STATE OF HAWAII — DEPARTMENT OF TAXATION
Dependent Care Provider’s Identification and Certification
(DO NOT file with your tax return. Keep for your records)
Part I — Dependent Care Provider’s Identification (See Instructions)
Name of dependent care provider
Provider’s taxpayer identification number
Address (number and street)
If the above number is a social security number,
check this box
City, state, and Postal/ZIP code
Hawaii Tax I.D. No.
W __ __ __ __ __ __ __ __ - __ __
Certification and Signature of Dependent Care Provider. Under penalties set forth in section 231-36, HRS, I as the dependent care provider, certify
that my name, address, taxpayer identification number, and general excise Hawaii tax identification number, as shown above, are correct.
Signature of Dependent Care Provider
Part II — Name and Address of Taxpayer Requesting Part I Information (See Instructions)
Name, street address, city, state, and Postal/ZIP code of person requesting information
How to Get a TIN and a general excise Hawaii
Tax I.D. No. below.
You are required to get the information in Part I
You only need to complete this part if you give
If the provider is exempt from federal income
from anyone who provides care for your child or
Form HW-16 to your provider and it is to be
tax as an organization described in IRC
other dependent if:
returned to you at some later time.
section 501(c)(3), see If Provider Is an Exempt
you intend to claim a tax credit on your tax return
for child and dependent care expenses; or
How To Get a TIN and a general excise Hawaii
If No Information Is Reported. — You will not be
Tax I.D. No.. — Providers who do not have a
you receive benefits from a dependent
allowed the tax credit or the income exclusion for
TIN or a general excise Hawaii Tax I.D. No.
care assistance program provided by your
employer-provided dependent care assistance if:
should apply for one immediately. To apply for
an SSN, they should get federal Form SS-5,
you do not include the name, address, TIN,
You must report the correct name, address,
Application for a Social Security Card (for
or general excise Hawaii Tax I.D. No. of the
taxpayer identification number (TIN), and general
individuals), from their local office of the Social
provider on your income tax return; and
excise Hawaii tax identification number (Hawaii
Security Administration. To apply for an ITIN, they
Tax I.D. No.) of the dependent care provider
you cannot establish, to the Department of
should get federal Form W-7, Application for IRS
(provider) on Schedule X, Tax Credits for Hawaii
Taxation upon its request, that you exercised
Individual Taxpayer Identification Number, from
due diligence in obtaining this information.
their local IRS office. To apply for a FEIN, they
You may use Form HW-16 to get this information
should get federal Form SS-4, Application for
Due Diligence. — You can show that you
from each provider or you may use any one of the
Employer Identification Number (for businesses
other methods described under Due Diligence,
and other entities), from their local IRS office.
information by getting and keeping:
below. A copy of federal Form W-10 may not be
To apply for a general excise Hawaii Tax I.D.
a Form HW-16 properly completed by the
submitted for Form HW-16. Do not file Form HW-
No., they should get Form BB-1, State of Hawaii
16 with your income tax return. Instead, keep it
Basic Business Application, from their respective
for your records.
district Department of Taxation office. Form BB-1
a copy of the provider’s social security card
may also be obtained by calling the Department
and general excise tax license; or
Section 235-55.6, Hawaii Revised Statutes
of Taxation at 808-587-4242 or toll-free at
(HRS), requires anyone providing dependent
a recently printed letterhead or printed invoice
1-800-222-3229, or by downloading it from the
care services to you to give you this information.
that has on it the provider’s name, address,
Department of Taxation’s website (
The Department of Taxation uses the TIN and
TIN, and general excise Hawaii Tax I.D. No.;
gov/tax). NOTE: An ITIN is for tax use only. It
general excise Hawaii Tax I.D. No. for identification
does not entitle the individual to social security
purposes and to help verify the accuracy of the
where the employer is the provider, a copy
benefits or change employment or immigration
provider’s return as well as your return. Providers
of the statement furnished by the employer
status under U.S. law.
must give you their TIN and general excise Hawaii
under a dependent care assistance program,
Tax I.D. No. whether or not they are required to
If Provider Is an Exempt Organization. — If the
showing the employer’s name, address, TIN
file a tax return.
provider is a tax-exempt organization of the type
and general excise Hawaii Tax I.D. No.; or
described in IRC section 501(c)(3), the provider
where the provider is your household employee
is not required to supply its TIN or general
and has given you a properly completed Form
excise Hawaii Tax I.D. No.. In such cases, the
The provider completes this part.
HW-4 to have income tax withheld, a copy of
organization completes the name and address
The provider’s name, address, TIN, and general
part of Form HW-16 and writes “tax-exempt” in
excise Hawaii Tax I.D. No. should be entered in
the space provided for the TIN and general excise
If your provider does not comply with your request
the spaces above.
Hawaii Tax I.D. No.. Generally, the type of exempt
for one of these items, you must still furnish
organization described in IRC section 501(c)(3)
the name, address, and, if known, the TIN and
For individuals and sole proprietors, the TIN is a
is one organized and operated exclusively for
general excise Hawaii Tax I.D. No. of the provider
social security number (SSN). But if the provider
religious, charitable, scientific, testing for public
on Schedule X.
Also, you should include a
is a nonresident or resident alien who does not
safety, literary, or educational purposes, or for the
statement on Schedule X that you requested the
have and is not eligible to get an SSN, the TIN
prevention of cruelty to children or animals.
information and that the provider did not comply
is an Internal Revenue Service (IRS) individual
with the request. This statement will show that
taxpayer identification number (ITIN). For other
Income Tax Reporting Requirements for
you exercised due diligence, unless you know
entities, it is the federal employer identification
Providers. — The provider must report on his
that the statement is incorrect.
number (FEIN). If the provider does not have a
or her income tax return all income received for
TIN or a general excise Hawaii Tax I.D. No., see
providing care for any person.