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Form OR-PS, Care Provider Statement, 150-101-190 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the taxpayer's name(s) and Letter ID at the top of the form. If you don't have a Letter ID, input your Social Security Number instead.
- Fill in the date range for the care provided, specifying both start and end dates.
- In the provider section, enter your name along with your Social Security Number (SSN), Individual Tax Identification Number (ITIN), or Federal Employer Identification Number (FEIN).
- List each dependent's name and age, along with total payments received from the taxpayer for each dependent. Include any payments received from third parties as applicable.
- Complete the additional questions regarding payment frequency and methods. Ensure to provide accurate details about receipts issued for payments.
- Sign and date the form at the bottom, confirming that all information is true and complete before submitting it back to the taxpayer or directly to the department.
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