Work Opportunity Credit for Qualified Tax-Exempt               
Form    5884-C
(Rev. March 2020)                            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
b       Check quarter (if applicable):       1: January, February, March                2: April, May, June
                                             3: July, August, September                 4: 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 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. 3-2020) 

Form 5884-C (Rev. 3-2020)                                                                                                          Page  2 

General Instructions                                                 Qualified Veteran
Section references are to the Internal Revenue Code unless           A qualified veteran is a veteran certified (as described below) as 
otherwise noted.                                                     any of the following. 
                                                                     • A member of a family receiving assistance under the 
Future Developments                                                  Supplemental Nutrition Assistance Program (SNAP) (food 
For the latest information about developments related to Form        stamps) for at least a 3-month period during the 15-month 
5884-C and its instructions, such as legislation enacted after       period ending on the hiring date. 
they were published, go to www.irs.gov/Form5884C.                    • Unemployed for a period or periods totaling at least 4 weeks 
                                                                     (whether or not consecutive) but less than 6 months in the        
What’s New                                                           1-year period ending on the hiring date. 
The work opportunity credit is now available for qualified first-    • Unemployed for a period or periods totaling at least 6 months 
year wages paid to qualified veterans who began work for the         (whether or not consecutive) in the 1-year period ending on the 
organization after December 31, 2019, and before January 1,          hiring date. 
2021.                                                                • Entitled to compensation for a service-connected disability 
                                                                     and hired not more than 1 year after being discharged or 
Purpose of Form                                                      released from active duty in the U.S. Armed Forces. 
Qualified tax-exempt organizations (defined below) use Form          • Entitled to compensation for a service-connected disability 
5884-C to claim the work opportunity credit for qualified            and unemployed for a period or periods totaling at least 6 
first-year wages paid to qualified veterans who begin working        months (whether or not consecutive) in the 1-year period ending 
for the organization on or after November 22, 2011, and before       on the hiring date. 
January 1, 2021. The credit is claimed against the employer 
portion of social security tax on wages paid to all employees          To be considered a veteran, the individual must: 
during the 1-year period beginning on the day a qualified            • Have served on active duty (not including training) in the U.S. 
veteran begins working for the organization. The credit does not     Armed Forces for more than 180 days or have been discharged 
apply to the employer portion of Medicare tax. The qualified         or released from active duty for a service-connected disability, 
veteran must be performing services in activities related to the     and 
purpose or function constituting the basis of the organization’s     • Not have a period of active duty (not including training) of 
exemption under section 501.                                         more than 90 days that ended during the 60-day period ending 
The organization files Form 5884-C after it files its                on the hiring date. 
employment tax return for the employment tax period for which 
it is claiming the credit. The organization files Form 5884-C for    Certification Requirement
each employment tax period during which qualified first-year         The organization must ask for and be issued a certification for 
wages are paid to a qualified veteran. Each Form 5884-C figures      each qualified veteran from the state workforce agency (SWA) 
the cumulative credit the organization is entitled to for all        (formerly known as the state employment security agency 
periods during which qualified first-year wages are paid to a        (SESA)) of the state in which the organization is located. The 
qualified veteran and reduces the amount claimed for the period      certification proves that the employee is a qualified veteran. The 
by any amounts claimed on previously filed Forms 5884-C.             organization must either:  
Generally, the organization should only file one Form 5884-C per     • Receive the certification by the day the individual begins work; 
employment tax period.                                               or
Form 5884-C is filed separately from any other returns. The          • Complete Form 8850, Pre-Screening Notice and Certification 
credit claimed on Form 5884-C will not affect the tax liability      Request for the Work Opportunity Credit, on or before the day it 
reported on the organization’s employment tax returns.               offers the individual a job and receive the certification before it 
Accordingly, the organization should not reduce its required         claims the credit. 
deposits in anticipation of any credit. Instead, the IRS will refund 
the amount shown on line 11 of Form 5884-C, plus any interest          If the organization completes Form 8850, it generally must be 
that applies, unless the IRS corrects Form 5884-C during             signed by an officer of the organization and the individual and 
processing or the organization owes other taxes, penalties, or       submitted to the SWA of the state in which the organization is 
interest.                                                            located (where the employee works) by the 28th calendar day 
                                                                     after the date the individual begins work. 
          The amount properly claimed on Form 5884-C is 
          treated as a credit on the first day of the                     If the credit expires and is retroactively extended, the 
                                                                          IRS may allow the organization more time to submit 
TIP       organization’s employment tax return period.               TIP  Form 8850 for an individual who began work while the 
          However, because Form 5884-C will generally not be 
processed with the organization’s employment tax return, an               credit was expired or for a reasonable time after it was 
organization that reduces its required deposits in anticipation of   extended. If more time is allowed, we will provide details at 
a Form 5884-C credit may receive a system-generated notice           www.irs.gov/Form8850 and in revised Instructions for Form 
reflecting a balance due and associated penalties and interest, if   8850.
applicable. The balance due, including any related penalties and        If the SWA denies the request, it will provide a written 
interest, resulting from the reduction in deposits to reflect the    explanation of the reason for denial. If the certification is 
Form 5884-C credit will be abated when the credit is applied.        revoked because it was based on false information provided by 
Such abatement will generally occur without any action from the      the worker, wages paid after the date the organization receives 
organization.                                                        the notice of revocation don’t qualify for the credit. 
Qualified Tax-Exempt Organization
A qualified tax-exempt organization is an organization described 
in section 501(c) and exempt from tax under section 501(a). An 
agency or instrumentality of the federal government, or of a 
state, local, or Indian tribal government, is not a qualified tax-
exempt organization unless it is an organization described in 
section 501(c) and exempt from tax under section 501(a). 

Form 5884-C (Rev. 3-2020)                                                                                                         Page  3 

Qualified First-Year Wages                                          Specific Instructions
Qualified first-year wages are generally wages subject to social 
security tax paid to a qualified veteran during the 1-year period   Name and Address
beginning on the day the qualified veteran begins working for       If the organization receives its mail in care of a third party (such 
the organization. However, qualified first-year wages for any       as an accountant or an attorney), enter on the street address 
employee must be reduced by the amount of any work                  line “C/O” followed by the third party’s name and street address 
supplementation payments the organization received under the        or P.O. box. 
Social Security Act for the employee.                               Include the suite, room, or other unit number after the street 
  Qualified first-year wages do not include any wages that          address. If the Post Office does not deliver mail to the street 
exceed the following amounts.                                       address and the organization has a P.O. box, enter the box 
• $6,000 for a qualified veteran certified as being either (a) a    number instead of the street address. 
member of a family receiving assistance under the 
Supplemental Nutrition Assistance Program (SNAP) (food              Line 1
stamps) for at least a 3-month period during the 15-month           Enter “Yes” if the organization is a qualified tax-exempt 
period ending on the hiring date, or (b) unemployed for a period    organization (defined earlier). 
or periods totaling at least 4 weeks (whether or not consecutive) 
but less than 6 months in the 1-year period ending on the hiring    Line 3
date. 
                                                                    As discussed earlier under Purpose of Form, the organization 
• $12,000 for a qualified veteran certified as being entitled to    claims this credit against the employer’s portion of social 
compensation for a service-connected disability and hired not       security tax on wages paid to all employees during the 1-year 
more than 1 year after being discharged or released from active     period beginning on the day a qualified veteran begins working 
duty in the U.S. Armed Forces.                                      for the organization. The organization files Form 5884-C for 
• $14,000 for a qualified veteran certified as being unemployed     each employment tax period during which it claims a credit for 
for a period or periods totaling at least 6 months (whether or not  qualified first-year wages paid to a qualified veteran. Each Form 
consecutive) in the 1-year period ending on the hiring date.        5884-C figures the cumulative credit the organization is entitled 
• $24,000 for a qualified veteran certified as being entitled to    to for all periods and reduces the amount claimed for the period 
compensation for a service-connected disability and                 by any amounts claimed on previously filed Forms 5884-C.
unemployed for a period or periods totaling at least 6 months       Check the box(es) on line 3 to indicate the year (and quarter, if 
(whether or not consecutive) in the 1-year period ending on the     applicable) for the employment tax period for which the 
hiring date.                                                        organization is claiming the credit.
  Qualified first-year wages also do not include any wages paid     Line 4
to a qualified veteran: 
                                                                    Enter on line 4a and multiply by the percentage shown on line 
• For services in activities not related to the purpose or function 4b the total qualified first-year wages (defined earlier) the 
constituting the basis of the organization’s exemption under        organization paid during the employment tax period indicated 
section 501, or                                                     on line 3 to qualified veterans who began working for the 
• During any period for which the organization received payment     organization on or after November 22, 2011, and before January 
for the employee from a federally funded on-the-job training        1, 2021, who worked for the organization at least 400 hours (as 
program.                                                            of the date Form 5884-C is filed). 
  The amount of qualified wages for any qualified veteran is 
zero if the qualified veteran:                                      Line 5
• Did not work for the organization for at least 120 hours, or      Enter on line 5a and multiply by the percentage shown on line 
                                                                    5b the total qualified first-year wages (defined earlier) the 
• Was a rehire (worked for the organization previously).            organization paid during the employment tax period indicated 
When To File                                                        on line 3 to qualified veterans who began working for the 
                                                                    organization on or after November 22, 2011, and before January 
File Form 5884-C after the organization has filed its employment    1, 2021, who worked for the organization at least 120 hours but 
tax return for the employment tax period for which it is claiming   fewer than 400 hours (as of the date Form 5884-C is filed). 
the credit. File Form 5884-C for each employment tax period 
during which the organization paid qualified first-year wages to    Line 7
a qualified veteran.                                                Enter on line 7 the total amount of credits claimed from line 11  
  Generally, an organization should not file more than one Form     of any previously filed Forms 5884-C minus the total amount of 
5884-C per employment tax period.                                   credits repaid from line 12. Each Form 5884-C figures the 
Note: The IRS cannot process Form 5884-C until the original         cumulative credit the organization is entitled to for all periods. 
employment tax return filed for the same tax period has been        The amount of the cumulative credit reported on line 6 is 
processed. Please allow 8–12 weeks for the processing of Form       reduced by the previously claimed credits and increased by any 
5884-C.                                                             previously repaid amounts to determine the credit claimed for 
                                                                    the employment tax period for which the Form 5884-C is filed.
Where To File                                                             If the credit refunded for a prior period was limited by 
                                                                          the employer’s social security tax liability for that 
Send Form 5884-C to the address provided at the bottom of the       TIP   period, any credit not refunded will be carried forward 
form. 
                                                                          and included in the cumulative credit figured on any 
More Information                                                    subsequent Form 5884-C. The portion of the credit not refunded 
For more information about this credit, see the following.          is not included in the amount on line 7.
• Section 3111(e). 
• Notice 2012-13, 2012-9 I.R.B. 421, available at 
www.irs.gov/irb/2012-09_IRB#NOT-2012-13. 

Form 5884-C (Rev. 3-2020)                                                                                                     Page  4 
Line 9                                                             If you are a paid preparer, enter your Preparer Tax 
                                                                   Identification Number (PTIN) in the space provided. Include your 
Enter on line 9 total taxable social security wages and tips       complete address. If you work for a firm, enter the firm’s name 
reported on the employment tax return indicated on line 2 for      and the EIN of the firm. You cannot use your PTIN in place of 
the employment tax period indicated on line 3. For example,        the EIN of the tax preparation firm.
taxable social security wages and tips included on Form 941 for 
wages paid in the 4th quarter of 2019 were reported on the         You can apply for a PTIN online or by filing Form W-12, IRS 
following lines.                                                   Paid Preparer Tax Identification Number (PTIN) Application and 
                                                                   Renewal. For more information about applying for a PTIN online, 
• Form 941, line 5a, column 1 (taxable social security wages).     visit the IRS website at www.irs.gov/PTIN.
• Form 941, line 5b, column 1 (taxable social security tips).      Generally, you are not required to complete this section if you 
Note: If you filed a corrected return (for example, Form 941-X)    are filing Form 5884-C as a reporting agent and have a valid 
for the period indicated on line 3, enter the amounts as           Form 8655, Reporting Agent Authorization, on file with the IRS. 
corrected.                                                         However, a reporting agent must complete this section if the 
                                                                   reporting agent offered legal advice, for example, advising the 
Line 11                                                            client on determining whether its workers are qualified veterans 
If your credit is less than $1, we will send a refund or apply it  for purposes of this credit.
only if you ask us in writing to do so.
                                                                   Paperwork Reduction Act Notice. We ask for the information 
Line 12                                                            on this form to carry out the Internal Revenue laws of the United 
You may pay the amount you owe on line 12 electronically using     States. You are required to give us the information. We need it 
the Electronic Federal Tax Payment System (EFTPS), by credit       to ensure that you are complying with these laws and to allow 
or debit card, or by a check or money order.                       us to figure and collect the right amount of tax. 
• The preferred method of payment is EFTPS. For more               You are not required to provide the information requested on 
information, visit www.eftps.gov, call EFTPS Customer Service      a form that is subject to the Paperwork Reduction Act unless 
at 800-555-4477 or 800-733-4829 (TDD), or see Pub. 966,            the form displays a valid OMB control number. Books or 
Electronic Federal Tax Payment System: A Guide To Getting          records relating to a form or its instructions must be retained as 
Started.                                                           long as their contents may become material in the 
                                                                   administration of any Internal Revenue law. Generally, tax 
• To pay by credit or debit card, visit the IRS website at         returns and return information are confidential, as required by 
www.irs.gov/PayByCard.                                             section 6103. However, certain returns and return information of 
• If you pay by check or money order, make it payable to           tax-exempt organizations and trusts are subject to public 
“United States Treasury.” On your check or money order, be         disclosure and inspection, as provided by section 6104.
sure to write your EIN, “Form 5884-C,” and the year (and           The time needed to complete and file this form will vary 
quarter, if applicable) indicated on line 3.                       depending on individual circumstances. The estimated burden 
You do not have to pay if the amount you owe is less than $1.      for tax-exempt organizations filing this form is approved under 
                                                                   OMB control number 1545-0047 and is included in the 
Signature                                                          estimates shown in the instructions for their information return. 
Form 5884-C must be signed by the president, vice president, 
treasurer, assistant treasurer, chief accounting officer, or other 
corporate officer (such as 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. 
Paid Preparer
A paid preparer must sign Form 5884-C and provide the 
information in the Paid Preparer Use Only section if the preparer 
was paid to prepare Form 5884-C and is not an employee of the 
filing entity. Paid preparers must sign paper returns with a 
manual signature. The preparer must give the organization a 
copy of Form 5884-C in addition to the copy to be filed with the 
IRS.