Form 14153 PDF Details

Understanding the process and requirements for filing a Medical Resident FICA Refund Claim is crucial for medical residency programs navigating the complexities of tax refunds on FICA payments. The Form 14153 serves as a comprehensive checklist to ensure that submissions for FICA refunds are complete, accurate, and compliant with the Internal Revenue Service (IRS) regulations. This form requires detailed information, including employer names, Employer Identification Numbers (EINs), a thorough verification of claims via supporting documents like Attachments 8305E and Schedule A on the Claim Support Spreadsheet, and proper documentation of new or corrected Forms 843 and 941c for each tax period in question. It also mandates the submission of original claim documents and proof of timely mailing for claims not initially listed, alongside securing written consent for employee share FICA tax refunds. Completeness of the Claim Support Spreadsheet and the consistency of claim amounts across different schedules and forms are verified to perfect the claim. Additionally, the procedural steps for assembling and sending this information to the IRS, including the specific document formats and instructions for electronic submissions, are highlighted to ensure the secure and efficient processing of claims. This intricate process underscores the importance of adherence to guidelines and meticulous record-keeping for institutions seeking FICA refunds on behalf of their medical residents.

QuestionAnswer
Form NameForm 14153
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesForm and Instructions 14153 claims support spreadsheet fica refund form

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Medical Resident FICA Refund Claim Checklist

Answer each question below to ensure your Medical Resident (MR) FICA Refund Claim submission is complete. Provide a completed copy of this checklist with your submission.

Employer name

Employer Identification Number (EIN)

1.Are all claims listed on Attachment 8305E also listed on Schedule A of your Claim Support Spreadsheet?

If you answered NO, your submission is incomplete. If you wish to withdraw a claim listed on Attachment 8305E, you must list it on Schedule A and enter "Y" under "Withdraw MR Claim". (For details about withdrawing a claim, see the instructions.)

Yes

No

2.Did you include new, signed Forms 843 and 941c for each tax period listed on Schedule A? If you answered NO, your submission may be incomplete. You must submit new Forms 843 and 941c for each MR claim listed on Schedule A unless you withdrew the claim.

Yes

No

3.Did you provide a copy of the original claim and proof of timely mailing for any claim you listed on Schedule A that was not listed on Attachment 8305E?

If you did not list any claims that were not on Attachment 8305E, check N/A.

If you answered NO, your claim(s) will be denied if you do not provide a copy of the original claim and proof of timely mailing.

Yes

No

N/A

4.Did you secure written consent or repay or reimburse all employees for which you are claiming a refund of the employee share of FICA tax?

If you answered NO, you may not claim the employee share of FICA tax.

Yes

No

5.Did you complete all tabs of the Claim Support Spreadsheet including the Entity Information, Schedules A and B, and the Employer Declaration or Schedule C (whichever is applicable)?

Yes

No

6.Do the MR claim amounts listed on Schedule A match the claim amounts shown on Forms 843 and 941c, as well as the total for each tax period listed on Schedule B?

(To verify that Schedule B and Schedule A amounts match, add the amounts shown under "Total MR Claim per Resident" on Schedule B for each tax period and compare the result to the "Amount of Perfected Claim" on Schedule A for the same tax period.)

Yes

No

Refer to page 2 of this form for information regarding sending this information to the IRS

Form 14153 (5-2010)

Catalog Number 55132P

www.irs.gov

Department of the Treasury-Internal Revenue Service

Sending Information to the IRS

(Medical Resident FICA Refund Claim Checklist)

Copy the documents listed below to a new compact disc (CD). Do not use the CD we sent to you. Unless otherwise indicated, the documents must be in either .PDF or .JPG format. If you use a different format, it will delay the processing of your claim(s).

Document

Format

 

 

 

Copy the completed spreadsheet to the CD.

Claim

Retain the file name and .xls extension.

Support

If required, print and sign the Employer Declaration. Scan the signed declaration

Spreadsheet

and copy to the CD. Name the file "Employer Declaration".

 

 

 

Scan your completed and signed forms and copy to the CD.

New, perfected Forms 843

Name the files "Form 843-941c YYYYMM" with YYYYMM identifying the tax

period(s) for which the forms apply. For example, if the forms are for the quarter

and 941c for each tax period

ending September 30, 2004, name the file "Form 843-941c 200409". A separate

 

 

Form 843 and 941c should be filed for each quarter and named accordingly.

 

 

 

Scan the original claim forms and documentation along with proof of timely

Original Forms 843 and 941c

mailing and copy to the CD.

Name the file "Original Claim YYYYMM" with YYYYMM identifying the tax

and proof of timely mailing for

period(s) of the MR claim. If the Forms 843 and 941c covered multiple quarters,

MR claims filed but not listed on

use the YYYYMM of the last quarter. For example, if the forms covered all four

Attachment 8305E.

quarters of 2004, name the file "Original Claim 200412".

 

 

 

 

Scan the relevant portions of your Section 218 Agreement or modification to

Section 218 Agreement,

the agreement which specifically excepts students from FICA tax, and

if applicable

copy to the CD.

(see instructions)

Name the file "218 Agreement".

 

 

 

Scan the signed Form 2848 or 8821, if you have not already provided it, and

 

copy to the CD.

Form 2848 or 8821

Name the file "Form 2848" or "Form 8821" as applicable. If you are providing

(if applicable)

more than one form, add a number to the file name (e.g., "Form 8821-1" and

 

 

"Form 8821-2").

 

 

After the documents have been copied to the CD, write your control number (located at the top of Letter 4609 we sent you) on the CD and mail it, along with a paper copy of the first page of Letter 4609 to:

Internal Revenue Service

Exempt Organization Compliance Area

M/S 1112

PO Box 12307

Ogden, UT 84412

We recommend you encrypt and password protect your CD using WinZip® software. We recommend that the password you select be at least eight characters long, contain at least one upper case and one lower case character, and contain at least one number. After you encrypt and add a password to the WinZip compressed folder, send an email to tege.eo.compliance@irs.gov that includes your control number and password (for security purposes, do not include your EIN). This email address is for the password related to this CD only. We cannot respond to questions or accept any other information sent to this address.

Form 14153 (5-2010)

Catalog Number 55132P

www.irs.gov

Department of the Treasury-Internal Revenue Service

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