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COBRA Recipients [Line 12b].

Reminder:

Internal Revenue Manual Part 3. Submission Processing · 2026-10-03 edition · updated 2026-10-04 · United States

Use these instructions for form revisions 2021 and 2022 (Rev. Mar 2022) only.

Number of individuals provided COBRA premium assistance from Form 941, Line 11f

Enter the number of individuals from column (p) box 1 through 5 of Sch R and/or box 1 through 8 of Sch R Continuation Sheet for form revisions 2021 and 2022 (Rev. Mar 2022).

LN nn Col n- Form 941-X Total Lines 18b and 26b Col 1

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