PDF document

- 1 -

                                      Work Opportunity Credit for Qualified Tax-Exempt               
Form    5884-C
(Rev. March 2021)                            Organizations Hiring Qualified Veterans                                                           OMB No. 1545-0047
                                           ▶ 
Department of the Treasury                   File this form separately; do not attach it to your return.                                  
Internal Revenue Service                   ▶ Go to www.irs.gov/Form5884C for the latest information.                                 
Name (not trade name) shown on Form 941 or other employment tax return                                                                      Employer identification number

Trade name (if any)

Number, street, and room or suite no.  If a P.O. box, see instructions.

City or town, state, and ZIP code

1       Is the organization a qualified tax-exempt organization (an organization described in section 501(c) and 
        exempt from tax under section 501(a))? See instructions  .                  . . . .  . .    .   . .  . .     . .           .      . .    Yes No
        If “Yes,” go to line 2. If “No,” do not file this form; the organization cannot claim this credit.
2       Check a box to indicate the employment tax return the organization filed to report wages paid to a qualified veteran:
        a     Form 941     b       Form 941-PR    c      Form 941-SS                d   Form 943    e     Form 943-PR
        f     Form 944 (or 944(SP))               g      Form 944-PR                h   Form 944-SS
3       Check a box or boxes to indicate the employment tax period for which the organization is claiming this credit. See instructions:
a       Check year:              2011        2012                        2013       2014            2015       2016                         2017     2018
                                 2019        2020                        2021       2022            2023       2024                         2025     2026
b       Check quarter (if applicable):     1st: January, February, March                2nd: April, May, June
                                           3rd: July, August, September                 4th: October, November, December
4a      See instructions and enter the total qualified first-year wages paid through the
        end of the employment tax period indicated on line 3 to all employees certified 
        as  qualified  veterans  who  began  working  for  you  on  or  after  November  22, 
        2011, and who worked for you for at least 400 hours (as of the date you file
        this form) .     . .     . .  .  . . .  .  .  .                . . .  . .   . . . .  . .        4a
b       Multiply line 4a by 26% (0.26)  .    .  .  .  .                . . .  . .   . . . .  . .    .   . .  . .     . .           .        4b
5a      See instructions and enter the total qualified first-year wages paid through the
        end of the employment tax period indicated on line 3 to all employees certified 
        as  qualified  veterans  who  began  working  for  you  on  or  after  November  22, 
        2011, and who worked for you for at least 120 hours but fewer than 400 hours 
        (as of the date you file this form)  .  .  .  .                . . .  . .   . . . .  . .        5a
b       Multiply line 5a by 16.25% (0.1625)  .     .  .                . . .  . .   . . . .  . .    .   . .  . .     . .           .        5b
6       Add lines 4b and 5b  .        .  . . .  .  .  .                . . .  . .   . . . .  . .    .   . .  . .     . .           .        6
7       Enter the total amount of credits claimed on line 11 (minus any amounts reported on line 12) of any 
        Forms 5884-C filed for prior employment tax periods. See instructions .              . .    .   . .  . .     . .           .        7
        Note: If line 7 is greater than line 6, skip lines 8 through 11 and go to line 12. Otherwise, go to line 8.
8       Subtract line 7 from line 6      . . .  .  .  .                . . .  . .   . . . .  . .    .   . .  . .     . .           .        8
9       Enter the organization’s total taxable social security wages and tips reported on the return indicated 
        on line 2 for the period indicated on line 3. See instructions  .             . . .  . .    .   . .  . .     . .           .        9
        Note: If you filed a corrected return (for example, Form 941-X) for the period indicated on line 3, enter the amount as corrected.
10      Multiply line 9 by 6.2% (0.062)  .   .  .  .  .                . . .  . .   . . . .  . .    .   . .  . .     . .           .        10
11      Credit claimed for the employment tax period indicated on line 3. Enter the smaller of line 8 or line 
        10. This is the amount that will be refunded to you. Stop here, sign, and mail this form to the address 
        below. See instructions       .  . . .  .  .  .                . . .  . .   . . . .  . .    .   . .  . .     . .           .        11
12      If line 7 is greater than line 6, subtract line 6 from line 7. This is the amount you owe. Sign and mail 
        this form to the address below with your payment for this amount. See instructions.               .  . .     . .           .        12
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and 
belief, it is true, correct, and complete. Declaration of preparer is based on all information of which preparer has any knowledge.
                                                                                             Daytime telephone number
Sign 
Here
              Signature of officer                                            Title                                    Date
              Print/Type preparer’s name              Preparer’s signature                              Date                                   PTIN
Paid                                                                                                                   Check         if 
                                                                                                                       self-employed
Preparer 
Use Only      Firm’s name      ▶                                                                                Firm’s EIN  ▶
              Firm’s address  ▶                                                                                 Phone no.
                             Send Form 5884-C to: Department of the Treasury, Internal Revenue Service, Ogden, UT 84201
For Paperwork Reduction Act Notice, see instructions.                                   Cat. No. 59008C                                   Form 5884-C (Rev. 3-2021)

- 2 -

Form 5884-C (Rev. 3-2021) Page 2
General Instructions The amount properly claimed on Form 5884-C is
treated as a credit on the first day of the
Section references are to the Internal Revenue Code unless TIP organization’s employment tax return period.
otherwise noted. However, because Form 5884-C will generally not be
processed with the organization’s employment tax return, an
Future Developments organization that reduces its required deposits in anticipation of
For the latest information about developments related to Form a Form 5884-C credit may receive a system-generated notice
5884-C and its instructions, such as legislation enacted after reflecting a balance due and associated penalties and interest, if
they were published, go to www.irs.gov/Form5884C. applicable. The balance due, including any related penalties and
interest, resulting from the reduction in deposits to reflect the
What’s New Form 5884-C credit will be abated when the credit is applied.
Such abatement will generally occur without any action from the
Credit extension. The work opportunity credit is now available organization.
for qualified veterans who began work for the organization after
2020 and before 2026. Qualified Tax-Exempt Organization
Coronavirus-related employee retention credit. You may A qualified tax-exempt organization is an organization described
have claimed an employee retention credit on an employment in section 501(c) and exempt from tax under section 501(a). An
tax return such as Form 941, Employer’s QUARTERLY Federal agency or instrumentality of the federal government, or of a
Tax Return. Wages paid after December 31, 2020, and before state, local, or Indian tribal government, is not a qualified tax-
July 1, 2021, and used to figure this coronavirus-related exempt organization unless it is an organization described in
employee retention credit can’t also be used to figure a credit section 501(c) and exempt from tax under section 501(a).
on Form 5884-C. See Qualified First-Year Wages.
Credit for qualified sick and family leave wages. You may Qualified Veteran
claim a credit for qualified sick and family leave wages on an A qualified veteran is a veteran certified (as described below) as
employment tax return such as Form 941. Wages paid after any of the following.
March 31, 2021, and before October 1, 2021, and used to figure
that credit, can't also be used to figure a credit on Form 5884-C. • A member of a family receiving assistance under the
See Qualified First-Year Wages. Supplemental Nutrition Assistance Program (SNAP) (food
stamps) for at least a 3-month period during the 15-month
Disaster-related employee retention credit. You may claim a period ending on the hiring date.
2020 qualified disaster employee retention credit on Form 5884-
D, Employee Retention Credit for Certain Tax-Exempt • Unemployed for a period or periods totaling at least 4 weeks
Organizations Affected by Qualified Disasters. Wages used to (whether or not consecutive) but less than 6 months in the
figure this disaster-related employee retention credit can’t also 1-year period ending on the hiring date.
be used to figure a credit on Form 5884-C. See Qualified First- • Unemployed for a period or periods totaling at least 6 months
Year Wages. (whether or not consecutive) in the 1-year period ending on the
hiring date.
Purpose of Form • Entitled to compensation for a service-connected disability
Qualified tax-exempt organizations (defined below) use Form and hired not more than 1 year after being discharged or
5884-C to claim the work opportunity credit for qualified released from active duty in the U.S. Armed Forces.
first-year wages paid to qualified veterans who begin working • Entitled to compensation for a service-connected disability
for the organization on or after November 22, 2011, and before and unemployed for a period or periods totaling at least 6
January 1, 2026. The credit is claimed against the employer months (whether or not consecutive) in the 1-year period ending
portion of social security tax on wages paid to all employees on the hiring date.
during the 1-year period beginning on the day a qualified
veteran begins working for the organization. The credit does not To be considered a veteran, the individual must:
apply to the employer portion of Medicare tax. The qualified • Have served on active duty (not including training) in the U.S.
veteran must be performing services in activities related to the Armed Forces for more than 180 days or have been discharged
purpose or function constituting the basis of the organization’s or released from active duty for a service-connected disability,
exemption under section 501. and
The organization files Form 5884-C after it files its • Not have a period of active duty (not including training) of
employment tax return for the employment tax period for which more than 90 days that ended during the 60-day period ending
it is claiming the credit. The organization files Form 5884-C for on the hiring date.
each employment tax period during which qualified first-year
wages are paid to a qualified veteran. Each Form 5884-C figures Certification Requirement
the cumulative credit the organization is entitled to for all The organization must ask for and be issued a certification for
periods during which qualified first-year wages are paid to a each qualified veteran from the state workforce agency (SWA)
qualified veteran and reduces the amount claimed for the period (formerly known as the state employment security agency
by any amounts claimed on previously filed Forms 5884-C. (SESA)) of the state in which the organization is located. The
Generally, the organization should only file one Form 5884-C per certification proves that the employee is a qualified veteran. The
employment tax period. organization must either:
Form 5884-C is filed separately from any other returns. The • Receive the certification by the day the individual begins work;
credit claimed on Form 5884-C will not affect the tax liability or
reported on the organization’s employment tax returns. • Complete Form 8850, Pre-Screening Notice and Certification
Accordingly, the organization should not reduce its required Request for the Work Opportunity Credit, on or before the day it
deposits in anticipation of any credit. Instead, the IRS will refund offers the individual a job and receive the certification before it
the amount shown on line 11 of Form 5884-C, plus any interest claims the credit.
that applies, unless the IRS corrects Form 5884-C during
processing or the organization owes other taxes, penalties, or
interest.

- 3 -

Form 5884-C (Rev. 3-2021) Page 3

If the organization completes Form 8850, it must be signed by When To File
an officer of the organization and the individual and submitted
to the SWA of the state in which the organization is located File Form 5884-C after the organization has filed its employment
(where the employee works) generally by the 28th calendar day tax return for the employment tax period for which it is claiming
after the date the individual begins work. the credit. File Form 5884-C for each employment tax period
during which the organization paid qualified first-year wages to
If the credit expires and is retroactively extended, the a qualified veteran.
IRS may allow the organization more time to submit
TIP Form 8850 for an individual who began work while the Generally, an organization should not file more than one Form
credit was expired or for a reasonable time after it was 5884-C per employment tax period.
extended. If more time is allowed, we will provide details at Note: The IRS cannot process Form 5884-C until the original
www.irs.gov/Form8850 and in revised Instructions for Form employment tax return filed for the same tax period has been
8850. processed. Please allow 8–12 weeks for the processing of Form
If the SWA denies the request, it will provide a written 5884-C.
explanation of the reason for denial. If the certification is Form 5884-C must be filed within 2 years from the
revoked because it was based on false information provided by date the tax reported on the employment tax return
the employee, wages paid after the date the organization ▲! was paid, or 3 years from the date the employment
receives the notice of revocation don’t qualify for the credit. CAUTION tax return was filed, whichever is later.
Qualified First-Year Wages Where To File
Qualified first-year wages are wages subject to social security tax Send Form 5884-C to the address provided at the bottom of the
paid to a qualified veteran during the 1-year period beginning on form.
the day the qualified veteran begins working for the organization.
Qualified first-year wages do not include any wages that More Information
exceed the following amounts. For more information about this credit, see the following.
• $6,000 for a qualified veteran certified as being either (a) a • Section 3111(e).
member of a family receiving assistance under the Supplemental • Notice 2012-13, 2012-9 I.R.B. 421, available at
Nutrition Assistance Program (SNAP) (food stamps) for at least a www.irs.gov/irb/2012-09_IRB#NOT-2012-13.
3-month period during the 15-month period ending on the hiring
date, or (b) unemployed for a period or periods totaling at least 4 Specific Instructions
weeks (whether or not consecutive) but less than 6 months in the
1-year period ending on the hiring date. Name and Address
• $12,000 for a qualified veteran certified as being entitled to
compensation for a service-connected disability and hired not If the organization receives its mail in care of a third party (such
more than 1 year after being discharged or released from active as an accountant or an attorney), enter on the street address
duty in the U.S. Armed Forces. line “C/O” followed by the third party’s name and street address
or P.O. box.
• $14,000 for a qualified veteran certified as being unemployed
for a period or periods totaling at least 6 months (whether or not Include the suite, room, or other unit number after the street
consecutive) in the 1-year period ending on the hiring date. address. If the Post Office does not deliver mail to the street
address and the organization has a P.O. box, enter the box
• $24,000 for a qualified veteran certified as being entitled to number instead of the street address.
compensation for a service-connected disability and unemployed
for a period or periods totaling at least 6 months (whether or not Line 1
consecutive) in the 1-year period ending on the hiring date. Enter “Yes” if the organization is a qualified tax-exempt
Qualified first-year wages also do not include any wages paid organization (defined earlier).
to a qualified veteran:
• For services in activities not related to the purpose or function Line 3
constituting the basis of the organization’s exemption under As discussed earlier under Purpose of Form, the organization
section 501; claims this credit against the employer’s portion of social
• During any period for which the organization received payment security tax on wages paid to all employees during the 1-year
for the qualified veteran from a federally funded on-the-job period beginning on the day a qualified veteran begins working
training program; for the organization. The organization files Form 5884-C for
each employment tax period during which it claims a credit for
• After December 31, 2020, and before July 1, 2021, if you use qualified first-year wages paid to a qualified veteran. Each Form
the same wages to claim the coronavirus-related employee 5884-C figures the cumulative credit the organization is entitled
retention credit on an employment tax return, such as Form 941; to for all periods and reduces the amount claimed for the period
• After March 31, 2021, and before October 1, 2021, if you use by any amounts claimed on previously filed Forms 5884-C.
the same wages to claim the credit for qualified sick and family Check the box(es) on line 3 to indicate the year (and quarter, if
leave wages on an employment tax return such as Form 941; and applicable) for the employment tax period for which the
• Generally after December 27, 2019, and before April 17, 2021, organization is claiming the credit.
if you use the same wages to claim the 2020 qualified disaster
employee retention credit on Form 5884-D. Line 4
Information about any future disaster credits that reduce Enter on line 4a and multiply by the percentage shown on line
qualified first-year wages may be posted under “Recent 4b the total qualified first-year wages (defined earlier) the
Developments ”at IRS.gov/Form5884C. organization paid during the employment tax period indicated
The amount of qualified wages for any qualified veteran is on line 3 to qualified veterans who began working for the
zero if the qualified veteran: organization on or after November 22, 2011, and before January
• Did not work for the organization for at least 120 hours, or 1, 2026, who worked for the organization at least 400 hours (as
of the date Form 5884-C is filed).
• Was a rehire (worked for the organization previously).

- 4 -

Form 5884-C (Rev. 3-2021) Page 4

Line 5 Paid Preparer
Enter on line 5a and multiply by the percentage shown on line A paid preparer must sign Form 5884-C and provide the
5b the total qualified first-year wages (defined earlier) the information in the Paid Preparer Use Only section if the preparer
organization paid during the employment tax period indicated was paid to prepare Form 5884-C and is not an employee of the
on line 3 to qualified veterans who began working for the filing entity. Paid preparers must sign paper returns with a
organization on or after November 22, 2011, and before January manual signature. The preparer must give the organization a
1, 2026, who worked for the organization at least 120 hours but copy of Form 5884-C in addition to the copy to be filed with the
fewer than 400 hours (as of the date Form 5884-C is filed). IRS.
If you are a paid preparer, enter your Preparer Tax
Line 7 Identification Number (PTIN) in the space provided. Include your
Enter on line 7 the total amount of credits claimed from line 11 complete address. If you work for a firm, enter the firm’s name
of any previously filed Forms 5884-C minus the total amount of and the EIN of the firm. You cannot use your PTIN in place of
credits repaid from line 12. Each Form 5884-C figures the the EIN of the tax preparation firm.
cumulative credit the organization is entitled to for all periods. You can apply for a PTIN online or by filing Form W-12, IRS
The amount of the cumulative credit reported on line 6 is Paid Preparer Tax Identification Number (PTIN) Application and
reduced by the previously claimed credits and increased by any Renewal. For more information about applying for a PTIN online,
previously repaid amounts to determine the credit claimed for visit the IRS website at www.irs.gov/PTIN.
the employment tax period for which the Form 5884-C is filed.
Generally, you are not required to complete this section if you
If the credit refunded for a prior period was limited by are filing Form 5884-C as a reporting agent and have a valid
the employer’s social security tax liability for that Form 8655, Reporting Agent Authorization, on file with the IRS.
TIP period, any credit not refunded will be carried forward However, a reporting agent must complete this section if the
and included in the cumulative credit figured on any reporting agent offered legal advice, for example, advising the
subsequent Form 5884-C. The portion of the credit not refunded client on determining whether its employees are qualified
is not included in the amount on line 7. veterans for purposes of this credit.
Line 9 Paperwork Reduction Act Notice. We ask for the information
Enter on line 9 total taxable social security wages and tips on this form to carry out the Internal Revenue laws of the United
reported on the employment tax return indicated on line 2 for States. You are required to give us the information. We need it
the employment tax period indicated on line 3. For example, to ensure that you are complying with these laws and to allow
taxable social security wages and tips included on Form 941 for us to figure and collect the right amount of tax.
wages paid in the 4th quarter of 2020 were reported on the You are not required to provide the information requested on
following lines. a form that is subject to the Paperwork Reduction Act unless
• Form 941, line 5a, column 1 (taxable social security wages). the form displays a valid OMB control number. Books or
• Form 941, line 5b, column 1 (taxable social security tips). records relating to a form or its instructions must be retained as
long as their contents may become material in the
Note: If you filed a corrected return (for example, Form 941-X) administration of any Internal Revenue law. Generally, tax
for the period indicated on line 3, enter the amounts as returns and return information are confidential, as required by
corrected. section 6103. However, certain returns and return information of
Line 11 tax-exempt organizations and trusts are subject to public
disclosure and inspection, as provided by section 6104.
If your credit is less than $1, we will send a refund or apply it The time needed to complete and file this form will vary
only if you ask us in writing to do so. depending on individual circumstances. The estimated burden
Line 12 for tax-exempt organizations filing this form is approved under
OMB control number 1545-0047 and is included in the
You may pay the amount you owe on line 12 electronically using estimates shown in the instructions for their information return.
the Electronic Federal Tax Payment System (EFTPS), by credit
or debit card, or by a check or money order.
• The preferred method of payment is EFTPS. For more
information, visit www.eftps.gov, call EFTPS Customer Service
at 800-555-4477 or 800-733-4829 (TDD), or see Pub. 966,
Electronic Federal Tax Payment System: A Guide To Getting
Started.
• To pay by credit or debit card, visit the IRS website at
www.irs.gov/PayByCard.
• If you pay by check or money order, make it payable to
“United States Treasury.” On your check or money order, be
sure to write your EIN, “Form 5884-C,” and the year (and
quarter, if applicable) indicated on line 3.
You do not have to pay if the amount you owe is less than $1.
Signature
Form 5884-C must be signed by the president, vice president,
treasurer, assistant treasurer, chief accounting officer, or other
corporate officer (such as a tax officer) authorized to sign. A
receiver, trustee, or assignee must sign any return filed for the
organization. For a trust, the authorized trustee must sign.

PDF file checksum: 2272302421

(Plugin #1/9.12/13.0)