Form 5884-A Credits for Affected Disaster Area Employers

Version A, Cycle 4

Form

5884-A

(Rev. December 2017)

Credits for Affected Disaster Area Employers

OMB No. 1545-1978

(for Employers Affected by Hurricane Harvey, Irma, or Maria)

Department of the Treasury
Internal Revenue Service

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Attach to your tax return.
Go to www.irs.gov/Form5884A for instructions and the latest information.

Attachment
Sequence No. 77A

Name(s) shown on return

Identifying number

SECTION A. Employee Retention Credit (see instructions)
1a

b

c

d
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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
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
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
Add amounts from lines 1a, 1b, and 1c . . . . . . . . . . . . . . . . . .
Multiply line 1d by 40% (0.40) . . . . . . . . . . . . . . . . . . . . . .
Employee retention credit from partnerships, S corporations, cooperatives, estates, and
trusts (see instructions) . . . . . . . . . . . . . . . . . . . . . . . .
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 . . . . . . . . . . . . .
Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust
(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cooperatives, estates, and trusts, subtract line 5 from line 4. Report this amount on
Form 3800, Part III, line 1aa . . . . . . . . . . . . . . . . . . . . . . .

1d
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INTERNAL USE ONLY
DRAFT AS OF
November 29, 2017
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SECTION B. Reserved for Future Use
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Reserved for future use
Reserved for future use
Reserved for future use
Reserved for future use

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For Paperwork Reduction Act Notice, see separate instructions.

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Cat. No. 47425B

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Form 5884-A (Rev. 12-2017)