This form contains 10 fields organized into 4 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Calculations
2 Multiply line 1c by 40% (0.40). See instructions for the adjustment you must make to your deduction for salaries and wages. 2 Text
Multiply the total qualified wages by 40% (0.40) and enter the result. Refer to the instructions for any adjustments needed to your deduction for salaries and wages.
Credit Amounts
3 Employee retention credit from partnerships, S corporations, cooperatives, estates, and trusts (see instructions) 3 Text
Enter the employee retention credit amount received from partnerships, S corporations, cooperatives, estates, and trusts. Refer to the instructions for more details.
4 Text
Enter the total employee retention credit amount.
5 5 Text
Enter any additional employee retention credit amounts.
6 Text
Enter the final total of the employee retention credit.
Employer Information
Identifying Text
Enter the identifying information for the employer, such as the business name.
Identifying number Text
Enter the employer's identifying number, such as the Employer Identification Number (EIN). This field has a maximum length of 11 characters.
Max length: 11 characters
Qualified Wages
1a Text
Enter the total qualified wages paid during the specified disaster period.
b 1b Text
Enter any additional qualified wages paid during the specified disaster period.
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Enter the total of all qualified wages paid during the specified disaster period.