Part 1 |
11b |
Nonrefundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021
|
11c |
Nonrefundable portion of employee retention credit |
11d |
Nonrefundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021 |
11e |
Nonrefundable portion of COBRA premium assistance credit |
11f |
Number of individuals provided COBRA premium assistance |
13c |
Refundable portion of credit for qualified sick and family leave wages for leave taken before April 1, 2021 |
13d |
Refundable portion of employee retention credit |
13e |
Refundable portion of credit for qualified sick and family leave wages for leave taken after March 31, 2021 |
13f |
Refundable portion of COBRA premium assistance credit (see instructions for applicable quarters) |
13h |
Total advances received from filing Form(s) 7200 for the quarter |
Part 3
|
19 |
Qualified health plan expenses allocable to qualified sick leave wages for leave taken before April 1, 2021 |
20 |
Qualified health plan expenses allocable to qualified family leave wages for leave taken before April 1, 2021 |
21 |
Qualified wages for the employee retention credit |
22 |
Qualified health plan expenses for the employee retention credit |
23 |
Qualified sick leave wages for leave taken after March 31, 2021 |
24 |
Qualified health plan expenses allocable to qualified sick leave wages reported on line 23 |
25 |
Amounts under certain collectively bargained agreements allocable to qualified sick leave wages reported on line 23 |
26 |
Qualified family leave wages for leave taken after March 31, 2021 |
27 |
Qualified health plan expenses allocable to qualified family leave wages reported on line 26 |
28 |
Amounts under certain collectively bargained agreements allocable to qualified family leave wages reported on line 26 |