Federal Application for Certification of Qualified Investments Eligible for Credits and Grants Under the Qualifying Therapeutic Discovery Project Program
Extracted from PDF file 2017-federal-form-8942.pdf, last modified March 2009
Application for Certification of Qualified Investments Eligible for Credits and Grants Under the Qualifying Therapeutic Discovery Project ProgramForm 8942 (June 2010) Department of the Treasury Internal Revenue Service Part I Application for Certification of Qualified Investments Eligible for Credits and Grants Under the Qualifying Therapeutic Discovery Project Program ▶ See OMB No. 1545-2175 separate instructions for required attachments. Applicant Information 1 Name of applicant 3 Number and street 4 City, town, or post office, state, and ZIP code Check if this is an amended application 2 Taxpayer identification number (TIN) Room/suite 5 6 7 Telephone number URL address for applicant's website Is the applicant a member of an affiliated group filing consolidated returns? . . If "Yes," complete lines 8 through 12. 8 This corporation has been a member of this group: a For the entire year From / / 20 until / / 20 . b 9 Name of the common parent of the affiliated group . . . . . . . Yes No 10 Employer identification number (EIN) 11 Number and street 12 City, town, or post office, state, and ZIP code 13 Contact person. Attach a properly completed Form 2848, Power of Attorney and Declaration of Representative, if necessary. See instructions. Room/suite a Name of contact person b Number and street c Room/suite City, town, or post office, state, and ZIP code d Telephone number e Fax number 14a Name of the project b Description of the project (see instructions) Part II 15 16 Certification and Grant Election Information (see instructions) Enter the number of employees in all businesses of the applicant on the date this application is submitted. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . ▶ If more than 250, do not continue with this application. Are the applicant and any other entities considered to be a single employer under section 52(a) or (b) or section 414(m) or (o)? See instructions . . . . . . . . . . . . . . . . . . . . . ▶ Yes No If "Yes": • Attach a statement listing the name, address, and employer identification number (EIN) for each of the other entities; and • Applicant certifies it has 250 or fewer employees, taking into account the employees of these other entities, on the date this application is submitted. 17 Is the applicant electing for this application for certification to be an application for a grant for a tax year beginning in: If "Yes" for either a or b, complete lines 18 and 19. a 2009? Yes No If "No" to both a and b, skip to line 20. b 2010? Yes No 18 Enter the applicant's Data Universal Numbering System (D-U-N-S) number. See instructions. ▶ 19 Check the applicable box that describes the applicant. If any of the following describes the applicant, the applicant is not eligible for a grant. Federal, state, or local government or any political subdivision, agency, or instrumentality thereof. Organization described in section 501(c) and exempt from tax under section 501(a). Entity referred to in section 54(j)(4). Partnership or other pass-through entity with a government or any political subdivision, agency, or instrumentality thereof, section 501(c) organization, or section 54(j)(4) entity as a direct or indirect partner (or other direct or indirect holder of an equity or profits interest). Note: Do not check this box if such entity owns only an indirect interest in the applicant through a C corporation. For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 37758D Form 8942 (6-2010) Page 2 Form 8942 (6-2010) Part II 20 21 Certification and Grant Election Information (continued) Yes No Will this project create and sustain (directly or indirectly) high-quality, high-paying jobs in the United States? Enter the number of full-time and part-time employees in the United States whose work is directly billed to the project and the average salaries of the employees in each category. See instructions. Employees a b 22a b c 23 24 25 Number of employees Average salaries of the employees Full-time Part-time Enter the number of contractors in the United States paid for work on the project . . . . . . . Enter the average monthly hours of the contractors entered on line 22a . . . . . . . . . . Enter the average monthly compensation of the contractors entered on line 22a. . . . . . . . Will this project advance United States competitiveness in the fields of life, biological, and medical sciences? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . As of the date this application is submitted, is the project active, terminated, or suspended? Check one. Active Terminated If the project is terminated or suspended for any of the failures below, check all boxes that apply. The project failed a clinical trial. The project failed a pre-clinical research milestone. The project failed to secure FDA licensure. If the applicant checked any of the boxes above, do not continue with this application. Yes No Suspended 26 Will the project produce a new or significantly improved technology, or a new application of or significant improvement to existing technology, as compared to commercial technologies currently in service? . Yes No 27 Is the project expected to lead to the construction or use of a contract production facility in the United States in the next 5 years? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Part III Qualified Investment (see instructions) Complete columns (a), (b), and (c), as applicable. See instructions. Complete column (a) only for 2009 grant applications if the applicant's 2009 tax year ends after the application date. (a) As of September 30, 2010 (tax year 2009 only) (see instructions) (b) Tax year 2009 (c) Tax year 2010 28 Qualified investment derived from employee wages. 29 Qualified investment derived from supplies and lab costs. 30 Qualified investment derived from depreciable property. 31 Qualified investment derived from third-party contractors. 32 Qualified investment derived from other costs. 33 Amount in line 30 attributable to qualified progress expenditures. 34 Total. Add lines 28 through 32 in each column. Qualified investment for which certification is requested. Add line 34 columns (b) and (c). This application is for certification of qualified investment, related to a qualifying therapeutic discovery project, for (check only one): Tax year beginning in 2009 only. Enter the ending date of the tax year . . . . . . . . ▶ / / Tax year beginning in 2010 only. Enter the ending date of the tax year . . . . . . . . ▶ / / Tax years beginning in 2009 and 2010. Enter the ending date of the tax year for 2009 . . . ▶ / / / / and for 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 35 36 Sign Here Keep a copy of this form for your records. Date Signature of Applicant Preparer’s signature ▲ Firm’s name (or yours if self-employed), address, and ZIP code Title Date ▲ Paid Preparer’s Use Only Under penalties of perjury, I declare that I have examined this submission, including the accompanying documents, and, to the best of my knowledge and belief, all of the facts contained herein are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Preparer’s SSN or PTIN Check if selfemployed EIN Phone no. Form 8942 (6-2010)
Form 8942 (Revised June 2010)
More about the Federal Form 8942 Other Tax Credit TY 2017
We last updated the Application for Certification of Qualified Investments Eligible for Credits and Grants Under the Qualifying Therapeutic Discovery Project Program in January 2018, so this is the latest version of Form 8942, fully updated for tax year 2017. You can download or print current or past-year PDFs of Form 8942 directly from TaxFormFinder. You can print other Federal tax forms here.
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The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 8942 from the Internal Revenue Service in January 2018.
Form 8942 is a Federal Other form. States often have dozens of even hundreds of various tax credits, which, unlike deductions, provide a dollar-for-dollar reduction of tax liability. Some common tax credits apply to many taxpayers, while others only apply to extremely specific situations. In most cases, you will have to provide evidence to show that you are eligible for the tax credit, and calculate the amount of the credit to which you are entitled.
Historical Past-Year Versions of Federal Form 8942
We have a total of five past-year versions of Form 8942 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
Form 8942 (Revised June 2010)
Form 8942 (Revised June 2010)
Form 8942 (Revised June 2010)
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