8974:
950817
Qualified Small Business Payroll Tax Credit for Increasing Research Activities
Form
OMB No. 1545-0029
(Rev. December 2017)
Department of the Treasury — Internal Revenue Service
Report for this quarter . . .
—
Employer identification number (EIN)
Check only one box.
Name (not your trade name)
1: January, February, March
2: April, May, June
Form 941, 941-PR, or 941-SS
The credit from Part 2, line 12, will be
3: July, August, September
reported on (check only one box):
4: October, November, December
Form 943 or 943-PR
Form 944 or 944(SP)
Calendar year
You must select a quarter if you file Form 941, 941-PR, or 941-SS.
Part 1:
Tell us about your income tax return.
(a)
(b)
(c)
(d)
(e)
(f)
(g)
Ending date
Income
Date income
EIN
Amount from
Amount of credit
Remaining credit
of income
tax return
tax return
used on
Form 6765, line 44,
from column (e)
(subtract column (f)
tax period
filed that
was filed
Form 6765
or if applicable,
taken on a
from column (e))
included
the amount that
previous period(s)
Form 6765
was allocated
to your EIN
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Add lines 1(g) through 5(g) and enter the total here
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Part 2:
Determine the credit that you can use this period.
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Enter the amount from Part 1, line 6(g) .
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8
Enter the amount from Form 941 (941-PR or 941-SS),
line 5a, Column 2; Form 943 (943-PR), line 3; or Form
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944 (944(SP)), line 4a, Column 2
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Enter the amount from Form 941 (941-PR or 941-SS),
line 5b, Column 2; or Form 944 (944(SP)), line 4b,
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Column 2 .
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10
Add lines 8 and 9
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10
Multiply line 10 by 50% (0.50). Check this box
if you're a third-party payer of sick pay or
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check this box
if you received a Section 3121(q) Notice and Demand. See the
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instructions before completing line 11 .
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Credit. Enter the smaller of line 7 or line 11. Also enter this amount on Form 941 (941-PR
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or 941-SS), line 11; Form 943 (943-PR), line 12; or Form 944 (944(SP)), line 8 .
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8974
For Paperwork Reduction Act Notice, see the separate instructions.
Form
(Rev. 12-2017)
Cat. No. 37797C