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January 26, 2021

Missouri affidavit form now available for claiming relief for 2020 income tax withholding shortages due to COVID-19

The Missouri Department of Revenue has released Form 5841, Affidavit for Withholding Based on Primary Work Location. Form 5841 was published to facilitate proposed regulations under 12 CSR 10-2.109  that allow employers that did not have an adequate time and attendance system in 2020 the option to declare that they withheld income tax from employees' wages as if they were earned for work performed at the employee's primary work location within the state, without regard to the employee's temporary work location during the COVID-19 relief period.

Under the proposed regulations, employers that elected in 2020 to withhold and remit Missouri income tax based on the primary work location of their employees are required to submit an affidavit that includes the information now contained in Form 5841.

Employers meeting the requirements for this relief are required to file Form 5841 with the Department by January 31, 2021.

For more information concerning the proposed regulations, see EY Tax Alert 2021-0124.


Contact Information
For additional information concerning this Alert, please contact:
Workforce Tax Services - Employment Tax Advisory Services
   • Debera Salam (
   • Kristie Lowery (
   • Kenneth Hausser (


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