Form  5884-A                  Employee Retention Credit for Employers                                         OMB No. 1545-1978
(Rev. March 2021)                   Affected by Qualified Disasters
Department of the Treasury          ▶ Attach to your tax return.                                              Attachment   
Internal Revenue Service    ▶ Go to www.irs.gov/Form5884A for instructions and the latest information.        Sequence No. 884A
Name(s) shown on return                                                                                Identifying number

1 a   Employers  affected  by  a  2018  through  2019  qualified  disaster,  enter 
      the total qualified wages paid or incurred during the applicable period 
      while the business was inoperable. See instructions  . . . . . . .           1a

b     Employers  affected  by  a  2020  qualified  disaster,  enter  the  total 
      qualified wages paid or incurred during the applicable period while the 
      business was inoperable. See instructions  . . . . . . . . . .               1b

c     Add amounts from lines 1a and 1b  . . . . . . . . . . . . . . . . . . . . .                        1c

2     Multiply line 1c by 40% (0.40). See instructions for the adjustment you must make to your 
      deduction for salaries and wages . . . . . . . . . . . . . . . . . . . . . .                       2

3     Employee  retention  credit  from  partnerships,  S  corporations,  cooperatives,  estates,  and 
      trusts (see instructions)  . . . . . . . . . . . . . . . . . . . . . . . . .                       3

4     Add  lines  2  and  3.  Cooperatives,  estates,  and  trusts,  go  to  line  5.  Partnerships  and 
      S corporations, stop here and report this amount on Schedule K. All others, stop here and 
      report this amount on Form 3800, Part III, line 1aa      . . . . . . . . . . . . . . .             4

5     Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see 
      instructions)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                           5

6     Cooperatives, estates, and trusts, subtract line 5 from line 4. Report this amount on Form 
      3800, Part III, line 1aa  . . . . . . . . . . . . . . . . . . . . . . . . . .                      6
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 47425B                           Form 5884-A (Rev. 3-2021)