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Slide 1: 2007 OREGON ERA Elderly Rental Assistance Program Form 90R and Instructions SU 6 13 20 27 MO JULYW2008 E TH FR TU 1 2 9 16 23 30 3 7 14 21 28 8 15 22 29 10 17 24 31 Before you mail Form 90R, check your ERA claim to make sure you: SA 5 12 19 26 4 11 18 25 ✓ Fill in your date of birth on the front of your claim form. ✓ Complete the income section on the front of your claim. ✓ Complete the rent schedule and the household assets list on the back of your claim. ✓ Sign your claim. We cannot process your claim without the information in the above checklist. File your claim by July 1, 2008 If you have a disability and need special accommodations, see page 16 for numbers to call and places to get help. Oregon Department of Revenue 955 Center Street NE Salem OR 97301-2555 PRSRT STD U.S. POSTAGE PAID Oregon Department of Revenue
Slide 2: Elderly Rental Assistance (ERA) Program Elderly Rental Assistance is for low-income people who rent their home and are age 58 or older. The property you rent must be subject to property tax. If the property you rent is exempt from property tax you are not eligible for ERA unless the property owner makes a “payment in lieu of tax” (PILOT). You must file a Form 90R to receive elderly rental assistance. Form 90R can be found on pages 9–12 of this booklet. ERA is based on your income, assets, and the amount of rent, fuel, and utilities you paid. Be sure to keep your rent receipts with your records. We may request them at a later date. Amended claims If you need to amend (change) your ERA claim, send in a Form 90R with the correct information along with an explanation of your changes. Write “Amended” at the top of the Form 90R in blue or black ink. Single or married and living apart You qualify for ERA if all the following are true: • You were age 58 or older on December 31, 2007, and • Your household income was under $10,000, and • You paid more than 20 percent of your household income for rent, fuel, and utilities (see “Special instructions” on page 3), and • The value of your household assets is $25,000 or less (if you are age 65 or older, there is no limit on the value of household assets), and • You rented an Oregon residence that was subject to property tax or PILOT, and • You lived in Oregon on December 31, 2007, and • You didn’t own your residence on December 31, 2007 (if you live in a manufactured home, see page 4). Important information ERA filing deadline. The deadline for filing an ERA claim (Form 90R) is July 1. If you file Form 90R after July 1, 2008, your claim will be processed the following year, and if you qualify, your ERA payment will be issued in November 2009. Payment issue date. The payment issue date is November 2008 for claims received by July 1, 2008. Do not contact the department to find out how to calculate your payment. We will not know the assistance amount until November 2008. Courtesy letter. You may receive a courtesy letter explaining a proposed change to your ERA claim. If you receive a courtesy letter and you disagree, it is important that you respond quickly. Otherwise we may not have time to process the additional information you provide about your claim before the November 2008 mailing. Objections to proposed changes must be sent to us in writing. If you choose not to respond to the courtesy letter, you will still have formal appeal rights after the department issues a formal notice and/or a check in November 2008. If you appeal the formal notice and it is determined that you are entitled to additional assistance, you will receive the additional payment in November 2009. 2 Qualifications for ERA Married and living together You qualify for ERA if all the following are true: • You or your spouse were age 58 or older on December 31, 2007, and • You and your spouse’s total household income was less than $10,000, and • You paid more than 20 percent of your total household income for rent, fuel, and utilities (see “Special instructions” on page 3), and • The total value of both spouses’ household assets is $25,000 or less (if either spouse is age 65 or older, there is no limit on the value of your household assets), and • You rented an Oregon residence that was subject to property tax or PILOT, and
Slide 3: • You lived in Oregon on December 31, 2007, and • You didn’t own your residence on December 31, 2007 (if you live in a manufactured home, see page 4). Household income includes all taxable and nontaxable income. See page 5. Fuel and utilities includes the amount you paid during the year for lights, water, garbage, sewer, and heating. Do not include food expenses or the amount you paid for telephone, cable television, or Internet access. Household assets include real and personal property described on page 7. See the list on the back of Form 90R. Special instructions Single. If you were single on December 31, 2007, list only the rent, fuel, and utilities you actually paid. Roommates. Each roommate can file for ERA. The amount of assistance is based on the rent, fuel, utilities, household income, and assets of each person who files Form 90R. List the name(s) of the other renter(s) on the rent schedule and the rent, fuel, and utilities you alone actually paid. Recently married. Did you marry during 2007? If so, you must file jointly. Include the rent, fuel, and utilities for places you rented both separately and together. Married—living together. If you were married and living in the same residence or facility on December 31, 2007, you must file jointly. The assistance is based on the rent, fuel, utilities, household income, and assets of both spouses. Married—living apart. If you were married and permanently living apart on December 31, 2007, you may file separately. List only the rent, fuel, and utilities you actually paid. File jointly if you are only temporarily living apart. Deceased persons. You cannot file a Form 90R for a deceased person. Clergy. Members of the clergy who live in housing provided by the church may be eligible for assistance. You qualify for ERA if you paid rent for the use of the housing, and the property was subject to Oregon property tax. Your minister’s rental allowance must be included in household income even if the allowance is excluded from federal adjusted gross income. Apartment managers. Include only the rent you actually paid on the Form 90R rent schedule. Don’t include the value of free rent provided by your employer. When do I file Form 90R? Claim Year 2007 2006 2005 2004 File By July 1, 2008 — — — Accepted Until July 1, 2011 July 1, 2010 July 1, 2009 July 1, 2008 Where do I send Form 90R? Mail your Form 90R to: ERA CLAIMS PO Box 14700 Salem OR 97309‑0930 When will I get my assistance check? If you file Form 90R by July 1, 2008, your ERA check will be mailed to you in November 2008. If your Form 90R is filed after July 1, 2008, your ERA claim will not be processed this year and your check will not be issued until November 2009. Fraudulent claims Filing a fraudulent Form 90R is against the law. You could be charged with a class C felony. You could be fined up to $100,000 and serve a jail sentence. You would also be required to pay back twice the amount you received plus interest. Special living places The amount of assistance may depend on the kind of housing you lived in. Caution: If your residence is exempt from property taxes, you Living places 3
Slide 4: are not eligible to file for ERA unless the property owners make a payment in lieu of tax (PILOT). Contact your landlord if you don’t know if your residence is subject to property tax or PILOT. Partially exempt property. If your residence is partially exempt from property taxes, you are allowed to file an ERA claim based on the percentage of property that is subject to Oregon property taxes. For example, if the property you rent is 75 percent exempt from property taxes, you may file a claim based on 25 percent of the rent you actually paid. Manufactured homes. You are allowed to file a claim based on the rent you actually paid for your manufactured home, your land, or both. If you owned both the manufactured home and the land on December 31, 2007, you don’t qualify for ERA. Low‑income housing. You can file for ERA only on the rent you actually paid. Caution: If your low-income housing is exempt from property taxes, you can’t file for ERA unless the property owners make a “payment in lieu of tax” (PILOT). Nursing home residents. If you lived in a nursing home, you may file for ERA. Nursing home payments include medical care and other expenses, not just rent. Generally, 20 percent of your total payment is considered rent, and 3 percent is considered fuel and utilities. You may claim a higher percentage if you can show it is correct. If you lived in a nursing home on December 31, 2007, while your spouse rented a separate residence, each of you can file a separate Form 90R for assistance. You may file for assistance based on your nursing home rent. Show only your own household income on Form 90R. Your spouse will file a separate Form 90R. Check with the nursing home to make sure it is subject to property tax. If you lived in a nursing home on December 31, 2007, but your spouse lived in a home you owned, you may file for assistance based on 4 Form 90R instructions your nursing home rent. Show only your own household income on Form 90R. Your spouse doesn’t qualify for ERA. Retirement/rest home or center. Generally, 60 percent of your total payment is considered rent, and 10 percent is considered fuel and utilities. You may claim a higher percentage if you can show it is correct. Group homes. Generally, 60 percent of your total payment is considered rent, and 10 percent is considered fuel and utilities. Caution: If your group home is exempt from property taxes, you can’t file for ERA. Boarders. Generally, 60 percent of your room and board payment is considered rent, and 10 percent is considered fuel and utilities. You may claim a higher percentage if you can show it is correct. Renting from relatives. If you pay rent to a relative for the right to occupy property owned by your relative, you may qualify for ERA. You must have a signed rental agreement and the relative you pay rent to must report the rental income on his or her tax return. Keep a copy of the signed agreement along with your rent receipts for your records. We may request them at a later date. Licensed trailers. If you lived in a licensed travel trailer that’s not on the county property tax rolls, and you rented the land, you may file a claim based on the rent you actually paid for the land only. You don’t qualify for ERA if you lived in: • Cooperative housing, or • A nonprofit home for the elderly, or • A condominium, a house, or an apartment you owned. If you lived in one of the above types of housing, you’re a homeowner, not a renter. Form 90R instructions Name and address section Clearly print or type your name, address, Social Security number, and date of birth on Form 90R.
Slide 5: Important — If your address changes between the time you file and November 2008, please notify the Department of Rev‑ enue. See page 16 for numbers to call. Social Security number. The request for your Social Security number(s) is authorized by Section 405, Title 42, of the United States Code. We will use this information only to establish your identity for tax purposes. Date of birth. You or your spouse must be age 58 or older as of December 31, 2007, to qualify for ERA. You must enter your date of birth and your spouse’s date of birth at the top of Form 90R or your claim may be denied. Work and investment income For each of the following, fill in the total amount received during the year. 1. Wages, salaries, and other pay for work. Fill in your wages, salaries, commissions, tips, barter income, fees, and other pay for work. 2. Interest and dividends. Fill in your total taxable and nontaxable interest and dividends. Don’t include “return of capital” dividends or insurance policy “return of premium” dividends. 3. Business net income. Fill in your net profit. Net profit is the combined income and losses on all your business schedules. This includes business partnerships and S corporations. Did you have a net business loss? If so, you can subtract up to $1,000 of the loss in figuring household income. For lines 3, 4, and 6, see note on page 6. Net operating loss carryovers and carrybacks can’t be used to reduce household income. 4. Farm net income. Fill in your net farm profit. Net farm profit is the combined income and losses on all your farm schedules. This includes farm partnerships and S corporations. If you had a net farm loss, you can subtract up to $1,000 of the loss in figuring household income. For lines 3, 4, and 6, see note on page 6. Net operating loss carryovers and carrybacks can’t be used to reduce household income. 5. Total gain on property sales. Fill in your total gain from any property sales: stocks, bonds, land, or other property. If you had a net loss, you can subtract up to $1,000 in figuring household income. Don’t include any gain you deferred or excluded from the sale of your house. Did you sell property you placed into service after December 31, 1980 and before January 1, 1985? If so, you may need to refigure your gain for Oregon. Did you take the federal investment tax credit? If so, you may have a difference between Oregon basis and federal basis. You will need to refigure your gain or loss for the ERA line instructions 5 Household income Household income includes taxable and nontaxable income of both spouses living in the same household. It doesn’t include your spouse’s income if you were permanently living apart on December 31, 2007. It also doesn’t include income of your children, roommates, or any other person living with you, other than your spouse. Use Form 90R lines 1–19 to figure your household income. Some of the household income items come from your federal tax return, if you filed an income tax return, and other items come from your personal records. See pages 13 through 15 for a household income checklist. Nonresidents and part‑year residents who lived in Oregon on December 31, 2007. Include all taxable and nontaxable income for the entire year. Include income from Oregon sources and income from sources outside of Oregon. Line instructions Instructions are for lines not fully explained on the form. Note: Do not fill in cents. You must round off cents to the nearest dollar. For example, $12.49 becomes $12 and $233.50 becomes $234.
Slide 6: assets, using the Oregon basis. See page 16 for telephone numbers to call for help. 6. Rental net income. Fill in your rental net income. Rental net income is the combined income or losses from all your rentals. This includes rental partnerships and S corporations. If you had a net loss, you can subtract up to $1,000 in figuring household income. For lines 3, 4, and 6, see note below. Note for lines 3, 4, and 6: Does the combined total of your depreciation, depletion, and amortization deductions from all businesses exceed $5,000? If so, you must refigure these items, limiting your total deduction to $5,000. Example: Jackson has a business that had gross income of $22,000 in 2007. He had a $10,000 depreciation deduction and other business expenses of $15,000. Jackson figures his $3,000 business loss for federal purposes as follows: Business gross income ..................................... $22,000 Less Depreciation..................................$10,000 Other business expenses ........... + 15,000 (25,000) Federal business loss ................................... $(3,000) • Federal income tax refunds. • Unemployment benefits. Instead, enter your unemployment benefits on Form 90R, line 13. Retirement income For each of the following, fill in the total amount received during the year. 9. Social Security, supplemental security income (SSI), and railroad retirement. Fill in the total taxable and nontaxable Social Security, SSI, and Railroad Retirement Board benefits you received in 2007. Include Medicare premiums for 2007, but don’t include reimbursed medical expenses. Also include any amounts you received in your name from Social Security for the benefit of a minor child. 10. Pensions and annuities. Fill in the total pension and annuity income you received in 2007. This will usually be the taxable portion of your pension. Federal pensions: Be sure to include your total taxable and nontaxable pension income. Don’t include your contribution to the plan. You should have a statement, Form 1099-R, from the payer that shows your contribution. Include lump-sum distributions and death benefits. Jackson figures his business income for ERA purposes as follows: Business gross income ..................................... $22,000 Less Depreciation limited to $5,000 ...$5,000 Other business expenses ........... + 15,000 (20,000) ERA business income .................................... $ 2,000 Other income For each of the following, fill in the total amount received during the year: 12. Children, Adults, and Families (CAF). Fill in the total amount of public assistance you received. Include assistance you received from Seniors and People with Disabilities. Also include Temporary Assistance for Needy Families. You should have received an Assistance Summary statement that shows the amount you received. Don’t include: • Special Shelter Allowance. • Amounts for food stamps or surplus foods. • Payments for medical care, drugs, medical supplies, and services related to medical care for which you received no direct payment. 7. Other income from your federal return. Fill in any other taxable income you received in 2007 that is on your federal return. This includes: • Alimony received from federal Form 1040, line 11. • Awards, bonuses, prizes, gambling winnings (including Oregon lottery winnings), and other income from federal Form 1040, line 21. Identify the other income. Don’t include: • Oregon income tax refunds. 6 Retirement income
Slide 7: • In-home services approved by the Oregon Department of Human Services. • Reimbursement of expenses from participating in work or training programs. If you receive public assistance benefits for your nursing home costs, include 23 percent of that payment as public assistance income. Generally, 23 percent of the payment represents your rent plus utilities and fuel (see “Special living places” on page 3). Don’t include public assistance payments to your nursing home for medical care, drugs, or medical supplies. 13. Unemployment benefits. Fill in your total unemployment benefits. 14. Veteran’s and military benefits. Fill in your total taxable and nontaxable veteran’s benefits, GI Bill benefits, family allowances, and educational allowances. 15. Family support, gifts, and grants. Add together all the gifts, grants, and scholarships you received. Include any amounts you received from your children and others to help pay your expenses. You can exclude up to $500 from household income. Fill in the total in excess of $500. This also includes gifts and grants from a foreign country. Don’t include federal grants to improve your home. Example: You received $250 from your child, a $600 gift, and a $300 state grant during the year. You must include a total of $650 in your household income: Money received from child ................$ 250 Gift .........................................................$ 600 Grant .....................................................$ 300 Total received .....................................$ 1150 Less: exclusion amount .................– 500 Include in household income ............$ 650 16. Other sources. Fill in amounts from any other sources of household income, including: • • • • • Child support. Minister’s rental allowance. Foreign earned income. Disability pay. Life insurance proceeds. • • • • • Personal injury damages. Strike benefits. Workers’ compensation. Accident and health insurance payments. Total inheritances. This includes anything that changed ownership because of death. It may be cash or property. Figure the fair market value of property as the amount you’d get if the property had been sold on the date of death. Don’t include property you received due to the death of your spouse. 19. Adjustments to income. Fill in the amount from Form 1040, line 36, or Form 1040A, line 20. If you filed Form 1040EZ, fill in -0-. 21. Household assets. If you or your spouse are age 65 or older, the limitations do not apply. Single or married—living apart. If you are under age 65, you must complete the household assets list on the back of your Form 90R. If the total value of your household assets is more than $25,000 you don’t qualify for ERA. Married—living together. If both you and your spouse are under age 65, you must complete the household assets list on the back of your Form 90R. If the total value of both spouses’ household assets is more than $25,000 you don’t qualify for ERA. Household assets include property you own together and separately. Household assets include the fair market value as of December 31, 2007, of the fol‑ lowing: • Real property, such as a vacant lot, farm land, mobile home, or rental property. • Personal property, such as money on hand, shares of stock, money owed to you by others, and funds on deposit. Don’t include the value of retirement plans. • Personal property used in a trade or business in which you are an owner. Examples include, but are not limited to, an automobile used in your business, your office equipment, inventory, and your percentage of partnership assets. Other income 7
Slide 8: Note: Examples of items not to include as household assets: TV, VCR, personal computer, personal vehicle, furniture, wedding ring, bicycle. (This is not intended to be a complete list.) Enter the total on line 24. If the total of lines 22 and 24 is 20 percent or less of your total household income on line 20, then you don’t qualify for ERA. If you lived in a nursing home, retirement/ rest home or center, group home, or paid room and board, only a portion of your total payment is for fuel and utilities. See “Special living places” on page 3. 25. Nursing home, retirement/rest home or center, or group home. If you paid rent to a nursing home, retirement/rest home, or group home, check the box that applies. Generally, a nursing home provides medical care, but retirement/rest homes or centers and group homes don’t. ERA payment. The Oregon Department of Revenue will figure your assistance for you. Remember your assistance will be reduced by any Special Shelter Allowance you already received in 2007. Qualifying rent 22. Total Oregon rent you paid during 2007. Complete the rent schedule on the back of Form 90R. Fill in the Oregon rent you paid during 2007. Include all Oregon rent you paid for each residence you rented in 2007. Rent doesn’t include advance rent or deposits for keys, cleaning, or security. Keep your rent receipts with your records for at least three years from the due date of your claim or when you file it, which ever is later. If the property you rented was partially exempt from property taxes, or you lived in a nursing home, retirement/rest home or center, group home, or pay room and board, only a portion of your payment is considered qualifying rent. See “Special living places” on page 3. 23. Special Shelter Allowance. Did you receive a Special Shelter Allowance (public assistance)? If you did, the Assistance Summary statement you received will show the amount of your Special Shelter Allowance. Fill in the amount from the notice on this line. This allowance is an advance payment of your ERA claim so it will reduce the amount of assistance you receive. 24. Fuel and utilities. Include the amount you paid during 2007 for lights, water, garbage, sewer, and heating while living in Oregon. Don’t include the amount you paid for telephone, cable television, or Internet access as utilities. Lights (electricity) .....................$ Water and sewer ........................$ Garbage.......................................$ Heating (gas, oil, wood, etc.) ....$ Total .............................................$ 8 Qualifying rent Sign and mail Form 90R Before you mail Form 90R, check your claim. ✓ Were you or your spouse age 58 or older on December 31, 2007? Did you fill in your date of birth and your spouse’s date of birth at the top of Form 90R? ✓ Did you sign and date Form 90R on the front page? Both spouses must sign a joint claim. ✓ Did you complete the entire form? — All income sections on the front page of 90R? — The rent section on the back page of 90R? — The household assets on the back page of 90R? (Asset list required if you and your spouse were under age 65 on December 31, 2007.) Be sure to complete the entire claim form. An incomplete claim could delay your assistance until next year. Remember—you must file your Form 90R by July 1, 2008 so we can process and issue your payment in November 2008.
Slide 9: Clear Form 90R Last name Spouse’s last name if joint claim Current mailing address City FORM OREGON ELDERLY RENTAL ASSISTANCE First name and initial Spouse’s first name and initial 2007 – – For department use only Date received You must fill in your date of birth in order to receive assistance. Enter your Social Security No. (SSN) Date of birth (mm/dd/yyyy) Enter spouse’s Social Security No. Date of birth (mm/dd/yyyy) – – 1 State ZIP code Telephone number For department use only 2 3 ( ) WORK AND INVESTMENT INCOME—Totals for the entire year .00 1 Wages, salaries, and other pay for work ........................................... 1 .00 2 Interest and dividends (total taxable and nontaxable) ....................... 2 .00 3 Business net income (loss limited to $1,000) .................................... 3 .00 4 Farm net income (loss limited to $1,000) .......................................... 4 .00 5 Total gain on property sales (loss limited to $1,000) ......................... 5 .00 6 Rental net income (loss limited to $1,000) ........................................ 6 .00 7 Other income from your federal return. Identify ________________... 7 .00 8 Add lines 1 through 7 ..................................................................................................... • 8 RETIREMENT INCOME—Totals for the entire year 9 Social Security, supplemental security income (SSI), .00 railroad retirement (total for 2007) ................................................... • 9 .00 10 Pensions and annuities (see instructions) ....................................... • 10 .00 11 Add lines 9 and 10 ............................................................................................................ 11 OTHER INCOME—Totals for the entire year 12 Children, Adults, and Families (public assistance, .00 not including food stamps) .............................................................. • 12 .00 13 Unemployment benefits .................................................................. • 13 .00 14 Veteran’s and military benefits ........................................................... 14 .00 15 Family support, gifts, and grants: Total received minus $500 .......... 15 .00 16 Other sources: Identify ___________________________________ ...... 16 .00 17 Add lines 12 through 16 ................................................................................................ • 17 18 Add lines 8, 11, and 17 ..................................................................................................................................... 18 19 Adjustments to income from federal Form 1040, line 36 or federal Form 1040A, line 20...............................• 19 20 YOUR TOTAL HOUSEHOLD INCOME. Line 18 minus line 19. If your household income is $10,000 or more, STOP HERE! You don’t qualify for elderly rental assistance ......................................• 20 21 YOUR TOTAL HOUSEHOLD ASSETS. Fill in your total household assets from the back of this form. (If you or your spouse are age 65 or older, the limitations do not apply. Fill in -0- on line 21.) If your household assets exceed $25,000, STOP HERE! .00 You don’t qualify for elderly rental assistance ............................................................. • 21 QUALIFYING RENT 22 Total Oregon rent you paid during 2007 (from box 7 of rent schedule on the back) ......................................• 22 23 Special Shelter Allowance (see page 8)...........................................................................................................• 23 24 Total fuel and utilities only (not telephone). Don’t include rent! (see page 8) ................................................• 24 25 Check the box if you paid rent to a: nursing home retirement/rest home or center group home .00 .00 .00 .00 .00 .00 Under penalties for false swearing, I declare that I have examined this claim, including accompanying schedules and statements. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person other than the taxpayer, this declaration is based on all information of which the preparer has any knowledge. SIGN HERE ➜ ➜ Your signature Spouse’s signature (If filing jointly, BOTH must sign) Date Signature of preparer other than taxpayer Address License No. Mail your completed 90R to: ERA CLAIMS, PO BOX 14700, SALEM OR 97309-0930 150-545-001 (Rev. 12-07) Web
Slide 10: Page 2 — Form 90R — 2007 List the places you rented in Oregon during 2007. Attach additional schedules if needed. RENT SCHEDULE Residence A 1. Your street address, city, state, ZIP code Residence B (if needed) 2. Full name of each roommate 3. Landlord’s name, street address, city, state, ZIP code, and telephone number 4. 2007 rental period From: To: From: To: 5. Rent you paid per month.............................. 5A $ $ .....................................5B $ $ $ 6. Total rent you paid (per address) .................. 6A .....................................6B 7. TOTAL RENT PAID IN 2007. Add boxes 6A and 6B and enter the total here. Also enter this amount in box 22 on the front of this form .................................................................. 7 2007 HOUSEHOLD ASSETS LIST Use Fair Market Value of your assets as of December 31, 2007. If you or your spouse are age 65 or older, this list is not required. 1. Real property (includes fair market value of mobile home) ...................................................................... $ 2. Personal property: $ A. Money on hand: Currency and bills of exchange or others (identify)__________________________ B. Money on deposit: Checking and savings account ............................................................................................................. $ $ Certificates of deposit or others (identify)_______________________________________________ C. Funds on deposit: Funds accruing due to death of the insured where withdrawal is at your option (insurance) ............... $ Funds accruing due to original maturity of a policy contract where withdrawal is at your option ........ $ D. Money owed to you: Personal or business notes receivable or others (identify) _________________ $ E. Value of shares of stock: Capital, common, and preferred ........................................................................................................... $ $ Shares in mutual funds and investment trusts or others (identify) ____________________________ F. Value of assets or property used in a trade or business in which you or your spouse have an ownership interest ......................................................................................................................... $ TOTAL HOUSEHOLD ASSETS. Fill in the total here and on line 21 on the front of this form ...................... $ 150-545-001 (Rev. 12-07)
Slide 11: HOUSEHOLd INCOME CHECkLISt Use this list to figure what must be included in total household income. Household Income Yes No Alimony and separate maintenance.......... × Annuities and pensions (reduced by cost recovery) .......................... × *Business income (reduced by expenses) ................................. × Cafeteria plan benefits ............................................ × *Capital loss carryover ........................................... × *Capital losses (in year determined) ......... × Child support................................................ × Child support included in public assistance ....................................................... × Clergy’s rental or housing allowance, in excess of expenses claimed to determine federal AGI ................................. × Compensation for services performed Back pay ..................................................... × Bonuses....................................................... × Clergy’s fees ............................................... × Commissions ............................................. × Director’s fees ............................................ × Fees in general (trustee, executor, jury duty) ................. × Lodging for convenience of employer .............. × Meals for convenience of employer .................. × Salaries........................................................ × Severance pay ............................................ × Tips .............................................................. × Wages .......................................................... × Deferred compensation Contributions made ............................................. × Payments received .................................... × Depletion in excess of basis ........................ × Household Income Yes No Depreciation, depletion, and amortization in excess of $5,000 ................. × Disability income (entire amount) ............. × Dividends, taxable and nontaxable ........... × Credit union savings account “dividends” (interest) ............................ × Insurance policy “dividends” (return of premium) .......................................... × Return of capital dividends ................................ × Stock dividends ......................................... × Tax-exempt dividends .............................. × Earned income credit, advanced........................... × *Estate and trust income (also see Inheritance) ................................... × *Farm income (reduced by expenses) ....... × Agricultural program payments............. × Patronage dividends................................. × Proceeds from sale of crops and livestock............................................ × Rents ........................................................... × Sale of services........................................... × Fellowships ................................................... × Foreign income excluded from federal AGI .................................................... × Foster child care (reduced by expenses) .............. × Funeral expenses received ..................................... × Gains on sales (receipts less cost)............... × Excluded gain for Oregon on sale of residence ................................................. × Gambling winnings (without reduction for losses) .................... × *Losses limited to $1,000. Household income checklist 13
Slide 12: Household Income Yes No Gifts and grants (totaling more than $500 in value) ............. × Cash ............................................................ × Gifts from nonspouse in the same household ........................... × Gifts from spouse in the same household ...................................... × Gifts other than cash (report at fair market value) .................. × Payment of indebtedness by another person ................................... × Grants and payments by foreign governments not included in federal adjusted gross income .................... × Grants by federal government for rehabilitation of home ...................................... × Gratuities ....................................................... × Hobby income .............................................. × Honorariums................................................. × Individual Retirement Arrangement (IRA) Conventional IRA Payments received .................................. × Payments contributed ....................................... × Rollovers or conversions .................................. × Roth IRA Payments received ............................................. × Payments contributed ............................ × Rollovers or conversions .................................. × Inheritance..................................................... × From spouse who resided in the same household ...................................... × Insurance proceeds Accident and health.................................. × Disability payments .................................. × Employee death benefits.......................... × Life insurance ............................................ × Personal injury damages (less attorney fees) .................................. × Household Income Yes No Property damage if included in federal income .................................... × Reimbursement of medical expense ................. × Sick pay (employer sickness and injury pay) ........................................ × Strike benefits ............................................ × Unemployment compensation................ × Workers’ compensation............................ × Interest, taxable and nontaxable ................ × Contracts .................................................... × Municipal bonds and other securities ... × Savings accounts ....................................... × Tax-exempt interest................................... × U.S. Savings Bonds ................................... × *Losses on sales (to extent used in determining adjusted gross income) ......... × From sales of real or personal property (nonbusiness) ..................................... × Lottery winnings .......................................... × Lump-sum distribution (less cost recovery) ....................................... × Military and veteran’s benefits (taxable and nontaxable) Combat pay................................................ × Disability pensions ................................... × Educational benefits (GI Bill) .................. × Family allowances .................................... × Pensions...................................................... × Net operating loss carryback and carryover ........................................................... × *Partnership income (reduced by expenses) ................................. × Parsonage (rental value) or housing allowance received by clergy in excess of expenses used in determining federal AGI ............................. × *Losses limited to $1,000. 14 Household income checklist
Slide 13: Household Income Yes No Pensions and annuities (taxable and nontaxable) (reduced by cost recovered in the current year) .................... × Prizes and awards ........................................ × Public assistance benefits ............................ × Aid to blind and disabled ........................ × Aid to dependent children ...................... × Child care payments ................................. × Child support included in public assistance ..................................... × Direct payments to nursing home ..................... × Food stamps (or cash payments in lieu of food stamps) ...................................... × Fuel assistance ...................................................... × In-home services approved by the Department of Human Services................ × Medical payments to doctors ............................. × Payments for medical care, drugs, medical supplies, and services for which no direct payment is received .............. × Reimbursements of expenses paid or incurred by participants in work or training programs .............................................. × Seniors and People with Disabilities assistance ............................. × Special shelter allowance .................................... × Surplus food ......................................................... × Women, Infants, and Children program (WIC) ................................................... × Railroad Retirement Board benefits (see Social Security and Railroad Retirement Board benefits) ......................... × Refunds Earned income credit........................................... × Federal tax............................................................. × Property tax .......................................................... × Oregon income tax ............................................... × Other states’ income tax (if included in federal AGI) ........................ × Reimbursements (in excess of expenses incurred) ....................................... × For moving expense ................................. × For travel .................................................... × *Losses limited to $1,000. Household Income Yes No Rental allowances paid to ministers and not included in federal adjusted gross income ................................. × *Rental and royalty income (reduced by expenses) ................................. × Residence sales (see gains on sales)........... × Retirement benefits (see pensions, Social Security, and Railroad Retirement Board benefits) Sales (see gains on sales and losses on sales) Scholarships (excess over $500) ................. × Sick pay.......................................................... × Social Security and Railroad Retirement Board Benefits (taxable and nontaxable) ............................. × Children’s benefits paid to parent .......... × Children’s benefits paid to your child .............. × Disability pension ..................................... × Medicare payments of medical expenses ............................................... × Medicare premiums deducted from Social Security ................................ × Old-age benefits ........................................ × Supplemental Security income ............... × Survivor benefits ....................................... × Stipends (excess over $500)......................... × Strike benefits ............................................... × Support from parents who don’t live in your household ................................ × Trust income.................................................. × Unemployment compensation ................... × Wages ............................................................. × Household income checklist 15
Slide 14: taxpayer assistance Internet www.oregon.gov/dOR • Download forms and publications • Get up-to-date tax information • E-mail: questions.dor@state.or.us Questions? Write Oregon Department of Revenue 955 Center St NE Salem OR 97301-2555 Include your Social Security number and a daytime telephone number for faster service. This e-mail address is not secure. Do not send any personal information. General questions only. Field offices Visit a field office to get forms and assistance. Do not send your claim form to these addresses. Bend..............951 SW Simpson Avenue, Suite 100 Eugene ..........1600 Valley River Drive, Suite 310 Gresham .......1550 NW Eastman Parkway, Suite 220 Lake Oswego 6405 SW Rosewood St, Suite A Medford ........3613 Aviation Way, Suite 102 Newport .......119 NE 4th St, Suite 4 North Bend ...3030 Broadway Pendleton .....700 SE Emigrant, Suite 310 Portland........800 NE Oregon Street, Suite 505 Salem ............Revenue Building, 955 Center St NE, Room 135 Salem ............4275 Commercial St SE, Suite 180 telephone Salem area or outside Oregon ......... 503-378-4988 toll-free from an Oregon prefix ... 1-800-356-4222 Call one of the numbers above to: • Check on the status of your 2007 personal income tax refund. • Order tax forms. • Hear recorded tax information. • Speak with a representative. Monday through Friday ............................ 7:30 a.m.–5:00 p.m. Closed Thursdays from 9:00 a.m. –11:00 a.m. Closed on holidays. Extended hours during tax season (wait times may vary): April 1–April 15, Monday–Friday ...........7:00 a.m.–7:00 p.m. Saturday, April 12 ........................................9:00 a.m.–3:00 p.m. Asistencia en español: En Salem o fuera de Oregon .......503-378-4988 Gratis de prefijo de Oregon .....1-800-356-4222 ttY (hearing or speech impaired; machine only): Salem area or outside Oregon ....503-945-8617 Toll-free from an Oregon prefix ...1-800-886-7204 Americans with disabilities Act (AdA): Call one of the help numbers for information in alternative formats. to get forms Income tax booklets are available at many post offices, banks, and libraries. For booklets and other forms and publications, you can also access our website, order by telephone, or write to: Forms, Oregon Department of Revenue, PO Box 14999, Salem OR 97309-0990. 150-545-002 (Rev. 12-07) Web 16 Taxpayer assistance