950823
Form  8974:           Qualified Small Business Payroll Tax Credit for Increasing Research Activities
(Rev. March 2023)     Department of the Treasury — Internal Revenue Service                                                              OMB No. 1545-0029
Employer identification             —                                                                               Report for this quarter...
number (EIN)
                                                                                                                Check only one box.
Name 
(not your trade name)                                                                                               1: January, February, March
The credit from Part 2, line 12 or, if applicable,                                                                  2: April, May, June
line 17, will be reported on (check only one box):     Form 941, 941-PR, or 941-SS
                                                                                                                    3: July, August, September
                                                       Form 943 or 943-PR 
                                                                                                                    4: October, November, December
                                                       Form 944 or 944(SP)
Calendar year                       You must select a quarter if you file Form 941, 941-PR, or 941-SS.

Part 1:   Tell us about your income tax return.
                  (a)           (b)                    (c)                     (d)            (e)                     (f)                (g) 
        Ending date of    Income                   Date income tax          EIN used on     Amount from           Amount of credit    Remaining credit 
      income tax period   tax return                 return was filed       Form 6765     Form 6765, line 44,     from column (e)     (subtract column (f) 
                          filed that                                                      or if applicable, the     taken on a        from column (e))  
                          included                                                        amount that was         previous period(s)  
                          Form 6765                                                     allocated to your EIN 
1       /             /                              /     /                                          .                   .                    .
2       /             /                              /     /                                          .                   .                    .
3       /             /                              /     /                                          .                   .                    .
4       /             /                              /     /                                          .                   .                    .
5       /             /                              /     /                                          .                   .                    .
6     Add lines 1(g) through 5(g) and enter the total here            .     . . .  .    . . . . .       . .     . . . .   .     .              .
Part 2:   Determine the credit that you can use this period.

7     Enter the amount from Part 1, line 6(g)          . .   . .      .     . . .  .    . . . . .       . .     . 7                            .
8     Enter the amount from Form 941 (941-PR or 941-SS), 
      line 5a, column 2; Form 943 (943-PR), line 3; or Form 
      944 (944(SP)), line 4a, column 2 .           . . . .   . .      .     8                             .
9     Enter the amount from Form 941 (941-PR or 941-SS), line 
      5b, column 2; or Form 944 (944(SP)), line 4b, column 2                9                             .
10    Add lines 8 and 9 . .     .   . .            . . . .   . .      .     10                            .
11    Multiply line 10 by 50% (0.50). Check this box         if you’re a third-party payer of sick pay or
      check this box    if you received a Section 3121(q) Notice and Demand. See the instructions
      before completing line 11  .  . .            . . . .   . .      .     . . .  .    . . . . .       . .     . 11                           .
12  Credit against the employer share of social security tax. Enter the smaller of line 7 or 
      11, but not more than $250,000. See the instructions before entering an amount if you file
      Form 943 or Form 944. If you entered the amount from line 7, stop here and also enter this
      amount on Form 941 (941-PR or 941-SS), line 11a; Form 943 (943-PR), line 12a; or Form
      944 (944(SP)), line 8a  . .   . .            . . . .   . .      .     . . .  .    . . . . .       . .     . 12                           .
13    Subtract line 12 from line 7  . .            . . . .   . .      .     13                            .
14    Enter the amount from Form 941 (941-PR or 941-SS), 
      line 5c, column 2; Form 943 (943-PR), line 5; or Form 
      944 (944(SP)), line 4c, column 2 .           . . . .   . .      .     14                            .
15    Multiply line 14 by 50% (0.50). If you’re a third-party payer 
      of sick pay or you received a Section 3121(q) Notice and 
      Demand, see the instructions before completing line 15                15                            .
16    Credit against the employer share of Medicare tax. Enter the smaller of line 13 or 15  .                    16                           .
17    Total credit. Add lines 12 and 16. Also, enter this amount on Form 941 (941-PR or 941-SS), 
      line 11a; Form 943 (943-PR), line 12a; or Form 944 (944(SP)), line 8a  .            . . . .       . .     . 17                           .
For Paperwork Reduction Act Notice, see the separate instructions.                 www.irs.gov/Form8974         Cat. No. 37797C     Form 8974 (Rev. 3-2023)