Form    5884                       Work Opportunity Credit                                                         OMB No. 1545-0219
  (Rev. December 2016)             ▶ Attach to your tax return. 
                                                                                                                   Attachment 
Internal Revenue Service
Department of the Treasury ▶ Information about Form 5884 and its separate instructions is at www.irs.gov/form5884. Sequence No. 77
Name(s) shown on return                                                                                    Identifying number

  1     Enter on the applicable line below the total qualified first- or second-year wages paid 
        or incurred during the tax year, and multiply by the percentage shown, for services of 
        employees who are certified as members of a targeted group.

  a     Qualified  first-year  wages  of  employees  who  worked 
        for you at least 120 hours but fewer than 400 hours  . $                             ×  25% (0.25) 1a

  b     Qualified  first-year  wages  of  employees  who  worked 
        for you at least 400 hours . . . . . . . . . .         $                             ×  40% (0.40) 1b

  c     Qualified second-year wages of employees certified as 
        long-term family assistance recipients  . . . . . .    $                             ×  50% (0.50) 1c

  2     Add  lines  1a,  1b,  and  1c.  See  instructions  for  the  adjustment  you  must  make  to 
        salaries and wages . . . . . . . . . . . . . . . . . . . . . . . . .                               2

  3     Work opportunity 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 4b  . . . . . . . . . . . .                    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 4b  . . . . . . . . . . . . . . . . . . . . . .                          6
For Paperwork Reduction Act Notice, see separate instructions.     Cat. No. 13570D                                 Form 5884 (Rev. 12-2016)