Form It-Tw - Teleworking Approval Form (Page 2 of 3) in pdf

Form It-Tw - Teleworking Approval Form Page 2

IT-TW

(REV 6/09)

Please attach a listing of the estimated eligible telework expenses for each participating

employee.

If you conducted a telework assessment on or after July 1, 2007 please complete Section

B of this form.

B. Calculation of Telework Assessment Credit

An employer who conducts a telework assessment on or after July 1, 2007 is allowed a

credit in the calendar year of implementation of the employer’s formal telework program

for 100% of the cost of preparing the assessment, up to a maximum credit of $20,000.00

per employer. This credit is intended to include program planning expenses, including

direct program development and training cost, raw labor cost, and professional consulting

fees; the credit shall not include expenses included in the eligible telework expenses.

This credit shall be allowed only once per employer.

1. Program development and training cost

________________________

2. Raw labor cost

________________________

3. Professional consulting fees

________________________

4. Other (please explain in attachment)

________________________

5. Add lines 1, 2, 3, and 4

________________________

6. Maximum Allowable Credit

$20,000

7. Enter the lesser of line 5 or 6

________________________

8. Enter the amount from line 4 of Section A

________________________

9. Add lines 7 and 8 for credit amount

________________________

Please attach a detailed listing of all actual or estimated program planning expenses.

C. CERTIFICATION BY APPLICANT

Applicant hereby certifies that the eligible telework expenses in Section A of this

form would not have been incurred but for the availability of the teleworking credit.

Applicant also certifies that all information contained above and in exhibits

attached hereto are true to his/her best knowledge and belief and are submitted for

the purpose of obtaining approval from the Commissioner.

Date:_____________________

Applicant:__________________________

By: _______________________________

Signature of Authorized Officer

Title: ______________________________

Phone Number: ______________________

Form It-Tw - Teleworking Approval Form Page 2

Related Articles

Related forms

Related Categories