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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)

▶ Attach to your tax return.

▶ 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)