Form 5884-C
(Rev. March 2016)
Department of the Treasury
Internal Revenue Service
Work Opportunity Credit for Qualified Tax-Exempt
Organizations Hiring Qualified Veterans
File this form separately; do not attach it to your return.
Information about Form 5884-C and its instructions is at www.irs.gov/form5884c.
OMB No. 1545-2226
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.
Sign
Here
Daytime telephone number
Signature of officer
Title
Date
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
Firm’s address
Firm’s EIN
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. 3-2016)
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Form 5884-C (Rev. 3-2016)
Page 2
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Future Developments
For the latest information about developments related to Form
5884-C and its instructions, such as legislation enacted after
they were published, go to www.irs.gov/form5884c.
What's New
The work opportunity credit is now available for qualified first-year
wages paid to qualified veterans who began work for the
organization after December 31, 2014, and before January 1, 2020.
Purpose of Form
Qualified tax-exempt organizations (defined below) use Form
5884-C to claim the work opportunity credit for qualified
first-year wages paid to qualified veterans who begin working
for the organization on or after November 22, 2011, and before
January 1, 2020. The credit is claimed against the employer
portion of social security tax on wages paid to all employees
during the 1-year period beginning on the day a qualified
veteran begins working for the organization. The credit does not
apply to the employer portion of Medicare tax. The qualified
veteran must be performing services in activities related to the
purpose or function constituting the basis of the organization's
exemption under section 501.
The organization files Form 5884-C after it files its
employment tax return for the employment tax period for which
it is claiming the credit. The organization files Form 5884-C for
each employment tax period during which qualified first-year
wages are paid to a qualified veteran. Each Form 5884-C figures
the cumulative credit the organization is entitled to for all
periods during which qualified first-year wages are paid to a
qualified veteran and reduces the amount claimed for the period
by any amounts claimed on previously filed Forms 5884-C.
Generally, the organization should only file one Form 5884-C per
employment tax period.
Form 5884-C is filed separately from any other returns. The
credit claimed on Form 5884-C will not affect the tax liability
reported on the organization's employment tax returns.
Accordingly, the organization should not reduce its required
deposits in anticipation of any credit. Instead, the IRS will refund
the amount shown on line 11 of Form 5884-C, plus any interest
that applies, unless the IRS corrects Form 5884-C during
processing or the organization owes other taxes, penalties, or
interest.
TIP
The amount properly claimed on Form 5884-C is
treated as a credit on the first day of the organization’s
employment tax return period. However, because
Form 5884-C will generally not be processed with the
organization’s employment tax return, an organization that
reduces its required deposits in anticipation of a Form 5884-C
credit may receive a system-generated notice reflecting a
balance due and associated penalties and interest, if applicable.
The balance due, including any related penalties and interest,
resulting from the reduction in deposits to reflect the Form
5884-C credit will be abated when the credit is applied. Such
abatement will generally occur without any action from the
organization.
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).
Qualified Veteran
A qualified veteran is a veteran certified (as described below) as
any of the following.
• A member of a family receiving assistance under the
Supplemental Nutrition Assistance Program (SNAP) (food
stamps) for at least a 3-month period during the 15-month
period ending on the hiring date.
• Unemployed for a period 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 date.
• Unemployed for a period or periods totaling at least 6 months
(whether or not consecutive) in the 1-year period ending on the
hiring date.
• Entitled to compensation for a service-connected disability
and hired not more than 1 year after being discharged or
released from active duty in the U.S. Armed Forces.
• Entitled to compensation for a service-connected disability
and unemployed for a period or periods totaling at least 6
months (whether or not consecutive) in the 1-year period ending
on the hiring date.
To be considered a veteran, the individual must:
• Have served on active duty (not including training) in the U.S.
Armed Forces for more than 180 days or have been discharged
or released from active duty for a service-connected disability,
and
• Not have a period of active duty (not including training) of
more than 90 days that ended during the 60-day period ending
on the hiring date.
Certification Requirement
The organization must be issued a certification for each qualified
veteran from the state employment security agency (SESA). The
certification proves that the employee is a qualified veteran.
For qualified veterans who will begin working for the
organization after May 31, 2016, the organization must either:
• Receive the certification by the day the individual begins work,
or
• Complete Form 8850, Pre-Screening Notice and Certification
Request for the Work Opportunity Credit, on or before the day it
offers the individual a job and receive the certification before it
claims the credit.
If the organization completes Form 8850, it generally must be
signed by an officer of the organization and the individual and
submitted to the SESA of the state in which the organization is
located (where the employee works) by the 28th calendar day
after the date the individual begins work.
For individuals who began working for the organization on or
after January 1, 2015, and on or before May 31, 2016, Form
8850 can be completed and signed as described above at any
time as long as it is completed, signed, and submitted to the
SESA by June 29, 2016.
If the SESA denies the request, it will provide a written
explanation of the reason for denial. If the certification is
revoked because it was based on false information provided by
the worker, wages paid or incurred after the date the
organization receives the notice of revocation do not qualify for
the credit.
Qualified First-Year Wages
Qualified first-year wages are generally wages subject to social
security tax paid to a qualified veteran during the 1-year period
beginning on the day the qualified veteran begins working for
the organization. However, qualified first-year wages for any
employee must be reduced by the amount of any work
supplementation payments the organization received under the
Social Security Act for the employee.
Form 5884-C (Rev. 3-2016)
Page 3
Qualified first-year wages do not include any wages that
exceed the following amounts.
$6,000 for a qualified veteran certified as being either (a) a
member of a family receiving assistance under the
Supplemental Nutrition Assistance Program (SNAP) (food
stamps) for at least a 3-month period during the 15-month
period ending on the hiring date, or (b) unemployed for a period
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
date.
$12,000 for a qualified veteran certified as being entitled to
compensation for a service-connected disability and hired not
more than 1 year after being discharged or released from active
duty in the U.S. Armed Forces.
$14,000 for a qualified veteran certified as being unemployed
for a period or periods totaling at least 6 months (whether or not
consecutive) in the 1-year period ending on the hiring date.
$24,000 for a qualified veteran certified as being entitled to
compensation for a service-connected disability and
unemployed for a period or periods totaling at least 6 months
(whether or not consecutive) in the 1-year period ending on the
hiring date.
Qualified first-year wages also do not include any wages paid
to a qualified veteran:
• For services in activities not related to the purpose or function
constituting the basis of the organization's exemption under
section 501, or
• During any period for which the organization received payment
for the employee from a federally funded on-the-job training
program.
The amount of qualified wages for any qualified veteran is
zero if the qualified veteran:
• Did not work for the organization for at least 120 hours, or
• Was a rehire (worked for the organization previously).
When To File
File Form 5884-C after the organization has filed its employment
tax return for the employment tax period for which it is claiming
the credit. File Form 5884-C for each employment tax period
during which the organization paid qualified first-year wages to
a qualified veteran.
Generally, an organization should not file more than one Form
5884-C per employment tax period.
Note: The IRS cannot process Form 5884-C until the original
employment tax return filed for the same tax period has been
processed. Please allow 8–12 weeks for the processing of Form
5884-C.
Where To File
Send Form 5884-C to the address provided at the bottom of the
form.
More Information
For more information about this credit, see the following.
• Section 3111(e).
• Notice 2012-13, 2012-9 I.R.B. 421, available at
www.irs.gov/irb/2012-09_IRB/ar07.html.
Specific Instructions
Name and Address
If the organization receives its mail in care of a third party (such
as an accountant or an attorney), enter on the street address
line “C/O” followed by the third party's name and street address
or P.O. box.
Include the suite, room, or other unit number after the street
address. If the Post Office does not deliver mail to the street
address and the organization has a P.O. box, enter the box
number instead of the street address.
Line 1
Enter “Yes” if the organization is a qualified tax-exempt
organization (defined earlier).
Line 3
As discussed earlier under Purpose of Form, the organization
claims this credit against the employer's portion of social
security tax on wages paid to all employees during the 1-year
period beginning on the day a qualified veteran begins working
for the organization. The organization files Form 5884-C for
each employment tax period during which it claims a credit for
qualified first-year wages paid to a qualified veteran. Each Form
5884-C figures the cumulative credit the organization is entitled
to for all periods and reduces the amount claimed for the period
by any amounts claimed on previously filed Forms 5884-C.
Check the box(es) on line 3 to indicate the year (and quarter, if
applicable) for the employment tax period for which the
organization is claiming the credit.
Line 4
Enter on line 4a and multiply by the percentage shown on line
4b the total qualified first-year wages (defined earlier) the
organization paid during the employment tax period indicated
on line 3 to qualified veterans who began working for the
organization on or after November 22, 2011, and before January
1, 2020, who worked for the organization at least 400 hours (as
of the date Form 5884-C is filed).
Line 5
Enter on line 5a and multiply by the percentage shown on line
5b the total qualified first-year wages (defined earlier) the
organization paid during the employment tax period indicated
on line 3 to qualified veterans who began working for the
organization on or after November 22, 2011, and before January
1, 2020, who worked for the organization at least 120 hours but
fewer than 400 hours (as of the date Form 5884-C is filed).
Line 7
Enter on line 7 the total amount of credits claimed from line 11
of any previously filed Forms 5884-C minus the total amount of
credits repaid from line 12. Each Form 5884-C figures the
cumulative credit the organization is entitled to for all periods.
The amount of the cumulative credit reported on line 6 is
reduced by the previously claimed credits and increased by any
previously repaid amounts to determine the credit claimed for
the employment tax period for which the Form 5884-C is filed.
TIP
If the credit refunded for a prior period was limited by
the employer's social security tax liability for that
period, any credit not refunded will be carried forward
and included in the cumulative credit figured on any
subsequent Form 5884-C. The portion of the credit not refunded
is not included in the amount on line 7.
Line 9
Enter on line 9 total taxable social security wages and tips
reported on the employment tax return indicated on line 2 for
the employment tax period indicated on line 3. For example,
taxable social security wages and tips included on Form 941 for
wages paid in the 4th quarter of 2015 were reported on the
following lines.
• Form 941, line 5a, column 1 (taxable social security wages).
• Form 941, line 5b, column 1 (taxable social security tips).
Form 5884-C (Rev. 3-2016)
Page 4
Note: If you filed a corrected return (for example, Form 941-X)
for the period indicated on line 3, enter the amounts as
corrected.
Line 11
If your credit is less than $1, we will send a refund or apply it
only if you ask us in writing to do so.
Line 12
You may pay the amount you owe on line 12 electronically using
the Electronic Federal Tax Payment System (EFTPS), by credit
or debit card, or by a check or money order.
• The preferred method of payment is EFTPS. For more
information, visit www.eftps.gov, call EFTPS Customer Service
at 1-800-555-4477 toll free, or see Pub. 966, Electronic Federal
Tax Payment System: A Guide To Getting Started.
• To pay by credit or debit card, visit the IRS website at
www.irs.gov/e-pay.
• If you pay by check or money order, make it payable to
“United States Treasury.” On your check or money order, be
sure to write your EIN, “Form 5884-C,” and the year (and
quarter, if applicable) indicated on line 3.
You do not have to pay if the amount you owe is less than $1.
Signature
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.
If you are a paid preparer, enter your Preparer Tax
Identification Number (PTIN) in the space provided. Include your
complete address. If you work for a firm, enter the firm’s name
and the EIN of the firm. You cannot use your PTIN in place of
the EIN of the tax preparation firm.
You can apply for a PTIN online or by filing Form W-12, IRS
Paid Preparer Tax Identification Number (PTIN) Application and
Renewal. For more information about applying for a PTIN online,
visit the IRS website at www.irs.gov/ptin.
Generally, you are not required to complete this section if you
are filing Form 5884-C as a reporting agent and have a valid
Form 8655, Reporting Agent Authorization, on file with the IRS.
However, a reporting agent must complete this section if the
reporting agent offered legal advice, for example, advising the
client on determining whether its workers are qualified veterans
for purposes of this credit.
Paperwork Reduction Act Notice. We ask for the information
on this form to carry out the Internal Revenue laws of the United
States. You are required to give us the information. We need it
to ensure that you are complying with these laws and to allow
us to figure and collect the right amount of tax.
You are not required to provide the information requested on
a form that is subject to the Paperwork Reduction Act unless
the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as
long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
section 6103.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated burden
for taxpayers who file this form is shown below.
Recordkeeping . . . . . . . . . . . 5 hr., 15 min.
Learning about the law or the form . . . . . . . 35 min.
Preparing and sending the form
to the IRS . . . . . . . . . . . . . . . 42 min.
If you have comments concerning the accuracy of these time
estimates or suggestions for making this form simpler, we would
be happy to hear from you. You can send us comments from
www.irs.gov/formspubs. Click on “More Information” and then
on “Give us feedback.” Or you can send your comments to:
Internal Revenue Service
Tax Forms and Publications
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224
Do not send Form 5884-C to this address. Instead, see
Where To File, earlier.
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