Form 7200
(March 2020)
Advance Payment of Employer Credits Due to COVID-19
Department of the Treasury
Internal Revenue Service
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Go to www.irs.gov/Form7200 for instructions and the latest information.
OMB No. 1545-0029
Name (not your trade name) Employer identification number (EIN)
Trade name (if any)
Applicable calendar quarter (check one)
(2)
April, May, June
(3)
July, August, September
(4)
October, November, December
Number, street, and apt. or suite no. If a P.O. box, see instructions.
City or town, state, and ZIP code. If a foreign address, also complete spaces below. (See instructions.)
Foreign country name Foreign province/county Foreign postal code
Does a third-party payer file your employment tax return? (See instructions.) If “Yes,” enter its name. Third-party payer’s EIN (if applicable)
Tip: File Form 7200 if you can’t reduce your employment tax deposits to fully account for these credits that you expect to claim on
your employment tax return for the applicable quarter. Don’t reduce your employment tax deposits and request advanced credits for
the same expected credits. You will need to reconcile your advanced credits and reduced deposits on your employment tax return.
You can’t request an advance payment of the credit for sick and family leave for self-employed individuals.
Part I Tell Us About Your Employment Tax Return
A Check the box to indicate which employment tax return form you file (or will file for 2020):
(1)
941, 941-PR, or 941-SS (2) 943 or 943-PR (3) 944 or 944(SP) (4) CT-1
B Is this a new business started on or after January 1, 2020? . . . . . . . . . . . . . . .
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Yes No
If “Yes,” skip line C unless you’ve already filed Form 941, Form 941-PR, or Form 941-SS for at least one
quarter of 2020.
C
Amount reported on line 2 of your most recently filed Form 941 (or wages reported on Schedule R (Form
941), column (c), by your third-party payer (see instructions)). If you file a different employment tax return,
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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D Enter the total number of employees you have. See instructions . . . . . . . . . . . . . .
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Part II Enter Your Credits and Advance Requested
1 Total employee retention credit for the quarter. See instructions . . . . . . . . . . . . . 1
2 Total qualified sick leave wages eligible for the credit and paid this quarter. See instructions . . . 2
3 Total qualified family leave wages eligible for the credit and paid this quarter. See instructions . . . 3
4 Add lines 1, 2, and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Total amount by which you have already reduced your federal employment tax
deposits for these credits for this quarter . . . . . . . . . . . .
5
6
Total advanced credits requested on previous filings of this form for this quarter
6
7
Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8 Advance requested. Subtract line 7 from line 4. If zero or less, don’t file this form . . . . . . .
8
Third-
Party
Designee
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the
instructions for details. Yes. Complete below. No
Designee’s name
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and phone number
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Select a 5-digit personal identification number (PIN) to use when talking to the IRS
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Sign
Here
Under penalties of perjury, I declare that I have examined this form, including any accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
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Your signature Date
Printed title
Printed name Best daytime phone
Paid
Preparer
Use Only
Print/Type preparer’s name
Preparer’s signature Date
PTIN
Check if
self-employed
Firm’s name
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Firm’s EIN
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Firm’s address
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Phone no.
How
To File
Fax your completed form to 855-248-0552.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 56392D
Form 7200 (3-2020)
