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