Internal Revenue Service United States Department of the Treasury
Level Basic Advanced Military International

Social Security Tax

Social Security and Medicare Tax Liability

Filing a Claim (continued)

Documentation for Form 843 (continued)

In certain situations, also attach these documents to Form 843:

  • A statement from the employer indicating the amount of the reimbursement the employer provided and the amount of the credit or refund the employer claimed or was authorized to claim. If the statement cannot be obtained from the employer, this information and an explanation why a statement from the employer is not attached must be provided on a statement or on Form 8316, Information Regarding Request for Refund of Social Security Tax Erroneously Withheld on Wages Received by a Nonresident Alien on an F, J, or M Type Visa, claiming the employer will not issue the refund.
  • If exempt from Social Security and Medicare tax for only part of the year, pay statements showing the tax paid during the exempt period.
Top of Form 843.