COBRA Credit for Q3 2021 Form 941

The American Rescue Plan Act (ARPA) allows for a COBRA Premium Subsidy, which provides a 100% subsidy to the employer for the cost of COBRA continuation coverage for eligible employees. The subsidy applies for up to six months of coverage from April 2021 through September 2021 (provided employees are within their maximum COBRA period and not eligible for coverage elsewhere). For subject plans, the employer is required to pay the COBRA premium, and is eligible for a payroll tax credit reimbursement on the quarterly 941.

References:

If your company is eligible for a credit in 3rd quarter 2021 (July, August, September), please fill out the form on this page and PayNorthwest will apply the credit to your quarterly 941. 

This form must be completed for each Federal EIN that you are requesting calculations for.

If your company is eligible for a credit in 3rd quarter 2021 (for July, August, and September), please fill out the below by Friday, October 1, 2021, and PayNorthwest will apply the credit to your quarterly 941. Forms received after October 1, 2021 are subject to a $150.00 late processing fee to apply the credit.

Name(Required)
If known
This applies to Q3 2021(Required)
Attestation(Required)