Pennsylvania Property Tax/Rent Rebate Preparation Guide

Property Tax/Rent Rebate Preparation Guide
Property Tax/Rent Rebate Preparation Guide (DFO-03)
PROPERTY TAX/RENT REBATE
PREPARATION GUIDE

DFO-03 (EX) 11-21

PROPERTY TAX/RENT REBATE PROGRAM

TOPIC

www.revenue.pa.gov

PAGE

General Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Households With More Than One Qualified Claimant . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Deceased Claimant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4
All Claimants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
First-Time Filers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Proof of Age/Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5
Property Owners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6
Renters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7
Property Owner/Renter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Completing the PA-1000
Sections I through IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16
Direct Deposit (Section III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
PA-1000 Schedules A, B, D, E, F & G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-19
Filing the Claim/Mailing Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Assistance & Forms Ordering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
County Codes & School District Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-23
PA Department of Revenue District Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

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www.revenue.pa.gov

PROPERTY TAX/RENT REBATE PROGRAM
GENERAL INSTRUCTIONS
WHAT’S NEW
Free Electronic Filing Option: Property Tax/Rent
Rebate Program claimants now have the option to
submit applications online with the Department of
Revenue's myPATH portal. The application can be
remitted directly from the homepage at
myPATH.pa.gov so a user profile is not required.
Be prepared to electronically upload supporting
documentation with your application. You will also
need to provide an email address. Filing online
leads to fast processing, easy direct deposit options
and automatic calculators that will help you apply
for your rebate.
Respond to Your Notice: Customers and their representatives can submit documents in response to
a department issued notice electronically via myPATH. Submitting correspondence this way is faster
and more accurate than mailing or faxing documentation in. Additionally, multiple attachments can
be added to one response making the process easier for the user. The customer will need to have their
Letter ID number from the notice and EIN or SSN.
Attachments can be in PDF, JPEG, JPG, PNG, GIF,
TIFF, RTF, HEIC.
View Previously Submitted Items: When submitting an application or correspondence in response
to a notice, you will receive a confirmation code.
This code along with the email address you used
when submitting the information will enable you to
check the status of the submission to see what
stage it is at in our processing operations.
Check rebate status: Check the status of a rebate
for the current claim year or prior claim years without logging in. All you need is the claim year, date
of birth, and SSN.
FORM AND INSTRUCTIONS CHANGES
An additional item has been added to the list of income that is not reported for Line 11g. All qualified
distributions from ABLE (Achieving a Better Life Experience) Savings Programs are not to be included
as eligibility income by Property Tax or Rent Rebate
claimants.
The country code field has been changed from a
three-character field to a two-character field. See

the instructions for Country Code on Page 10 for
additional information.
PURPOSE
The Property Tax/Rent Rebate Preparation Guide’s
purpose is to provide volunteer preparers and
Department of Revenue Field Office personnel with
additional information and instructions for the preparation of the PA-1000, Property Tax or Rent Rebate
Claim.
GENERAL INFORMATION
Claimants who filed handwritten rebate claims the
previous year should automatically receive new
rebate booklets in the mail. Claimants who filed
their rebate claims using software to produce the
claim forms no longer receive booklets unless they
specifically request to receive them.
File the claim form using the preprinted label, if possible. However, even if using the label, the Social
Security Number(s) (SSN) must be entered on the
claim form in the boxes provided, as the Department
of Revenue removed these numbers from the label
due to confidentiality concerns. SSNs enable the
department to verify income from Social Security
and Supplemental Security Income (SSI). If the
preprinted label is not 100 percent correct, do
not use the label. If it is correct, the label should be
placed on the claim form. If there is no label or if it is
not correct, all the information should be entered on
the claim form.
If the claimant has received a claim form with a label
addressed to a spouse who passed away during the
claim year, do not use the label. However, if the
claimant on the label passed away after Dec. 31 of
the year for which the rebate is being claimed, it may
be used. It is recommended that a widow or widower
of a deceased claimant who qualifies for a rebate
complete a claim for him/ herself.
To aid in processing the rebate properly, be sure to
provide a claimant’s school district and county codes,
which indicate where he/she resided as of Dec. 31 of
the claim year. School district and county codes are
listed on Pages 22 through 24. The codes are also
available online at www.revenue.pa.gov/schools.
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PROPERTY TAX/RENT REBATE PROGRAM

The department will make automated phone calls
to rebate claimants notifying them of receipt and
approval of their rebate claims. Claimants should be
encouraged to include a telephone number on the
application form to facilitate these calls.
All documents submitted must feature the SSN of the
claimant. By law, (42 U.S.C. Section 405(c)(2)(i); 61
PA Code Section 117.16) the Pennsylvania Department of Revenue has the authority to use the SSN
to administer the Property Tax/Rent Rebate Pro-

gram and Pennsylvania tax laws. The department
uses the SSN to identify individuals, verify incomes
and administer tax-offset and child-support programs required by federal and Pennsylvania laws.
The commonwealth may also use the SSN in exchange-of-tax-information
agreements
with
government authorities. Pennsylvania law prohibits
the commonwealth from disclosing information individuals provide on income tax returns and rebate
claims, including SSNs, except for official purposes.

QUALIFICATIONS
1. The claimant must have owned and occupied a
home or rented and occupied a home, apartment, nursing home, boarding house or similar
residence in Pennsylvania during the period for
which a rebate is being claimed.
NOTE: If a claimant transferred the property to
his/her offspring (often to avoid the payment of
inheritance tax), he/she is not eligible for a rebate unless a life estate is created that provides
proof that the claimant still has the right of ownership until death. Proof of the life estate’s
creation must be provided with the filing of the
claim. In order for the claimant to document
ownership via a life estate, complete copies of
the deed, trust agreement, will or decree of distribution showing the language providing for the
claimant’s rights of ownership are required.
2. (a) The claimant or spouse living with the
claimant was 65 years of age or older as of
Dec. 31 of the claim year.
NOTE: Pennsylvania, under Title 23 of the
Pennsylvania Consolidated Statutes, Section 1103, eliminated the establishment of
Common Law Marriages contracted Jan. 1,
2005, and later. If a common law marriage
was established and the conditions fulfilled
prior to that date, it is valid.
(b) The claimant was a widow or widower during all or part of the claim year and was 50
years of age or older as of Dec. 31 of the
claim year.
NOTES: If the most recent marriage ended
in a divorce, the individual does not qualify
as a widow/widower, even if the divorced
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spouse subsequently passed away (a socalled “grass widow”).
If the claimant remarried during the claim
year, see Schedule B.
(c) The claimant was permanently disabled and
18 years of age or older as of Dec. 31 of the
claim year and the physical or mental disability is expected to continue indefinitely.
For example: If a claimant receives his/her
award letter on Dec. 31 of the claim year
but does not begin receiving SSI payments
until the following year, that claimant is
eligible to file a rebate. It is not necessary
that the claimant received SSI payments for
the claim year in question. As long as the
claimant has an award letter from SSI confirming the disability date for that year,
he/she is eligible for a rebate as long as all
other requirements are met.
NOTE: If the claimant applied to the Social
Security Administration and was denied disability benefits, he/she is not eligible for a
rebate as a disabled claimant.
3. Certain eligibility income levels were not
exceeded:
(a) If the claimant is a property owner and the
total household income, including that received by a spouse while residing with the
claimant, for the claim year is $35,000 or
less; or
(b) If the claimant is a renter and the total household income, including that received by a
spouse while residing with the claimant, for
the claim year is $15,000 or less.

PROPERTY TAX/RENT REBATE PROGRAM

4. Property taxes for the claim year must have
been paid (either by the claimant or someone
else), if the claimant is a property owner. If the
claimant is a renter, the property owner must
have been liable for the payment of real estate
taxes or payment in lieu thereof on the rental
property, and rent must have been paid (either
by the renter or someone else).
5. The claimant must have lived at least one day
and paid rent or property tax during the claim
year in order to be eligible for a rebate. A claim
may be filed on behalf of a claimant who dies
during the claim year by a surviving spouse,
personal representative or estate.
6. If a claimant is a renter and received cash public assistance, he/she is not eligible for a rebate
for the months the benefit was received. Cash
public assistance does not include SSI, food
stamps, surplus foods, Department of Public
Assistance payments for Medicare or other noncash relief from a government agency.

MISCELLANEOUS PROVISIONS
A claimant may qualify as an Owner/Renter if:
1. The claimant owned, occupied and paid taxes
for part of the year and was a renter for the
other part of the year (PA-1000 Schedule A
must be completed);
2. The claimant owned, occupied and paid taxes
on a home and paid rent for the land upon
which the home is situated (such as, but not limited to, a mobile home in a mobile home park or
a home on which land rent is paid); or
3. The claimant paid rent for the home he/she occupied and paid property taxes on the land
upon which it stood (such as, but not limited to,
a mobile home).

HOUSEHOLDS WITH MORE THAN
ONE QUALIFIED CLAIMANT
Only one member of a household may file a claim,
even if more than one person qualifies for a rebate.
If someone other than the claimant’s spouse
appears on the deed or lease, a PA-1000 Schedule
F must be completed. The decision as to who will file
for the rebate is that of the eligible claimants, however it is recommended that the one with the
smallest income file the claim.

www.revenue.pa.gov

DECEASED CLAIMANT
To be eligible for a rebate, the claimant must have
lived at least one day of a claim year, owned and occupied and paid taxes or rented and occupied and
paid rent for the claim year during the time period
the claimant was alive. The property tax paid for a
deceased claimant will be prorated based upon the
number of days the claimant lived during the claim
year. Rent rebate claims filed on behalf of deceased
claimants will be paid based upon the amount of
rent paid during the claim year. Schedule A must be
completed for the calculation of the prorated property tax rebate.
To determine if a deceased claimant is eligible for a
rebate, a deceased claimant’s claim form must also
include an annualized income amount in the calculation of total household income. Schedule G must
be completed for the calculation of annualized income amount to be included in household
income. A copy of the death certificate must also be
included with the claim form. A surviving spouse, estate or personal representative may file a claim on
behalf of a deceased claimant. A personal representative can also have a previously filed rebate
issued in his or her name, instead of the name of the
decedent, in certain circumstances.
Surviving Spouse: The surviving spouse may file
the claim, including the death certificate and a
letter stating he/she was the spouse of the claimant
at the time of death, and sign as the surviving
spouse. If the surviving spouse is eligible to file a
claim, he/she should discard any label and file as
the claimant. In this case, the claim should be completed as a first-time filer indicating he/she has not
received a rebate in the past. The deceased
spouse’s SSN should be entered in the area provided and the oval filled in, indicating the spouse is
deceased.
Estate: A claim may be filed by the executor or the
administrator of an estate. In this case, a copy of the
Short Certificate showing the will was registered or
probated must be submitted. If there is no will but
there are assets, submit a copy of the Letters of Administration. Either of these may be obtained from
the county courthouse where the death is recorded.
Personal Representative: If a person dies and
there is no will, the will has not been registered or
probated or there is no estate, then a personal repPage 3

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PROPERTY TAX/RENT REBATE PROGRAM

resentative may file a claim on behalf of an eligible
decedent. A decedent’s personal representative
must submit a copy of the decedent’s death certificate, a DEX-41, Application for Refund/ Rebate
Due the Decedent, and a receipted copy of the
decedent’s funeral bill showing that the personal
representative personally paid the decedent’s funeral expenses in an amount that is greater than or
equal to the amount of the property tax/rent rebate
to which the decedent is entitled.
If a person dies after filing a claim and there is no
will, or if the will has not been registered or probated, or there is no estate, then a personal
representative can also request that the department change the rebate to be issued into his/her
name. In cases where the rebate check has been
received but cannot be cashed, the check must be
returned with a request to have the rebate issued in
the name of the personal representative. The decedent’s personal representative must submit a copy
of the decedent’s death certificate, a DEX-41, Application for Refund/Rebate Due the Decedent, and
a receipted copy of the claimant’s funeral bill showing that the personal representative personally paid
the funeral expenses in an amount that is greater
than or equal to the amount of the property tax/rent
rebate to the claimant is entitled.
The DEX-41, Application for Refund/Rebate Due
the Decedent, can be obtained by visiting the department’s website at www.revenue.pa.gov or by
using one of the department’s Forms Ordering Services found on Page 21.

ALL CLAIMANTS

reportable income and income that may be excluded are found in the instructions for completion
of the PA-1000, Section III, Lines 4 through 11g.
NOTE: If taxable income exceeds $33, a Pennsylvania income tax return must be filed.

FIRST-TIME FILERS
If a claimant is a first-time filer 65 years of age or
older, proof of age must be submitted.
If a claimant is a first-time filer under 65 years of age
and is married to a person 65 years of age or older,
proof of the spouse’s age must be submitted.
If a claimant is a widow or widower 50 to 64 years
of age, proof of age must be submitted along with a
photocopy of the spouse’s death certificate.
If a claimant is permanently disabled and 18 to 64
years of age, proof of age and permanent disability
must be submitted.
NOTE: Do not send any original documents, as
they cannot be returned.

PROOF OF AGE
The following documents are acceptable as proof of
age:
• Birth Certificate
• Medicare Card (be sure Social Security
Numbers are the same)
• Church Baptismal Record
• Hospital Birth Record
• Document issued by the Social Security
Administration clearly showing the date of birth

All claimants must submit proof of income reported
on the Property Tax/Rent Rebate Claim (PA-1000),
with the exception of Social Security benefits, SSI
and/or State Supplementary Payments (SSP) for
those using Pennsylvania addresses. Claimants not
using Pennsylvania addresses must submit documentation verifying this income.

• Blue Cross or Blue Shield 65 Special Card

If a claimant is required to submit a federal income
tax return or a Pennsylvania income tax return and
this return reflects all income (using Pennsylvania
rules) of the claimant and his/her spouse living together, a copy of the front of either of these returns
is sufficient proof. However, if there is additional income not shown on either of these returns, copies
of proof documents must be submitted. Details on

• Dated marriage record showing age at time of
marriage

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• Driver’s License or PA Identification Card
• Military Discharge Paper (if age shown)
• PACE/PACENET card
• Naturalization/Immigration Paper (if age shown)
• Passport

• Family Bible showing family records and
indicating the claimant’s date of birth
• Department of Commerce, Bureau of Census
Form
• All senior citizens public transit authority cards

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PROPERTY TAX/RENT REBATE PROGRAM

• A dated insurance record drawn up years prior
to the Property Tax/Rent Rebate Program being
initiated
• Any other document which indicates the
claimant’s date of birth if none of the previously
listed items are available. Document must be
dated at a time when it was not particularly
beneficial to be of that age.
The following documents are not acceptable as
Proof of Age:
• Social Security Card
• Hunting License
• Fishing License
• Any other document on which the claimant has
supplied the date of birth arbitrarily and without
proof.

PROOF OF DISABILITY
The following will be accepted as proof of disability:
• A copy of the award letter issued by Social Security, SSI, Railroad Retirement or Black Lung,
showing the claimant was permanently and totally disabled
• A letter from the Veterans Administration stating the claimant is 100 percent disabled
• A letter from the federal Civil Service Commission stating the claimant is 100 percent disabled
• A copy of the claimant’s medical assistance
card or a letter from the Department of Human
Services verifying the claimant is receiving disability benefits under the “Welfare Aid to the
Permanent and Totally Disabled” program
• If the claimant is not covered under any disability program, a completed Physicians Statement
of Permanent and Total Disability (PA-1000 PS)
may be accepted. This must be signed by the
claimant’s physician stating the claimant is permanently and totally disabled under the
standards of the federal Social Security Act or
federal Railroad Retirement Act. (This form of
proof cannot be used if the claimant was denied
Social Security Disability.)
The Department of Revenue has the legal authority to require additional evidence of a claimant’s
disability, including all medical records, to determine eligibility for a rebate.

PROPERTY OWNERS
All property owners, with the exception of residents
of Philadelphia, must submit proof that property
taxes were paid for the claim year. In order to verify
taxes were paid, proof of one of the following must
be submitted:
• Photocopy of the tax bill(s) for the claim year,
that have been marked or stamped “PAID” by
the tax collector, indicating the date and amount
paid;
• Photocopy of the un-receipted tax bill(s), along
with a photocopy of both the front and back of
the cancelled check(s) that paid the tax;
• A copy of the year-end mortgage statement
showing the amount of real estate taxes paid;
• A letter signed by the tax collector certifying the
amount of real estate taxes paid, excluding any
nuisance taxes or penalty, and indicating the
claimant’s name and address of the property; or
• A receipted copy of the tax billing from the
owner’s association or corporation. A resident
stockholder of such a cooperative housing corporation, like a condominium, may be eligible
as a property owner on the prorated share of
property taxes paid to the corporation for his/her
residence.
Residents of Philadelphia do not have to submit
copies of tax bills or payments as long as the taxes
for the claim year were paid by Dec. 31 of the claim
year, as the City and County of Philadelphia provide
to the department electronic records of taxes paid.
If the claimant does not know the amount of taxes
paid, he/she should estimate the amount. If the
claimant’s amount does not match the amount provided by Philadelphia, the Department of Revenue
will use the figures provided by the city/county. If the
taxes were not paid until after Dec. 31, the proof
documents listed above must be submitted.
The following real estate taxes are eligible for
consideration for a rebate:
• County
• School district
• City
• Borough
• Township
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PROPERTY TAX/RENT REBATE PROGRAM

The following taxes are not eligible for rebate (even
if based on millage):
• Flat rate charges
• Footage charges
• Personal property tax
• Per capita tax
• Occupational privilege tax
• Sewer rent
• Garbage collection charges
• Municipal assessments such as road, institution,
street, library, light, water, fire, debt and sinking
fund taxes
• Interest or penalty payments
If a tax bill contains any of the above disallowed
charges, the charges must be deducted from the
total amount paid to arrive at the amount of taxes allowed for consideration of the rebate.
If tax bills do not reflect the names of the claimants,
proof of ownership must be submitted. Examples of
documents acceptable as proof are:
• A copy of the deed;
• A copy of the trust agreement; or
• A copy of the will or decree of distribution, if
inherited.
If the name listed is that of a spouse and the name
of the spouse or deceased spouse is shown on the
claim, proof is not necessary. Note that the term Et
Vir (and husband) and Et Ux (and wife) indicate joint
ownership. However, if the term Et Al or Et Alia
(and others) appear, the additional owners must be
identified.
If a life estate or a life time lease agreement has
been retained, the individual retaining the life estate
or lease agreement may file a rebate claim, but
proof of either must be submitted.
If the tax bill or mortgage statement does not reflect
the claimant’s address on the form, an explanation
must be submitted. This may take the form of a
letter from either the tax collector or mortgage
company verifying the claimant’s home address. If
the claimant moved, PA-1000 Schedule A may need
to be completed.
A rebate may not be claimed on more than one property, with the exception of the sale of one primary
residence and the subsequent purchase of another
Page 6

primary residence. A rebate may not be claimed on
property not used for primary personal residential
use, unless the second property is adjoining and not
separated by a road, lane, etc. and is used in connection with the residence. This exception may be in
the nature of a double lot where the residence is located on one half, and the adjoining lot is empty and
used as a yard. It is the obligation of the claimant to
substantiate the right to claim both properties. Generally speaking, the maximum size of a property
deemed necessary for personal use is 75 acres. If the
land exceeds this, the taxes on the land should be
prorated. Again, it is up to the claimant to prove to the
department otherwise. If the property is used for
other than the claimant’s personal use, PA-1000
Schedule E must be submitted.

INCREASED REBATES FOR
QUALIFYING HOMEOWNERS
Now that slots gaming is providing annual property tax
relief to all Pennsylvania homeowners, supplemental
property tax rebates are available to homeowners
through the Property Tax/Rent Rebate program. These
supplemental rebates are automatically calculated by
Revenue and are awarded to qualifying seniors with
eligibility incomes of $30,000 or less who live in
Philadelphia, Scranton, Pittsburgh and other parts of
the state with particularly high tax burdens.
Supplemental rebates may increase base rebates up
to $975. Many senior homeowners have property
taxes completely eliminated when supplemental property tax rebates through the Property Tax/Rent Rebate
program combine with general property tax relief.

RENTERS
A rental unit may be a self-contained dwelling that
is a separate bedroom, kitchen and bath, but it may
also be a single room or set of rooms within a private home, hotel or other dwelling. A room in a
private home may qualify as a homestead (a selfcontained dwelling the claimant rents for use as a
home) if a landlord-tenant relationship exists. Such
a relationship exists when a landlord (the lessor)
provides the claimant (the lessee) with a lease for a
self-contained dwelling within the property owner’s
residence. As mentioned above, this usually means
a separate kitchen, bath and bedroom. The homeowner must maintain a lease agreement, have
separate utility bills, have other evidence of a self-

PROPERTY TAX/RENT REBATE PROGRAM

contained dwelling, and report the rental income on
his/her federal or state income tax return. The
claimant is responsible to prove that a landlordtenant relationship exists.
Self-contained dwellings for rent eligible for rent rebates can include:
• Apartment in a house
• Apartment building
• Boarding home
• Mobile home
• Mobile home lot
• Nursing home
• Private home
• Personal care home
• Assisted living facility
• Domiciliary care facility
• Foster care facility
If this is a domiciliary care facility, foster care facility, boarding home or personal care home, a copy of
the contract agreement must be submitted with the
claim form.
If a claimant receives any rent subsidies provided by
or through a government agency, the amount of such
subsidy must be deducted from the total rent paid.
All renters must submit one of the following to
substantiate the amount of rent paid:
• A fully completed Rent Certificate (PA-1000 RC)
for each place the claimant rented and occupied during the year, completed and signed by
the landlord or authorized agent;
• A fully completed Rent Certificate, filled out by
the claimant, along with a completed and notarized Occupancy Affidavit stating the reason the
landlord’s signature could not be obtained;
• A fully completed Rent Certificate, filled out by
the claimant, along with copies of rent receipts
signed by the landlord or authorized agent for
each month the claimant is claiming the rent

www.revenue.pa.gov

rebate, showing the claimant’s name, address
of the rental unit, the amount paid and the period
for which the rent was paid. The department will
only allow the rebate based on amounts for
periods for which rent receipts are submitted; or
• A statement from a housing authority that contains each of the following:
° Name and address of the claimant;
° Name, address, building name, federal tax
identification number and telephone number of the authority;
° The amount and date of each payment;
° A statement that the authority was required
to pay property taxes or make payments in
lieu thereof; and
° An original signature of a representative of
the authority.
If a properly completed Rent Certificate is provided,
no rent receipts are necessary.
If a landlord is exempt from paying property taxes
and does not make payment in lieu of such taxes,
a rent rebate will be denied. The Department of
Revenue maintains a record of exempt rental units
and will review each claim to determine a unit’s eligibility. It is presumed that the exemption from
payment of such taxes has already been figured into
the amount charged to the lessee resulting in lower
rent than would normally be charged.
If there is a monthly charge that includes items
other than rent, such as board, meals, personal
cleaning services, nursing care, medications, etc.,
the amount applicable for rent must be obtained
from the landlord. Only the amounts attributable to
rent may be considered.
NOTE: Amounts that are separately charged for
storage and/or parking are not includable. Checks,
money orders, money order receipts and similar
records, cancelled or otherwise, are not acceptable
forms of proof of rent paid.

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COMPLETION OF THE PA RENT CERTIFICATE AND RENTAL
OCCUPANCY AFFIDAVIT (PA-1000 RC)
Enter the name of the claimant as shown on the
PA-1000 and his/her SSN.
1. Enter the street address (not PO Box), City,
State and ZIP Code of the residence for which
the PA-1000 RC is being completed.
NOTE: The residence must be in Pennsylvania.
2. Enter the business name of the lessor or the
name of the landlord (last name, first name and
middle initial) if an individual, the complete address and the landlord’s federal tax
identification number, if applicable. If there is
none, do not enter the SSN. Include the landlord’s daytime telephone number.
3. Fill in completely the appropriate oval indicating
the type of rental unit and include the building
name, if there is one.
4. The total amount of rent per month must be entered. If the total includes security deposits,
amounts paid for food, medicine, medical care
or personal care, these amounts must be
excluded. Only the amount that is allocated for
rent is to be entered. If the amount of rent paid
during the year was changed, explain the
difference in the block to the right of Numbers 4
through 6. Divide Block 4 into separate sections
and enter each amount in one section. For example, if the rent was raised from $800 to $825
on July 1, a statement explaining the rent was
raised $25 on July 1 should be included.
5. If any of the total rent amount was paid or subsidized by a government agency, this amount
should be entered in this block. If none, enter
“0”. If the amount of subsidy changed during the
year, this block should be divided in the same
manner as Block 4 and an explanation should
be provided.
6. Subtract the amount in Block 5 from the amount
in Block 4 to arrive at the amount the claimant
was required to pay. If the amount of rent
changed during the year, this block should be
divided in the same manner as Block 4.
7. Enter the number of months this rental property
was occupied by the claimant during the claim
year. If less than 12 months, enter an explanation

Page 8

in the area provided to the right of Blocks 7 and
8. An example would be if the claimant moved.
NOTES: If the taxpayer occupied more than
one rental unit during the claim year, separate
PA-1000 RC’s must be filed (one for each location).
If the figure in Block 6 is divided, this block
should also be divided to reflect the number of
months for which rent was paid for each figure.
8. Multiply the monthly rent paid by the number of
months it was paid and enter the total amount
of rent paid for the claim year.
9. Enter the result on the Rent Certificate and on
Line 15 of the claim form or the appropriate
line(s) of Schedules D, E or F.
If a rent certificate was completed by the landlord or
an authorized agent, the landlord or authorized
agent must sign the Landlord’s Oath. The signatory
must also fill in the appropriate oval affirming either
property tax payment or payment in lieu thereof as
made. If names other than the claimant’s spouse or
minor child(ren) appear on the lease, the signatory
must indicate such by filling in the appropriate oval,
and PA-1000 Schedule F must be completed and
submitted.
If the claimant was unable to have the landlord or
authorized agent complete this certificate, he/she
must complete the Occupancy Affidavit stating
why he/she could not get the landlord/agent to
complete the form. The claimant must then sign
the affidavit and have it notarized. If the
landlord/agent has completed the certificate, the
claimant should not complete the affidavit.
If either the Landlord’s Oath or the Occupancy
Affidavit is not completed in full, the rent rebate
claim will be denied.

PROPERTY OWNER/RENTER
If a claimant is filing as an owner and a renter, proof
of property taxes paid and verification of rent paid
must be submitted. Acceptable forms of proof of
paid property taxes are found on Page 5, and acceptable forms of proof of rent paid are found on
Pages 6 and 7 of this guide.

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PROPERTY TAX/RENT REBATE PROGRAM

COMPLETING THE PA-1000
GENERAL GUIDELINES
If preparing a paper claim form for the claimant, use
black ink. Another color will delay the processing of
the claim. Use ink only. DO NOT use pencil.
Refrain from using White-Out or similar products.
Erasable pens may be used to make corrections.
When entering letters, use only UPPER CASE block
letters. Use the following form for entering letters
and numbers:
ABCDEFGHIJKLMNOPQRSTUVWXYZ
1234567890
Print all information neatly inside the boxes on the
claim.
Print only one letter or number in each box when
entering the SSN(s), name(s), address(es), dollar
amounts and other information on the claim. If a
name, address and/or city begin with Mc, Van, O’,
etc., do not enter a space or punctuation mark.
Completely fill in all the appropriate ovals on the
claim form.
Otherwise, type in the information and complete
the claim in the myPATH portal for the claimant.

SECTION I
SOCIAL SECURITY NUMBER, NAME,
ADDRESS AND RESIDENCE INFORMATION
If the claimant received a booklet with a preprinted
label and the label is correct, use the label. If the label
is incorrect, discard it. Do not make any corrections on
the label. Even if using the preprinted label, the SSN
of the claimant and his/her spouse must be entered.
If the spouse did not live with the claimant for the entire year, DO NOT include the spouse’s SSN.
Example: The spouse was a nursing home resident
for part of the year. You must fill in the claimant’s
county and school district codes even if using the
preprinted label.
If the spouse lived in a nursing home the entire year
do not include his/her Social Security number on the
claim form. He or she may qualify for a separate rebate on the rent paid to the nursing home.
If completing the information in Section I, the following guidelines must be followed:
1. The claimant’s SSN must be entered on the
claim. The spouse’s SSN must also be entered

if the claimant and spouse resided together for
the entire year.
2. Enter the current address of the claimant (or the
address where correspondence is to be delivered). This should match the address on the tax
bills or the current rental address; if not, an explanation must be included. There are two lines
for entering an address. For the First Line of Address, enter the street address. If the address has
an apartment number (APT), suite (STE), floor
(FL) or rural route number (RR), enter it after the
street address. If the street address and the
apartment number, suite, etc. do not fit on the
First Line of Address, enter the street address on
the Second Line of Address and the apartment
number, suite, etc. on the First Line of Address.
For the Second Line of Address, enter the post office box, if applicable. If there is no post office box,
leave the Second Line of Address blank.
The U.S. Postal Service prefers that the actual
delivery address appears on the line immediately above the city, state and ZIP code. Do not
include any punctuation such as apostrophes,
commas, periods and hyphens.
On the third line, enter the city or post office. If either exceeds 14 letters, use the approved postal
abbreviation. Also enter the two-letter state abbreviation and five-digit ZIP Code.
Below is an example of a properly completed
address.
M C D O E
A P T

4 5 6

1 2 3

A N Y

J O H N

S T

H A R R I S B U R G
J A N E

A

P A
A

2 2

1 7 1 2 8

2 2 2 7 5

U S

3. Enter the spouse’s first name and middle initial,
even if deceased. If the spouse is deceased,
fillin completely the oval in the upper right-hand
corner of Block A, to the right of the spouse’s
SSN. This is especially important if the spouse’s
name still appears on the tax bill.
4. The two-digit county and school district codes
indicating where the claimant resided as of Dec.
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PROPERTY TAX/RENT REBATE PROGRAM

31 of the claim year must be entered. A list of
these codes appears on Pages 22 through 24 of
this guide. School district codes may also be
found on county and/or school tax bills and
online at www.revenue.pa.gov/schools.
5. If a claimant has an address within the United
States, they are not required to enter the county
code. If they have a current mailing address in
another country but they are claiming a rebate
because they lived at least part of the year in
Pennsylvania, they must enter the alphabetic
abbreviation for the county. This list of country
codes can be found at https://www.irs.gov/
efile-providers/foreign-country-code-listingfor-modernized-e-file under the country codes
menu selection.
6. The birth date of all claimants must be entered.
7. A daytime telephone number should be provided.

SECTION II
FILING STATUS CATEGORIES
Fill in completely one oval in each section. Failure
to do so will delay the processing of the claim and
may reduce the amount of the rebate.
1. Indicate if the claimant is filing as a property
owner (P), a renter (R) or both a property owner
and a renter (B). A claimant should file as a
property owner and a renter when he/she
resided in a self-owned home for part of a year
(complete PA-1000 Schedule A), owned and
occupies a home and rented the land on which
it is situated, or owned the land and rented and
occupied his/her residence on the land. If filing
as an owner/renter, the claimant may be eligible
for a tax rebate on the taxes paid and rent paid.
2. Indicate if the claimant was 65 years of age or
older as of Dec. 31 of the claim year (A), under
65, but married to and lived with a spouse 65 or
older as of Dec. 31 of the claim year (B), a
widow/widower 50 to 64 years of age as of Dec.
31 of the claim year (C) or permanently disabled
and 18 to 64 years of age as of Dec. 31 of the
claim year (D). If more than one category applies, such as being a widow/widower age 50
through 64 and permanently disabled, fill in the
first applicable category. If the claimant had
been filing as permanently disabled and turned
65 during the claim year, he/she should now file
under Category A.
Page 10

A surviving spouse age 50 to 64 is eligible for a
rebate as a widow or widower, while a surviving
spouse who is 65 or older can file as a claimant.
A surviving spouse under 50 may be able to file
a claim for a deceased claimant if the deceased
was 65 or older. The surviving spouse of a former claimant who is now deceased, when filing
for the first time in his/her own name, is considered a first-time filer and must submit all
documentation required as such.
If a widow or widower remarried during the claim
year and is between 50 and 64, he/she is entitled to a rebate only for the portion of the year
he/she was not married and must complete PA1000 Schedule B. Further, if the person’s most
recent marriage ended in divorce and the former
spouse subsequently passed away (a “grass
widow/widower”), the surviving individual does
not qualify as a widow/widower, even if the person had been eligible as a widow/widower prior
to the most recent marriage.
3. Indicate if the claim is being filed on behalf of a
decedent (a claimant who died during the claim
year who otherwise would have been an eligible
claimant under (A), (B), (C) or (D) for Line 2 in
Section II). The type of claimant under which
the decedent qualifies under Line 2 must also be
included. A copy of the death certificate must be
submitted and Schedule G must be completed.

SECTION III
TOTAL INCOME AND CALCULATION
OF REBATE
PA-1000 Lines 4 through 19
A claimant must report all income (except exempt income identified in this section) received and/or
earned during the claim year, including that of a
spouse while residing together in the same household. This includes income that may or may not be
taxable or reportable for federal or Pennsylvania income tax purposes. The department will accept
copies of federal or Pennsylvania tax returns as
proof of income, however if income not reported on
these forms has been earned and/or received, it
must be supported by documentation. All income
except Social Security, SSI and SSP received by a
claimant and his/her spouse residing together and
showing a Pennsylvania address must be documented. Proof of Social Security, SSI and SSP are

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PROPERTY TAX/RENT REBATE PROGRAM

not required, as the Social Security Administration
provides the department with a record of these
benefits.

•

The income earned and/or received by any household resident other than a claimant and/or spouse,
whether related or not, should not be included.

•

GAINS AND LOSSES: The rules governing the handling of gains and losses in the Property Tax/Rent
Rebate Program are the same as those for Pennsylvania income tax. That is, a claimant’s loss in one
category of income (sale, exchange or disposition
of property, rental income or business income)
may not be used to offset a spouse’s gain in that
same category and vice versa. In order for a loss to
offset a gain, the ownership must be consistent.
Also, a loss in one category may not be used to offset a gain in any other category.
Please be sure the claimant’s SSN appears on each
proof document.
The following income should not be included when
determining eligibility for the Property Tax/Rent
Rebate Program:
• 50 percent of Social Security benefits appearing
in Block 5 of the SSA-1099
• 50 percent of SSI
• 50 percent of SSP
• 50 percent of Railroad Retirement Tier 1
benefits from RRB-1099
• Federal veterans’ disability payments or state
veterans’ disability benefits received by the
veteran or unmarried surviving spouse
• The first $5,000 of life insurance death benefits
• A gift of money or property of $300 or less, as
well as the first $300 of any gift in excess of $300
• Any gift from a household member
• Medicare benefits
• Food stamps, surplus foods, HUD rent (Section
8), Medicare premiums paid by Department of
Human Services or any other non-cash relief
from a government agency
• Property Tax/Rent Rebate previously received
• The amount of any damages due to personal injuries or sickness including Black Lung benefits
and benefits granted under Section 306(c) of
the Worker’s Compensation Security Fund Act
(relating to Schedule of Compensation for dis-

•
•

•
•
•
•
•
•
•
•

•

ability from permanent injuries of certain classes
such as amputation)
Payments provided to eligible low-income
households under the commonwealth’s Low-Income Home Energy Assistance Program
Payments received by home providers of the
domiciliary care program administered by the
Department of Aging, except for the amount of
those payments in excess of the actual expense
of the care
Payments from long-term care insurance to
someone other than the claimant
Individual Retirement Account and employer
pension rollovers (must provide a copy of
federal Form 1099R indicating rollover or other
supporting documentation)
Health insurance reimbursement
Disability income received by disabled children
in the household
Federal, state or local tax refunds
Spouse’s income earned or received while not
living with the claimant
Federal stimulus or economic impact payments
STRIVE Program credits
Child support
Public Assistance (welfare) benefits received by
children in the household, even though the
check is issued in the claimant’s name
The difference between the purchase price of
the claimant’s residence and its selling price,
but only if the proceeds from the sale are used
to purchase a new principal residence.

All other income earned and/or received by a claimant
and spouse while living together must be included.
Line 4:
Enter the full amount of Social Security benefits
from Box 5 of the SSA-1099, SSI and SSP in the
area provided. Divide this amount by 2 and enter the
amount in the block in the right-hand column. If the
claimant has a Pennsylvania address, no documentation is required. If the claimant has an
out-of-state address, a copy of SSA-1099(s) and
other proof documents must be provided.
Line 5:
Enter the full amount of Railroad Retirement Tier 1
benefits in the area provided. Divide this amount by
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PROPERTY TAX/RENT REBATE PROGRAM

2 and enter the amount in the block in the right-hand
column. A copy of RRB-1099(s) must be submitted.
Line 6:
Enter the full, gross amount of all pensions, annuities,
Individual Retirement Account (IRA) distributions,
Railroad Retirement Tier 2 benefits and Civil Service
disability benefits (not including black lung benefits).
Copies of pension/annuity benefit statements and/or
1099(s) must be submitted.
If there are one or more distributions from annuity,
life insurance or endowment contracts reported on
Form 1099-R that are included as interest income
on the PA-40 Personal Income Tax Return, please
write “Included as Interest Income on PA-40” across
the top of any Form 1099-R for such distributions
and include copies of all Forms 1099-R with the
claim form.
Line 7:
Enter the full amount of all interest and dividends
received and/or credited during the year (including
capital gains reported on a 1099 DIV from a mutual
fund), whether or not actually received. This includes
nontaxable interest from U.S. savings bonds, Pennsylvania bonds, municipal bonds, those statutorily
exempt, etc.
Copies of the federal Schedule B, PA-40 A/B,
1099-INT, 1099-DIV, federal Schedule K-1, PA RK1 and/or PA NRK-1, or any other document to verify
the amounts reported must be submitted.
Line 8:
Enter the amount of gain or loss realized from the
sale or exchange of all stocks, bonds and other
real, tangible and/or intangible property (with the exception of a personal residence when the proceeds
are used to purchase a new principal residence).
Losses on the sale of property may be used to offset gains on the sale of other property as long as the
ownership is consistent, however a loss in this category may not be used to offset any income
reported on another line of income. If there is a net
loss, the oval in front of the reporting boxes must be
filled in or the figure will be considered as a gain.
Further, losses on the sale of property for personal
use cannot be used to offset any gain. Only losses
on investment property can be used to offset gains.
For the purposes of this program, the historic gain
or loss must be used. Submit federal Schedule D,
PA-40 Schedule D, federal Schedule K-1, PA RK-1
Page 12

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or PA NRK-1 to verify the figure reported. If the
claimant sold his/her primary personal residence
and is not using the proceeds to purchase a new primary personal residence, a statement showing the
sales price less the sum of the original cost plus any
permanent improvements must submitted (PA1000 Schedule A must be completed).
Line 9:
Enter the total net rental, royalty, patent and/or
copyright income or loss for the claim year. Rental
losses may be used to offset any income reported
in this category as long as ownership is consistent,
however a net loss in this category cannot be used
to offset a gain on another line of income. If there is
a net loss, the oval in front of the reporting boxes on
this line must be filled in or the figure entered will
be treated as a gain. Rental income does not include amounts of those who share expenses within
a household. If the claimant rents a portion of
his/her primary personal residence to a boarder, including a room, garage, etc., a PA-1000 Schedule E
must be completed. A copy of the federal or PA40 Schedule E, federal Schedule K-1, PA RK-1 or PA
NRK-1 must be submitted to verify this income.
Line 10:
Enter the total net income or loss from a business,
profession, farm, partnership and/or Pennsylvania
Sub S corporation. Losses in this category may be
used to offset a gain reported in this category as
long as the ownership is consistent, however a net
loss in this category cannot be used to offset a gain
on another line of income. If there is a net loss, the
oval in front of the reporting boxes on this line must
be filled in or the figure entered will be treated as a
gain. If the business operates out of the claimant’s
primary personal residence, a PA-1000 Schedule E
must be completed. A copy of the federal Schedule C or F, PA Schedule C or F, PA-40 Schedule
C-F, federal Schedule K-1, PA RK-1 or PA NRK-1
must be submitted to substantiate the income or
loss from each business.
Lines 11a - 11g - Other Income:
Complete Lines 11a through 11g to report all other
income that you and your spouse earned, received
and realized.
For each category of income shown below, you
must submit proof, such as photocopies of Forms
W-2, Department of Human Services cash assis-

PROPERTY TAX/RENT REBATE PROGRAM

tance statements, your federal or PA income tax returns, and any other documents verifying income.
Line 11a:
Enter the total of any salaries, wages, bonuses,
commissions, estate and trust income. Submit a
copy of W-2(s), 1099 MISC(s), PA-40 Schedule
W-2S, PA-40 Schedule MC, federal Schedule K-1,
PA RK-1, PA NRK-1 or the federal or Pennsylvania
income tax return to verify this income.
Line 11b:
Enter the net total of all gambling and lottery winnings. This includes Pennsylvania Lottery winnings
and other prizes and awards. This also includes
the fair market value of items received. Losses may
be used to offset these winnings, but not expenses.
Losses may not exceed the amount of winnings.
In other words; there cannot be a net loss in this category. A PA-40 Schedule T should be completed to
verify these winnings, as well as a W-2G to document PA Lottery winnings.
Line 11c:
Enter the value of any inheritance, alimony and
spousal support. Both cash and the fair market
value of items received must be included. However, do not include any child support received
for a dependent child, even if received in the name
of the claimant or claimant’s spouse. Submit appropriate documentation to verify this amount.
Line 11d:
Enter the amount of any cash public assistance and/
or relief, unemployment compensation, disability
payments and workers’ compensation (except Section 306(c) benefits) received by the claimant or the
claimant’s spouse living with the claimant.
NOTE: A claimant renter receiving cash public assistance is not eligible for the rent rebate for those
months the assistance was received. If the claimant
received cash public assistance for the entire year,
no claim for rent rebate may be filed.
If the cash public assistance was received for only
a portion of the year, PA-1000 Schedule D must be
completed. This does not apply if the cash public assistance was received by the spouse of the claimant
or by any other person in the household. Submit a
copy of the Department of Human Services cash assistance statement, the federal income tax return
(Form 1040) or any other documentation to verify
this income.

www.revenue.pa.gov

Line 11e:
Enter the total gross amount of loss of time insurance
benefits, disability insurance benefits, long-term care
insurance benefits received directly by the claimant
(not included if paid to the facility) and life insurance
benefits and proceeds (excluding the first $5,000 of
the total death benefit payments). Submit appropriate
documentation to verify the amount reported.
Line 11f:
Enter the total amount of any gifts that exceeded
$300, whether the gifts were cash or property. Do
not include the value of gifts between members of
the household. A list of those gifts reported on this
line should be provided.
Line 11g:
Include any other income not already reported and
not specifically excluded plus the amount of annualized income for a deceased claimant. If a claimant
died during the claim year, an annualized income
amount must also be included. To calculate the annualized income amount, complete Schedule G.
Submit a listing and value of the other income
amounts reported as well as proof documents to
verify the amounts.
NOTES: If a claimant had significant income that is
not typically received in equal amounts throughout
the claim year, or if the number-of-days method does
not accurately calculate the annualized income, the
claim may be filed using an alternative method for determining the annualized income amount to be
included on Line 11g. A worksheet must be included
to show how the amount of annualized income was
determined in those instances. The worksheet must
clearly show how the income was determined and an
explanation of the reason for deviating from the
Schedule G method. Examples of when the claim
would be filed using an alternative method include instances where there is income from a one-time event
such as a gain on the sale of stock, lump sum payments from an IRA or annuity, an amount is reported
as an inheritance or a payment is received as a beneficiary on a life insurance policy. Proof of the
deviation from the number-of-days method may be
required. Reasonable methods of calculating the annualized income amount will be accepted.
A claim filed by surviving spouse who is 65 or older,
a widow or widower age 50 to 64 or a disabled
person is not required to include an annualized
Page 13

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PROPERTY TAX/RENT REBATE PROGRAM

income amount for their deceased spouse. The total
income for the year of the surviving spouse and
only the income earned by the deceased through
his/her date of death is required to be included in
these circumstances.
Line 12:
If benefits were received from the federal Civil
Service Retirement System (CSRS) for a retired
federal civil service employee or surviving spouse,
reduce the total eligibility income by 50% of the
average retired worker Social Security payment.
The average retired worker Social Security payment
is $9,514. If both the claimant and spouse received
CSRS benefits, or if the claimant received his/her
own CSRS benefit and CSRS benefits as a
surviving spouse, enter $19,028 on Line 12. Enter
an amount on Line 12 only if CSRS benefits are
included in Line 6. Otherwise, enter $0.
Line 13:
Add the positive income figures reported on Lines 4
through 11g, subtract the amount on Line 12 (if applicable) and enter the net result on Lines 13 and 23.
Do not include losses reported on Lines 8, 9 and/or
10. If this amount exceeds $15,000, the person is not
eligible for a rent rebate. If this amount exceeds
$35,000, the person is not entitled to any rebate.

Property Owners
Lines 14 and 15 are to be filled in only by claimants
who filled in the oval marked “P. Property Owner” or
“B. Owner/Renter” in Section II of the claim form.
NOTE: If a claimant’s total income as shown on
Line 13 is over $35,000, he/she is not entitled to a rebate.
Line 14:
To determine the amount to enter on Line 14, first determine if any of the Schedules A, B, E and/or F
apply to the claimant. See Pages 17 through 19 to
determine if one or more of these schedules must be
included. If more than one schedule applies, they
must be completed in the order of A, B, E and then
F and use the amount from any previously completed schedule on the next schedule in succession.
If a schedule does not apply, skip it and complete the
next schedule that applies. Use the amount from the
last schedule completed to enter on Line 14. If none
of the Schedules A, B, E and F applies, enter the
amount of property taxes paid on the residence.
Page 14

NOTE: Be sure to include the total amount of property taxes paid for the year when entering the tax
amount on this line or on the first schedule that
applies, as the amount from Line 14 is also used to
determine if a supplemental rebate will be paid (see
Page 6). The department will calculate and determine the amount of any supplemental rebate.
Line 15:
To determine the amount for Line 15, start by using
the total income amount from Line 23. In Table A from
the claim form or the table below, find the income
range that includes the Line 23 amount and circle the
corresponding Maximum Standard Rebate amount.
Compare this amount to the amount on Line 14 and
enter the lesser of the two amounts on Line 15.
INCOME
MAXIMUM STANDARD
LEVEL
REBATE
0 to $8,000
$650
$8,001 to $15,000
$500
$15,001 to $18,000
$300
$18,001 to $35,000
$250
No rebate will be issued for less than $10, and the
maximum standard rebate is $650. Applicants qualifying for supplemental rebates may receive up to
$975 (see Page 6). The department will calculate
the amount of any supplemental rebate.

Renters
Lines 16, 17 and 18 are to be filled in only by
claimants who filled in the oval marked “R. Renter”
or “B. Owner/Renter” in Section II of the claim form.
NOTE: If a claimant’s total income as shown on Line
12 is over $15,000, he/she is not entitled to a rent
rebate (an owner/renter may still be entitled to a
property tax rebate).
Line 16:
To determine the amount to enter on Line 16, first
decide if any of the Schedules B, D, E and/or F
apply. See Pages 18 through 19 to determine if one
or more of these schedules must be included. If
more than one schedule applies, they must be completed in the order of B, D, E and then F and use the
amount from any previously completed schedule
on the next schedule in succession. If a schedule
does not apply, skip it and complete the next schedule that applies. Use the amount from the last
schedule completed to enter on Line 16. If none of

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PROPERTY TAX/RENT REBATE PROGRAM

the Schedules B, D, E and F applies, enter the total
amount of rent paid on the residence.

(see Page 6). The department will calculate the
amount of any supplemental rebate.

Line 17:
Multiply the amount on Line 16 by 0.2.

Direct Deposit

Line 18:
To determine the amount for Line 18, start by using
the total income amount from Line 23. In Table B
from the claim form or the table below, find the income range that includes the Line 23 amount and
circle the corresponding Maximum Rebate amount.
Compare this amount to the amount on Line 17
and enter the lesser of the two amounts on Line 18.
INCOME
LEVEL
0 to $8,000
$8,001 to $15,000

MAXIMUM
REBATE
$650
$500

No rebate will be issued for less than $10 and the
maximum rebate is $650.

Owner/Renter
Line 19:
This line is to be completed only in cases where a
claimant qualifies as an owner and a renter and has
filled in the oval marked “B. Owner/Renter” in Section II of the claim form. Lines 14 and 15 must be
completed to determine the amount of the property
tax rebate allowed. Lines 16, 17 and 18 must be
completed to determine the amount of rent rebate
allowed. However, if the income claimed on Line 13
is greater than $15,000, the rent rebate portion cannot be claimed.
To determine the amount for Line 19, start with the
amount of income on Line 23. In Table A on the
claim form or the following table, find the income
range that includes your Line 23 amount and circle
the corresponding Maximum Rebate amount.
Compare this amount to the sum of Lines 15 and 18
and enter the lesser of the two amounts on Line 19.
INCOME
MAXIMUM STANDARD
LEVEL
REBATE
0 to $8,000
$650
$8,001 to $15,000
$500
$15,001 to $18,000
$300
$18,001 to $35,000
$250
No rebate will be issued for less than $10 and the
maximum rebate is $650. Applicants qualifying for
supplemental rebates may receive more than $650

If a claimant wishes to have a rebate directly deposited into a checking or savings account, Lines
20, 21 and 22 must be completed. In order to comply with banking rules, direct deposit is not available
for rebates going to bank accounts outside the U.S.
NOTE: If the direct deposit request is to a representative payee bank account or bank account for
anyone other than the claimant or the claimant’s
spouse (in the case of a joint claim), each claim filed
requesting payment to that account must include a
copy of the contract, agreement, or other document
authorizing the payee as the proper receiver of the
claimant’s rebate. If the department cannot verify the
rebate is authorized for direct deposit into a representative payee bank account, a direct deposit
payment request will be converted into a paper
check to be mailed to the claimant.
Line 20:
Place an “X” in the appropriate block indicating
checking or savings account.
Line 21:
Enter the routing number. This number must be
nine digits, of which the first two must be 01 through
12 or 21 through 32. Include any hyphens, but omit
any spaces and special symbols. This number is
found on a check except in the case where the
check is payable through a bank different from the
financial institution where the claimant has his/her
account. Do not use numbers from a deposit slip. If
there is any doubt as to the correct routing number,
have the claimant obtain the information from
his/her financial institution.
Line 22:
Enter the account number to which the rebate is
to be deposited. This may be up to 17 characters
in length and include both numbers and letters. Include any hyphens, but do not include any other
special characters. The numbers should be entered
from left to right leaving any unused blocks blank.
Do not use numbers from a deposit slip. If there is
any doubt as to the correct account number, have
the claimant obtain the information from his/her
financial institution.
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PROPERTY TAX/RENT REBATE PROGRAM

If the claimant’s bank recently changed ownership,
the information on the check may not be accurate.
Be sure to ask the claimant if this is the current
name of the financial institution. If not, have the
claimant obtain the correct routing number and
account number from the institution.
The Department of Revenue is not responsible for
a lost rebate, if incorrect information was entered on
the claim form. If the financial institution returns the
deposit or there is any other reason that the direct
deposit cannot be made, the department will mail a
check to the claimant.
The Department of Revenue cannot change the
banking information entered on the claim form. If the
information entered is not accurate or up to date, the
department will send a check instead of making a direct deposit into the claimant’s account.
The Department of Revenue will convert a direct deposit payment request into a paper check to be
mailed to the claimant if the department cannot verify the rebate is authorized for direct deposit into a
representative payee bank account.
Line 23:
Line 23 is used to determine the correct rebate
amount. Enter the amount from Line 13 of the claim
form on this line and circle the corresponding Maximum Standard Rebate or Maximum Rebate amount
for your income level. Owners use Table A and
Renters use Table B.

www.revenue.pa.gov

claim filed by a member of this household. The signature of the claimant also gives the Department of
Revenue the authority to access the claimant’s
Pennsylvania income tax records, federal income tax
records, Social Security records, PACE records
and/or Department of Human Services records to
verify the truth, accuracy and completeness of the information on the claim.
If the claimant signs, the name must match the
name on the label or printed in the blocks on the
name line. If someone other than the claimant signs
the claim, documentation verifying that person’s authority to sign for the claimant must be submitted
with the claim, such as a copy of the Power of Attorney or guardianship papers.
If the claimant makes a mark in lieu of a signature,
two people must witness the making of the mark
and sign attesting to witnessing the making of the
mark.
The name of the claimant’s Power of Attorney, nearest relative or other person with intimate knowledge
of the claimant, along with that person’s telephone
number and address, is to be printed in the areas
provided. This helps the department locate a
claimant if a rebate