New Mexico Rural Health Care Practitioner Tax Credit Claim Form

Rural Health Care Practitioner Tax Credit Claim Form
Form RPD-41326
RPD-41326
Rev. 05/15/2024

State of New Mexico - Taxation and Revenue Department

RURAL HEALTH CARE PRACTITIONER TAX CREDIT CLAIM FORM

WHO MUST FILE THIS FORM: A taxpayer who files a New Mexico personal income tax return, who is not a dependent of another
individual, who is an eligible health care practitioner and who has provided health care services in New Mexico in a rural health care underserved area in a tax year, may claim a credit against personal income tax liability.
The rural health care practitioner tax credit may be claimed and allowed in an amount up to $5,000 for all physicians, osteopathic physicians,
dentists, psychologists, podiatric physicians, and optometrists who qualify, and up to $3,000 for all pharmacists, dental hygienists, physician assistants, certified registered nurse anesthetists, certified nurse practitioners, clinical nurse specialists, registered nurses, midwives,
licensed clinical social workers, licensed independent social workers, professional mental health counselors, professional clinical mental
health counselors, marriage and family therapists, professional art therapists, alcohol and drug abuse counselors and physical therapists
who qualify. If the amount of the credit claimed exceeds a taxpayer’s tax liability for the tax year in which the credit is being claimed, the
excess may be carried forward for three consecutive tax years.
To qualify for the rural health care practitioner tax credit, an eligible health care practitioner shall have provided health care during a tax
year for at least 1,584 hours at a practice site located in an approved rural health care underserved area. An eligible rural health care
practitioner who provides health care services for at least 792 hours, but less than 1,584 hours, at a practice site located in an approved
rural health care underserved area during a tax year is eligible for one-half of the credit amount.
Before an eligible health care practitioner may claim the rural health care practitioner tax credit, the practitioner shall submit an application
to the New Mexico Department of Health (NMDOH) that describes the practitioner’s clinical practice and contains additional information that
NMDOH may require. NMDOH will determine whether an eligible health care practitioner qualifies for the rural health care practitioner tax
credit, and will issue a certificate to each qualifying eligible health care practitioner. To apply for certification of eligibility, contact NMDOH at
(505) 841-5849, by e-mail at [email protected], or visit their website at https://www.nmhealth.org/about/phd/pchb/oprh/rhcptc/.
HOW TO CLAIM THIS CREDIT: Compute the credit amount on the worksheet below and submit RPD-41326, Rural Health Care Practitioner Tax Credit Claim Form, with the New Mexico personal income tax return during the tax year the credit is certified by NMDOH or the
tax year in which a carryforward is claimed against a personal income tax liability. During the tax year the credit is certified by NMDOH,
you must also submit a copy of the certificate of eligibility issued by NMDOH. Include Schedule A if you have unused rural health care
practitioner tax credit eligible to be carried forward from prior years.
For assistance completing this form or claiming the credit, email [email protected] or call (505) 827-0792.
Social security number (SSN) or ITIN

Name of taxpayer

Mailing address

Name of contact

City, state and ZIP code

E-mail address

Phone number

1.	 Enter the beginning and ending date of the tax year of this claim.

From _____________ to _____________

2.	 Enter the Net New Mexico income tax calculated before applying any credit.
3.	 Enter the portion of total credit available (from Schedule A) claimed on your current New
Mexico personal or fiduciary income tax return. Do not enter more than the amount of
Net New Mexico personal or fiduciary income tax due. In a tax year the credit used may
not exceed the amount of personal or fiduciary income tax otherwise due. Also attach
a completed Schedule CR for the applicable tax return.

2.

$

3.

$

Under penalty of perjury, I declare I have examined this claim, including accompanying returns, schedules and
statements, and to the best of my knowledge and belief, it is true, correct and complete.

Signature of Taxpayer or Agent

Title

Date

RPD-41326
Rev. 05/15/2024

State of New Mexico - Taxation & Revenue Department

RURAL HEALTH CARE PRACTITIONER TAX CREDIT CLAIM FORM
Schedule A

Once a credit application is approved by the New Mexico Department of Health (NMDOH), complete and attach Form RPD41326, Rural Health Care PractitionerTax Credit Claim Form, including Schedule A, to your New Mexico income tax return
along with the tax credit Schedule CR applicable to the tax program toward which you are applying the credit. Attach a copy
of your certificate from NMDOH.
(a)
Certification number

(b)
Date of approval

(c)
Amount of credit
approved

(d)
Total credit claimed
in previous tax years

(e)
Unused credit [(c) - (d)]

TOTAL credit available

Enter the sum of column (f) here and on
line 3 of Form RPD-41326, page 1.

(f)
Applied to the attached
return

RPD-41326
Rev. 05/15/2024

State of New Mexico - Taxation & Revenue Department

RURAL HEALTH CARE PRACTITIONER TAX CREDIT CLAIM FORM
Schedule A Instructions

For each rural health care practitioner tax credit approved by
the New Mexico Department of Health (NMDOH) complete a
row in Schedule A. Do not include credits approved in a tax
year that is more than four years prior to the tax year for which
this claim is filed. Unused rural health care practitioner tax
credit may not be carried forward for more than three consecutive tax years following the tax year for which the credit was
approved. Do not include credits which have been claimed
in full in prior tax years..
COLUMN INSTRUCTIONS
(a) Certification number. Enter the certification number for

each rural health care practitioner tax credit shown on the credit
approval document issued by NMDOH. Do not enter a credit

if the certificate of eligibility is for a tax year more than four
years from the tax year of this claim or if the credit was not
approved by NMDOH. Unused credit may only be carried
forward for three years following the tax year for which the
credit was approved.
(b) Date of approval. Enter the date the rural health care
practitioner tax credit was approved as indicated on the certificate issued by NMDOH.

(c) Amount of credit approved. For each credit, enter the
amount approved, as indicated on the certificate issued by
NMDOH.
(d) Total credit claimed in previous tax years. For each

credit listed, enter the total amount of credit claimed in all tax
years prior to the current tax year.

(e) Unused credit. For each credit, subtract the amount in
column (d) from the amount in column (c).
(f) Applied to the attached return. For each credit, enter
in column (f) the amount that is applied to the attached New
Mexico income tax return.
When calculating the amount in column (f), apply the following rules:
•	

Applying credits: Apply rural health care practitioner
tax credit in the order that they were approved. The
oldest credit should be applied first. If you have both
a carry forward credit and a credit approved in the
current tax year, apply the older credits first.

•	

The maximum amount of credit claimed in a tax
year. The sum of tax credits applied to the tax due on
the return may not exceed the income tax claimed on
the New Mexico income tax return. That amount is the
net New Mexico income tax calculated before applying
any tax credits claimed.

IMPORTANT DEFINITIONS
“Eligible health care practitioner” means:
(a) a dentist or dental hygienist licensed pursuant to the Dental
Health Care Act;
(b) a midwife that is a: 1) certified nurse-midwife licensed by
the board of nursing as a registered nurse and licensed by
the public health division of the New Mexico Department of
Health (DOH) to practice nurse-midwifery as a certified nursemidwife; or 2) licensed midwife licensed by the Public Health
Division of the DOH to practice licensed midwifery;
(c) an optometrist licensed pursuant to the provisions of the
Optometry Act;
(d) an osteopathic physician licensed pursuant to the
provisions of the Medical Practice Act;
(e) a physician licensed pursuant to the provisions of the
Medical Practice Act or a physician assistant licensed
pursuant to the provisions of the Physician Assistant Act;
(f) a podiatric physician licensed pursuant to the provisions
of the Podiatry Act;
(g) a psychologist licensed pursuant to the provisions of the
Professional Psychologist Act;
(h) a registered nurse licensed pursuant to the provisions of
the Nursing Practice Act;
(i) a pharmacist licensed pursuant to the provisions of the
Pharmacy Act;
(j) a licensed clinical social worker or a licensed independent
social worker licensed pursuant to the provisions of the Social
Work Practice Act;
(k) a professional mental health counselor, a professional
clinical mental health counselor, a marriage and family
therapist, an alcohol and drug abuse counselor or a
professional art therapist licensed pursuant to the provisions
of the Counseling and Therapy Practice Act; and
(l) a physical therapist licensed pursuant to the provisions of
the Physical Therapy Act;.
“Health care underserved area” means a geographic area
or practice location in which it has been determined by the
New Mexico Department of Health, through the use of indices
and other standards set by the New Mexico Department of
Health, that sufficient health care services are not being
provided.
“Practice site” means a private practice, public health clinic,
hospital, public or private non-profit primary care clinic or other
health care service location in a health care underserved area.
“Rural” means a rural county or an unincorporated area of a
partially rural county, as designated by the Health Resources
and Services Administration of the United States Department
of Health and Human Services.