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

Form 941-X is an IRS form used by employers to correct errors on previously filed Form 941, the Employer's Quarterly Federal Tax Return. This form allows employers to make necessary adjustments or changes to the information reported on the original Form 941.

To use the Upload PDF endpoint for this document, you must use A_941_X in the form_type parameter.

Field descriptions

The following fields are available on this form type:

JSON AttributeData TypeDescription
a_941_x-General:employerIdentificationNumberEINEmployer Identification Number
a_941_x-General:name(NotYourTradeName)TextName (Not Your Trade Name)
a_941_x-General:tradeName(IfAny)TextTrade Name (If Any)
a_941_x-General:address:numberAndStreetTextAddress
a_941_x-General:address:suiteOrRoomNumberTextAddress
a_941_x-General:address:cityTextAddress
a_941_x-General:address:stateStateAddress
a_941_x-General:address:zipCodeZIP CodeAddress
a_941_x-General:address:foreignCountryNameTextAddress
a_941_x-General:address:foreignProvince/CountyTextAddress
a_941_x-General:address:foreignPostalCodeTextAddress
a_941_x-General:returnYou'ReCorrecting:941CHECKED, NOT CHECKEDReturn You're Correcting
a_941_x-General:returnYou'ReCorrecting:941-ssCHECKED, NOT CHECKEDReturn You're Correcting
a_941_x-General:checkTheOneQuarterYou'ReCorrecting1 - JANUARY FEBRUARY MARCH, 2 - APRIL MAY JUNE, 3 - JULY AUGUST SEPTEMBER, 4 - OCTOBER NOVEMBER DECEMBERCheck The One Quarter You're Correcting
a_941_x-General:enterTheCalendarYearOfTheQuarterYou'ReCorrectingIntegerEnter The Calendar Year Of The Quarter You're Correcting
a_941_x-Part1-SelectOnlyOneProcess:selectOnlyOneProcess1 - ADJUSTED EMPLOYMENT TAX RETURN, 2 - CLAIMSelect Only One Process
a_941_x-Part1-SelectOnlyOneProcess:enterTheDateYouDiscoveredErrorsDateEnter The Date You Discovered Errors
a_941_x-Part2-CompleteTheCertifications:line3-ICertifyThatI'VeFiledOrWillFileFormsW-2WageAndTaxStatementCHECKED, NOT CHECKEDLine 3 - I Certify That I've Filed Or Will File Forms W-2 Wage And Tax Statement
a_941_x-Part2-CompleteTheCertifications:line4-IfYouCheckedLine1BecauseYou'ReAdjustingOverreportedFederalIncomeTax:a-IRepaidOrReimbursedEachAffectedEmployeeForTheOvercollectedFederalIncomeTaxCHECKED, NOT CHECKEDLine 4 - If You Checked Line 1 Because You're Adjusting Overreported Federal Income Tax
a_941_x-Part2-CompleteTheCertifications:line4-IfYouCheckedLine1BecauseYou'ReAdjustingOverreportedFederalIncomeTax:b-TheAdjustmentsOfSocialSecurityTaxAndMedicareTaxAreForTheEmployer'SShareCHECKED, NOT CHECKEDLine 4 - If You Checked Line 1 Because You're Adjusting Overreported Federal Income Tax
a_941_x-Part2-CompleteTheCertifications:line4-IfYouCheckedLine1BecauseYou'ReAdjustingOverreportedFederalIncomeTax:c-TheAdjustmentIsForFederalIncomeTaxSocialSecurityTaxMedicareTaxCHECKED, NOT CHECKEDLine 4 - If You Checked Line 1 Because You're Adjusting Overreported Federal Income Tax
a_941_x-Part2-CompleteTheCertifications:line5-IfYouCheckedLine2BecauseYou'ReClaimingARefundOrAbatement:a-IRepaidOrReimbursedEachAffectedEmployeeForTheOvercollectedSocialSecurityTaxCHECKED, NOT CHECKEDLine 5 - If You Checked Line 2 Because You're Claiming A Refund Or Abatement
a_941_x-Part2-CompleteTheCertifications:line5-IfYouCheckedLine2BecauseYou'ReClaimingARefundOrAbatement:b-IHaveAWrittenConsentFromEachAffectedEmployeeCHECKED, NOT CHECKEDLine 5 - If You Checked Line 2 Because You're Claiming A Refund Or Abatement
a_941_x-Part2-CompleteTheCertifications:line5-IfYouCheckedLine2BecauseYou'ReClaimingARefundOrAbatement:c-TheClaimForSocialSecurityTaxAndMedicareTaxIsForTheEmployer'SShareOnlyCHECKED, NOT CHECKEDLine 5 - If You Checked Line 2 Because You're Claiming A Refund Or Abatement
a_941_x-Part2-CompleteTheCertifications:line5-IfYouCheckedLine2BecauseYou'ReClaimingARefundOrAbatement:d-TheClaimIsForFederalIncomeTaxSocialSecurityTaxMedicareTaxCHECKED, NOT CHECKEDLine 5 - If You Checked Line 2 Because You're Claiming A Refund Or Abatement
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line6-WagesTipsAndOtherCompensation:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 6 - Wages Tips And Other Compensation
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line6-WagesTipsAndOtherCompensation:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 6 - Wages Tips And Other Compensation
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line6-WagesTipsAndOtherCompensation:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 6 - Wages Tips And Other Compensation
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line7-FederalIncomeTaxWithheldFromWagesTipsAndOtherCompensation:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 7 - Federal Income Tax Withheld From Wages Tips And Other Compensation
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line7-FederalIncomeTaxWithheldFromWagesTipsAndOtherCompensation:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 7 - Federal Income Tax Withheld From Wages Tips And Other Compensation
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line7-FederalIncomeTaxWithheldFromWagesTipsAndOtherCompensation:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 7 - Federal Income Tax Withheld From Wages Tips And Other Compensation
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line7-FederalIncomeTaxWithheldFromWagesTipsAndOtherCompensation:column4-TaxCorrectionMoneyLine 7 - Federal Income Tax Withheld From Wages Tips And Other Compensation
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line8-TaxableSocialSecurityWages:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 8 - Taxable Social Security Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line8-TaxableSocialSecurityWages:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 8 - Taxable Social Security Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line8-TaxableSocialSecurityWages:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 8 - Taxable Social Security Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line8-TaxableSocialSecurityWages:column4-TaxCorrectionMoneyLine 8 - Taxable Social Security Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line9-QualifiedSickLeaveWages:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 9 - Qualified Sick Leave Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line9-QualifiedSickLeaveWages:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 9 - Qualified Sick Leave Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line9-QualifiedSickLeaveWages:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 9 - Qualified Sick Leave Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line9-QualifiedSickLeaveWages:column4-TaxCorrectionMoneyLine 9 - Qualified Sick Leave Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line10-QualifiedFamilyLeaveWages:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 10 - Qualified Family Leave Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line10-QualifiedFamilyLeaveWages:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 10 - Qualified Family Leave Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line10-QualifiedFamilyLeaveWages:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 10 - Qualified Family Leave Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line10-QualifiedFamilyLeaveWages:column4-TaxCorrectionMoneyLine 10 - Qualified Family Leave Wages
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line11-TaxableSocialSecurityTips:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 11 - Taxable Social Security Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line11-TaxableSocialSecurityTips:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 11 - Taxable Social Security Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line11-TaxableSocialSecurityTips:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 11 - Taxable Social Security Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line11-TaxableSocialSecurityTips:column4-TaxCorrectionMoneyLine 11 - Taxable Social Security Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line12-TaxableMedicareWages&Tips:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 12 - Taxable Medicare Wages & Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line12-TaxableMedicareWages&Tips:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 12 - Taxable Medicare Wages & Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line12-TaxableMedicareWages&Tips:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 12 - Taxable Medicare Wages & Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line12-TaxableMedicareWages&Tips:column4-TaxCorrectionMoneyLine 12 - Taxable Medicare Wages & Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line13-TaxableWages&TipsSubjectToAdditionalMedicareTaxWithholding:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 13 - Taxable Wages & Tips Subject To Additional Medicare Tax Withholding
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line13-TaxableWages&TipsSubjectToAdditionalMedicareTaxWithholding:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 13 - Taxable Wages & Tips Subject To Additional Medicare Tax Withholding
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line13-TaxableWages&TipsSubjectToAdditionalMedicareTaxWithholding:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 13 - Taxable Wages & Tips Subject To Additional Medicare Tax Withholding
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line13-TaxableWages&TipsSubjectToAdditionalMedicareTaxWithholding:column4-TaxCorrectionMoneyLine 13 - Taxable Wages & Tips Subject To Additional Medicare Tax Withholding
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line14-Section3121(Q)NoticeAndDemand-TaxDueOnUnreportedTips:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 14 - Section 3121(Q) Notice And Demand - Tax Due On Unreported Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line14-Section3121(Q)NoticeAndDemand-TaxDueOnUnreportedTips:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 14 - Section 3121(Q) Notice And Demand - Tax Due On Unreported Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line14-Section3121(Q)NoticeAndDemand-TaxDueOnUnreportedTips:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 14 - Section 3121(Q) Notice And Demand - Tax Due On Unreported Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line14-Section3121(Q)NoticeAndDemand-TaxDueOnUnreportedTips:column4-TaxCorrectionMoneyLine 14 - Section 3121(Q) Notice And Demand - Tax Due On Unreported Tips
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line15-TaxAdjustments:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 15 - Tax Adjustments
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line15-TaxAdjustments:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 15 - Tax Adjustments
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line15-TaxAdjustments:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 15 - Tax Adjustments
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line15-TaxAdjustments:column4-TaxCorrectionMoneyLine 15 - Tax Adjustments
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line16-QualifiedSmallBusinessPayrollTaxCreditForIncreasingResearchActivities:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 16 - Qualified Small Business Payroll Tax Credit For Increasing Research Activities
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line16-QualifiedSmallBusinessPayrollTaxCreditForIncreasingResearchActivities:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 16 - Qualified Small Business Payroll Tax Credit For Increasing Research Activities
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line16-QualifiedSmallBusinessPayrollTaxCreditForIncreasingResearchActivities:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 16 - Qualified Small Business Payroll Tax Credit For Increasing Research Activities
a_941_x-Part3-1-EnterTheCorrectionsForThisQuarter:line16-QualifiedSmallBusinessPayrollTaxCreditForIncreasingResearchActivities:column4-TaxCorrectionMoneyLine 16 - Qualified Small Business Payroll Tax Credit For Increasing Research Activities
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line17-NonrefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 17 - Nonrefundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line17-NonrefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 17 - Nonrefundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line17-NonrefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 17 - Nonrefundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line17-NonrefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column4-TaxCorrectionMoneyLine 17 - Nonrefundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18A-NonrefundablePortionOfEmployeeRetentionCredit:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 18A - Nonrefundable Portion Of Employee Retention Credit
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18A-NonrefundablePortionOfEmployeeRetentionCredit:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 18A - Nonrefundable Portion Of Employee Retention Credit
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18A-NonrefundablePortionOfEmployeeRetentionCredit:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 18A - Nonrefundable Portion Of Employee Retention Credit
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18A-NonrefundablePortionOfEmployeeRetentionCredit:column4-TaxCorrectionMoneyLine 18A - Nonrefundable Portion Of Employee Retention Credit
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18B-NonrefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 18B - Nonrefundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18B-NonrefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 18B - Nonrefundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18B-NonrefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 18B - Nonrefundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18B-NonrefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column4-TaxCorrectionMoneyLine 18B - Nonrefundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18C-NonrefundablePortionOfCobraPremiumAssistanceCredit:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 18C - Nonrefundable Portion Of Cobra Premium Assistance Credit
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18C-NonrefundablePortionOfCobraPremiumAssistanceCredit:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 18C - Nonrefundable Portion Of Cobra Premium Assistance Credit
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18C-NonrefundablePortionOfCobraPremiumAssistanceCredit:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 18C - Nonrefundable Portion Of Cobra Premium Assistance Credit
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18C-NonrefundablePortionOfCobraPremiumAssistanceCredit:column4-TaxCorrectionMoneyLine 18C - Nonrefundable Portion Of Cobra Premium Assistance Credit
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18D-NumberOfIndividualsProvidedCobraPremiumAssistance:column1-TotalCorrectedAmount(ForAllEmployees)IntegerLine 18D - Number Of Individuals Provided Cobra Premium Assistance
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18D-NumberOfIndividualsProvidedCobraPremiumAssistance:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)IntegerLine 18D - Number Of Individuals Provided Cobra Premium Assistance
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line18D-NumberOfIndividualsProvidedCobraPremiumAssistance:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)IntegerLine 18D - Number Of Individuals Provided Cobra Premium Assistance
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line19-SpecialAdditionToWagesForFederalIncomeTax:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 19 - Special Addition To Wages For Federal Income Tax
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line19-SpecialAdditionToWagesForFederalIncomeTax:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 19 - Special Addition To Wages For Federal Income Tax
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line19-SpecialAdditionToWagesForFederalIncomeTax:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 19 - Special Addition To Wages For Federal Income Tax
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line19-SpecialAdditionToWagesForFederalIncomeTax:column4-TaxCorrectionMoneyLine 19 - Special Addition To Wages For Federal Income Tax
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line20-SpecialAdditionToWagesForSocialSecurityTaxes:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 20 - Special Addition To Wages For Social Security Taxes
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line20-SpecialAdditionToWagesForSocialSecurityTaxes:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 20 - Special Addition To Wages For Social Security Taxes
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line20-SpecialAdditionToWagesForSocialSecurityTaxes:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 20 - Special Addition To Wages For Social Security Taxes
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line20-SpecialAdditionToWagesForSocialSecurityTaxes:column4-TaxCorrectionMoneyLine 20 - Special Addition To Wages For Social Security Taxes
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line21-SpecialAdditionToWagesForMedicareTaxes:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 21 - Special Addition To Wages For Medicare Taxes
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line21-SpecialAdditionToWagesForMedicareTaxes:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 21 - Special Addition To Wages For Medicare Taxes
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line21-SpecialAdditionToWagesForMedicareTaxes:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 21 - Special Addition To Wages For Medicare Taxes
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line21-SpecialAdditionToWagesForMedicareTaxes:column4-TaxCorrectionMoneyLine 21 - Special Addition To Wages For Medicare Taxes
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line22-SpecialAdditionToWagesForAdditionalMedicareTax:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 22 - Special Addition To Wages For Additional Medicare Tax
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line22-SpecialAdditionToWagesForAdditionalMedicareTax:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 22 - Special Addition To Wages For Additional Medicare Tax
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line22-SpecialAdditionToWagesForAdditionalMedicareTax:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 22 - Special Addition To Wages For Additional Medicare Tax
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line22-SpecialAdditionToWagesForAdditionalMedicareTax:column4-TaxCorrectionMoneyLine 22 - Special Addition To Wages For Additional Medicare Tax
a_941_x-Part3-2-EnterTheCorrectionsForThisQuarter:line23-CombineTheAmountsOnLines7Through22OfColumn4:column4-TaxCorrectionMoneyLine 23 - Combine The Amounts On Lines 7 Through 22 Of Column 4
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line24-DeferredAmountOfSocialSecurityTax:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 24 - Deferred Amount Of Social Security Tax
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line24-DeferredAmountOfSocialSecurityTax:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 24 - Deferred Amount Of Social Security Tax
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line24-DeferredAmountOfSocialSecurityTax:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 24 - Deferred Amount Of Social Security Tax
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line24-DeferredAmountOfSocialSecurityTax:column4-TaxCorrectionMoneyLine 24 - Deferred Amount Of Social Security Tax
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line25-RefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 25 - Refundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line25-RefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 25 - Refundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line25-RefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 25 - Refundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line25-RefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column4-TaxCorrectionMoneyLine 25 - Refundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26A-RefundablePortionOfEmployeeRetentionCredit:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 26A - Refundable Portion Of Employee Retention Credit
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26A-RefundablePortionOfEmployeeRetentionCredit:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 26A - Refundable Portion Of Employee Retention Credit
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26A-RefundablePortionOfEmployeeRetentionCredit:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 26A - Refundable Portion Of Employee Retention Credit
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26A-RefundablePortionOfEmployeeRetentionCredit:column4-TaxCorrectionMoneyLine 26A - Refundable Portion Of Employee Retention Credit
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26B-RefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 26B - Refundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26B-RefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 26B - Refundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26B-RefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 26B - Refundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26B-RefundablePortionOfCreditForQualifiedSickAndFamilyLeaveWages:column4-TaxCorrectionMoneyLine 26B - Refundable Portion Of Credit For Qualified Sick And Family Leave Wages
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26C-RefundablePortionOfCobraPremiumAssistanceCredit:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 26C - Refundable Portion Of Cobra Premium Assistance Credit
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26C-RefundablePortionOfCobraPremiumAssistanceCredit:column2-AmountOriginallyReportedOrAsPreviouslyCorrected(ForAllEmployees)MoneyLine 26C - Refundable Portion Of Cobra Premium Assistance Credit
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26C-RefundablePortionOfCobraPremiumAssistanceCredit:column3-Difference(IfThisAmountIsANegativeNumberUseAMinusSign.)MoneyLine 26C - Refundable Portion Of Cobra Premium Assistance Credit
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line26C-RefundablePortionOfCobraPremiumAssistanceCredit:column4-TaxCorrectionMoneyLine 26C - Refundable Portion Of Cobra Premium Assistance Credit
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line27-TotalCombineTheAmountsOnLines23Through26COfColumn4:column4-TaxCorrectionMoneyLine 27 - Total Combine The Amounts On Lines 23 Through 26C Of Column 4
a_941_x-Part3-3-EnterTheCorrectionsForThisQuarter:line28-QualifiedHealthPlanExpensesAllocableToQualifiedSickLeaveWages:column1-TotalCorrectedAmount(ForAllEmployees)MoneyLine 28 - Qualified Health Plan Expenses Allocable To Qualified Sick Leave Wages
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a_941_x-Part5-SignHereYouMustCompleteAllFivePagesOfThisFormAndSignIt:dateDateDate
a_941_x-Part5-SignHereYouMustCompleteAllFivePagesOfThisFormAndSignIt:printYourNameHereTextPrint Your Name Here
a_941_x-Part5-SignHereYouMustCompleteAllFivePagesOfThisFormAndSignIt:printYourTitleHereTextPrint Your Title Here
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a_941_x-Part6-PaidPreparerUseOnly:ptinTextPTIN
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a_941_x-Part6-PaidPreparerUseOnly:dateDateDate
a_941_x-Part6-PaidPreparerUseOnly:firm'sName(OrYoursIfSelf-Employed)TextFirm's Name (Or Yours If Self-Employed)
a_941_x-Part6-PaidPreparerUseOnly:einEINEIN
a_941_x-Part6-PaidPreparerUseOnly:phonePhone NumberPhone
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a_941_x-Part6-PaidPreparerUseOnly:address:addressLine2TextAddress
a_941_x-Part6-PaidPreparerUseOnly:address:cityTextAddress
a_941_x-Part6-PaidPreparerUseOnly:address:stateStateAddress
a_941_x-Part6-PaidPreparerUseOnly:address:zipCodeZIP CodeAddress

Sample document

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