Form  5884-A                        Employee Retention Credit                                                 OMB No. 1545-1978
(Rev. March 2020)                   ▶ Attach to your tax return. 
                                                                                                              Attachment   
Department of the Treasury  ▶ Go to www.irs.gov/Form5884A for instructions and the latest information.        Sequence No. 77A
Internal Revenue Service
Name(s) shown on return                                                                                Identifying number

1 a   Employers affected by Hurricane Harvey, enter the total qualified wages 
      paid  or  incurred  after  August  23,  2017,  and  before  January  1,  2018, 
      while the business was inoperable  . . . . . . . . . . . . .                   1a

b     Employers affected by Hurricane Irma, enter the total qualified wages 
      paid or incurred after September 4, 2017, and before January 1, 2018, 
      while the business was inoperable  . . . . . . . . . . . . .                   1b

c     Employers affected by Hurricane Maria, enter the total qualified wages 
      paid or incurred after September 16, 2017, and before January 1, 2018, 
      while the business was inoperable  . . . . . . . . . . . . .                   1c

d     Employers affected by certain California wildfires beginning on or after 
      October  8,  2017,  and  before  November  1,  2017,  enter  the  total 
      qualified  wages  paid  or  incurred  after  October  8,  2017,  and  before 
      January 1, 2018, while the business was inoperable  . . . . . . .              1d

e     Employers affected by certain California wildfires beginning on or after 
      December 4, 2017, enter the total qualified wages paid or incurred on 
      or  after  December  4,  2017,  and  before  January  1,  2018,  while  the 
      business was inoperable  . . . . . . . . . . . . . . . . .                     1e

f     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  . . . . . . .             1f

g     Add amounts from lines 1a, 1b, 1c, 1d, 1e, and 1f        . . . . . . . . . . . . . . .             1g

2     Multiply line 1g 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. 3-2020)