Instructions For Form A1-Qtc - Quarterly Payment Of Reduced Withholding For Tax Credits - 2017

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2017 Quarterly Payment of
Arizona Form
Reduced Withholding for Tax Credits
A1-QTC
For information or help, call one of these numbers:
Please do not mail this form to the Arizona Department of
Phoenix
(602) 255-3381
Revenue. Mail the completed form to the Entity listed in the
From area codes 520 and 928, toll-free
(800) 352-4090
left column. Keep a copy of the completed form, and any
attachments, for the employer’s records.
Tax forms, instructions, and other tax information
If you need tax forms, instructions, and other tax information,
Specific Instructions
go to the department’s website at
Withholding Tax Procedures and Rulings
Type or print the employer’s name and address in the boxes
These instructions may refer to the department’s withholding
in the upper right column. Enter the date the payment is
tax procedures and rulings. To view or print these, go to our
made. Type or print the Entity’s name and address in the
website and click on Legal Research then click on
boxes in the left column.
Procedures or Rulings and select a tax type from the drop
down menu.
Enter the payment amount enclosed. This should be the total
amount of contributions made to the Entity by all employees.
Publications
To view or print the department’s publications, go to our
Complete the worksheet on Form A1-QTC. Use one column
website and click on Publications.
for each employee that donated to this entity. If more than
three employees made donations, check the box under the
General Instructions
employee chart, and attach additional forms or your own
schedule that contains the same information included in the
Arizona Revised Statutes (A.R.S.) § 43-401(G) provides that
worksheet.
an employee may request that his or her employer reduce his
Sign and date the Form A1-QTC where indicated. Complete
or her withholding in an amount equal to income tax credit(s)
the information boxes below your signature, in case the
the employee will qualify for when filing his or her income
Entity needs to contact you with any questions.
tax return.
Mail the completed form to the Entity listed in the left
Purpose of the Form
column.
Keep a copy of the completed form, and any
This form is optional and provided as a courtesy by the
attachments, for the employer’s records.
Arizona Department of Revenue. The same result can be
accomplished using your own form or a letter.
Employers use this form to report contributions made by their
employees to the Entity (qualifying charitable organizations,
public schools, and/or school tuition organizations).

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