Form 8974 Qualified Small Business Payroll Tax Credit for Increasi

Form

8974:

(January 2017)

Qualified Small Business Payroll Tax Credit for Increasing Research Activities

OMB No. 1545-0029

Department of the Treasury — Internal Revenue Service

Report for this quarter . . .

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Employer identification number (EIN)

950817

Check only one box.
1: January, February, March

Name (not your trade name)

2: April, May, June

Form 941, 941-PR, or 941-SS

The credit from Part 2, line 12, will be

3: July, August, September

reported on (check only one box):

4: October, November, December

Reserved
Reserved
You must select a quarter if you file Form 941, 941-PR, or 941-SS.

Calendar year

Part 1:

Tell us about your income tax return.

1

Which income tax return did you file that elected a qualified small business payroll tax credit on Form 6765, Credit for Increasing Research Activities?
Check only one box.
Form 1040
Form 1065
Form 1120
Form 1120-F
Form 1120S

2

What tax period was covered by your income tax return?
Calendar year

or tax year beginning
/

/

When did you file your income tax return?

4

If the EIN shown above isn’t the same as the EIN used on
Form 6765, enter the EIN used on Form 6765.

5
6

ending

/

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/

3

Part 2:

/

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Determine the credit that you can use this period.

Enter the amount from Form 6765, line 44, or, if applicable,
the amount that was allocated to your EIN . . . . .

5

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Enter the amount of the credit from line 5 that was taken
on a previous period(s) . . . . . . . . . . .

6

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7

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10

Add lines 8 and 9

11

Multiply line 10 by 50% (0.50). See the instructions if you’re a third-party payer of sick pay or if
you received a Section 3121(q) Notice and Demand . . . . . . . . . . . . . .

11

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12

Credit. Enter the smaller of line 7 or line 11. Also enter this amount on Form 941 (941-PR or
941-SS), line 11 . . . . . . . . . . . . . . . . . . . . . . . . .

12

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7

Subtract line 6 from line 5 .

8

Enter the amount from Form 941 (941-PR or 941-SS),
line 5a, Column 2
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. . . . . . . . . . . . . . . . . .

8

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Enter the amount from Form 941 (941-PR or 941-SS), line
5b, Column 2 . . . . . . . . . . . . . .
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For Paperwork Reduction Act Notice, see the separate instructions.

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IRS.gov/form8974

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Cat. No. 37797C

Form 8974 (1-2017)