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September 2010) Department of the Treasury — Internal Revenue Service OMB No. 1545-0029  \n\n| (EIN)\u003Cbr>Employer identification number |  |  | | |\n| --- | --- | --- | --- | --- |\n| Name (not your trade name) |  | |  |  |\n| Trade name (if any) | |  |  |  |\n| \u003Cbr>Number Street Suite or room number\u003Cbr>\u003Cbr>City State ZIP code |  |  |  |  |\n\nRead the instructions before completing this form. Use this form to correct errors you made on Form 941 or 941-SS for one quarter only. Type or print within the boxes. You MUST complete all three pages. Do not attach this form to Form 941 or 941-SS.  \nPart 1: Select ONLY one process.  \n 1. Adjusted employment tax return. Check this box if you underreported amounts. Also check this box if you overreported amounts and you would like to use the adjustment process to correct the errors. You must check this box if you are correcting both underreported and overreported amounts on this form. The amount shown on line 20, if less than zero, may only be applied as a credit to your Form 941, Form 941-SS, Form  \n944, or Form 944-SS for the tax period in which you are filing this form.  \n 2. Claim. Check this box if you overreported amounts only and you would like to use the claim process to ask for a refund or abatement of the amount shown on line 20. Do not check this box if you are correcting ANY underreported amounts on this form.  \nPart 2: Complete the certifications.  \n 3. I certify that I have filed or will file Forms W-2, Wage and Tax Statement, or Forms W-2c, Corrected Wage and Tax Statement, as required.  \nNote. If you are correcting underreported amounts only, go to Part 3 on page 2 and skip lines 4 and 5.  \n4. If you checked line 1 because you are adjusting overreported amounts, check all that apply. You must check at least one box.  \nI certify that:  \n a. I repaid or reimbursed each affected employee for the overcollected federal income tax for the current year and the overcollected social security and Medicare tax for current and prior years. For adjustments of employee social security and Medicare tax overcollected in prior years, I have a written statement from each employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.  \n b. The adjustment of social security tax and Medicare tax is for the employer’s share only. I could not find the affected employees or each employee did not give me a written statement that he or she has not claimed (or the claim was rejected) and will not claim arefund or credit for the overcollection.  \n c. The adjustment is for federal income tax, social security tax, and Medicare tax that I did not withhold from employee wages.  \n5. If you checked line 2 because you are claiming a refund or abatement of overreported employment taxes, check all that apply.  \nYou must check at least one box.  \nI certify that:  \n a. I repaid or reimbursed each affected employee for the overcollected social security and Medicare tax. For claims of employee social security and Medicare tax overcollected in prior years, I have a written statement from each employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.  \n 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 and Medicare tax. For refunds of employee social security and Medicare tax overcollected in prior years, I also have a written statement from each employee stating that he or she has not claimed (or the claim was rejected) and will not claim a refund or credit for the overcollection.  \n c. The claim for social security tax and Medicare tax is for the employer’s share only. I could not find the affected employees; or each employee did not give me a written consent to file a claim for the employee’s shar","cbCaij3VJLezpJBe","https://ap.wps.com/l/cbCaij3VJLezpJBe","pdf",110098,"English","# Form 941-X (Rev. September 2010)\n## Part 1: Select only one process\n## Part 2: Complete the certifications\n## Part 3: Enter the corrections for this quarter","[{\"question\":\"What is Form 941-X used for?\",\"answer\":\"Form 941-X is used to correct errors made on Form 941 or 941-SS for one quarter only, either by adjusting employment tax returns or by claiming a refund or abatement for overreported amounts.\"},{\"question\":\"When should you use the “Adjusted employment tax return” option versus the “Claim” option?\",\"answer\":\"Check “Adjusted employment tax return” when amounts were underreported or when you want to correct errors using the adjustment process. Check “Claim” only when you overreported amounts and you want to request a refund or abatement, and do not check it if any underreported amounts are being corrected.\"},{\"question\":\"What certifications are required in Part 2?\",\"answer\":\"Part 2 requires certifications such as filing (or will file) W-2 or corrected W-2 forms and, depending on the selected process, repayment/reimbursement of affected employees or obtaining written statements or consents for employee-share claims.\"}]","Form 941-X - Adjusted Employer's QUARTERLY Federal Tax Return or Claim for Refund - Rev. September 2010 | PDF",1789820374]