Act Notice. We ask for the                             If you have comments concerning the accuracy of 
information on Form 941-X to carry out the Internal              these time estimates or suggestions for making Form 
Revenue laws of the United States. We need it to figure          941-X simpler, we would be happy to hear from you. You 
and collect the right amount of tax. Subtitle C,                 can send us comments from IRS.gov/FormComments. Or 
Employment Taxes, of the Internal Revenue Code                   you can send your comments to: Internal Revenue 
imposes employment taxes, including federal income tax           Service, Tax Forms and Publications Division, 1111 
withholding, on wages. This form is used to determine the        Constitution Ave. NW, IR-6526, Washington, DC 20224. 
amount of taxes that you owe. Section 6011 requires you          Don’t send Form 941-X to this address. Instead, see 
to provide the requested information if the tax is               Where Should You File Form 941-X, earlier.
applicable to you.
You’re not required to provide the information 
requested on a form that is subject to the Paperwork 

Instructions for Form 941-X (Rev. 4-2023)                 -31-

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