This form contains 55 fields organized into 9 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Contact Information
Daytime telephone number Text
Enter a daytime telephone number where the organization can be reached.
Credit Calculation
Multiply line 4a by 26% (0.26) 4b Text
Multiply the amount on line 4a by 26% (0.26) to calculate the Work Opportunity Credit.
5b b Multiply line 5a by 16.25% (0.1625) Text
Multiply the amount on line 5a by 16.25% (0.1625) and enter the result here.
6 6 Add lines 4b and 5b Text
Add the amounts on lines 4b and 5b and enter the total here.
Subtract line 7 from line 6 8 Text
Subtract the amount on line 7 from the amount on line 6 and enter the result here.
Note: If you filed a corrected return (for example, Form 941-X) for the period indicated on line 3, enter the amount as corrected. Multiply line 9 by 6.2% (0.062) . 10 Text
If you filed a corrected return (e.g., Form 941-X) for the period indicated on line 3, enter the corrected amount. Multiply the amount on line 9 by 6.2% (0.062) and enter the result here.
Credit claimed for the employment tax period indicated on line 3. Enter the smaller of line 8 or line Text
Enter the credit claimed for the employment tax period indicated on line 3. Enter the smaller of the amounts on line 8 or line 9.
Credit Information
topmostSubform[0].Page1[0].c1_3[8]_9 CheckBox
Check this box if the organization is claiming the Work Opportunity Credit for the first time.
topmostSubform[0].Page1[0].c1_3[9]_10 CheckBox
Check this box if the organization is claiming the Work Opportunity Credit for additional qualified veterans.
Employment Tax Period
topmostSubform[0].Page1[0].c1_3[2]_3 CheckBox
Check this box if the organization is filing for the first quarter of the year.
topmostSubform[0].Page1[0].c1_3[3]_4 CheckBox
Check this box if the organization is filing for the second quarter of the year.
topmostSubform[0].Page1[0].c1_3[4]_5 CheckBox
Check this box if the organization is filing for the third quarter of the year.
topmostSubform[0].Page1[0].c1_3[5]_6 CheckBox
Check this box if the organization is filing for the fourth quarter of the year.
topmostSubform[0].Page1[0].c1_3[6]_7 CheckBox
Check this box if the organization is filing an annual employment tax return.
topmostSubform[0].Page1[0].c1_3[7]_8 CheckBox
Check this box if the organization is filing a final employment tax return.
topmostSubform[0].Page1[0].c1_4[0]_1 CheckBox
Check this box if the organization is claiming the Work Opportunity Credit for the first quarter.
topmostSubform[0].Page1[0].c1_4[1]_2 CheckBox
Check this box if the organization is claiming the Work Opportunity Credit for the second quarter.
topmostSubform[0].Page1[0].c1_4[2]_3 CheckBox
Check this box if the organization is claiming the Work Opportunity Credit for the third quarter.
topmostSubform[0].Page1[0].c1_4[3]_4 CheckBox
Check this box if the organization is claiming the Work Opportunity Credit for the fourth quarter.
Employment Tax Return Type
topmostSubform[0].Page1[0].c1_1[0 CheckBox
Check this box if the organization files Form 941, 941-SS, or 941-PR.
topmostSubform[0].Page1[0].c1_1[1]_No CheckBox
Check this box if the organization does not file Form 941, 941-SS, or 941-PR.
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
Check this box if the organization files Form 944.
topmostSubform[0].Page1[0].c1_2[1]_2 CheckBox
Check this box if the organization files Form 943.
topmostSubform[0].Page1[0].c1_2[2]_3 CheckBox
Check this box if the organization files Form 945.
topmostSubform[0].Page1[0].c1_2[3]_4 CheckBox
Check this box if the organization files Form CT-1.
topmostSubform[0].Page1[0].c1_2[4]_5 CheckBox
Check this box if the organization files Form 1042.
topmostSubform[0].Page1[0].c1_2[5]_6 CheckBox
Check this box if the organization files any other type of employment tax return not listed above.
topmostSubform[0].Page1[0].c1_3[10]_11 CheckBox
Check this box if the organization files Form 941, Employer's Quarterly Federal Tax Return.
topmostSubform[0].Page1[0].c1_3[11]_12 CheckBox
Check this box if the organization files Form 944, Employer's Annual Federal Tax Return.
topmostSubform[0].Page1[0].c1_3[12]_13 CheckBox
Check this box if the organization files Form 943, Employer's Annual Federal Tax Return for Agricultural Employees.
topmostSubform[0].Page1[0].c1_3[13]_14 CheckBox
Check this box if the organization files Form CT-1, Employer's Annual Railroad Retirement Tax Return.
topmostSubform[0].Page1[0].c1_3[14]_15 CheckBox
Check this box if the organization files Form 945, Annual Return of Withheld Federal Income Tax.
topmostSubform[0].Page1[0].c1_3[15]_16 CheckBox
Check this box if the organization files any other type of employment tax return not listed above.
Filing Information
topmostSubform[0].Page1[0].c1_2[6]_7 CheckBox
Check this box if the organization is filing Form 5884-C for the first time.
topmostSubform[0].Page1[0].c1_2[7]_8 CheckBox
Check this box if the organization is amending a previously filed Form 5884-C.
topmostSubform[0].Page1[0].f1_16[0 Text
Enter the date.
Title Text
Enter the title of the person signing the form.
topmostSubform[0].Page1[0].c1_5[0]_1 CheckBox
Check this box if applicable.
Organization Information
topmostSubform[0].Page1[0].f1_1[0 Text
Enter the name of the organization claiming the Work Opportunity Credit.
Employer identification number Text
Enter the Employer Identification Number (EIN) of the organization. This is a 10-digit number.
Max length: 10 characters
Trade name (if any) Text
Enter the trade name of the organization, if applicable.
Number, street, and room or suite no. If a P.O. box, see instructions Text
Enter the street address, including room or suite number. If using a P.O. box, refer to the instructions.
City or town, state, and ZIP code Text
Enter the city, state, and ZIP code of the organization's address.
topmostSubform[0].Page1[0].c1_3[0]_1 CheckBox
Check this box if the organization is a qualified tax-exempt organization.
topmostSubform[0].Page1[0].c1_3[1]_2 CheckBox
Check this box if the organization is a qualified veteran organization.
topmostSubform[0].Page1[0].f1_8[0 Text
Enter the organization's name.
topmostSubform[0].Page1[0].f1_11[0 Text
Enter the organization's address.
topmostSubform[0].Page1[0].f1_13[0 Text
Enter the organization's Employer Identification Number (EIN).
Firm's address Text
Enter the complete address of the organization claiming the Work Opportunity Credit.
Firm's EIN Text
Enter the Employer Identification Number (EIN) of the organization. This should be a 10-digit number.
Max length: 10 characters
Phone no Text
Enter the phone number of the organization for contact purposes.
Preparer Information
Print/Type preparer's name Text
Print or type the name of the preparer.
PTIN Text
Enter the Preparer Tax Identification Number (PTIN).
Max length: 11 characters
Firm's name Text
Enter the name of the preparer's firm.
Qualified Wages
topmostSubform[0].Page1[0].f1_6[0 Text
Enter the total qualified first-year wages paid to qualified veterans.