FFCRA Tax Credit Form

FFCRA tax credits Form

This form is only intended for employers who are subject to the Family First Coronavirus Response Act (FFCRA) tax credits. Complete this form if you'd like to request setup of applicable earning codes. Please see the Empeon COVID-19 Guide for more information about the FFCRA and which employers are included in the Act.

If you have 500 employees or more, or otherwise do not qualify for the FFCRA tax credits, DO NOT complete this form. Rather, use one of your existing earning codes, or submit the standard New Earning Code request form to request new codes.

EmailEnter the same email address which you signed in with:

Applicable company codesFor multiple companies, enter all company codes separated by a comma. IE. 9999, 9999A, 9999B

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By Submitting this form you confirm that you are subject to the Family First Coronavirus Response Act and assume full responsibility for all refunds claimed under the Act.

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In no event will ADS/Empeon be liable for any direct, indirect, incidental, consequential, punitive, or monetary damages, occurring as a result of this request, whether or not such damages were foreseeable and/ or preventable and even if ADS/Empeon was or should have been aware.