Pennsylvania Property Tax or Rent Rebate Program Instruction Booklet

Property Tax or Rent Rebate Program Instruction Booklet
2023 Pennsylvania Property Tax or Rent Rebate Program Instruction Booklet (PA-1000 Booklet)
PENNSYLVANIA
or

PROPERTY TAX

RENT REBATE PROGRAM
2023

PA-1000 Booklet 04-23

HARRISBURG PA 17128-0503
www.revenue.pa.gov

APPLICATION INSIDE
INCOME
$

MAX. REBATE

0 to $ 8,000

$1,000

$ 8,001 to $ 15,000

$ 770

$15,001 to $ 18,000

$ 460

$18,001 to $ 45,000

$ 380

INCOME

MAX. REBATE

$

0 to $ 8,000

$1,000

$ 8,001 to $ 15,000

$ 770

$15,001 to $ 18,000

$ 460

$18,001 to $ 45,000

$ 380

Applicants can exclude one-half
of all Social Security income.

IMPORTANT DATES
Application deadline: JUNE 30, 2024
Rebates begin: EARLY JULY, 2024
NOTE: The department may extend the
application deadline if funds are available.

Rebates for eligible seniors, widows,
widowers and people with disabilities.

WHAT IS THE PROPERTY TAX/RENT
REBATE PROGRAM?

A Pennsylvania program providing rebates on
property tax or rent paid the previous year by
income-eligible seniors and people with disabilities.

AM I ELIGIBLE?

The program benefits income-eligible Pennsylvanians
age 65 and older; widows and widowers age 50 and
older; and people with disabilities age 18 and older.

HOMEOWNERS
Income
$
0 to
$ 8,001 to
$15,001 to
$18,001 to

$ 8,000
$15,000
$18,000
$45,000

Maximum Rebate
$1,000
$ 770
$ 460
$ 380

RENTERS
Income
$
0 to $ 8,000
$ 8,001 to $15,000
$15,001 to $18,000
$18,001 to $45,000

Maximum Rebate
$1,000
$ 770
$ 460
$ 380

ELECTRONIC PTRR FILING
Pennsylvanians can visit mypath.pa.gov to file
their Property Tax/Rent Rebate program
applications. It’s free to use and has many benefits
for applicants, including:
• Error reducing automatic calculators
• Faster processing
• Direct deposit
• Ability to upload required documents
• Security features to ensure your sensitive information
is safe
• User-friendly features that are not available when
filing a paper application

CHECK APPLICATION STATUS
Applicants can check the status of their rebates
using the myPATH portal (mypath.pa.gov).
Be sure to include a valid phone number on your
application to receive updates automatically. The

2

2023
department will make automated phone calls to
advise when your claim is received and again when
your claim is approved for payment. These calls
begin around April.
If you prefer to call to check the status of your
application, you may dial 1-888-PA-TAXES.

DIRECT DEPOSIT

Get your rebate faster with direct deposit.
See Pages 12 and 13 for details.

WHAT’S NEW THIS YEAR?

Governor Josh Shapiro delivered on a promise he
made to older Pennsylvanians when he signed a
new law that significantly expands the Property
Tax/Rent Rebate (PTRR) program, the largest
targeted tax cut for Pennsylvania seniors in
nearly two decades.
Under the expansion first proposed by the
Governor, nearly 175,000 more Pennsylvanians
qualify for a property tax or rent rebate. At the same
time, many of the 430,000 claimants who
previously qualified under the program’s prior
guidelines will see their rebates increase.
Here are the specific changes that will be in effect
as eligible Pennsylvanians apply for rebates on
property taxes or rent paid in 2023:
• The income cap for homeowners has increased
from $35,000 to $45,000
• The income cap for renters has increased from
$15,000 to $45,000
• The maximum standard rebate has increased from
$650 to $1,000
This is the first time the program has been
expanded since 2006. Additionally, the income
limits will be tied to the cost of living – which
means older Pennsylvanians and those with
disabilities will not lose out on their rebates through
no fault of their own.
Governor Shapiro pushed to make these
commonsense changes to boost a program
that provides a lifeline for hundreds of thousands
of Pennsylvanians, helping many of them to age in
place in their homes.

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

www.revenue.pa.gov

BEFORE YOU BEGIN
STATE SUPPLEMENTARY PAYMENT RECIPIENTS
The State Supplementary Payment (SSP) is not included
on your SSA-1099 form. The Department of Human
Services will issue annual statements to verify your SSP
benefit. SSP is still considered reportable income. As with
other Social Security income, only half of the SSP income
needs to be included on Line 4 of the Property Tax/Rent
Rebate claim form.
SOCIAL SECURITY RECIPIENTS WITH
PA ADDRESSES
If you were a Pennsylvania resident for all of 2023, you do
not have to submit proof of your Social Security income
including Social Security retirement and Supplemental
Security benefits. The Social Security Administration
provides Social Security income information to the PA
Department of Revenue. The PA Department of Human
Services will provide State Supplementary Payment
information to the department.
However, you or the person who prepares your claim will
need these statements to correctly calculate the amount of
your rebate. If none of these documents are available, you
or your preparer will need to estimate the amount you
received during the year. If the dollar amount you provide
is not correct, the department will adjust the amount of
your rebate based upon income amounts reported directly
to the department by the Social Security Administration or
the Department of Human Services.
SOCIAL SECURITY RECIPIENTS WITHOUT
PA ADDRESSES
If your address in Social Security Administration records
was not a Pennsylvania address for 2023, you must submit
a copy of one of the following documents as proof of your
2023 Social Security income: Form SSA-1099 reporting
your 2023 Social Security benefits, a statement from
Social Security that reports the monthly or yearly Social
Security/Supplemental Security Income benefits you
received during 2023, or a bank statement showing the
amount of Social Security/Supplemental Security Income
benefits deposited into your account during 2023.
PHILADELPHIA RESIDENTS
Please read the special filing instructions on Page 11.

ELIGIBILITY REQUIREMENTS
You are eligible for a Property Tax/Rent Rebate for claim
year 2023, if you meet the requirements in each of the
three categories below:

CATEGORY 1 – TYPE OF FILER
a. You were 65 or older as of Dec. 31, 2023;
b. You were not 65, but your spouse who lived with you
was 65 or older as of Dec. 31, 2023;
c. You were a widow or widower during all or part of
2023 and were 50 or older as of Dec. 31, 2023; or

d. You were permanently disabled and 18 or older
during all or part of 2023, you were unable to work
because of your medically determined physical or
mental disability, and your disability is expected to
continue indefinitely. If you received Supplemental
Security Income (SSI) payments, you are eligible for
a rebate if you meet all other requirements.
NOTE: If you applied for Social Security disability benefits
and the Social Security Administration did not rule in your
favor, you are not eligible for a Property Tax/Rent Rebate
as a disabled claimant.

CATEGORY 2 – ELIGIBILITY INCOME
When calculating your total eligible annual household
income, exclude one-half of your Social Security benefits
as shown in Box 5 of your SSA-1099 statement, one-half
of your Supplemental Security Income benefits, one-half of
your State Supplementary Payment benefits and one-half
of any Railroad Retirement Tier 1 benefits as shown on
Form RRB-1099.
Your total eligible annual household income, including the
income that your spouse earned and received while residing with you, was $45,000 or less in 2023.
You must report all items of income, except the nonreportable types of income listed on Pages 8 and 9, whether
or not the income is taxable for federal or PA income tax
purposes.
NOTE: There may be differences between eligibility
income and PA-taxable income. Please see specific line
instructions for each category of income.

CATEGORY 3 – OWNER, RENTER OR
OWNER/RENTER
To file as a property owner, renter, or owner/renter, you must
meet all requirements for one of the following categories:
OWNER
a. You owned and occupied your home, as evidenced
by a contract of sale, deed, trust, or life estate held by
a grantee;
b. You occupied your home (rebates are for your
primary residence only); and
c. You or someone on your behalf paid the 2023
property taxes on your home.
RENTER
a. You rented and occupied a home, apartment, nursing
home, boarding home, or similar residence in
Pennsylvania;
b. Your landlord paid property taxes or agreed to make
a payment in lieu of property taxes on your rental
property for 2023 (see Page 12); and
c. You or someone on your behalf paid the rent on your
residence for 2023.

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

3

OWNER/RENTER
a. You owned, occupied, and paid property taxes for
part of the year and were a renter for part of the year;
b. You owned and occupied your home and paid
property taxes and paid rent for the land upon which
your home is situated; or
c. You paid rent for the home you occupied, and paid
property taxes on the land upon which your home is
situated.
CAUTION: As a renter, if you received cash public assistance during 2023, you are not eligible for any rebate for
those months you received cash public assistance. Please
complete a PA-1000 Schedule D (enclosed in this booklet).

PROOF DOCUMENTS THAT FIRST
TIME FILERS MUST SUBMIT
IMPORTANT: Please send photocopies, since the department cannot return original documents. Print your Social
Security Number (SSN) on each proof document that you
submit with your claim form.
• If you are age 65 or older, provide proof of your age.
• If you are under age 65 and your spouse is age 65 or
older, provide proof of your spouse’s age.
• If you are a widow or widower age 50 to 64, provide
proof of your age and a photocopy of your spouse’s
death certificate.
• If you are permanently disabled, age 18 to 64, you must
provide proof of your age and proof of your permanent
disability.
PROOF OF AGE
NOTE: If you receive Social Security or SSI benefits and
have proven your age with the Social Security
Administration, you do not need to submit proof of age.
IMPORTANT: The department accepts photocopies of the
following documents as proof of your age. Do not send
your original documents since the department cannot
return original documents.
• Birth certificate
• Blue Cross or Blue Shield 65 Special Card
• Church baptismal record
• Driver’s license or PA identification card
• Hospital birth record
• Naturalization/immigration paper, if age is shown
• Military discharge paper, if age is shown
• Medicare card
• PACE/PACENET card
• Passport
The department will not accept a Social Security card or
hunting or fishing license as proof of age.
If you have questions on other types of acceptable
documents, please call the department at 1-888-222-9190.
4

PROOF OF DISABILITY
• For Social Security disability, SSI permanent and total
disability, Railroad Retirement permanent and total
disability, or Black Lung disability, provide a copy of your
award letter.
• For Veterans Administration disability, provide a letter
from the Veterans Administration stating that you are
100 percent disabled.
• For Federal Civil Service disability, provide a letter from
Civil Service stating that you are 100 percent disabled.
• If you do not qualify under any of the disability programs
mentioned above, did not apply for Social Security
benefits, or do not have a letter from the Veterans
Administration or Civil Service Administration, you must
submit a Physician’s Statement of Permanent Disability
(PA-1000 PS), enclosed in this booklet. The form must
describe your disability as permanent and your
physician must sign the statement to certify that the
information is true and accurate to the best of his/her
knowledge and belief.
IMPORTANT: The Physician’s Statement of Permanent
Disability cannot be used if you were denied Social
Security disability. The Department of Revenue has the
legal authority to require additional evidence that you are
permanently disabled and eligible for a rebate.
HOUSEHOLDS WITH MORE THAN
ONE QUALIFIED CLAIMANT
Only one member of your household may file a claim even
if more than one person qualifies for a rebate. If someone
other than your spouse appears on the deed or the lease,
please complete a PA-1000 Schedule F (enclosed in this
booklet). You may apply for only one rebate each year.
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. See Schedule A 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. See Schedule G, specifically the
instructions for Line 11g, for information on the calculation of
annualized income 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. Please see sections entitled

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

SURVIVING SPOUSE, AN ESTATE, and PERSONAL
REPRESENTATIVE for details.
SURVIVING SPOUSE
The surviving spouse can file the completed claim and
include a copy of the death certificate and a letter stating that
he/she was the spouse of the claimant at the time of death.
The surviving spouse may sign on the claimant’s signature
line.
OR
If the surviving spouse is eligible to file a claim, he/she can
file under his/her own name instead of submitting a claim
using the deceased individual’s claim form.
The surviving spouse should print his/her name, address,
and Social Security Number (SSN) in Section I, and follow
the filing instructions. The surviving spouse should furnish
proof required for a first time filer. Do not use the label the
department sent to the decedent in the booklet. The surviving
spouse should enter the deceased spouse’s SSN and name
in the spouse information area, and fill in the oval “if Spouse
is Deceased”, located in the area next to the Spouse’s SSN
on the claim form.
AN ESTATE
The executor or the administrator of the claimant’s estate
may file the claim and submit a Short Certificate showing the
will was registered or probated. When there is no will and
there are assets (an estate), submit a copy of the Letters of
Administration. A Short Certificate or Letters of Administration
can be obtained from the county courthouse where the death
is recorded. The person filing the claim form on behalf of the
deceased person may sign on the claimant’s signature line.
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 representative 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 18.
If you have any questions regarding the filing of a claim on
behalf of a deceased claimant, please call the department
at 1-888-222-9190.
PRIVACY NOTIFICATION
By law, (42 U.S.C. § 405(c)(2)(C)(i); 61 Pa. Code §117.16)
the Pennsylvania Department of Revenue has the authority
to use the Social Security Number (SSN) to administer the
Property Tax or Rent Rebate Program, the Pennsylvania
personal income tax and other Commonwealth of Pennsylvania tax laws. The department uses the SSN to identify
individuals and verify their incomes. The department also
uses the SSN to administer a number of tax-offset and
child-support programs federal and Pennsylvania laws
require. The commonwealth may also use the SSN in
exchange-of-tax-information agreements with governmental
authorities.
Pennsylvania law prohibits the commonwealth from
disclosing information that individuals provide on income
tax returns and rebate claims, including the SSN(s), except
for official purposes.

PA - 1000 FILING INSTRUCTIONS
SECTION I - SOCIAL SECURITY NUMBER, NAME,
ADDRESS AND RESIDENCE INFORMATION
You must fill in your Social Security Number and enter
your county and school district codes even if using
the preprinted label. If you are not using software or
myPATH to prepare your claim and your label is correct,
place your label in Section I. If you or your preparer are
using software or myPATH to prepare your claim, or if any
information on the preprinted label is incorrect, discard the
label. If not using a label, follow the instructions for printing
letters and numbers and completing your name and
address.
If your 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.
IMPORTANT TIPS: There are two lines to enter your
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,

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

5

state and ZIP code. Do not include any punctuation such
as apostrophes, commas, periods and hyphens.
• Use black ink. Another color such as red ink will delay
the processing of your rebate claim.
• Do not use pencil or pens labeled as gel pens or any red
ink.
• Print all information on your claim neatly inside the boxes.
• Use upper case (capital) letters. Use a blank box to
separate words.
• Print one letter or number in each box when entering
your Social Security Number, name, address, dollar
amounts, and other information. If your name, address,
or city begins with Mc, Van, O’, etc., do not enter a
space or a punctuation mark.
• Completely fill in all the appropriate ovals on your
claim form.

Sample
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

As a claimant, you must provide your birth date, telephone
number, county code, school district code, and, if applicable,
your spouse’s Social Security Number, birth date, and name.
If your spouse is deceased, completely fill in the oval “If
Spouse is Deceased” in Section I of the form.
COUNTRY CODE
If your current mailing address is in the United States of
America, you are not required to enter a country code.
The department will automatically include the correct
code for you. However, if - you lived at least part of the
year in Pennsylvania; you meet the eligibility requirements for a property tax or rent rebate; and your current mailing address is in any other country, you must
enter the alphabetic abbreviation for your mailing
address country. The list of alphabetic abbreviation
country codes can be found at https://www.irs.gov/efile-providers/foreign-country-code-listing-formodernized-e-file under the country codes menu
selection.
COUNTY & SCHOOL CODES
You must enter the two-digit county code and five-digit
school district code for where you lived on Dec. 31, 2023,
even if you moved after Dec. 31, 2023. Using incorrect
codes may affect your property tax rebate.
IMPORTANT: The lists of county and school district names
and the respective codes are on Pages 15, 16 and 17. If
you do not know the name of the county or school district
where you reside, you can either 1) check the county and
school property tax bills used to complete this claim if you
6

are a property owner, or 2) obtain this information from the
Online Customer Service Center at www.revenue.pa.gov.
NOTE: Be sure to include your phone number when completing the claim form. The department will make automated phone calls to advise when claims are received and
again when they are approved for payment.

SECTION II - FILING STATUS CATEGORIES
Line 1 - Please fill in the oval that shows your correct
filing status. Fill in only one oval. Filling in more than one
oval may reduce the amount of your rebate.
(P) Property Owners: Fill in this oval if you owned and
occupied your home for all or part of 2023 and did not rent
for any part of the year. If your deceased spouse’s name is
on your deed or tax bills, include the decedent’s Social
Security Number and name.
(R) Renters: Fill in this oval if you rented and occupied
your residence for all or part of 2023.
(B) Owner/Renter: Fill in this oval if you owned and occupied your residence for part of 2023, and also rented and
occupied another residence for the rest of 2023, or if you
owned your residence and rented the land where your
residence is located.
EXAMPLE: John pays property taxes on a mobile home
that he owns and occupies. His mobile home is on land
that he leases. John may claim a property tax rebate on
the mobile home and a rent rebate on the land. See Pages
9, 11 and 12 for documents you must send as proof of
property taxes or rents paid.
Line 2 - Certification. Please read each description and
select the type of filer that applies best to your situation
as of Dec. 31, 2023. 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.
Please complete the claim form using your Social Security
Number, name and address, and supply all appropriate
documentation.
a. Claimant age 65 or older
b. Claimant under age 65, with a spouse age 65 or older
who resided in the same household (You must submit
proof of your spouse’s age the first time you file.)
c. Widow or widower, age 50 to 65 (If your most recent
marriage ended in divorce, you do not qualify as a
widow/widower.)
d. Permanently disabled and age 18 to 64
See Page 4 for acceptable proof of age documents.
Line 3 - If you are filing 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 above), completely fill in the oval. The type
of claimant under which the decedent qualifies under
Line 2 above must also be included. A copy of the death

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

certificate must be submitted and Schedule G must be
completed.

SECTION III - LINES 4 THROUGH 18
You must report the total household income you earned
and/or received during 2023 for each category, which
includes your spouse’s income earned and/or received
while residing with you.
All claimants must submit proof of annual income.
IMPORTANT: The department reserves the right to
request additional information or make adjustments to
federal data if credits or deductions were taken to reduce
income.
CAUTION: Spouses may not offset each other’s income
and losses.
The department has the legal authority to require evidence
of the income you report on your claim. The following lists
the kinds of income you must report and the documents
you must submit as proof of the reported income. You must
include the income that your spouse received while
residing with you. See Pages 8 and 9 for a list of the kinds
of income that you do not need to report.
NOTE: Print your Social Security Number on each Proof
Document that you submit with your claim form.
Line 4 - Include one-half of your 2023 Social Security
Benefits as shown in Box 5 of your benefit statement
SSA-1099, one-half of your 2023 SSI, one-half of your
2023 Social Security Disability Income, and one-half of
your 2023 State Supplementary Payment. No documentation is required, if using a PA address.
Line 5 - Include one-half of your Railroad Retirement
Tier 1 Benefits. Submit a copy of form RRB-1099.
CAUTION: The total income from old age benefit
programs from other countries, such as Service Canada
Old Age Security, must be converted into U.S. dollars and
reported on Line 6.
Line 6 - Include the gross amount (not the taxable
amount) of pensions, annuities, Individual Retirement
Account distributions, Tier 2 Railroad Retirement Benefits,
and Civil Service Disability Benefits. Do not include Black
Lung Benefits, federal veterans’ disability payments, or
state veterans’ benefits. State veterans’ benefits include
service connected compensation or benefits of any kind
provided to a veteran or unmarried surviving spouse
paid by a commonwealth agency or authorized under
the laws of the commonwealth. Submit photocopies of
pension/annuity benefits statements along with other
forms 1099 showing income for 2023.
IMPORTANT: Do not include rollovers from Individual
Retirement Accounts and employer pensions. However,
proof must be provided. Proof includes, but is not limited
to, a federal Form 1099-R showing a rollover or other
documentation indicating that the distribution was rolled
into a new account.

If you have one or more distributions from annuity, life
insurance or endowment contracts reported on Form
1099-R that are included as interest income on your 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 your
Forms 1099-R with your claim form.
Line 7 - Report interest and dividends received or credited
during the year, whether or not you actually received
the cash. If you received dividends and capital gains
distributions from mutual funds, report the capital gains
distributions portion of the income as dividends, not
as gains from the sale or exchange of property. Include
interest received from government entities. You must also
include all tax-exempt interest income from direct obligations of the U.S. government, any state government, or any
political subdivision thereof in the amount shown on Line 7.
SUBMIT THE FOLLOWING:
• A copy of your federal Form 1040 Schedule B or your
PA-40 Schedule A and/or B; or copies of any federal
Forms 1099 you received; OR
• A copy of the front page of your PA or federal income tax
return verifying the income reported on Line 7.
IMPORTANT: If you received capital gains distributions
from a mutual fund, you must use PA Schedule B or the
front page of your PA tax return to verify your income. If
you have PA tax-exempt interest income, you must include
federal Form 1040 Schedule B along with a copy of the
front page of your federal tax return.
Line 8 - Include gains or losses you realized from the sale
of stocks, bonds, and other tangible or intangible property
as well as any gains or losses realized as a partner in a
partnership or shareholder in a PA S corporation. Do not
include capital gains distributions from mutual funds
required to be reported on Line 7.
NOTE: The nontaxable gain on the sale of your principal
residence must also be reported on this line. If you realized
a loss from the sale of your principal residence, this loss
may be used to offset any other gains you realized from
the sale of tangible or intangible property. However, any
net loss reported on this line cannot be deducted from any
other income. You may also submit photocopies of each
PA Schedule RK-1, PA Schedule NRK-1 or federal
Schedule K-1 that shows your gains or losses for each
partnership or PA S corporation.
Submit a copy of your federal Form 1040 Schedule D, a
copy of your PA-40 Schedule D, or copies of any federal
Forms 1099 you received which will verify any gains or
losses you realized. If you received capital gains distributions from mutual funds, do not include a copy of federal
Form 1040 Schedule D. You must include a copy of your
PA-40 Schedule D.
If you sold your personal residence during this claim
year, submit a statement showing the sale price less
selling expenses, minus the sum of the original cost and
permanent improvements.

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

7

CAUTION: You may only use losses from the sale or
exchange of property to offset gains from the sale or
exchange of property.
Line 9 - Include net rental, royalty, and copyright income or
loss realized during 2023 from property owned and rented
to others, oil and gas mineral rights royalties or income
received from a copyright as well as any net income or loss
realized as a partner in a partnership or shareholder in a
PA S corporation.
CAUTION: You may only use rental losses to offset
rental income.
IMPORTANT: If you receive income from the rental of a
portion of your own home, you must complete and submit
a PA-1000 Schedule E (enclosed in this booklet). Submit a
copy of your federal Form 1040 Schedule E, Part I, or
PA-40 Schedule E from your income tax return. You may
also submit photocopies of each PA Schedule RK-1,
PA Schedule NRK-1 or federal Schedule K-1 that shows
your net income or loss from rents, royalties, patents and
copyrights for each partnership or PA S corporation.
Line 10 - Include net income or loss from a business,
profession, or farm, and net income or loss you realized
as a partner in a partnership or a shareholder in a PA
S corporation.
CAUTION: You may only use business losses to offset
business income.
IMPORTANT: If you operate your business or profession at
your residence, you must complete and submit a PA-1000
Schedule E (enclosed in this booklet).
Submit a photocopy of each federal Form 1040 Schedule
C or F, or PA-40 Schedule C or F from your income tax
return. You may also submit photocopies of each PA
Schedule RK-1, PA Schedule NRK-1, or federal Schedule
K-1 that shows your income or loss for 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 on Lines 11a through 11g,
you must submit proof, such as photocopies of Forms
W-2, Department of Human Services cash assistance
statements, your federal or PA income tax returns, and any
other documents verifying income.
Line 11a. - Gross salaries, wages, bonuses, commissions, and estate or trust income not included in business,
profession, or farm income.
Line 11b. - Gambling and lottery winnings, including
PA Lottery, Powerball and Mega Millions winnings, prize
winnings, and the value of other prizes and awards. (A
PA-40 Schedule T must be submitted to verify these winnings,
as well as a W-2G to document PA Lottery winnings.)
Line 11c. - Value of inheritance, alimony, and spousal
support money.
Line 11d. - Cash public assistance/relief, unemployment
compensation, and workers’ compensation benefits,
except Section 306(c) benefits.
8

Line 11e. - Gross amount of loss of time insurance benefits,
disability insurance benefits, long-term care insurance
benefits (if received directly by the claimant), and life
insurance benefits and proceeds, except the first $5,000 of
the total death benefit payments.
Line 11f. - Gifts of cash or property totaling more than
$300, except gifts between members of a household.
Line 11g. - Miscellaneous income and annualized
income amount. Include any income not identified above
prior to the calculation of annualized income. 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. When adding amounts for
Line 3 of Schedule G, do not add any negative amounts
reported on Lines 8, 9 or 10.
Do not report the following income:
• Medicare or health insurance reimbursements;
• Food stamps, surplus foods, or other such non-cash
relief supplied by a governmental agency;
• Property Tax/Rent Rebate received in 2023;
• The amount of any damages due to personal injuries or
sickness. Damages include Black Lung benefits and
benefits granted under Section 306(c) of the Workers’
Compensation Security Fund Act (relating to Schedule
of Compensation for disability from permanent injuries
of certain classes);
• 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 those payments in excess of the actual expenses
of the care;
• Disability income received by disabled children in the
household;
• Federal veterans’ disability payments or state veterans’
benefits received by the veteran or unmarried surviving
spouse;
• The difference between the purchase price of your
residence and its selling price, if you used the proceeds
from the sale to purchase a new residence. This new
residence must be your principal residence;
• Federal or state tax refunds;
• Spouse’s income earned or received while not living
with you;
• Public Assistance benefits received by children in the
household, even though the check is issued in
claimant’s name;
• Qualified distributions from ABLE (Achieving a Better
Life Experience) Savings Programs;
• Federal stimulus or economic impact payments;
• STRIVE Program credits;
• Child support; and

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

• Individual Retirement Account and employer pension

rollovers (must provide a copy of federal Form 1099-R
indicating rollover or other supporting documentation).
CAUTION: 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 would 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 by the department. The department will accept reasonable methods of calculating the
annualized income amount.
Line 12 - If you and/or your spouse received benefits
from the federal Civil Service Retirement System (CSRS)
as (a) retired federal civil service employee(s) or as a surviving spouse, you may reduce your total eligibility income
by 50% of the average retired worker Social Security payment for 2022. The average retired worker Social Security
payment for 2022 is $9,948. Enter $9,948 on Line 12 only
if you include CSRS benefits in Line 6. If both you and your
spouse received CSRS benefits, or if you received your
own CSRS benefits and CSRS benefits as a surviving
spouse, enter $19,896 on Line 12. 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 Line 13 and 23. Do
not include losses reported on Lines 8, 9 and/or 10.
IMPORTANT: If you have over $45,000 of income claimed
on Line 13, you are not eligible for either Property Tax or
Rent Rebate relief under this program.
Line 14 - For Property Owners Only
Before completing Line 14 of the claim form, complete any
schedules listed in the instructions for this line. If you must
complete more than one schedule, you must complete
them in alphabetical order. If one schedule does not apply
to you, skip it, and go to the next schedule. You must carry
forward, as the total tax paid, the last amount shown on the
previous schedule you complete to the next schedule
you complete.
Enter the total amount of the property taxes paid for
your primary residence, or the amount shown as eligible
property taxes paid on the last schedule completed.
IMPORTANT: If you do not enter the amount of all taxes
paid on the primary residence, you will limit the
department’s ability to determine your eligibility for and

amount of a supplemental rebate. See Page 14 for more
information on supplemental rebates.
You must deduct interest or penalty payments, municipal
assessments, per capita taxes, or occupation taxes included
in your payment. If you paid early and received a discount,
you enter the amount you actually paid on Line 14. You
must also deduct other charges included in your tax bills.
See taxes that are not acceptable on Page 11.
If your name does not appear on the receipted tax bills,
you must submit proof of ownership. Examples of proper
proof are: a copy of the deed or a copy of the trust
agreement, will, or decree of distribution if you inherited
your property. If your address is not on your receipted
property tax bill or mortgage statement, you also must
submit a letter from your tax collector or mortgage company
verifying your home address.
NOTE: If your tax bills include a name and/or names other
than yours and your spouse’s, you must complete PA-1000
Schedule F or submit proof that you are the sole owner of
the property.
Include only the property tax on the amount of land that is
necessary for your personal use.
PA-1000 Schedule A - If you owned and occupied your
home for less than the entire year of 2023 or a claim
is being filed on behalf of a deceased owner who died
during 2023.
PA-1000 Schedule B - If you were a widow or widower
age 50 to 64 who remarried in 2023.
PA-1000 Schedule E - If you used part of your residence
for a purpose other than living quarters in 2023.
PA-1000 Schedule F - If your deed shows owners other
than your spouse.
As proof of property tax paid, homeowners must
provide photocopies of one of the following real estate
documents:
• All 2023 real estate tax bills that have been marked
“paid” by the tax collector (see the instructions beginning
on this page for the proper calculation of the amount on
Line 14). If you paid your taxes in quarterly installments,
a tax bill must be submitted for each period. For tax bills
that are not marked paid by the tax collector, the department will accept a photocopy of both sides of the
cancelled check along with a copy of the tax bill;
• Your year-end mortgage statement showing the amount
of real estate taxes paid;
• A letter signed by the tax collector certifying that you
paid your 2023 real estate taxes. The letter should also
declare the total tax does not include nuisance taxes or
penalty; OR
• A receipted copy of your tax billing from your owner’s
association or corporation. Resident stockholders of a
cooperative housing corporation, such as a condominium,
may qualify as property owners based on their pro rata
share of the property taxes paid to the corporation for
their residence.

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

9

PA-1000 COMPLETION SAMPLE
Fill in your Social Security Number.

Fill in this oval if your spouse is deceased.

2305010015

PA-1000

Fill in only one oval for Line 1.

Property Tax or Rent
Rebate Claim 03-23
PA Department of Revenue
P.O. Box 280503
Harrisburg PA 17128-0503

OFFICIAL USE ONLY

II Fill in only one oval in each

If Spouse is
Deceased, fill
in the oval.

Spouse’s Social Security Number

PLEASE WRITE IN YOUR SOCIAL SECURITY NUMBER(S) ABOVE

HERE

Last Name

LABEL

Discard label if
it is not correct
and fill in all
data in Section I.

2023

Check your label for accuracy. If incorrect, do not use the label. Complete Section I.

Your Social Security Number

PLACE

If your label
is correct,
place it here.

I

First Name

MI

First Line of Address

Second Line of Address

City or Post Office

State

Spouse’s First Name

MI

County Code School District Code

*
Claimant’s Birthdate

Spouse’s Birthdate

M M D D Y Y
III

ZIP Code

CODES
*REQUIRED

section.
1. I am filing for a rebate as a:
P. Property Owner – See
instructions
R. Renter – See instructions
B. Owner/Renter – See
instructions
2. I Certify that as of Dec. 31, 2023,
I am (a):
A. Claimant age 65 or older
B. Claimant under age 65,
with a spouse age 65 or
older who resided in the
same household
C. Widow or widower, age
50 to 64
D. Permanently disabled
and age 18 to 64

Country Code

*

3.
Filing on behalf of a
decedent

Daytime Telephone Number

M M D D Y Y
Dollars

TOTAL INCOME received by you and your spouse during 2023

4. Social Security, SSI and SSP Income (Total benefits $

divided by 2) . . . . . . . . . .

4.

divided by 2) . . . . . . . . . . .

5.

6. Total Benefits from Pension, Annuity, IRA Distributions and Railroad Retirement Tier 2 (Do not
include federal veterans’ disability payments or state veterans’ payments.) . . . . . . . . . . . . . . . . . . .

6.

7. Interest and Dividend Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.

5. Railroad Retirement Tier 1 Benefits (Total benefits $

LOSS

e
l
p

8.

8. Gain or Loss on the Sale or Exchange of Property. . . . . . . . . If a loss, fill in this oval. . . . .
LOSS

9.

9. Net Rental Income or Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . If a loss, fill in this oval. . . . .
LOSS

10.

10. Net Business Income or Loss . . . . . . . . . . . . . . . . . . . . . . . . . If a loss, fill in this oval. . . . .
Other Income.
11a. Salaries, wages, bonuses, commissions, and estate and trust income. . . . . . . . . . . . . . . . . . . . .

11a.

11b. Gambling and Lottery winnings, including PA Lottery winnings, prize winnings and the value
of other prizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11b.

am

11c.

11c. Value of inheritances, alimony and spousal support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11d. Cash public assistance/relief. Unemployment compensation and workers’ compensation,
except Section 306(c) benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11e. Gross amount of loss of time insurance benefits and disability insurance benefits,
and life insurance benefits, except the first $5,000 of total death benefit payments. . . . . . . . . . . .

S

11d.
11e.

Cents

s
s
s

s
s
s
s
s

11f. Gifts of cash or property totaling more than $300, except gifts between
members of a household. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11f.

s

11g.

12. Claimants with Federal Civil Service Retirement System Benefits enter $9,948 or $19,896.
See the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.

13. TOTAL INCOME. Add only the positive income amounts from Lines 4 through 11g and subtract
the amount on Line 12. See Page 3 for income limitations. Enter this amount on Line 23. . . . . . . .

13.

s
s
s

Fill in this oval on behalf
of decedent.
Fill in School District Code
(see Pages 16 and 17). Fill in
County Code (see Page 15). Fill
in Country Code if applicable
(see Page 6).
Report your total Social
Security, SSI, and SSP benefits
here. Divide the total by 2 and
enter the result on Line 4.

s
s
s
s

11g. Miscellaneous income and annualized income amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fill in only one oval for Line 2.

Report your total Railroad
Retirement Tier 1 benefits here.
Divide the total by 2 and enter
the result on Line 5.
Enter the total of Lines 4
through 11g, less Line 12.

IMPORTANT: You must submit proof of the income you reported – See the instructions on Pages 7 to 9.

2305010015

2305120012

PA-1000 2023 03-23
Your Social Security Number

Property Owners
complete Lines
14 and 15.
Renters complete
Lines 16, 17 and 18.

Your Name:

PROPERTY OWNERS ONLY
14. Total 2023 property tax. Submit copies of receipted tax bills.
15. Property Tax Rebate. Enter the maximum standard rebate
amount from Table A for your income level here: (_______)

. . . . . . . . . . . . . . . . . . . . . . . . . . . 14.
Compare this amount to line 14 and
enter the lesser amount to the right. 15.

RENTERS ONLY

e
l
p

16. Total 2023 rent paid. Submit PA Rent Certificate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.
17. Multiply Line 16 by 20 percent (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.
18. Rent Rebate. Enter the maximum rebate amount
Compare this amount to line 17 and
from Table B for your income level here: (_______)
enter the lesser amount to the right.
18.

OWNER – RENTER ONLY
19. Property Tax/Rent Rebate. Enter the maximum
rebate amount from Table A for your income
level here: (_______)

Compare this amount to the sum of
Lines 15 and 18 and enter the lesser
amount to the right.

m
a

19.

s
s
s
s
s
s

DIRECT DEPOSIT. Banking rules do not permit direct deposits to bank accounts outside the U.S. If your bank account is outside the U.S.,

If you want your
rebate directly
deposited, complete
Lines 20,
21 and 22.

do not complete the direct deposit Lines 20, 21 and 22. The department will mail you a paper check. If your rebate will be going to a bank
account within the U.S., you have the option to have your rebate directly deposited. If you want the department to directly deposit your rebate
into your checking or savings account, complete Lines 20, 21 and 22.

S

Checking

20. Place an X in one box to authorize the Department of Revenue to directly deposit your rebate
into your: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.

21. Routing number. Enter in boxes to the right. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Savings

21.

23.
Enter the amount from Line 13 of
the claim form on this line and circle
the corresponding Maximum Rebate
amount for your income level.
Owners use Table A and Renters
use Table B.

TABLE A - OWNERS ONLY
INCOME LEVEL
Maximum Standard
Rebate
$
0 to $ 8,000
$1,000
$ 8,001 to $15,000
$ 770
$15,001 to $18,000
$ 460
$18,001 to $45,000
$ 380

TABLE B - RENTERS ONLY
INCOME LEVEL
Maximum
Rebate
$
0 to $ 8,000
$1,000
$ 8,001 to $15,000
$ 770
$ 15,001 to $18,000
$ 460
$ 18,001 to $45,000
$ 380

CLAIMANT OATH: I declare that this claim is true, correct and complete to the best of my knowledge and belief, and this is the only claim filed by
members of my household. I authorize the PA Department of Revenue access to my federal and state Personal Income Tax records, my PACE records, my
Social Security Administration records and/or my Department of Human Services records. This access is for verifying the truth, correctness and
completeness of the information reported in this claim.
Claimant’s Signature

Date

Spouse’s Signature

Date

Witnesses’ Signatures: If the claimant cannot sign, but only makes a mark.
1.

2.
PREPARER: I declare that I prepared this return, and that it is to the best of my
knowledge and belief, true, correct and complete.
Preparer’s Signature, if other than the claimant

Date

Name of claimant’s power of attorney or nearest relative. Please print.

Telephone number of claimant’s power of attorney or nearest relative.
(
)

Preparer’s Name. Please print.

Home address of claimant’s power of attorney or nearest relative. Please print.

Preparer’s telephone number
(
)

City or Post Office

State

Claim filing deadline – June 30, 2024
You can call 1-888-728-2937 after June 1 to verify the status of your claim.
2305120012

10

Enter your Routing Number
here (direct deposit only).

22. Account number. Enter in boxes to the right. . . . . . . . . . 22.

IV An excessive claim with intent to defraud is a misdemeanor punishable by a maximum fine of $1,000, and/or imprisonment for up to one year
upon conviction. The claimant is also subject to a penalty of 25 percent of the entire amount claimed.

Claimant signs here.

If you were both a Property
Owner and a Renter,
complete Lines 14 through 19.

2305120012

PA-1000 Pennsylvania Property Tax or Rent Rebate Program

ZIP Code

Enter your Account Number
here (direct deposit only).

IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
2305010056

PA-1000

Property Tax or Rent
Rebate Claim 03-23 (FI)
PA Department of Revenue
P.O. Box 280503
Harrisburg PA 17128-0503

I

START

2023

OFFICIAL USE ONLY

Check your label for accuracy. If incorrect, do not use the label. Complete Section I.

Your Social Security Number

Spouse’s Social Security Number

➜

II Fill in only one oval in each

If Spouse is
Deceased, fill
in the oval.

PLEASE WRITE IN YOUR SOCIAL SECURITY NUMBER(S) ABOVE

Last Name

First Name

MI

First Line of Address

Second Line of Address

City or Post Office

State

Spouse’s First Name

MI

ZIP Code

County Code School District Code

*

*

CODES
*REQUIRED

section.
1. I am filing for a rebate as a:
P. Property Owner – See
instructions
R. Renter – See instructions
B. Owner/Renter – See
instructions
2. I Certify that as of Dec. 31, 2023,
I am (a):
A. Claimant age 65 or older
B. Claimant under age 65,
with a spouse age 65 or
older who resided in the
same household
C. Widow or widower, age
50 to 64
D. Permanently disabled
and age 18 to 64

Country Code
3.
Filing on behalf of a
decedent

Claimant’s Birthdate MM/DD/YY Spouse’s Birthdate MM/DD/YY Daytime Telephone Number

III

Dollars

TOTAL INCOME received by you and your spouse during 2023
divided by 2) . . . . . . . . . .

4.

divided by 2) . . . . . . . . . . .

5.

6. Total Benefits from Pension, Annuity, IRA Distributions and Railroad Retirement Tier 2 (Do not
include federal veterans’ disability payments or state veterans’ payments.) . . . . . . . . . . . . . . . . . . .

6.

7. Interest and Dividend Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.

4. Social Security, SSI and SSP Income (Total benefits $
5. Railroad Retirement Tier 1 Benefits (Total benefits $

Cents

LOSS

8.

8. Gain or Loss on the Sale or Exchange of Property. . . . . . . . . If a loss, fill in this oval. . . . .
LOSS

9.

9. Net Rental Income or Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . If a loss, fill in this oval. . . . .
LOSS

10.

10. Net Business Income or Loss . . . . . . . . . . . . . . . . . . . . . . . . . If a loss, fill in this oval. . . . .
Other Income.
11a. Salaries, wages, bonuses, commissions, and estate and trust income. . . . . . . . . . . . . . . . . . . . .

11a.

11b. Gambling and Lottery winnings, including PA Lottery winnings, prize winnings and the value
of other prizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11b.

11c. Value of inheritances, alimony and spousal support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11c.

11d. Cash public assistance/relief. Unemployment compensation and workers’ compensation,
except Section 306(c) benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11e. Gross amount of loss of time insurance benefits and disability insurance benefits,
and life insurance benefits, except the first $5,000 of total death benefit payments. . . . . . . . . . . .

11d.
11e.

11f. Gifts of cash or property totaling more than $300, except gifts between
members of a household. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11f.

11g. Miscellaneous income and annualized income amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11g.

12. Claimants with Federal Civil Service Retirement System Benefits enter $9,948 or $19,896.
See the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.

13. TOTAL INCOME. Add only the positive income amounts from Lines 4 through 11g and subtract
the amount on Line 12. See Page 3 for income limitations. Enter this amount on Line 23. . . . . . . .

13.

IMPORTANT: You must submit proof of the income you reported – See the instructions on Pages 7 to 9.

2305010056
Reset Entire Form

TOP OF PAGE

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IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
2305110054

PA-1000 2023 03-23 (FI)
START

Your Social Security Number

➜
Your Name:

PROPERTY OWNERS ONLY

14. Total 2023 property tax. Submit copies of receipted tax bills.

15. Property Tax Rebate. Enter the maximum standard rebate
amount from Table A for your income level here: (_______)

. . . . . . . . . . . . . . . . . . . . . . . . . . . 14.
Compare this amount to line 14 and
enter the lesser amount to the right. 15.

RENTERS ONLY

16. Total 2023 rent paid. Submit PA Rent Certificate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.
17. Multiply Line 16 by 20 percent (0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.
18. Rent Rebate. Enter the maximum rebate amount
Compare this amount to line 17 and
from Table B for your income level here: (_______)
enter the lesser amount to the right.
18.

OWNER – RENTER ONLY

19. Property Tax/Rent Rebate. Enter the maximum
rebate amount from Table A for your income
level here: (_______)

Compare this amount to the sum of
Lines 15 and 18 and enter the lesser
amount to the right.

19.

DIRECT DEPOSIT. Banking rules do not permit direct deposits to bank accounts outside the U.S. If your bank account is outside the U.S.,
do not complete the direct deposit Lines 20, 21 and 22. The department will mail you a paper check. If your rebate will be going to a bank
account within the U.S., you have the option to have your rebate directly deposited. If you want the department to directly deposit your rebate
into your checking or savings account, complete Lines 20, 21 and 22.
Checking

20. Place an X in one box to authorize the Department of Revenue to directly deposit your rebate
into your: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.

21. Routing number. Enter in boxes to the right. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Savings

21.

22. Account number. Enter in boxes to the right. . . . . . . . . . 22.

23.
Enter the amount from Line 13 of
the claim form on this line and circle
the corresponding Maximum Rebate
amount for your income level.
Owners use Table A and Renters
use Table B.

TABLE A - OWNERS ONLY
INCOME LEVEL
Maximum Standard
Rebate
$
0 to $ 8,000
$1,000
$ 8,001 to $15,000
$ 770
$15,001 to $18,000
$ 460
$18,001 to $45,000
$ 380

TABLE B - RENTERS ONLY
INCOME LEVEL
Maximum
Rebate
$
0 to $ 8,000
$1,000
$ 8,001 to $15,000
$ 770
$ 15,001 to $18,000
$ 460
$ 18,001 to $45,000
$ 380

IV An excessive claim with intent to defraud is a misdemeanor punishable by a maximum fine of $1,000, and/or imprisonment for up to one year
upon conviction. The claimant is also subject to a penalty of 25 percent of the entire amount claimed.
CLAIMANT OATH: I declare that this claim is true, correct and complete to the best of my knowledge and belief, and this is the only claim filed by
members of my household. I authorize the PA Department of Revenue access to my federal and state Personal Income Tax records, my PACE records, my
Social Security Administration records and/or my Department of Human Services records. This access is for verifying the truth, correctness and
completeness of the information reported in this claim.
Claimant’s Signature

Date
MM/DD/YY

Spouse’s Signature

Date

Please sign the PA-1000 after printing.

1.

Please sign the PA-1000 after printing.

2.

PREPARER: I declare that I prepared this return, and that it is to the best of my
knowledge and belief, true, correct and complete.
MM/DD/YY
Preparer’s Signature, if other than the claimant

Please sign the PA-1000 after printing.

Witnesses’ Signatures: If the claimant cannot sign, but only makes a mark.

Date

Please sign the PA-1000 after printing.

Please sign the PA-1000 after printing.

Name of claimant’s power of attorney or nearest relative. Please print.
Telephone number of claimant’s power of attorney or nearest relative.

Preparer’s Name. Please print.

Home address of claimant’s power of attorney or nearest relative. Please print.

Preparer’s telephone number

City or Post Office

State

ZIP Code

Claim filing deadline – June 30, 2024
You can call 1-888-728-2937 after June 1 to verify the status of your claim.
2305110054
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2305110054
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IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
2305210052

PA Rent Certificate
PA Rent Certificate and
Rental Occupancy Affidavit
PA-1000 RC (EX) MOD 03-23 (FI)
PA Department of Revenue

START

2023

OFFICIAL USE ONLY

Name as shown on PA-1000

Social Security Number

➜
You may make photocopies of this form as needed.
If filing as a renter, you must provide proof of the rent you paid. If you rented at more than one address, you must submit proof for each address.

PA RENT CERTIFICATE
Your landlord must provide all the information on Lines 1 through 8. Your landlord, or your landlord’s authorized agent, must sign this PA Rent
Certificate. If your landlord, or your landlord’s authorized agent, does not sign this PA Rent Certificate, you must complete Lines 1 through 8
and the Rental Occupancy Affidavit below. Your Rental Occupancy Affidavit must be notarized.
1. Street address of the residence for which the claimant paid rent

3. Rental unit is (fill in the appropriate oval):

City, State, ZIP Code
2. Owner’s business name or landlord’s name (last, first, middle initial) if an individual

Apartment in a House

Mobile Home Lot

Apartment Building

Nursing Home

Boarding Home

Private Home

Mobile Home

Assisted Living

Personal Care Home
Building Name:

Landlord’s Address
City, State, ZIP Code

Domiciliary Care
Landlord’s EIN (if applicable) and daytime telephone number

Foster Care

If Domiciliary or Foster Care or if a Boarding or Personal Care
Home, you must submit a copy of your contract agreement.

Dollars

YOU MUST COMPLETE ALL LINES. IF NONE, ENTER “0”.

Cents

Explanation of Item 4.

4. What was the amount of rent per month? (Include only the amount charged for rental.
Do not include security deposits or amounts paid for food, medicine, medical care
or personal care.) If your rental amounts changed during the year, please explain in the
space provided. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. How much of the monthly rental amount was paid or subsidized
by a governmental agency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Total monthly amount of rent paid. (Subtract Line 5 from Line 4.) . . . . . . . . . . . . . . 6.
Explanation of Item 7.

7. Number of months unit was occupied by the claimant in 2023.
(If less than 12 months, please explain in the space provided.) . . . . . . . . . . . . . . . . . . 7.
8. What was the total rent paid in 2023 by the claimant?
(Multiply Line 6 by Line 7.) Enter the amount here and on Line 16 of the claim form
or the appropriate line(s) of Schedules D, E or F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.

LANDLORD’S OATH: (Read carefully before signing)
I certify that the information provided on this PA Rent Certificate is true, correct and complete to the best of my knowledge, information and
belief. I further certify that – fill in the applicable oval(s).
I was required to pay 2023 property taxes on the property in which the claimant resided in 2023.
I made, or was required to make, a payment in lieu of taxes for 2023 on the property in which the claimant resided in 2023.
The property in which the claimant resided in 2023 was tax exempt.
Other names, excluding the spouse or minor children, appear on the lease.

Please sign and date after printing.

X

Landlord’s Signature

Date

MM/DD/YY

OCCUPANCY AFFIDAVIT

I am, or am filing on behalf of, the claimant named above. I certify that I was unable to obtain the landlord’s signature on the PA Rent Certificate
for the following reason(s):

Affidavit: I certify that I am, or am filing on behalf of, the claimant named
above. I also affirm all the information on the above PA Rent Certificate
and Occupancy Affidavit is true, correct and complete to the best of my
knowledge, information and belief.

x

Claimant's Signature. Please sign after printing.
Claimant's Signature

Notarize:
Subscribed and sworn before me this
day of

x
Date

20

Signature of Notary Public. Please sign after printing.
Signature of Notary Public

MM/DD/YY

2305210052
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IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
PHYSICIAN’S STATEMENT

2305310050

Physician’s Statement of
Permanent and Total Disability
PA-1000 PS 03-23 (FI)
PA Department of Revenue

2023

OFFICIAL USE ONLY

START Name as shown on PA-1000

Social Security Number

➜
Instructions
A claimant not covered under the federal Social Security Act or the federal Railroad Retirement Act who is unable
to submit proof of permanent and total disability may submit this Physician’s Statement. The physician must determine the claimant’s status using the same standards used for determining permanent and total disability
under the federal Social Security Act or the federal Railroad Retirement Act. CAUTION: If the claimant applied
for Social Security disability benefits and the Social Security Administration did not rule in the claimant’s favor,
the claimant is not eligible for a Property Tax or Rent Rebate.
Confidentiality Statement. All information on this Physician’s Statement and claim form is confidential. The
department shall only use this information for the purposes of determining the claimant’s eligibility for a Property
Tax or Rent Rebate.
CERTIFICATION
I certify the claimant named above is my patient and is permanently and totally disabled under the standards that
the federal Social Security Act or the federal Railroad Retirement Act requires for determining permanent and total
disability. Upon request from the PA Department of Revenue, I will provide the medical reports or records indicating diagnosis and prognosis of the claimant’s condition, including signs, symptoms and laboratory findings, if
applicable or appropriate.

Please sign after printing.
Physician Signature

Date MM/DD/YY

Description of Claimant’s Permanent and Total Disability. Briefly describe the reason(s) the above-named
claimant is totally and permanently disabled.

Physician Identification Information. Please print.
Name

National Provider Identifier

Business name, if applicable
Address
City

State

Office telephone number

Office email address

2305310050
Reset Entire Form

ZIP Code

2305310