Form Rpd-41326 - New Mexico Rural Health Care Practitioner Tax Credit Claim Form Page 3
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3RPD-41326
State of New Mexico - Taxation & Revenue Department
Rev. 08/27/2014
RURAL HEALTH CARE PRACTITIONER TAX CREDIT CLAIM FORM
Schedule A Instructions
For each rural health care practitioner tax credit approved by the New Mexico Department of Heatlh (NMDOH) complete a
row in Schedule A. Do not include credits approved in a tax year that is more than four years prior to the tax year for which
this claim is filed. Unused rural health care practitioner tax credit may not be carried forward for more than three consecu-
tive tax years following the tax year for which the credit was approved. Do not include credits which have been claimed in
full in prior tax years.
.
COLUMN INSTRUCTIONS
(a) Certification number. Enter the certification number for each rural health care practitioner tax credit shown on the credit ap-
Do not enter a credit if the certificate of eligibility is for a tax year more than four years
proval document issued by NMDOH.
from the tax year of this claim or if the credit was not approved by NMDOH. Unused credit may only be carried forward for
three years following the tax year for which the credit was approved.
(b) Date of approval. Enter the date the rural health care practitioner tax credit was approved as indicated on the certificate
issued by NMDOH.
(c) Amount of credit approved. For each credit, enter the amount approved, as indicated on the certificate issued by NMDOH.
Total credit claimed in previous tax years. For each credit listed, enter the total amount of credit claimed in all tax
(d)
years prior to the current tax year.
(e) Unused credit. For each credit, subtract the amount in column (d) from the amount in column (c).
(f) Applied to the attached return. For each credit, enter in column (f) the amount that is applied to the attached New
Mexico income tax return.
When calculating the amount in column (f), apply the following rules:
Applying credits: Apply rural health care practitioner tax credit in the order that they were approved. The oldest
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credit should be applied first. If you have both a carry forward credit and a credit approved in the current tax year,
apply the older credits first.
The maximum amount of credit claimed in a tax year. The sum of tax credits applied to the tax due on the return
•
may not exceed the income tax claimed on the New Mexico income tax return. That amount is the net New Mexico
income tax calculated before applying any tax credits claimed.
IMPORTANT DEFINITIONS
“Eligible health care practitioner” means: (a) a certified nurse-midwife licensed by the board of nursing as a registered
nurse and licensed by the public health division of the New Mexico Department of Health to practice nurse-midwifery as a
certified nurse-midwife; (b) a dentist or dental hygienist licensed pursuant to the Dental Health Care Act; (c) an optometrist
licensed pursuant to the provisions of the Optometry Act; (d) an osteopathic physician licensed pursuant to the provisions
of Chapter 61, Article 10 NMSA 1978, or an osteopathic physician assistant licensed pursuant to the provisions of the
Osteopathic Physicians’ Assistants Act; (e) a physician or physician assistant licensed pursuant to the provisions of Chapter
61, Article 6 NMSA 1978; (f) a podiatrist licensed pursuant to the provisions of the Podiatry Act; (g) a clinical psychologist
licensed pursuant to the provisions of the Professional Psychologist Act; and (h) a registered nurse in advanced practice who
has been prepared through additional formal education as provided in Sections 61-3-23.2 through 61-3-23.4 NMSA 1978
to function beyond the scope of practice of professional registered nursing, including certified nurse practitioners, certified
registered nurse anesthetists and clinical nurse specialists.
“Health care underserved area” means a geographic area or practice location in which it has been determined by the
New Mexico Department of Health, through the use of indices and other standards set by the New Mexico Department of
Health, that sufficient health care services are not being provided.
“Practice site” means a private practice, public health clinic, hospital, public or private non-profit primary care clinic or other
health care service location in a health care underserved area.
“Rural” means an area or location identified by the New Mexico Department of Health as falling outside of an urban area.
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