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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 revision 2017 only.

Medicare Tax allocated to the listed client EIN from Form 943, Line 5

Enter the amount from column (d) box 1 through 10 of Sch R and/or box 1 through 23 of Sch R Continuation Sheet for form revision 2017.

LN nn Col e- Sick Lv

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