FICA Tax Refund Authorization

Complete this form to authorize Cornell University to refund the employee's share of FICA taxes (i.e., Medicare and Social Security taxes withheld). An employee who is exempt from FICA taxes and eligible for a FICA refund will be repaid or reimbursed to the extent that the taxes are refunded by the IRS. Exemption requirements must be met.

IMPORTANT: Employees who have been contacted by the university regarding a FICA refund, must submit this completed form within 45 days of the certified mailing date, or the employee will be considered to have refused to provide authorization.