Form 312n - Nebraska Advantage Act Incentive Computation
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Nebraska Advantage Act Incentive Computation
FORM
312N
for use with Forms 1120N, 1120-SN, 1120NF, 1065N, 1041N, and 1040N
Page 1
• Application date on or after September 6, 2013.
Name on Return
Nebraska ID or Social Security No. Federal ID Number
Year End
Project Number
Date of Application
Type of Return
1120N
1120-SN
1120NF
1065N
1041N
1040N
Project Location
Business Classification Code Tier Selected in Nebraska Advantage Act Agreement
Tier 1
Tier 2
Tier 3
Tier 4
Tier 5
Tier 6
Name of Contact Person
Phone Number
Email Address
Eligibility Survey
1 Does the project include a political subdivision or an organization that is exempt from income
taxes under § 501(a) of the Internal Revenue Code (IRC)? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
If the answer is Yes, your project includes an entity that cannot participate in the incentive
program. STOP HERE. Contact the Nebraska Department of Revenue before completing
the remainder of the form.
2 Has there been any change in the project ownership, entities, locations, or business activities
during the year that has not been reported? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
If the answer is Yes, complete and attach Schedule III.
3 a Have you timely verified the work eligibility of all newly-hired Nebraska employees through
the
E-Verify
system operated by the the United States Citizenship and Immigration Service?
YES
NO
b Have the hours worked by, and compensation paid to any employee who is not eligible to
work in Nebraska, according to E-Verify, been excluded from the project calculations? . . . . .
YES
NO
If the answer to either 3a or 3b is No, revise the computation of benefits to exclude
the hours and wages for employees hired after the date of application and not timely verified,
or for unauthorized Nebraska employees.
8-733-2016
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