This form contains 13 fields organized into 3 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Basic Information
Name(s) shown on return Text
Enter the name(s) as shown on your tax return.
Identifying number Text
Enter your identifying number, such as your Social Security Number (SSN) or Employer Identification Number (EIN). Maximum length is 11 characters.
Max length: 11 characters
Credit Calculation
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Check this box if you are claiming the credit for wages paid during the tax year.
topmostSubform[0].Page1[0].c1_3[1]_2 CheckBox
Check this box if you are not claiming the credit for wages paid during the tax year.
topmostSubform[0].Page1[0].c1_4[0]_1 CheckBox
Check this box if you have completed all required calculations for the credit.
topmostSubform[0].Page1[0].c1_4[1]_2 CheckBox
Check this box if you have not completed all required calculations for the credit.
1 Text
Enter the total amount of wages paid during the tax year that qualify for the credit.
2 Text
Enter any additional amounts that qualify for the credit.
3 Add lines 1 and 2. Partnerships and S corporations, report this amount on Schedule K. All others, report this amount on Form 3800, Part III, line 4j 3 Text
Add the amounts from lines 1 and 2. Partnerships and S corporations should report this amount on Schedule K. All others should report this amount on Form 3800, Part III, line 4j.
Eligibility
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Check this box if you meet the eligibility criteria for the Employer Credit for Paid Family and Medical Leave.
topmostSubform[0].Page1[0].c1_1[1]_2 CheckBox
Check this box if you do not meet the eligibility criteria for the Employer Credit for Paid Family and Medical Leave.
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
Check this box if you have provided paid family and medical leave to your employees.
topmostSubform[0].Page1[0].c1_2[1]_2 CheckBox
Check this box if you have not provided paid family and medical leave to your employees.