Form 7200 Advance Payment of Employer Credits Due to COVID-19

7200

Form
(March 2020)
Department of the Treasury
Internal Revenue Service

Version B, Cycle 5
Fillable Fields: Font=8pt Helvetica LT Std Bold; Color=Black

Advance Payment of Employer Credits Due to COVID-19
OMB No. 1545-0029
▶ Go to www.irs.gov/Form7200 for instructions and the latest information.

Name (not your trade name)

Employer identification number (EIN)

Trade name (if any)

Applicable calendar quarter (check one)

Number, street, and apt. or suite no. If a P.O. box, see instructions.

(2)

April, May, June

(3)

July, August, September

(4)

October, November, December

City or town, state, and ZIP code. If a foreign address, also complete spaces below. (See instructions.)
Foreign country name

Foreign province/county

Foreign postal code

Does a third-party payer file your employment tax return? (See instructions.) If “Yes,” enter its name.

Third-party payer’s EIN (if applicable)

Tip: File Form 7200 if you can’t reduce your employment tax deposits to fully account for these credits that you expect to claim on
your employment tax return for the applicable quarter. Don’t reduce your employment tax deposits and request advanced credits for
the same expected credits. You will need to reconcile your advanced credits and reduced deposits on your employment tax return.
You can’t request an advance payment of the credit for sick and family leave for self-employed individuals.

Part I
A
B

C

D

INTERNAL USE ONLY
DRAFT AS OF
March 30, 2020

Part II
1
2
3
4
5

Tell Us About Your Employment Tax Return

Check the box to indicate which employment tax return form you file (or will file for 2020):
(1)
941, 941-PR, or 941-SS
(2)
943 or 943-PR
(3)
944 or 944(SP)
(4)
CT-1
Is this a new business started on or after January 1, 2020? . . . . . . . . . . . . . . . ▶
If “Yes,” skip line C unless you’ve already filed Form 941, Form 941-PR, or Form 941-SS for at least one
quarter of 2020.
Amount reported on line 2 of your most recently filed Form 941 (or wages reported on Schedule R (Form
941), column (c), by your third-party payer (see instructions)). If you file a different employment tax return,
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶
Enter the total number of employees you have. See instructions . . . . . . . . . . . . . . ▶

6
7
8

Yes

No

Enter Your Credits and Advance Requested

Total employee retention credit for the quarter
. . . . . . . . . . . . . . .
Total qualified sick leave wages eligible for the credit and paid this quarter. See instructions
Total qualified family leave wages eligible for the credit and paid this quarter. See instructions
Add lines 1, 2, and 3 . . . . . . . . . . . . . . . . . . . . . . . .
Total amount by which you have already reduced your federal employment tax
deposits for these credits for this quarter . . . . . . . . . . . .
5
Total advanced credits requested on previous filings of this form for this quarter
6
Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . .
Advance requested. Subtract line 7 from line 4. If zero or less, don’t file this form . . . .

.
.
.
.

.
.
.
.

.
.
.
.

1
2
3
4

7
8
Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See the
instructions for details.
Yes. Complete below.
No
.
.

.
.

.
.

ThirdParty
▶
Designee Designee’s name

and phone number ▶
Select a 5-digit personal identification number (PIN) to use when talking to the IRS ▶

▲

Sign
Here

Under penalties of perjury, I declare that I have examined this form, including any accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature

Date

Printed title

Printed name

Paid
Preparer
Use Only
How
To File

Best daytime phone

Print/Type preparer’s name

Preparer’s signature

Firm’s name ▶
Firm’s address

PTIN

Date

Check
if
self-employed

Firm’s EIN ▶
▶

Phone no.

Fax your completed form to 855-248-0552.

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 56392D

Form 7200 (3-2020)