Utah State Tax Commission
TC-40HD
Employers Who Hire Persons With Disabilities Tax Credit
Rev. 12/09
Get forms online - tax.utah.gov
Utah law ( 59-7-608) allows a nonrefundable tax credit against the corporate franchise or income tax for employers who hire persons with
§
disabilities who work for the employer for at least six months in a taxable year.
Do not send this form with your return. Keep this form and all related documents with your records.
PART A
Name of employer claiming credit
Employer's identification number
Address
Telephone number
City
State
ZIP Code
PART B - Certification To be completed by the Division of Services for People with Disabilities
I certify the individuals listed below (1) have been receiving services from a day-training program or from a supported employment
program for persons with disabilities, certified by the Department of Human Services as a qualifying program, for at least
six consecutive
months
in the taxable year prior to working for the employer claiming the tax credit, or (2) were eligible for services from the Division of
Services for People with Disabilities at the time the individuals began working for the employer.
Date
Authorized signature
Title
PART C - Summary Worksheet For Disabled Employees Credit Worksheet instructions on back
Col. B
Column C
Column D
Column E
Column F
Column G
Column H
Column A
Number
First 180 days of
Remainder of gross
Name of
Add columns F and G
Social security number
10% of Column D 20% of Column E
of months
gross wages earned
wages earned by
disabled employee
of disabled employee
Limited to $3,000
worked in
by disabled
disabled employee
per disabled
employee
in taxable year
the taxable
(see instructions)
(see instructions)
employee
year
1
1. Total amount of tax credit (add amounts in column H)
2
2. Tax from tax return
3. Tax credit allowed (lesser of line 1 or line 2)
3
Column A
Column B
Column C
Previous year
Column C less
Credit claimed in
current year
Carryover year
carryover year
Column B
Carryover of Excess Credit (if any)
4. Carryover from original year (subtract line 3 from line 1)
4
5. First carryover year
5
6. Second carryover year
6
No further carryover
Refer to the corporate tax (TC-20) instructions on how to claim this credit.
Credit code is "09"
.