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Workers with Disabilities Tax Credit Program

Individual Application

* Indicates required fields

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

Workers wtih Disabilities Tax Credit Program Overview

Individual Information

Primary Phone Number
( ) -
Secondary Phone Number
( ) -

Provider/Person Assisting with the Application

Phone Number*
( ) -
I am a current employee of a sheltered workshop, which is an organization or environment that employs people with disabilities segregated from others.*
Business Phone Number*
( ) -
I have been unemployed for at least three months prior to January 1,2015*

Terms of Service Agreement

I agree to allow the New York State Department of Taxation and Finance to share my wage records with the New York State Department of Labor.

I understand that the New York State Department of Labor will make sure that the information submitted in this application is true and may ask me for details.

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