Tax Credit Survey | Your Tax Credits

Language Options English
Opciones de idioma Español

1 2 3 4 5 6 7 8 9 10 11 12 13

We have contracted with R. Jeffrey Tax Credits to administer this federal employment program called the Work Opportunity Tax Credit (WOTC). We request that you complete the following questions to determine if our company may be eligible for tax credits.

In order to maintain the confidentiality of your answers, the employer will not see your response.

The information that you provide will NOT affect your employment, wages or taxes. It will only be used to determine and document our company's eligibility for the tax benefit.

*Required Field

First Name *

Middle Initial

Last Name *

Current Phone Number and Address

Phone Number

Street Address 1 *

Street Address 2

City *

State *

Zip Code *

County / Parish

Location *

Please upload a picture of your drivers' license or photo ID:

Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png pdf.