Form 5884-C

(Rev. January 2013) 

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

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% (.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% (.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% (.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. 1-2013) 
Form 5884-C (Rev. 1-2013) 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.

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, 2014. 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 taxexempt 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. 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. 

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 by the 28th calendar day after the date 

the individual begins work. However, for individuals who begin 

working for the organization on or after January 1, 2013, and on 

or before March 31, 2013, the organization has until April 29, 

2013, to submit Form 8850 to the SESA. 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. 

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. 
Form 5884-C (Rev. 1-2013) Page 3 

• $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, 2014, 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, 2014, 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 2012 were reported on the 

following lines.

• Form 941, line 5a, column 1 (taxable social security wages).
Form 5884-C (Rev. 1-2013) Page 4 

• Form 941, line 5b, column 1 (taxable social security tips).

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 write to the Internal 

Revenue Service, Tax Products Coordinating Committee, 

SE:W:CAR:MP:T:M:S, 1111 Constitution Ave. NW, IR-6526, 

Washington, DC 20224. Do not send Form 5884-C to this 

address. Instead, see Where To File, earlier.