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Pennsylvania Free Printable Tax Credit Certification Request Form (REV-1601) for 2024 Pennsylvania Tax Credit Certification Request Form

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Tax Credit Certification Request Form
Tax Credit Certification Request Form (REV-1601)

TAX CREDIT CERTIFICATION REQUEST FORM PENNSYLVANIA EMPLOYMENT INCENTIVE PAYMENT (EIP) PROGRAM INSTRUCTIONS ENTRIES ON THIS FORM MUST BE CLEAR AND LEGIBLE. Other than signatures, entries must be handprinted or typed. ADDITIONAL INSTRUCTIONS FOR EMPLOYER OR AUTHORIZED REP ONLY: All items must be completed and both signatures must be present – failure to complete the form is reason for rejection. NEW EMPLOYEE INFORMATION SOCIAL SECURITY #: / / NAME:______________________________________________________________ FIRST MI LAST STREET ADDRESS:__________________________________________________________ ___________________________________________________________________ CITY ST ZIP CODE SEX: _____Male _____Female To be considered for EIP certification processing, the st completed form must be MAILED on or before the 21 day following the date that the employee began work. Forms not meeting this standard will be rejected. Certification letters will be issued to the employer by the Pennsylvania Department of Labor and Industry. The employer is responsible for maintaining the certification form. When filing for the EIP Tax Credit, the employer is required to submit a legible copy of the certification form with a completed PA Schedule W. Rejection letters will be issued to the employer by the Pennsylvania Department of Labor and Industry and will indicate the reason for rejection. Rejections may be appealed only if the reason for rejection was not: ƒ ƒ ƒ Failure to meet the timeliness standard Missing identification information or signature(s) Alteration, defacing, or omission of any part of the original form After completing the required information, MAIL this form to: TAX CREDIT COORDINATION SERVICES TH LABOR & INDUSTRY BUILDING, 13 FLOOR TH 7 AND FORSTER STREETS HARRISBURG, PA 17120 PHONE #: 800-345-2555 AUTHORIZED REP INFORMATION: (WHEN APPLICABLE) ______________________________________________ REPRESENTATIVE FIRM NAME ______________________________________________ STREET ADDRESS ______________________________________________ CITY, STATE, ZIP CODE ______________________________________________ PHONE NUMBER ______________________________________________ FAX NUMBER ______________________________________________ E-MAIL ADDRESS I hereby certify that: I RECEIVED PENNSYLVANIA CASH ASSISTANCE IN THE GA or TANF CATEGORY WITHIN THE PAST 12 MONTHS; AND/OR I AM RECEIVING OR HAVE RECEIVED REHABILITATION SERVICES THROUGH A STATE REHABILITATION SERVICES PROGRAM OR THE VETERANS’ ADMINISTRATION. I authorize release of information by the PA Dept. of Public Welfare and/or the state Office of Voc. Rehab. to the Tax Credit Unit to determine if the following employer is eligible to receive a state tax credit for hiring and retaining me as an employee. __________________________________________________/_________________ Employee Signature Date EMPLOYER INFORMATION: EMPLOYER NAME:_____________________________________________________________ STREET ADDRESS:__________________________________________________________ ___________________________________________________________________ CITY ST ZIP CODE EMPLOYEE START DATE:__________________________ FEDERAL EMPLOYER IDENTIFICATION # (FEIN):__________________________ EMPLOYER’S AREA CODE AND PHONE #: ( )________________________ JOB TITLE_______________________________ EMPLOYEE’S STARTING HOURLY WAGE $__________ DID THE AVAILABILITY OF THE EIP TAX CREDIT CONTRIBUTE TO THE DECISION TO HIRE THIS PERSON? Yes_____ No_____ I CERTIFY THAT THE INFORMATION I HAVE PROVIDED IS ACCURATE: ___________________________________________________________________ Signature of Employer/Representative ___________________________________________________________________ Name and Title of Employer/Representative (please print clearly) REV. 1601(A) (01/06)
Extracted from PDF file 2023-pennsylvania-form-rev-1601.pdf, last modified February 2006

More about the Pennsylvania Form REV-1601 Other Tax Credit TY 2023

This form is related to the PA EMPLOYMENT INCENTIVE PAYMENT (EIP) PROGRAM.

We last updated the Tax Credit Certification Request Form in February 2024, so this is the latest version of Form REV-1601, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form REV-1601 directly from TaxFormFinder. You can print other Pennsylvania tax forms here.

Other Pennsylvania Other Forms:

TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form PA-1000 Property Tax or Rent Rebate Claim
Form PA-1000 Booklet Property Tax or Rent Rebate Program Instruction Booklet
Form PA-1000 RC PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA Property Tax/Rent Rebate)
Form REV-1176 E-TIDES Administrative Access Change Request Form
Form REV-181 Application for a PA Tax Clearance Certificate

Download all PA tax forms View all 175 Pennsylvania Income Tax Forms


Form Sources:

Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania Form REV-1601 from the Department of Revenue in February 2024.

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Form REV-1601 is a Pennsylvania 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 Pennsylvania Form REV-1601

We have a total of thirteen past-year versions of Form REV-1601 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

2022 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

2021 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

2020 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

2019 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

2018 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

2017 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

2016 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

Forms/Publications 2015 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

Forms/Publications 2014 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

Forms/Publications 2013 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

Forms/Publications 2012 Form REV-1601

Tax Credit Certification Request Form (REV-1601)

Forms/Publications 2011 Form REV-1601

Tax Credit Certification Request Form (REV-1601)


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