Part 5: Sign — Instruction 941-X — Instructions for Form

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.

Who must sign Form 941-X? The following persons are authorized to sign the return for each type of business entity.

Sole proprietorship— The individual who owns the business.
Corporation (including a limited liability company (LLC) treated as a corporation)— The president, the vice president, or other principal officer duly authorized to sign.
Partnership (including an LLC treated as a partnership) or unincorporated organization— A responsible and duly authorized member, partner, or officer having knowledge of its affairs.
Single-member LLC treated as a disregarded entity for federal income tax purposes— The owner of the LLC or a principal officer duly authorized to sign.
Trust or estate— The fiduciary. Form 941-X may also be signed by a duly authorized agent of the taxpayer if a valid power of attorney has been filed.

Alternative signature method. Corporate officers or duly authorized agents may sign Form 941-X by rubber stamp, mechanical device, or computer software program. For details and required documentation, see Rev. Proc. 2005-39. You can find Rev. Proc. 2005-39, 2005-28 I.R.B. 82, at IRS.gov/irb/2005-28_IRB#RP-2005-39 .

Paid Preparer Use Only A paid preparer must sign Form 941-X and provide the information in the Paid Preparer Use Only section of Part 5 if the preparer was paid to prepare Form 941-X and isn’t an employee of the filing entity. Paid preparers must sign paper returns with a manual signature. The preparer must give you a copy of the return in addition to the copy to be filed with the IRS.

If you’re a paid preparer, enter your preparer tax identification number (PTIN) in the space provided. Include your complete address. If you work for a firm, enter the firm’s name and the EIN of the firm. You can apply for a PTIN online or by filing Form W-12. For more information about applying for a PTIN online, go to IRS.gov/PTIN . You can’t use your PTIN in place of the EIN of the tax preparation firm.

Generally, you’re not required to complete this section if you’re filing the return as a reporting agent and have a valid Form 8655 on file with the IRS. However, a reporting agent must complete this section if the reporting agent offered legal advice, for example, advising the client on determining whether its workers are employees or independent contractors for federal tax purposes.

24 Instructions for Form 941-X (Rev. 4-2026)

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. 4-2026) 25

Worksheet 2. 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 Reserved for future use 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 Reserved fo

. . . . . . . . 2l 2m Credit for qualified sick and family leave wages. Add lines 2f and 2l . . . . . . . . . . . . . . . . . . . 2m 2n Reserved for future use 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 Reserved for future use 2q Credit for qualified sick and family leave wages after adjusting for other credits. Subtract line 2o 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

26 Instructions for Form 941-X (Rev. 4-2026)

Worksheet 3. 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 2 for a quarter in which you’re also claiming the COBRA premium assistance credit, enter the amount listed on Worksheet 2, line 1h. Otherwise, complete lines 1b–1i 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 1h 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) . . . . . . . . 1h 1i Employer share of Medicare tax remaining. Subtract line 1h from line 1g . . . . . . . . . . . 1i

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 1i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 2, 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 Reserved for future use 2e Reserved for future use 2f Subtract line 2c 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