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         The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
         deferred under Notice 2020-65 and Notice 2021-11 if paid   as a qualifying employer, receive an approved Form 4029,
         by the due date.                                       Application for Exemption From Social Security and
                                                                Medicare Taxes and Waiver of Benefits, from one or more
         Specific Instructions                                  of your employees, enter “Form 4029” on the dotted line
                                                                next to the entry space.
         Line 1. Number of Agricultural                           For purposes of the credit for qualified sick and family
         Employees                                              leave wages, qualified sick leave and family leave wages
                                                                are wages for social security and Medicare tax purposes,
         Enter the number of agricultural employees on your     determined without regard to the exclusions from the
                                                                definition of employment under sections 3121(b)(1)–(22),
         payroll during the pay period that included March 12,   that an employer pays that otherwise meet the
         2022. Don't include household employees, persons who   requirements of the Emergency Paid Sick Leave Act
         received no pay during the pay period, pensioners, or   (EPSLA) or the Emergency Family and Medical Leave
         members of the Armed Forces.                           Expansion Act (Expanded FMLA), as enacted under the
                For purposes of these instructions, all references   FFCRA and amended for purposes of the ARP. However,
          TIP   to “sick pay” mean ordinary sick pay, not “qualified   don't include any wages otherwise excluded under
                sick leave wages” that are reported on line 2a for   section 3121(b) when reporting qualified sick and family
         leave taken after March 31, 2020, and before April 1,   leave wages on lines 2, 2a, 2b, 4, and, if applicable, 6.
         2021, or reported on line 2 for leave taken after March 31,   See the instructions for line 12d for information about the
         2021, and before October 1, 2021.                      credit for qualified sick and family leave wages paid in
                                                                2022 for leave taken after March 31, 2021, and before
         Line 2. Wages Subject to Social                        October 1, 2021.
         Security Tax                                           EPSLA.  Employers with fewer than 500 employees and,

         Enter the total cash wages, including qualified sick leave   for leave taken after March 31, 2021, and before October
                                                                1, 2021, certain governmental employers without regard
         wages and qualified family leave wages paid in 2022 for   to number of employees (except for the federal
         leave taken after March 31, 2021, and before October 1,   government and its agencies and instrumentalities unless
         2021; sick pay; and taxable fringe benefits subject to   described in section 501(c)(1)) are entitled to a credit if
         social security taxes you paid to your employees for   they provide paid sick leave to employees that otherwise
         farmwork during the calendar year. Don’t include the   meets the requirements of the EPSLA. Under the EPSLA,
         qualified sick leave wages paid in 2022 reported on    as amended for purposes of the ARP, wages are qualified
         line 2a or the qualified family leave wages paid in 2022   sick leave wages if paid to employees that are unable to
         reported on line 2b for leave taken after March 31, 2020,   work before October 1, 2021, because the employee:
         and before April 1, 2021. For this purpose, sick pay
         includes payments made by an insurance company to        1. Is subject to a federal, state, or local quarantine or
         your employees for which you received timely notice from   isolation order related to COVID-19;
         the insurance company. See section 6 of Pub. 15-A for    2. Has been advised by a health care provider to
         more information about sick pay reporting. See the     self-quarantine due to concerns related to COVID-19;
         instructions for line 10 for an adjustment that you may   3. Is experiencing symptoms of COVID-19 and
         need to make on Form 943 for sick pay.                 seeking a medical diagnosis; or, for leave taken after

            Enter the amount before payroll deductions. Cash    March 31, 2021, and before October 1, 2021, is seeking
         wages include checks, money orders, etc. Don't include   or awaiting the results of a diagnostic test for, or a medical
         the value of noncash items, such as food or lodging, or   diagnosis of, COVID-19 (and the employee has been
         pay for services other than farmwork. See section 3 of   exposed to COVID-19 or the employee's employer has
         Pub. 51 for information on cash and noncash wages. See   requested such test or diagnosis), or the employee is
         Purpose of Form 943, earlier, for household employee   obtaining immunizations related to COVID-19 or
         information.                                           recovering from an injury, disability, illness, or condition
                                                                related to such immunization;
            For 2022, the rate of social security tax on taxable   4. Is caring for an individual subject to an order
         wages, except for qualified sick leave wages and qualified   described in (1) or who has been advised as described in
         family leave wages paid in 2022 for leave taken after   (2);
         March 31, 2020, and before April 1, 2021, is 6.2% (0.062)   5. Is caring for a son or daughter because the school
         each for the employer and employee or 12.4% (0.124) for
         both. Stop paying social security tax on and entering an   or place of care for that child has been closed, or the
                                                                childcare provider for that child is unavailable, due to
         employee's wages on line 2 when the employee's taxable   COVID-19 precautions; or
         wages, including qualified sick leave wages paid in 2022
         that are reported on line 2a and qualified family leave   6. Is experiencing any other substantially similar
         wages paid in 2022 that are reported on line 2b, reach   condition specified by the U.S. Department of Health and
         $147,000 for the year. However, continue to withhold   Human Services, which for leave taken after March 31,
         income and Medicare taxes for the whole year on all    2021, and before October 1, 2021, includes to
         wages, including qualified sick leave wages and qualified   accompany an individual to obtain immunization related to
         family leave wages paid in 2022, even when the social   COVID-19, or to care for an individual who is recovering
         security wage base of $147,000 has been reached. If you,

                                                            -10-                       Instructions for Form 943 (2022)
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