Non-Resident COVID - EZ Refund Petition - Salary/Hourly

Sep 19, 2026

Non-resident Wage Tax refund petition for tax year 2022 covering salary and hourly employees, excluding commissioned employees. The form collects employee identity details, employer information, and determines refund eligibility using a Philadelphia “requirement of employment” test for days worked outside Philadelphia due to COVID-19. It requires attaching the applicable W-2 and employer verification letter, then calculates gross compensation, non-taxable compensation outside Philadelphia, taxable wages, tax due, withheld tax, and the requested refund.

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Non-Resident COVID - EZ Refund Petition - Salary/Hourly

Petition requirements and eligibility

Filing instructions and attachments

Wage tax calculation lines

| TAX YEAR
2022 | NON-RESIDENT COVID – EZ REFUND PETITION
SALARY/HOURLY
(Not to be used by Commissioned Employees) | | | | | | | OFFICE USE ONLY | | | | | | | | | | | | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Read the instructions for both the Employer as well as the Employee on the reverse side of this form prior to completing this petition. Print or type all information. The completed petition must include:
Attach W-2 showing Federal, State, Medicare and Local wages
Please have employer sign or attach letter on Company letterhead verifying your work outside of Philadelphia due to COVID-19. | | | | | | | | | | | | | | | | | | | | | | | | | | | | EMPLOYEE'S NAME | | | SOCIAL SECURITY NUMBER | | | | | | | | | | | | | DAYTIME TELEPHONE NUMBER | | | | | | | | | | | | HOME ADDRESS | | | | | | | | | OCCUPATION | | | | | | | | | | | | | | | | | | | CITY STATE ZIP CODE | | | | | | | | | IF PARTIAL YEAR, PROVIDE DATES:
From To | | | | | | | | | | | | | | | | | | | EMPLOYER | | | | | | | | | EMPLOYER IDENTIFICATION NUMBER (EIN) | | | | | | | | | | | | | | | | | | | PLACE OF EMPLOYMENT | | | | COLUMN A January 1, 2022 to June 30, 2022 | | | | | | | | | | | | COLUMN B
July 1, 2022 to December 31, 2022 | | | | | | | | | | | | 1. Gross Compensation per W-2 | | | | .00 | | | | | | | | | | | | .00 | | | | | | | | | | | | 2. Number of workdays. | | | | 126 Days | | | | | | | | | | | | 126 Days | | | | | | | | | | | | 3. Number of workdays outside of Philadelphia. | | | | Days | | | | | | | | | | | | Days | | | | | | | | | | | | 4. Percentage of time worked outside of Philadelphia.
(Divide Line 3 by Line 2 and round to 4 decimal places. ) | | | | | | | | | . | | | | | | % | | | | | | . | | | | | % | | 5. Non-taxable compensation earned outside of Philadelphia (Line 1 times Line 4) | | | | .00 | | | | | | | | | | | | .00 | | | | | | | | | | | | 6. Net Taxable compensation (Line 1-Line 5) | | | | .00 | | | | | | | | | | | | .00 | | | | | | | | | | | | 7. TAX
DUE Non-Resident multiply Line 6, Column A by .034481 , and Column B by .034400. | | | | .00 | | | | | | | | | | | | .00 | | | | | | | | | | | | 8. TOTAL TAX DUE (Add Line 7, Column A and B) | | | | | | | | | | | .00 | | | | | | | | | | | | | | | | | 9. Wage tax withheld per W-2 | | | | | | | | | | | .00 | | | | | | | | | | | | | | | | | 10. REFUND REQUESTED (Line 9-Line 8) | | | | | | | | | | | .00 | | | | | | | | | | | | | | | | | EMPLOYER CERTIFICATION
I certify that the facts shown above supporting employee's claims are correct based on available payroll records. Individuals serving as authorized official signatories should be familiar with employee's time and attendance, as well as applicable Wage Tax Regulations. Income Tax Regulations Section 401 through 404 requires that the employer withhold and allocate wages for tax purposes. General Regulation Section 306 (2) provides that the employer, for and on behalf of the employee, requests the refund. | | | | | | | | | | | | | | | | | | | | | | | | | | | | AUTHORIZED OFFICIAL SIGNATURE (Signature must be clear and legible.) | | PRINTED NAME | | | | | | | | | | | | | | | DAYTIME TELEPHONE NUMBER | | | | | | | | | | | EMPLOYEE CERTIFICATION
I HEREBY CERTIFY that the statements contained herein and in any supporting schedule or exhibit are true and correct to the best of my knowledge and belief. I understand that if

FAQs

Who is this petition for and who should not use it?

This petition is for salary and hourly employees only. It is not to be used by commissioned employees.

What documents must be attached when filing?

Attach the applicable W-2 showing Federal, State, Medicare, and Local wages. Also attach a letter on company letterhead verifying work outside Philadelphia due to COVID-19, including the required remote work dates or time period.

How does Philadelphia determine eligibility for non-residents?

Philadelphia applies a “requirement of employment” test. A non-resident is exempt for days when the employer requires remote work outside Philadelphia due to the COVID-19 situation, but remote work for personal convenience is not exempt.

Sep 19, 2026

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