Note:

Line 18b is only valid on form revision 2021 (Rev. June 2021) with tax quarters of 202106 through 202112.

If you're eligible for the employee retention credit solely because your business is a recovery startup business

Enter an "X" if Part 3 box 18b is marked.

Qual. Health Plan Exps. Sick Lv. Wages (Before Apr 1) [Line 19]

Qual. Health Plan Exps. Sick Lv. Before Apr 1 [Line 19] is valid on form revisions 2021 (Rev. June 2021) through 2023 (Rev. March 2023) with a tax quarter of 202006 through 202312

Qual. Health Plan Exps. Sick Lv. Wages [Line 19] is valid on form revisions 2020 (Rev. April 2020) through 2021 (Rev. Mar 2021) with tax a quarter of 202006 through 202312

Qualified health plan expenses allocable to qualified sick leave wages (for leave taken before April 1, 2021)

Enter the amount from box 19.

Qual. Health Plan Exps. Fam. Lv. Wages (Before Apr 1) [Line 20]

Qual. Health Plan Exps. Family Lv. Before Apr 1 [Line 20] is valid on form revisions 2021 (Rev. June 2021) through 2023 (Rev. March 2023) with a tax quarter of 202006 through 202312

Qual. Health Plan Exps. Family Lv. Wages [Line 20] is valid on form revisions 2020 (Rev. April 2020) through 2021 (Rev. Mar 2021) with a tax quarter of 202006 through 202312

Qualified health plan expenses allocable to qualified family leave wages (for leave taken before April 1, 2021)

Enter the amount from box 20.

Qual. Wages for Emp. Retention Credit [Line 21]