Skip to Content Skip to Navigation

Workers with Disabilities Tax Credit Program

Confirmation of Hire

Please have your printer ready to print the confirmation page that appears after you submit this form.

* Indicates required fields

Questions? Need assistance? Call 1-877-226-5724 or E-mail.

Workers with Disabilities Tax Credit Program Overview

Business Address *
Hours per Week*
Phone Number*
( ) - ext.


To the best of my knowledge, this information is true, correct and complete. I am aware that there are significant civil and criminal penalties for filing false documents or other information with the government.

Thanks for the feedback! It will help us improve your experience.