Schedule W - Employment Incentive Payments Credit
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4Schedule W (10-02)
TAX YEAR ENDING
50000011041
(Month
Day
Year)
COMMONWEALTH OF PENNSYLVANIA
(ATTACH TO YOUR PENNSYLVANIA RETURN)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
SCHEDULE W – EMPLOYMENT INCENTIVE PAYMENTS CREDIT
HARRISBURG, PA 17128
Business Name
Corporation Tax File (Box) Number
Federal Employer Identification Number
Social Security Number
NAME.
PARTNER’S OR SHAREHOLDER’S SSN OR EIN.
IF A MEMBER OF A PARTNERSHIP, OR A SHAREHOLDER OF A PA S CORPORATION, ENTER YOUR
IMPORTANT – Your wage and salary expense deduction must be reduced by the credit on Line 16. (See Instructions for Line 16.)
EMPLOYMENT INCENTIVE PAYMENTS. (EIP) Complete the schedule below for qualified wages (up to $9,000 for each employee) paid or incurred during the tax year for
PART I
service of employees who are certified and for qualified Employment Incentive Payments for day care or transportation services. Attach certificates for all employees.
1.
First-year employee salary or wages and qualified day care or transportation services. Enter check ( ) mark in day care/transportation block if day care or transportation services were provided.
Day Care /
Name of Employee
Social Security Number
Date Employment Began
EIP Wages
Transportation
$
(a)
(b)
(c)
(d)
(e)
2.
Total qualified first year wages paid or incurred – Add wages on Line 1(a) through (e)
2.
3.
Total Employment Incentive Payment Credit for Wages – Multiply Line 2 by .30.
3.
4.
Total Employment Incentive Payment Credit for Day Care Services and Transportation Services –
Multiply number of blocks checked – Lines 1(a) – 1(e) by $800. Actual expenses must be used that do not exceed these amounts.
4.
5.
Total First Year Employment Incentive Credit – Add Lines 3 and 4.
5.
6.
Second Year Employee salary or wages and qualified day care or transportation services. Enter check ( ) mark in day care/transportation block if day care or transportation services were provided.
Day Care /
Name of Employee
Social Security Number
Date Employment Began
EIP Wages
Transportation
$
(a)
(b)
(c)
(d)
(e)
7.
Total qualified second year wages paid or incurred – Add wages on Line 6(a) through (e)
7.
8.
Total Employment Incentive Payment Credit for Wages – Multiply LIne 7 by .20.
8.
9.
Total Employment Incentive Payment Credit for Day Care Services and Transportation Services –
Multiply number of blocks checked – Lines 6(a) – 6(e) by $600. Actual expenses must be used that do not exceed these amounts.
9.
10. Total Second Year Employment Incentive Credit – Add Lines 8 and 9.
10.
11.
Third Year Employee salary or wages and qualified day care or transportation services. Enter check ( ) mark in day care/transportation block if day care or transportation services were provided.
Day Care /
Name of Employee
Social Security Number
Date Employment Began
EIP Wages
Transportation
$
(a)
(b)
(c)
(d)
(e)
12. Total qualified third year wages paid or incurred – Add wages on Line 11(a) through (e)
12.
13. Total Employment Incentive Payment Credit for Wages – Multiply Line 12 by .10.
13.
14. Total Employment Incentive Payment Credit for Day Care Services and Transportation Services –
Multiply number of blocks checked – Lines 11(a) – 11(e) by $400. Actual expenses must be used that do not exceed these amounts.
14.
15. Total Third year Employment Incentive Credit – Add Lines 13 and 14.
15.
Total credit for wages – Add Lines 3, 8, and 13. Enter here and on Line 33b of Schedule C or Line 23b of Schedule F.
16. If corporation, enter on Section C, Line 4c of RCT-101, or Page 2, Part I, II (a) of RCT-143.
16.
17. Total credit for day care or transportation services – Add Lines 4, 9, & 14.
17.
18. Total current Employment Incentive Payment Credit – Add Lines 16 and 17.
18.
50000011041
50000011041
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