Note:

Line 21 is valid on form revisions 2020 (Rev. April 2020) through 2021 (Rev. June 2021) with tax quarters of 202006 through 202112.

Qualified wages for the employee retention credit

Enter the amount from box 21.

Qual. Health Plan Exps. on Wages (For Emp. Ret.) [Line 22]

Qual. Health Plan Exps. For Emp. Ret. [Line 22] is valid on form revision 2021 (Rev June 2021) with tax quarters of 202006 through 202112

Qual. Health Plan Exps. on Wages [Line 22] is valid for form revisions 2020 (Rev. April 2020) through 2021 (Rev. Mar 2021) with tax quarters of 202006 through 202112

Qualified health plan expenses allocable to wages reported on Line 21

Enter the amount from box 22.

Credit from F5884-C [Line 23]