Form   

8820

(Rev. December 2012)

Department of the Treasury  Internal Revenue Service 

Orphan Drug Credit

a Information about Form 8820 and its instructions is available at www.irs.gov/form8820.

a Attach to your tax return.

OMB No. 1545-1505

Attachment   Sequence No. 103

Name(s) shown on returnIdentifying number

Part ICurrent Year Credit

1 Qualified clinical testing expenses paid or incurred during the tax year (see instructions)....1 

2a Current year credit. Multiply line 1 by 50% (.50) (see instructions) ...........2a 

bEnter the portion of the credit from Form 8932, line 2, that is attributable to wages that were also 

used to figure the credit on line 2a above ...................2b

c Subtract line 2b from line 2a. If zero or less, enter -0- ...............2c 

3 Orphan drug credit from partnerships, S corporations, estates, or trusts .........3 

4Add lines 2c and 3. Estates and trusts go to line 5. Partnerships and S corporations, report this 

amount on Schedule K. All others, report this amount on Form 3800, line 1h ........4 

5 Amount allocated to the beneficiaries of the estate or trust (see instructions) ........5 

6 Estates and trusts. Subtract line 5 from line 4. Report this amount on Form 3800, line 1h....6 

For Paperwork Reduction Act Notice, see instructions.Cat. No. 11208SForm 8820 (Rev. 12-2012)

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Form 8820 (Rev. 12-2012)Page 2

Part II  Orphan Drug Information (see instructions)

(a)  (b) Name of orphan drug(c) Designation application number(d) Date drug designated 

(mm/dd/yyyy)

7a

b

c

d

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f

g

h

i

j

k

l

m

n

o

p

q

r

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Form 8820 (Rev. 12-2012)

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