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Form   944-X:            Adjusted Employer’s ANNUAL Federal Tax Return or Claim for Refund
(Rev. February 2022)     Department of the Treasury — Internal Revenue Service                                                                                             OMB No. 1545-2007
                                                  —                                                                                                  Return You’re Correcting ...
Employer identification number (EIN)
                                                                                                                                                    Enter the calendar year of the return 
                                                                                                                                                    you’re correcting:
Name (not your trade name)
                                                                                                                                                                    (YYYY)
Trade name (if any)
                                                                                                                                                     Enter the date you discovered errors:
Address
          Number                                                   Street                                                      Suite or room number / /
                                                                                                                                                    (MM / DD / YYYY)
          City                                                       State             ZIP code

          Foreign country name                           Foreign province/county Foreign postal code
Read  the  separate  instructions  before  completing  this  form.  Use  this  form  to  correct  errors  you  made  on  Form  944,  Employer’s 
ANNUAL Federal Tax Return. Use a separate Form 944-X for each year that needs correction. Type or print within the boxes. You 
MUST complete all five pages. Don’t attach this form to Form 944 unless you’re reclassifying workers; see the instructions for line 42.
Part 1:     Select ONLY one process. See page 6 for additional guidance, including information on how to treat 
            employment tax credits and social security tax deferrals.
       1. Adjusted employment tax return. Check this box if you underreported tax amounts. Also check this box if you overreported tax amounts 
          and you would like to use the adjustment process to correct the errors. You must check this box if you’re correcting both underreported and 
          overreported tax amounts on this form. The amount shown on line 27, if less than zero, may only be applied as a credit to your Form 944,   
          Form 941, or Form 941-SS for the tax period in which you’re filing this form.
       2. Claim. Check this box if you overreported tax amounts only and you would like to use the claim process to ask for a refund or abatement of 
          the amount shown on line 27. Don’t check this box if you’re correcting ANY underreported tax amounts on this form.

Part 2:     Complete the certifications.
       3. I certify that I’ve filed or will file Forms W-2, Wage and Tax Statement, or Forms W-2c, Corrected Wage and Tax Statement, as 
          required.
       Note: If you’re correcting underreported tax amounts only, go to Part 3 on page 2 and skip lines 4 and 5. If you’re correcting overreported tax 
       amounts, for purposes of the certifications on lines 4 and 5, Medicare tax doesn’t include Additional Medicare Tax. Form 944-X can’t be used 
       to correct overreported amounts of Additional Medicare Tax unless the amounts weren’t withheld from employee wages.
       4. If you checked line 1 because you’re adjusting overreported federal income tax, social security tax, Medicare tax, or Additional 
       Medicare Tax, check all that apply. You must check at least one box.
          I certify that:
               a. I repaid or reimbursed each affected employee for the overcollected social security tax and Medicare tax for prior years. I have a 
                 written statement from each affected employee stating that he or she hasn’t claimed (or the claim was rejected) and won’t claim a 
                 refund or credit for the overcollection.

               b. The adjustments of social security tax and Medicare tax are for the employer’s share only. I couldn’t find the affected employees or 
                 each affected employee didn’t give me a written statement that he or she hasn’t claimed (or the claim was rejected) and won’t claim 
                 a refund or credit for the overcollection.
               c. The adjustment is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I didn’t withhold from       
                 employee wages.
       5. If you checked line 2 because you’re claiming a refund or abatement of overreported federal income tax, social security tax, 
       Medicare tax, or Additional Medicare Tax, check all that apply. You must check at least one box.
           I certify that:
               a. I repaid or reimbursed each affected employee for the overcollected social security tax and Medicare tax for prior years. I have a 
                 written statement from each affected employee stating that he or she hasn’t claimed (or the claim was rejected) and won’t claim a 
                 refund or credit for the overcollection.

               b. I have a written consent from each affected employee stating that I may file this claim for the employee’s share of social security tax 
                 and Medicare tax overcollected in prior years. I also have a written statement from each affected employee stating that he or she  
                 hasn’t claimed (or the claim was rejected) and won’t claim a refund or credit for the overcollection.
               c. The claim for social security tax and Medicare tax is for the employer’s share only. I couldn’t find the affected employees; or each 
                 affected employee didn’t give me a written consent to file a claim for the employee’s share of social security tax and Medicare tax; 
                 or each affected employee didn’t give me a written statement that he or she hasn’t claimed (or the claim was rejected) and won’t 
                 claim a refund or credit for the overcollection.
               d. The claim is for federal income tax, social security tax, Medicare tax, or Additional Medicare Tax that I didn’t withhold from 
                 employee wages.
                                                                                                                                                                                 Next 
For Paperwork Reduction Act Notice, see the separate instructions.             www.irs.gov/Form944X                                                 Cat. No. 20335M   Form 944-X (Rev. 2-2022)



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Name (not your trade name)                                              Employer identification number (EIN) Correcting Calendar Year (YYYY)

Part 3: Enter the corrections for the calendar year you’re correcting. If any line doesn’t apply, leave it blank.
                                           Column 1            Column 2               Column 3                                                             Column 4
                                           Total corrected     Amount originally      Difference 
                                           amount (for ALL   — reported or as       = (If this amount is a                                                 Tax correction
                                           employees)          previously corrected   negative number, 
                                                               (for ALL employees)    use a minus sign.)
                                                                                                             Use the amount in Column 1 
6.     Wages, tips, and other                                —                      =            .           when you prepare your Forms 
       compensation (Form 944, line 1)                     .                  .
                                                                                                             W-2 or Forms W-2c.
7.     Federal income tax withheld from                                                                      Copy 
                                                             —                                               Column 3 
       wages, tips, and other                              .                  .     =            .           here      ▶                                           .
       compensation (Form 944, line 2)
                                                                                                             × 0.124*
       (Form 944, line 4a, Column 1)                       .                  .
8.     Taxable social security wages                         —                      =            .                       =                                         .
                                                                                    *If you’re correcting your employer share only, use 0.062. See instructions.

                                                                                                             × 0.062
9.     Qualified sick leave wages*                           —                      =            .                       =                                         .
       (Form 944, line 4a(i), Column 1)                    .                  .
                                           *Use line 9 only for qualified sick leave wages paid after March 31, 2020, for leave taken before April 1, 2021.
                                                                                                             × 0.062
       (Form 944, line 4a(ii), Column 1)                   .                  .
10.    Qualified family leave wages*                         —                      =            .                       =                                         .
                                           *Use line 10 only for qualified family leave wages paid after March 31, 2020, for leave taken before April 1, 2021.

                                                                                                             × 0.124*
       (Form 944,  line 4b, Column 1)                      .                  .
11.    Taxable social security tips                          —                      =            .                       =                                         .
                                                                                    *If you’re correcting your employer share only, use 0.062. See instructions.

                                                                                                             × 0.029*
12.    Taxable Medicare wages  &tips                         —                      =            .                       =                                         .
       (Form 944, line 4c, Column 1)                       .                  .
                                                                                 *If you’re correcting your employer share only, use 0.0145. See instructions.

                                                                                                             × 0.009*
       Additional Medicare Tax withholding                 .                  .
13.    Taxable wages & tips subject to                       —                      =            .                       =                                         .
       (Form 944, line 4d, Column 1)                           *Certain wages & tips reported in Column 3 shouldn’t be multiplied by 0.009. See instructions.

                                                                                                             Copy 
14.    Tax adjustments (Form 944,                            —                      =            .           Column 3                                              .
       line 6)                                             .                  .                                   ▶
                                                                                                             here      
15.    Qualified small business payroll                                                                      See 
                                                             —
       tax credit for increasing research                  .                  .     =            .           instructions                                          .
       activities (Form 944, line 8a; you 
       must attach Form 8974)
                                                                                                             See 
       for qualified sick and family                       .                  .
16.    Nonrefundable portion of credit                       —                      =            .           instructions                                          .
       leave wages for leave taken 
       before April 1, 2021 (Form 944, 
       line 8b)
                                                                                                             See 
       employee retention credit (Form                     .                  .
17a.  Nonrefundable portion of                               —                      =            .           instructions                                          .
       944, line 8c)
                                                                                                             See 
       for qualified sick and family                       .                  .
17b.  Nonrefundable portion of credit                        —                      =            .           instructions                                          .
       leave wages for leave taken 
       after March 31, 2021 (Form 944, 
       line 8d)
                                                                                                             See 
       COBRA premium assistance                            .                  .
17c.  Nonrefundable portion of                               —                      =            .           instructions                                          .
       credit (Form 944, line 8e)

17d.  Number of individuals provided                         —                      =
       COBRA premium assistance 
       (Form 944, line 8f)

                                                                                                             See 
       federal income tax                                  .                  .
18.    Special addition to wages for                         —                      =            .           instructions                                          .
                                                                                                                                                              Next 
Page 2                                                                                                            Form 944-X (Rev. 2-2022)



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Name (not your trade name)                                                Employer identification number (EIN)                 Correcting Calendar Year (YYYY)

Part 3: Enter the corrections for the calendar year you’re correcting. If any line doesn’t apply, leave it blank. (continued)
                                            Column 1            Column 2                                Column 3                            Column 4
                                            Total corrected     Amount originally                       Difference 
                                            amount (for ALL   — reported or as                        = (If this amount is a                Tax correction
                                            employees)          previously corrected                    negative number, 
                                                                (for ALL employees)                     use a minus sign.)

                                                                                                                               See 
       social security taxes                                .                     .
19.    Special addition to wages for                          —                                       =              .         instructions             .

                                                                                                                               See 
       Medicare taxes                                       .                     .
20.    Special addition to wages for                          —                                       =              .         instructions             .

                                                                                                                               See 
21.    Special addition to wages for                          —                                       =              .         instructions             .
       Additional Medicare Tax                              .                     .

22.    Subtotal. Combine the amounts on lines 7 through 21 of Column 4  . .     .   .               . . . . .      . .    .  . . . . .                  .
23.    Deferred amount of the employer                                                                                         See 
                                                              —
       share of social security tax* (Form                  .                     .                   =              .         instructions             .
       944, line 10b)                       *Line 23 can only be used if correcting a 2020 Form 944.
                                                                                                                               See 
       employee share of social                             .                     .
24.    Deferred amount of the                                 —                                       =              .         instructions             .
       security tax* (Form 944, line 10c)   *Line 24 can only be used if correcting a 2020 Form 944.
                                                                                                                               See 
       qualified sick and family leave                      .                     .
25.    Refundable portion of credit for                       —                                       =              .         instructions             .
       wages for leave taken before 
       April 1, 2021 (Form 944, line 10d)
                                                                                                                               See 
       employee retention credit                            .                     .
26a.  Refundable portion of                                   —                                       =              .         instructions             .
       (Form 944, line 10e)
                                                                                                                               See 
26b.   Refundable portion of credit for                       —                                       =              .         instructions             .
       qualified sick and family leave                      .                     .
       wages for leave taken after 
       March 31, 2021 (Form 944, line 10f)
                                                                                                                               See 
       premium assistance credit                            .                     .
26c.  Refundable portion of COBRA                             —                                       =              .         instructions             .
       (Form 944, line 10g)

27.    Total. Combine the amounts on lines 22 through 26c of Column 4 .   .     .   .               . . . . .      . .    .  . . . . .                  .
       If line 27 is less than zero:
        • If you checked line 1, this is the amount you want applied as a credit to your Form 944 for the tax period in which you’re filing this form. 
        (If you’re currently filing a Form 941 or Form 941-SS, Employer’s QUARTERLY Federal Tax Return, see the instructions.)
        • If you checked line 2, this is the amount you want refunded or abated.
        If line 27 is more than zero, this is the amount you owe. Pay this amount by the time you file this return. For information on how to pay, 
        see Amount you owe in the instructions.

       allocable to qualified sick leave                    .                     .
28.    Qualified health plan expenses                         —                                       =              .
       wages for leave taken before 
       April 1, 2021 (Form 944, line 15)

       allocable to qualified family leave                  .                     .
29.    Qualified health plan expenses                         —                                       =              .
       wages for leave taken before 
       April 1, 2021 (Form 944, line 16)

       retention credit (Form 944, line 17)                 .                     .
30.    Qualified wages for the employee                       —                                       =              .

                                                                                                                                             Next 
Page 3                                                                                                                             Form 944-X (Rev. 2-2022)



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Name (not your trade name)                                                 Employer identification number (EIN)           Correcting Calendar Year (YYYY)

Part 3:      Enter the corrections for the calendar year you’re correcting. If any line doesn’t apply, leave it blank. (continued)
                                           Column 1            Column 2                              Column 3
                                           Total corrected     Amount originally                     Difference 
                                           amount (for ALL   — reported or as                      = (If this amount is a 
                                           employees)          previously corrected                  negative number, 
                                                               (for ALL employees)                   use a minus sign.)

       for the employee retention                          .                  .
31.    Qualified health plan expenses                        —                                     =            .
       credit (Form 944, line 18)

       for the year* (Form 944, line 19)                   .                  .
32.    Credit from Form 5884-C, line 11,                     —                                     =            .
                                           *Line 32 can only be used if correcting a 2020 Form 944.
Caution: Lines 33–40 don’t apply to years beginning before January 1, 2021.

       leave taken after March 31,                         .                  .
33.    Qualified sick leave wages for                        —                                     =            .
       2021 (Form 944, line 19)

       allocable to qualified sick leave                   .                  .
34.    Qualified health plan expenses                        —                                     =            .
       wages for leave taken after 
       March 31, 2021 (Form 944, line 20)

       collectively bargained                              .                  .
35.    Amounts under certain                                 —                                     =            .
       agreements allocable to 
       qualified sick leave wages for 
       leave taken after March 31, 
       2021 (Form 944, line 21)

       leave taken after March 31,                         .                  .
36.    Qualified family leave wages for                      —                                     =            .
       2021 (Form 944, line 22)

       allocable to qualified family                       .                  .
37.    Qualified health plan expenses                        —                                     =            .
       leave wages for leave taken after 
       March 31, 2021 (Form 944, line 23)

       collectively bargained                              .                  .
38.    Amounts under certain                                 —                                     =            .
       agreements allocable to qualified 
       family leave wages for leave 
       taken after March 31, 2021 (Form 
       944, line 24)

       retention credit in the third                       .                  .
39.    If you’re eligible for the employee                   —                                     =            .
       quarter of 2021 solely because 
       your business is a recovery 
       startup business, enter the total 
       of any amounts included on Form 
       944, lines 8c and 10e (or, if 
       corrected, Form 944-X, lines 17a 
       and 26a), for the third quarter of 
       2021 (Form 944, line 25)

       retention credit in the fourth                      .                  .
40.    If you’re eligible for the employee                   —                                     =            .
       quarter of 2021 solely because 
       your business is a recovery 
       startup business, enter the total 
       of any amounts included on 
       Form 944, lines 8c and 10e (or, if 
       corrected, Form 944-X, lines 17a 
       and 26a), for the fourth quarter of 
       2021 (Form 944, line 26)

                                                                                                                                    Next 
Page 4                                                                                                                    Form 944-X (Rev. 2-2022)



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Name (not your trade name)                                           Employer identification number (EIN)     Correcting Calendar Year (YYYY)

Part 4:  Explain your corrections for the calendar year you’re correcting.
     41. Check here if any corrections you entered on a line include both underreported and overreported amounts.  
         Explain both your underreported and overreported amounts on line 43.
     42. Check here if any corrections involve reclassified workers. Explain on line 43.

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

Part 5:  Sign here. You must complete all five pages of this form and sign it.
Under penalties of perjury, I declare that I have filed an original Form 944 and that I have examined this adjusted return or claim, including 
accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer 
(other than taxpayer) is based on all information of which preparer has any knowledge.
                                                                                        Print your 
                                                                                        name here
✗        Sign your                                                                      Print your 
         name here                                                                      title here

                     Date         /       /                                             Best daytime phone

Paid Preparer Use Only                                                                            Check if you’re self-employed . .    .

Preparer’s name                                                                                   PTIN

Preparer’s signature                                                                              Date            /       /
Firm’s name (or yours if 
self-employed)                                                                                    EIN

Address                                                                                           Phone

City                                                                 State                        ZIP code

Page 5                                                                                                        Form 944-X (Rev. 2-2022)



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                       Form 944-X: Which process should you use?
                  Unless otherwise specified in the separate instructions, an underreported employment tax credit or social security tax 
Type of errors    deferral should be treated like an overreported tax amount. An overreported employment tax credit or social security tax 
you’re correcting deferral should be treated like an underreported tax amount. For more information, including which process to select on 
                  lines 1 and 2, see Correcting an employment tax credit or social security tax deferral in the separate instructions.

Underreported     Use the adjustment process to correct underreported tax amounts.
tax amounts       • Check the box on line 1.
ONLY              • Pay the amount you owe from line 27 by the time you file Form 944-X.

Overreported      The process you    If you’re filing Form 944-X        Choose either the adjustment process or the claim 
tax amounts       use depends on     MORE THAN 90 days before the       process to correct the overreported tax amounts.
ONLY              when you file      period of limitations on credit or 
                  Form 944-X.        refund for Form 944 expires...     Choose the adjustment process if you want the 
                                                                        amount shown on line 27 credited to your Form 944, 
                                                                        941, or 941-SS for the period in which you file Form 
                                                                        944-X. Check the box on line 1.
                                                                        OR
                                                                        Choose the claim process if you want the amount 
                                                                        shown on line 27 refunded to you or abated. Check 
                                                                        the box on line 2.
                                     If you’re filing Form 944-X WITHIN You must use the claim process to correct the 
                                     90 days of the expiration of the   overreported tax amounts. Check the box on line 2.
                                     period of limitations on credit or 
                                     refund for Form 944...

BOTH              The process you    If you’re filing Form 944-X        Choose either the adjustment process or both the 
underreported     use depends on     MORE THAN 90 days before the       adjustment process and the claim process when you 
and overreported  when you file      period of limitations on credit or correct both underreported and overreported tax 
tax amounts       Form 944-X.        refund for Form 944 expires...     amounts.
                                                                        Choose the adjustment process if combining your 
                                                                        underreported tax amounts and overreported tax 
                                                                        amounts results in a balance due or creates a credit 
                                                                        that you want applied to Form 944, 941, or 941-SS.
                                                                        • File one Form 944-X, and 
                                                                        • Check the box on line 1 and follow the instructions 
                                                                                  on line 27.
                                                                        OR
                                                                        Choose both the adjustment process and the 
                                                                        claim process if you want the overreported tax 
                                                                        amount refunded to you or abated.
                                                                        File two separate forms. 
                                                                        1. For the adjustment process, file one Form 944-X 
                                                                                  to correct the underreported tax amounts. Check 
                                                                                  the box on line 1. Pay the amount you owe from 
                                                                                  line 27 by the time you file Form 944-X. 
                                                                        2. For the claim process, file a second Form 944-X 
                                                                                  to correct the overreported tax amounts. Check the 
                                                                                  box on line 2.

                                     If you’re filing Form 944-X WITHIN You must use both the adjustment process and 
                                     90 days of the expiration of the   the claim process.
                                     period of limitations on credit or File two separate forms. 
                                     refund for Form 944...
                                                                        1. For the adjustment process, file one Form 944-X 
                                                                                  to correct the underreported tax amounts. Check 
                                                                                  the box on line 1. Pay the amount you owe from 
                                                                                  line 27 by the time you file Form 944-X. 
                                                                        2. For the claim process, file a second Form 944-X 
                                                                                  to correct the overreported tax amounts. Check the 
                                                                                  box on line 2.
Page 6                                                                                                         Form 944-X (Rev. 2-2022)






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