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    F 843

    Uploaded by

    Manjula.bs
    This is a 3 sentence summary of the IRS Form 843 document: The form requests a refund of $547 for Social Security and Medicare taxes that were incorrectly withheld from a student's wages while on Optional or Curricular Practical Training. As a nonresident alien for less than 5 years, the student is not subject to Social Security or Medicare taxes during practical training. The taxes withheld are reported on Boxes 4 and 6 of the student's Form W-2.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    F 843

    Uploaded by

    Manjula.bs
    520 views1 page
    This is a 3 sentence summary of the IRS Form 843 document: The form requests a refund of $547 for Social Security and Medicare taxes that were incorrectly withheld from a student's wages while on Optional or Curricular Practical Training. As a nonresident alien for less than 5 years, the student is not subject to Social Security or Medicare taxes during practical training. The taxes withheld are reported on Boxes 4 and 6 of the student's Form W-2.

    Original Description:

    Form 843

    Original Title

    f843

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    This is a 3 sentence summary of the IRS Form 843 document: The form requests a refund of $547 for Social Security and Medicare taxes that were incorrectly withheld from a student's wages while on Optional or Curricular Practical Training. As a nonresident alien for less than 5 years, the student is not subject to Social Security or Medicare taxes during practical training. The taxes withheld are reported on Boxes 4 and 6 of the student's Form W-2.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    520 views1 page

    F 843

    Uploaded by

    Manjula.bs
    This is a 3 sentence summary of the IRS Form 843 document: The form requests a refund of $547 for Social Security and Medicare taxes that were incorrectly withheld from a student's wages while on Optional or Curricular Practical Training. As a nonresident alien for less than 5 years, the student is not subject to Social Security or Medicare taxes during practical training. The taxes withheld are reported on Boxes 4 and 6 of the student's Form W-2.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    1

    TLS, have you


    transmitted all R
    text files for this
    cycle update?

    Date

    I.R.S. SPECIFICATIONS
    TO BE REMOVED BEFORE PRINTING
    INSTRUCTIONS TO PRINTERS
    FORM 843, PAGE 1 of 2 (Page 2 is Blank.)
    MARGINS; TOP 13mm (1/2"), CENTER SIDES. PRINTS: HEAD TO HEAD
    PAPER: WHITE WRITING, SUB. 20.
    INK: BLACK
    FLAT SIZE: 216mm (8-1/2") x 279mm (11")
    PERFORATE: None
    DO NOT PRINT DO NOT PRINT DO NOT PRINT DO NOT PRINT

    Action

    Date

    Signature

    O.K. to print
    Revised proofs
    requested

    EXAMPLE: Refund request for Social Security and/or Medicare taxes withheld in error

    843

    Form
    (Rev. November 2005)

    Claim for Refund and Request for Abatement

    Department of the Treasury


    Internal Revenue Service

    OMB No. 1545-0024

    See separate instructions.

    Use Form 843 only if your claim involves (a) one of the taxes shown on line 3a or (b) a refund or abatement of interest, penalties,
    or additions to tax on line 4a.
    Do not use Form 843 if your claim is for
    An overpayment of income taxes;
    A refund for nontaxable use (or sales) of fuel; or
    An overpayment of excise taxes reported on Form(s) 11-C, 720, 730, or 2290.
    Your SSN or ITIN

    Name of claimant

    Your Social
    or or
    ITIN
    # #
    Your
    SocialSecurity
    Security
    ITIN

    Type or print

    Your name as is appears on your Form W-2


    Address (number, street, and room or suite no.)

    Spouses SSN or ITIN

    Your local street address in the US


    City or town, state, and ZIP code

    Employer identification number (EIN)


    Found in Box b of Form W-2

    Your local city, state and zip code in the US


    Name and address shown on return if different from above

    Daytime telephone number

    If the name and address on your tax return is different, put it here. Otherwise,
    leave this area blank.
    1 Period. Prepare a separate Form 843 for each tax period
    01 /
    01
    12 /
    31
    From
    / 05
    to
    / 05
    3a Type of tax, penalty, or addition to tax:
    Employment
    Estate
    Gift
    PenaltyIRC section
    b Type of return filed (see instructions):
    941
    706
    709
    940

    Your local phone number in the US


    (
    ) Your local phone number in the US

    Amount to be refunded or abated


    $ Example: $547

    Excise (see instructions)

    943

    945

    990-PF

    4720

    Other (specify)

    4a Request for abatement or refund of:


    Interest as a result of IRS errors or delays.
    A penalty or addition to tax as a result of erroneous advice from the IRS.
    b Dates of payment
    5

    Explanation and additional claims. Explain why you believe this claim should be allowed, and show the computation of your
    tax refund or abatement of interest, penalty, or addition to tax. If you need more space, attach additional sheets.

    EXAMPLE:
    I am a (indicate F-1 or J-1) student who has been in the U.S. less than 5 calendar years and I am considered a
    nonresident alien for tax purposes. Social Security and Medicare taxes were withheld from my wages while I was on
    (indicate: Optional Practical Training or Curricular Practical Training). According to IRS Pub. 519, I am not subject
    to Social Security and Medicare taxes while on Practical Training as long as I am a nonresident alien for tax
    purposes.
    Social Security tax withheld
    Medicare tax withheld
    Total refund due

    $327
    $220
    ---------$547

    Note: Social security taxes withheld are reported in box 4 of Form W-2.
    Medicare taxes withheld are reported in box 6 of form W-2.

    Signature. If you are filing Form 843 to request a refund or abatement relating to a joint return, both you and your spouse must
    sign the claim. Claims filed by corporations must be signed by a corporate officer authorized to sign, and the signature must be
    accompanied by the officers title.
    Under penalties of perjury, I declare that I have examined this claim, including accompanying schedules and statements, and, to the best of my knowledge and
    belief, it is true, correct, and complete.

    Sign your name here

    Date form signed

    Signature (Title, if applicable. Claims by corporations must be signed by an officer.)

    Date

    Signature

    Date

    For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

    Cat. No. 10180R

    Form

    843

    (Rev. 11-2005)

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