[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-304721-105":53,"doc-detail-304721-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","annual-tax-exemption-form-verification-of-difficulty-of-care","Annual Tax Exemption Form - Verification of Difficulty of Care","","Annual declaration form for employees providing domestic and live-in caregiving services under a self-directed program. Collects residential status, marital status, and eligibility details to verify special tax exemption status tied to the difficulty of care income tax exclusion. Includes clear instructions to mark responses, complete W4 and MW507 when required, and confirms federal/state tax treatment based on IRS Notice 2014-7. Provides an attestation under penalties of perjury, including employee and participant/employer signing and driver’s license copy requirement.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/annual-tax-exemption-form-verification-of-difficulty-of-care/304721/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/annual-tax-exemption-form-verification-of-difficulty-of-care/304721.png","ImageObject",442,249,{"name":88,"@type":89},"Cart","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of the Annual Declaration form?","Question",{"text":108,"@type":109},"It verifies an employee’s information and special tax exemption status for annual payroll accuracy, based on residential status and difficulty of care eligibility.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"When must an employee complete a W4 and MW507?",{"text":113,"@type":109},"If the employee does not reside full-time in the same legal residence as the employer, and the “NO” option is selected, completing a W4 and MW507 is required.",{"name":115,"@type":106,"acceptedAnswer":116},"What does the attestation statement require?",{"text":117,"@type":109},"The employee attests under penalties of perjury that the information provided is true, understands the responsibility to notify the SDS if circumstances change, and acknowledges potential federal income tax and IRS penalties if statements are false.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},304721,1790008169,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},18829141979164,"https://eur-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Employee Special Tax Exemption Annual Declaration  \nEmployees providing domestic services, like those employees hired directly by participants selfdirecting their services, may be exempt from paying certain federal and state taxes that are normally paid by employers and employees. These special tax exemptions are based on an employee’s residential status. This form is an annual declaration to verify the employee’s information and special tax exemption status.  \nPLEASE ANSWER EACH QUESTION BELOW TO ENSURE ACCURACY IN PAYROLL  \n1. INCOME TAX EXEMPTIONS FOR A LIVE-IN CAREGIVER  \nDo you share the same residence (legal address) as the care recipient?  \n\n| PLEASE MARK THE APPROPRIATE BOX |  |\n| --- | --- |\n| YES | |\n| NO | |\n\nI am the employee in the self-directed program and I reside in the same legal residence as my employer and we are related. I do not maintain any other legal residence. The shared residence is a home where I reside full time and regularly perform the routines of private life.  \nI do not reside full-time in the same legal residence as my employer. If no, is selected, you must complete a W4 and MW507 .  \n2. MARTIAL STATUS  \nPlease select the appropriate response:  \n\n| PLEASE MARK THE  APPROPRIATE BOX |  |\n| --- | --- |\n| | Married |\n| | Single |\n| | Head of Household |\n\nIncome Tax Exemption: If the answer is yes to all qualifying statements, then the employee’s income is excluded from federal and state income tax based on the difficulty of care income tax exclusion. Per IRS Notice 2014-7, payments to a care provider for services to a Medicaid Waiver eligible individual sharing a home with the providerare excluded from federal income tax as they are considered difficulty of care payments. See linked resources for more info.  \nATTESTATION STATEMENT:  \nUnder penalties of perjury, I declare that I am an individual care provider receiving payments under a state Medicaid Home and Community-Based Services waiver program for services I provide to the  \nEmployer/Participant signing below.  \nThe information I’ve provided is true and accurate. I understand my responsibility to inform the SDS if my circumstances change. I understand that if these statements turn out to be false, I may personally owe federal income tax and be subject to IRS penalty.  \nI will contact my tax accountant for additional information and guidance, as needed. We recommend speaking with a tax professional should you have any questions about the impact of declaring tax exemptions.  \nEmployee Name (please print):   Employee Signature:   Date:   Participant/Employer Name (please print ):    \n*All forms must include a copy of your driver’s license as proof of residency at time of submission to avoid delays in processing.","cbCaiv4WJeCJNaxh","https://ap.wps.com/l/cbCaiv4WJeCJNaxh","pdf",124546,"English","# Employee Special Tax Exemption Annual Declaration\n## Income Tax Exemptions for a Live-in Caregiver\n## Marital Status\n## Attestation Statement","[{\"question\":\"What is the purpose of the Annual Declaration form?\",\"answer\":\"It verifies an employee’s information and special tax exemption status for annual payroll accuracy, based on residential status and difficulty of care eligibility.\"},{\"question\":\"When must an employee complete a W4 and MW507?\",\"answer\":\"If the employee does not reside full-time in the same legal residence as the employer, and the “NO” option is selected, completing a W4 and MW507 is required.\"},{\"question\":\"What does the attestation statement require?\",\"answer\":\"The employee attests under penalties of perjury that the information provided is true, understands the responsibility to notify the SDS if circumstances change, and acknowledges potential federal income tax and IRS penalties if statements are false.\"}]","Annual Tax Exemption Form - Verification of Difficulty of Care | PDF",1789816534]