Form 5884-A
(Rev. February 2018)
Department of the Treasury
Internal Revenue Service
Credits for Affected Disaster Area Employers
(for Employers Affected by Hurricane Harvey, Irma, or Maria or
Certain California Wildfires)
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Attach to your tax return.
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Go to www.irs.gov/Form5884A for instructions and the latest information.
OMB No. 1545-1978
Attachment
Sequence No.
77A
Name(s) shown on return Identifying number
SECTION A. Employee Retention Credit (see instructions)
1 a 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
b 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
c 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
d Employers affected by certain California wildfires beginning on
or after October 8, 2017, and before November 1, 2017, enter
the total qualified wages paid or incurred after October 8, 2017,
and before January 1, 2018, while the business was inoperable
1d
e Employers affected by certain California wildfires beginning on
or after December 4, 2017, enter the total qualified wages paid
or incurred on or after December 4, 2017, and before January 1,
2018, while the business was inoperable . . . . . . . . .
1e
f Add amounts from lines 1a, 1b, 1c, 1d, and 1e . . . . . . . . . . . . . . . .
1f
2 Multiply line 1f by 40% (0.40). See instructions for the adjustment you must make to
salaries and wages . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Employee retention 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 1aa . . . . . . . . . . . . .
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 1aa . . . . . . . . . . . . . . . . . . . . . . .
6
SECTION B. Reserved for Future Use
7 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . .
7
8 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . .
9
10 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . .
10
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 47425B
Form 5884-A (Rev. 2-2018)
