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20 Instructions for Form CT-1 X (Rev. 4-2025)

Worksheet 1. Adjusted Credit for Qualified Sick and Family Leave Compensation for Leave Taken After March 31, 2020, and Before April 1, 2021 Keep for Your Records

You must use this worksheet if you claimed the credit for qualified sick and family leave compensation for leave taken after March 31, 2020, and before April 1, 2021, on your original Form CT-1 and you correct any amounts used to figure the credit for qualified sick and family leave compensation for leave taken after March 31, 2020, and before April 1, 2021. You'll also use this worksheet to figure this credit if you're claiming it for the first time on Form CT-1 X.

Step 1. Figure the Tier 1 Employer Tax 1a Enter the amount from Form CT-1, line 1 (Tax Column), or, if corrected, enter the amount from Form CT-1 X, line 6, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a 1b Enter the amount from Form CT-1, line 8 (Tax Column), or, if corrected, enter the amount from Form CT-1 X, line 13, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b 1c Tier 1 Employer tax. Add lines 1a and 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c

Step 2. Figure the credit for qualified sick and family leave compensation 2a Qualified sick leave compensation reported on Form CT-1, line 30, or, if corrected, the amount from Form CT-1 X, line 27, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a 2a(i) Enter the amount, if any, included on line 2a that is compensation excluded from the definition of compensation under section 3231(e)(1) . . . . . . . . . . . . . . . . . . . . . . . . . 2a(i) 2a(ii) Subtract line 2a(i) from line 2a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(ii) 2b Qualified health plan expenses allocable to qualified sick leave compensation reported on Form CT-1, line 31, or, if corrected, Form CT-1 X, line 28, column 1 . . . . . . . . . . . . 2b 2c Tier 1 Employer Medicare tax on qualified sick leave compensation. Multiply line 2a(ii) by 1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c 2d Credit for qualified sick leave compensation. Add lines 2a, 2b, and 2c . . . . . . . . . 2d 2e Qualified family leave compensation reported on Form CT-1, line 32, or, if corrected, the amount from Form CT-1 X, line 29, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e 2e(i) Enter the amount, if any, included on line 2e that is compensation excluded from the 2e(i) definition of compensation under section 3231(e)(1) . . . . . . . . . . . . . . . . . . . . . . . . .

2e(ii) Subtract line 2e(i) from line 2e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e(ii) 2f Qualified health plan expenses allocable to qualified family leave compensation reported on Form CT-1, line 33, or, if corrected, the amount from Form CT-1 X, line 30, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f 2g Tier 1 Employer Medicare tax on qualified family leave compensation. Multiply line 2e(ii) by 1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g 2h Credit for qualified family leave compensation. Add lines 2e, 2f, and 2g . . . . . . . 2h 2i Credit for qualified sick and family leave compensation. Add lines 2d and 2h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2i 2j Nonrefundable portion of credit for qualified sick and family leave compensation for leave taken after March 31, 2020, and before April 1, 2021. Enter the smaller of line 1c or line 2i. Enter this amount on Form CT-1 X, line 19, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2j 2k Refundable portion of credit for qualified sick and family leave compensation for leave taken after March 31, 2020, and before April 1, 2021. Subtract line 2j from line 2i and enter this amount on Form CT-1 X, line 24, column 1 . . . . . . . . . . . . . 2k

Instructions for Form CT-1 X (Rev. 4-2025) 21

Worksheet 2. Adjusted Credit for Qualified Sick and Family Leave Compensation for Leave Taken After March 31, 2021, and Before October 1, 2021 Keep for Your Records

You must use this worksheet if you claimed the credit for qualified sick and family leave compensation for leave taken after March 31, 2021, and before October 1, 2021, on your original Form CT-1 and you correct any amounts used to figure the credit for qualified sick and family leave compensation for leave taken after March 31, 2021, and before October 1, 2021. You'll also use this worksheet to figure this credit if you're claiming it for the first time on Form CT-1 X.

Step 1. Figure the Tier 1 Employer Medicare Tax 1a Enter the amount from Form CT-1, line 2 (Tax Column), or, if corrected, the amount from Form CT-1 X, line 7, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a 1b Enter the amount from Form CT-1, line 9 (Tax Column), or, if corrected, the amount from Form CT-1 X, line 14, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b 1c Tier 1 Employer Medicare tax. Add lines 1a and 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c

Step 2. Figure the credit for qualified sick and family leave compensation 2a Qualified sick leave compensation for leave taken after March 31, 2021, and before October 1, 2021, reported on Form CT-1, line 36, or, if corrected, the amount from Form CT-1 X, line 33, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a 2a(i) Enter the amount, if any, included on line 2a that is compensation excluded from the definition of compensation under section 3231(e)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(i) 2a(ii) Subtract line 2a(i) from line 2a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(ii) 2a(iii) Enter the amount, if any, included on line 2a that was not included as compensation on Form CT-1, lines 1, 4, 8, and 10, or, if corrected, on Form CT-1 X, lines 6, 9, 13, and 15, because the qualified sick leave compensation was limited by the Tier 1 compensation base . . . . . . . . . . . 2a(iii) 2a(iv) Subtract line 2a(iii) from line 2a(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a(iv) 2b Qualified health plan expenses allocable to qualified sick leave compensation taken after March 31, 2021, and before October 1, 2021, reported on Form CT-1, line 37, or, if corrected, the amount from Form CT-1 X, line 34, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b 2c Amounts under certain collectively bargained agreements allocable to qualified sick leave compensation for leave taken after March 31, 2021, and before October 1, 2021, reported on Form CT-1, line 38, or, if corrected, the amount from Form CT-1 X, line 35, column 1 . . . . . . . 2c 2d Tier 1 Employer tax on qualified sick leave compensation. Multiply line 2a(iv) by 6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d 2e Tier 1 Employer Medicare tax on qualified sick leave compensation. Multiply line 2a(ii) by 1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e 2f Credit for qualified sick leave compensation. Add lines 2a, 2b, 2c, 2d, and 2e . . . . . . . . . 2f 2g Qualified family leave compensation for leave taken after March 31, 2021, and before October 1, 2021, reported on Form CT-1, line 39, or, if corrected, the amount from Form CT-1 X, line 36, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g 2g(i) Enter the amount, if any, included on line 2g that is compensation excluded from the definition of compensation under section 3231(e)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g(i) 2g(ii) Subtract line 2g(i) from line 2g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g(ii) 2g(iii) Enter the amount, if any, included on line 2g that was not included as compensation on Form CT-1, lines 1, 4, 8, and 10, or, if corrected, on Form CT-1 X, lines 6, 9, 13, and 15, because the qualified family leave compensation was limited by the Tier 1 compensation base . . . . . . . . . 2g(iii) 2g(iv) Subtract line 2g(iii) from line 2g(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2g(iv) 2h Qualified health plan expenses allocable to qualified family leave compensation taken after March 31, 2021, and before October 1, 2021, reported on Form CT-1, line 40, or, if corrected, the amount from Form CT-1 X, line 37, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2h 2i Amounts under certain collectively bargained agreements allocable to qualified family leave compensation for leave taken after March 31, 2021, and before October 1, 2021, reported on Form CT-1, line 41, or, if corrected, the amount from Form CT-1 X, line 38, column 1 . . . . . . . 2i 2j Tier 1 Employer tax on qualified family leave compensation. Multiply line 2g(iv) by 6.2% (0.062) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2j 2k Tier 1 Employer Medicare tax on qualified family leave compensation. Multiply line 2g(ii) by 1.45% (0.0145) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2k 2l Credit for qualified family leave compensation. Add lines 2g, 2h, 2i, 2j, and 2k . . . . . . . . . 2l 2m Credit for qualified sick and family leave compensation. Add lines 2f and 2l . . . . . . . . . . 2m 2n Reserved for future use 2o Enter any credit claimed under section 41 for increasing research activities with respect to any compensation taken into account for the credit for qualified sick and family leave compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2o 2p Reserved for future use 2q Credit for qualified sick and family leave compensation after adjusting for other credits. Subtract line 2o from line 2m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2q 2r Nonrefundable portion of credit for qualified sick and family leave compensation for leave taken after March 31, 2021, and before October 1, 2021. Enter the smaller of line 1c or line 2q. Enter this amount on Form CT-1 X, line 20b, column 1 . . . . . . . . . . . . . . . . . . . . . 2r 2s Refundable portion of credit for qualified sick and family leave compensation for leave taken after March 31, 2021, and before October 1, 2021. Subtract line 2r from line 2q and enter this amount on Form CT-1 X, line 25b, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2s

22 Instructions for Form CT-1 X (Rev. 4-2025)

Worksheet 3. Adjusted COBRA Premium Assistance Credit Keep for Your Records

You must use this worksheet if you claimed the COBRA premium assistance credit on your original Form CT-1 and you correct any amounts used to figure the COBRA premium assistance credit. You'll also use this worksheet to figure this credit if you're claiming it for the first time on Form CT-1 X.

Step 1. Figure the Tier 1 Employer Medicare Tax 1a If you completed Worksheet 2 and you’re also claiming the COBRA premium assistance credit, enter the amount from Worksheet 2, Step 1, line 1c. Otherwise, complete lines 1b–1d below and then go to Step 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a

1b Enter the amount from Form CT-1, line 2 (Tax Column), or, if corrected, the amount from Form CT-1 X, line 7, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b

1c Enter the amount from Form CT-1, line 9 (Tax Column), or, if corrected, the amount from Form CT-1 X, line 14, column 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c

1d Tier 1 Employer Medicare tax. Add lines 1b and 1c . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1d

Step 2. Figure the COBRA premium assistance credit 2a Enter the COBRA premium assistance that you provided for periods of coverage beginning on or after April 1, 2021, through periods of coverage beginning on or before September 30, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a

2b Enter the amount of the Tier 1 Employer Medicare tax from Step 1, line 1a, or, if applicable, Step 1, line 1d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b

2c Enter the amount of the nonrefundable portion of the credit for qualified sick and family leave compensation for leave taken after March 31, 2021, and before October 1, 2021 (this amount may come from Worksheet 2, Step 2, line 2r, in these instructions if you're correcting that credit or you may need to enter the credit claimed on your original Form CT-1) . . . . . . . . . . . . . . . 2c

2d Reserved for future use 2e Reserved for future use 2f Subtract line 2c from line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f

2g Nonrefundable portion of the COBRA premium assistance credit. Enter the smaller of line 2a or line 2f. Enter this amount on Form CT-1 X, line 20c, column 1 . . . . . . . . . . . . . . . . 2g 2h Refundable portion of the COBRA premium assistance credit. Subtract line 2g from line 2a and enter this amount on Form CT-1 X, line 25c, column 1 . . . . . . . . . . . . . . . . . . . 2h

Instructions for Form CT-1 X (Rev. 4-2025) 23