Hawaii Dependent Care Provider's Identification and Certification

Dependent Care Provider's Identification and Certification
Form HW-16 Rev 2016 Dependent Care Provider's Identification and Certification
Clear Form
Form

HW-16

STATE OF HAWAII — DEPARTMENT OF TAXATION

Dependent Care Provider’s Identification and Certification

	
	
	

Please print or type

(REV. 2016)
(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 ä ............................................... £

City, State, and Postal/ZIP code	
	

GE/Use I.D. No.
GE __ __ __-__ __ __-__ __ __ __ - __ __

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 tax identification number, as shown above, are correct.
Please Signature of Dependent Care Provider	
Sign
Here

Date

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

General Information

and a GE/Use I.D. No. below.

Part II

You are required to get the information in Part I
from anyone who provides care for your child or
other dependent if:

If the provider is exempt from federal income
tax as an organization described in IRC
section 501(c)(3), see If Provider Is an Exempt
Organization below.

You only need to complete this part if you give
Form HW-16 to your provider and it is to be
returned to you at some later time.

•	 you intend to claim a tax credit on your tax return
for child and dependent care expenses; or

•	 you

receive benefits from a dependent
care assistance program provided by your
employer.

You must report the correct name, address,
taxpayer identification number (TIN), and general
excise tax identification number (GE/Use I.D.
No.) of the dependent care provider (provider)
on Schedule X, Tax Credits for Hawaii Residents.
You may use Form HW-16 to get this information
from each provider or you may use any one of the
other methods described under Due Diligence,
below. A copy of federal Form W-10 may not be
submitted for Form HW-16. Do not file Form HW16 with your income tax return. Instead, keep it
for your records.
Section 235-55.6, Hawaii Revised Statutes
(HRS), requires anyone providing dependent
care services to you to give you this information.
The Department of Taxation (Department) uses
the TIN and GE/Use I.D. No. for identification
purposes and to help verify the accuracy of the
provider’s return as well as your return. Providers
must give you their TIN and GE/Use I.D. No.
whether or not they are required to file a tax
return.

Part I
The provider completes this part.
The provider’s name, address, TIN, and GE/Use
I.D. No. should be entered in the spaces above.
For individuals and sole proprietors, the TIN is a
social security number (SSN). But if the provider
is a nonresident or resident alien who does not
have and is not eligible to get an SSN, the TIN
is an Internal Revenue Service (IRS) individual
taxpayer identification number (ITIN). For other
entities, it is the federal employer identification
number (FEIN). If the provider does not have a
TIN or a GE/Use I.D. No., see How to Get a TIN

How To Get a TIN and a GE/Use Tax I.D. No. —
Providers who do not have a TIN or a GE/Use
I.D. No. should apply for one immediately. To
apply for an SSN, they should get federal Form
SS-5, Application for a Social Security Card (for
individuals), from their local office of the Social
Security Administration. To apply for an ITIN, they
should get federal Form W-7, Application for IRS
Individual Taxpayer Identification Number, from
their local IRS office. To apply for a FEIN, they
should get federal Form SS-4, Application for
Employer Identification Number (for businesses
and other entities), from their local IRS office. To
apply for a GE/Use I.D. No., they should get Form
BB-1, State of Hawaii Basic Business Application,
from their respective district Department office.
Form BB-1 may also be obtained by calling
the Department at 808-587-4242 or toll-free
at 1-800-222-3229, or by downloading it from
the Department’s website (tax.hawaii.gov).
NOTE:  An ITIN is for tax use only. It does not
entitle the individual to social security benefits or
change employment or immigration status under
U.S. law.
If Provider Is an Exempt Organization. — If the
provider is a tax-exempt organization of the type
described in IRC section 501(c)(3), the provider
is not required to supply its TIN or GE/Use I.D.
No. In such cases, the organization completes
the name and address part of Form HW-16
and writes “tax-exempt” in the space provided
for the TIN and GE/Use I.D. No.. Generally, the
type of exempt organization described in IRC
section 501(c)(3) is one organized and operated
exclusively for religious, charitable, scientific,
testing for public safety, literary, or educational
purposes, or for the prevention of cruelty to
children or animals.
Income Tax Reporting Requirements for
Providers. — The provider must report on his
or her income tax return all income received for
providing care for any person.

Other Information
If No Information Is Reported. — You will not be
allowed the tax credit or the income exclusion for
employer-provided dependent care assistance if:

•	 you do not include the name, address, TIN, or

GE/Use I.D. No. of the provider on your income
tax return; and

•	 you cannot establish, to the Department upon
its request, that you exercised due diligence in
obtaining this information.

Due Diligence. — You can show that you
exercised due diligence in obtaining this
information by getting and keeping:

•	 a

Form HW-16 properly completed by the
provider; or

•	 a

copy of the provider’s social security card
and general excise tax license; or

•	 a recently printed letterhead or printed invoice

that has on it the provider’s name, address,
TIN, and GE/Use I.D. No.; or

•	 where

the employer is the provider, a copy
of the statement furnished by the employer
under a dependent care assistance program,
showing the employer’s name, address, TIN
and GE/Use I.D. No.; or

•	 where the provider is your household employee

and has given you a properly completed Form
HW-4 to have income tax withheld, a copy of
that HW-4.

If your provider does not comply with your request
for one of these items, you must still furnish the
name, address, and, if known, the TIN and GE/
Use I.D. No. of the provider on Schedule X. Also,
you should include a statement on Schedule X
that you requested the information and that the
provider did not comply with the request. This
statement will show that you exercised due
diligence, unless you know that the statement is
incorrect.