Michigan Worksheet for Determining Support

Worksheet for Determining Support
4622, Worksheet for Determining SupportReset Form
Michigan Department of Treasury
4622 (Rev. 10-18)

Worksheet for Determining Support
Issued under authority of Public Act 281 of 1967.

Keep a copy for your records.

Filer’s Name (First, Middle Initial, Last)

Tax Year

Filer’s Full Social Security Number

Your individual income tax return for the year noted in the enclosed letter indicates that you were claimed as a dependent on another person’s
tax return. As a claimed dependent, another person(s) must have provided more than 50 percent of your financial support during the year. Your
total household resources did not include that support as gifts, expenses paid on your behalf, or as other nontaxable income.
Check One:
I AM a dependent. Report the amount of support received on this form. If applicable, include copies of tuition statements, property tax
statements and/or lease agreement(s). The amount reported will be added to total household resources on your property tax credit and/
or home heating credit claim, and the credit(s) will be recalculated and processed.
I AM NOT a dependent. Complete this form and return with required documentation to support your claim. Written statements without
supporting documentation will not be accepted. Include a copy of the enclosed letter with your documentation.
Documentation required if claiming that you ARE NOT a dependent:
1. Copy of financial aid application showing your income is the only income included in the computation for financial aid eligibility.
2. Copy of parent/qualified relative (who claimed you as a dependent) health insurance information showing you are not a dependent
on the health insurance plan.
3. Copy of your federal return
For assisstance, call 517-636-4486 or visit www.michigan.gov/incometax

Savings and Loans
1. Enter the total amount you withdrew from a savings account to assist with paying expense for the tax year.
Attach a copy of your bank statement....................................................................................................................

2. Enter the total amount you borrowed to assist with paying expenses for the tax year...........................................
Enter the name and address of the person or institution you borrowed from. Attach a copy of the loan
agreement and/or a notarized statement from the person who you borrowed the money from.

Household Expenses for the Residence(s) Claimed on your Property Tax and/or Home Heating Credit
3. Residence(s) (complete lines 3a, 3b and 3c):

3a. Did you own your home? Circle Yes or No.
3b. If you answered “Yes” to 3a, enter total property taxes paid for the year
(provide copy of property tax statement)................................................................................................................

3b.

3c. If you answered “No” to 3a, enter your total rent paid for the year (provide copy of lease agreement)..........

3c.

4. Enter the total amount of utilities (heat, light, water, etc. not included in line 3c)...................................................

5. Enter the total amount of repairs that you paid for (not included in line 3c)...........................................................

6. Enter the total of other expenses (do not include mortgage interest, real estate taxes or insurance) ..................

7. Add lines 3b through 6. These are the total household expenses.....................................................................

8. Enter your total clothing expenses.........................................................................................................................

9. Enter your total food expenses...............................................................................................................................

10. Enter your total education expenses (include copies of tuition statements)...........................................................

10.

Your Expenses

11. Enter your total medical and dental expenses not paid for or reimbursed by insurance........................................

11.

12. Enter your total travel and recreation expenses.....................................................................................................

12.

13. Enter the total of any other expenses.....................................................................................................................

13.

14. Add lines 8 through 13. This is the total cost of your support for the year..............................................................

14.

15. Enter the amount of support provided by person claiming you as a dependent (for dependents only).................

15.

16. Enter amounts provided by state, local, and other welfare societies or agencies..................................................

16.

17. Add lines 15 and 16. This is the amount you received for your support.................................................................

17.

Amount of Support From Others and/or Those Who Claimed You

Return the completed worksheet and required documentation with a copy of the Request for Information to the address noted
in the letter.

Extracted from PDF file 2023-michigan-form-4622.pdf, last modified August 2015

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More about the Michigan Form 4622 Individual Income Tax TY 2023

We last updated the Worksheet for Determining Support in February 2024, so this is the latest version of Form 4622, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form 4622 directly from TaxFormFinder. You can print other Michigan tax forms here.

Other Michigan Individual Income Tax Forms:

TaxFormFinder has an additional 97 Michigan income tax forms that you may need, plus all federal income tax forms.

Form Code	Form Name
Form MI-1040CR	Homestead Property Tax Credit Claim Tax Credit
Form MI-1040	Individual Income Tax Return Tax Return
Form MI-1040CR-7	Home Heating Credit Claim Tax Credit
Schedule W	Withholding Tax Schedule
Form MI-1040ES	Estimated Individual Income Tax Voucher Estimated

Download all MI tax forms View all 98 Michigan Income Tax Forms

Form Sources:

Michigan usually releases forms for the current tax year between January and April. We last updated Michigan Form 4622 from the Department of Treasury in February 2024.

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About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Michigan Form 4622

We have a total of eleven past-year versions of Form 4622 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

2023 Form 4622