Hawaii Certified Statement of Research and Development Company

Certified Statement of Research and Development Company
Form N-346A Rev. 2021 Certified Statement of Research and Development Costs Incurred By a Qualified High Technology Business (QHTB) and Claim of the T
Clear Form
STATE OF HAWAII—DEPARTMENT OF TAXATION

FORM

N-346A
(REV. 2021)

CERTIFIED STATEMENT OF RESEARCH AND DEVELOPMENT COSTS
INCURRED BY A QUALIFIED HIGH TECHNOLOGY BUSINESS (QHTB)
AND CLAIM OF THE TAX CREDIT FOR RESEARCH ACTIVITIES

Name of QHTB as shown on Form N-11, N-15, N-20, N-30, N-35, N-40, N-70NP	

CALENDAR
YEAR

20__

SSN or FEIN

Contact Information

Mailing Address	

	Name:
	Telephone:
	

E-mail address:

•	 Part I of Form N-346A is to be completed by the QHTB claiming or distributing the tax credit for research activities (credit). File Form N-346A on or
before March 30 for eligible research expenses incurred in the previous calendar year.
•	 For taxable years beginning after December 31, 2019, the Department of Business, Economic Development and Tourism (DBEDT) is responsible
for certifying the credit. See Department of Taxation Tax Announcement 2021-03, which explains how to apply to DBEDT for the certificate. See the
instructions for further details.

	 Part I
1	

TO BE COMPLETED BY THE QHTB. ATTACH ALL SUPPLEMENTAL SCHEDULES.

Enter the amount of eligible research expenses incurred in the calendar year to be reported on federal Form(s) 6765 and the amount of these
expenses attributable to the research activity conducted IN HAWAII (see instructions). (Note: Expenses attributed to research activities OUTSIDE
HAWAII do not qualify for the credit)
Reported on
Federal Form 6765	

				
(Round off all dollar entries to the nearest whole dollar)	
		
a	
b	
c	
	
d	
e	
f	
g	
	

	
	
	
	
	
	
	

2	

1d
1e
1f
1g
2

Have you claimed or will you be claiming the credit for increasing research activities for the expenses shown on line 1g?
Yes    No (Note: If you answered “No,” you cannot claim the Hawaii credit)
Are you are a partnership, S corporation, estate, trust, or cooperative for income tax purposes?    Yes   No
If you answered “Yes,” attach a list of (a) the partners’, shareholders’, beneficiaries’, or patrons’ names and SSN/FEIN and (b) each partner’s,
shareholder’s, beneficiary’s, or patron’s allocated/distributive share of the credit.
Are you a nonprofit organization exempt from taxation under IRC section 501(c)?
 Yes    No (Note: If you answered “Yes,” you cannot claim the Hawaii credit)
Briefly describe the research project(s) undertaken. (Attach a separate sheet if more space is needed.)

4	

	

	

1c

 

	

6	

1a
1b

Multiply the expenses shown in line 1g that were incurred IN HAWAII by 0.20 (20%) and enter result. . . . . . . . . . .  	

3	

5	

Certain amounts paid or incurred to energy consortia  . . . . . . . . . . . . . 	
Basic research payments to qualified organizations . . . . . . . . . . . . . . . 	
Wages for qualified services (do not include wages used in
figuring the federal work opportunity credit)  . . . . . . . . . . . . . . . . . . . . . 	
Cost of supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 	
Rental or lease costs of computers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 	
Enter the applicable percentage of contract research expenses  . . . . . 	
Total Eligible Research Expenses. Add lines 1a through 1f,
and enter result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 	

In Hawaii

DECLARATION
I hereby declare under the penalties of perjury that I have the authority to sign Part I of Form N-346A on behalf of the above named QHTB. I declare, under the
applicable penalties set forth in sections 231-34, 231-35, and 231-36, HRS, that the information reported in Part I of Form N-346A (including any accompanying
schedules or statements) has been examined by me and, to the best of my knowledge and belief, is true, correct, and complete and made in good faith, for the taxable
year stated, pursuant to the Hawaii Income Tax Law, Chapter 235, HRS. I understand that submission of this completed form is a prerequisite for the above-named
QHTB to claim or distribute this credit, and that this information is collected by the Department of Taxation for preliminary fact finding only. I further understand that the
above-named QHTB may be subject to audit at a later date.

Signature		Date

Print Name		

Title

		
FORM N-346A

STATE OF HAWAII - DEPARTMENT OF TAXATION

	

FORM

	
	

(REV. 2021)
Page 2

	 N-346A

Certified Statement of Research and Development Costs
Incurred by a Qualified High Technology Business (QHTB)
and Claim of the Tax Credit for Research Activities

Part II of Form N-346A is for use by the Department of Business, Economic Development, and Tourism (DBEDT).
Upon completion, DBEDT will mail Part II to the QHTB at the address reported on page 1 of Form N-346A.
ATTACH TO FORM N-11, N-15, N-20, N-30, N-35, N-40, OR, N-70NP

Name of QHTB claiming the credit as shown on Form N-11, N-15, N-20, N-30, N-35, N-40, N-70NP	

N346A_I 2021A 01 VID01

SSN or FEIN

The taxpayer claiming the credit shall attach a copy of the completed Part II of Form N-346A to Form N-346, Tax Credit for Research Activities. If the
QHTB is a flow-through entity, the taxpayer shall also attach a copy of the Schedule K-1 issued by the QHTB establishing the taxpayer’s share of the
total credit allowed to the QHTB.

	 Part II

CERTIFICATION — Lines 1 thru 3 are to be completed by the QHTB, then submitted to and certified by DBEDT

Based upon the representations and declarations made by the named QHTB, DBEDT certifies the receipt of the following information:

	

1	

Submitted for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calendar Year	

1

2	
	

Amount of eligible research expenses attributable to the research activity conducted IN HAWAII
during the noted calendar year as reported by the named QHTB (see Instructions) . . . . . . . . . . . . . . . . . . 	

2

3	

Amount of credit (20% of the amount shown on line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 	

3

IMPORTANT AUDIT NOTICE: All claims of credit are subject to audit. This certification is based solely on information provided by the taxpayer and
solely acknowledges receipt of such information by the Department. Nothing in this certification shall be deemed to be an acknowledgment or
admission by the Department that the taxpayer is entitled to the credit claimed. The Department expressly reserves all rights to challenge, in whole
or in part, the claim for credit.

Signature of Certifying Officer		

Date of Certification

Print Name		

Title

		
FORM N-346A

ID NO 01