Enter the non refundable portion of credits for qualified sick and family leave wages for leave taken before March 31, 2021. These credits can be calculated using Worksheet 3.
Enter the non refundable portion of COBRA premium assistance that you provided for the quarter. These credits can be calculated using Worksheet 5.
Report the number of individuals who were provided COBRA premium assistance
for the quarter.
To report total nonrefundable credits, add together lines 11a, 11b, 11c, 11d, and 11e, and enter the total on line 11g.
Line 12: Total taxes after adjustments and nonrefundable credits
Enter the total taxes after the adjustments and credits. Subtract line 11d from line 10.
Line 13a: Total deposits for this quarter, including overpayment applied from a prior quarter and overpayments applied from Form 941-X, 941-X (PR), 944-X, or 944-X (SP) filed in the current quarter
Enter the total amount of deposits for the quarter. This should include overpayment applied from previous quarters and Form 941-X for the
Line 13b: Reserved for future use
No need to report anything in this line.
To report on the refundable portion of credits for qualified sick and family leave wages for leave taken before April 1, 2021, enter the amount from Worksheet 1.
Line 13d: Refundable portion of employee retention credit from Worksheet 1 (Not part of the original form. Included due to COVID-19 changes)
After determining the nonrefundable employee retention credit using Worksheet 1, subtract the amount of the non refundable portion from the total amount of the credit to determine the amount of the refundable portion. Enter the refundable portion of the credit identified in Line 3k of the worksheet in
Enter the refundable portion of credits for qualified sick and family leave wages for leave taken after March 31, 2021 from Worksheet 3.
Enter the refundable portion of COBRA premium assistance credit from Worksheet 1.
To report the total deposits and refundable credits, add lines 13a, 13c, 13d, 13e, and 13f and enter the total on line 13g.
Enter the total advances that you received by filing Form 7200 for the quarter.
To report total deposits and refundable credits, minus advances, subtract line 13h from line 13g and enter the result on line 13i.
To report your balance due, if line 12 is more than line 13i, enter the difference on line 14.
This line calculates overpayment. If line 13i is more than line 12, subtract and enter the difference on line 15.