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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 2022 - 2023 only.

Qualified health plan expenses allocable to qualified sick leave wages reported on Line 23 from Form 941, Line 24

Enter the amount from column (u) box 1 through 5 of Sch R and/or box 1 through 8 of Sch R Continuation Sheet for form revisions 2022 (Rev. Jun 2022) through 2023 (Rev. March 2023).

LN nn Col u- Tot Ln 19 and 20

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