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Begin by entering your name(s) as shown on your tax return and your taxpayer identification number at the top of the form.
In Part 1, enter the calendar year from your certificate of tax credit issued by the New York State DHSES. Complete lines 1 through 5 carefully, ensuring you submit a copy of the certificate.
If applicable, move to Part 2 and provide details about any partnerships or S corporations. Enter the type (P, S, ET), name of entity, employer identification number, and share of credit.
Finally, complete Part 3 if you are a fiduciary or beneficiary. List each beneficiary’s name and their share of credit accurately.
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