Form 5884-A, Employee Retention Credit Completed Form Examples and Samples
Explore a completed example of Form 5884-A used by a mid-sized retail business to claim Employee Retention Credit due to COVID-19 impacts. This example includes essential business details, credit calculation, and authoritative signature, offering a practical guide for filing correctly.
Form 5884-A Example – Employee Retention Credit
How this form was filled:
This example demonstrates how a mid-sized retail company fills out Form 5884-A to claim Employee Retention Credit due to COVID-19 impacts. It contains essential business information, credit calculation, and authoritative signature.
Information used to fill out the document:
- Business Name: Tech Retail Corp
- Employer Identification Number (EIN): 98-7654321
- Business Address: 456 Innovation Avenue, New York, NY, 10001
- Total Number of Employees: 150
- Qualified Wages Paid: $1,250,000
- Credit Calculation: $75,000
- COVID-19 Impact Description: Significant decline in gross receipts
- Authorized Signature: Jane Smith
- Date Signed: 03/10/2025
What this filled form sample shows:
- Complete business information and employer identification
- Detailed calculation of qualified wages and resultant credit
- Explanation of COVID-19 impact on business operations
- Properly formatted signature and date
- Useful for mid-sized businesses in the retail sector
Form specifications and details:
| Use Case: | Mid-sized retail business claiming Employee Retention Credit |
| Filing Requirement: | COVID-19 related impacts on business |
