SETC Form

Self Employed Tax Credit Sign-Up Form

To begin your application, please thoroughly fill out the form below.
Name*

First NameLast Name
Birth Date*

MonthDayYear
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tax Information

Please answer accurately the following tax information for years 2019-2021.
I was self-employed in 2019 through 2021.*

Yes
I paid taxes (IRS Form 1040) in 2019 through 2021.*

Yes
I do not owe any back-taxes to the IRS.*

Yes
I have copies of my 2019 through 2021 IRS Form 1040's with attached schedules.*

Yes
My 2019 net Self Employment earnings (Line 6 of your Schedule SE) were; (if applicable)
My 2020 net Self Employment earnings (Line 6 of your Schedule SE) were; (if applicable)
My 2021 net Self Employment earnings (Line 6 of your Schedule SE) were; (if applicable)
COVID Information

Please answer the following information to the best of your ability. Pertains to 2020 and 2021.
I sacrificed working my business because I had COVID 19, had COVID 19 symptoms, a COVID 19 related illness or were told to quarantine because you were exposed or affected by COVID 19*

YesNo
I sacrificed working my business because I cared for someone else (ex: son, daughter, spouse, elder, other person) whom had COVID 19, had COVID 19 symptoms, a COVID 19 related illness or was told to quarantine because they were exposed or affected by COVID 19?*

YesNo
I sacrificed working my business because a minor's (under the age of 18 or a child with severe disabilities) child’s school or daycare closed, your child out was sick, or your child was told to quarantine due to COVID 19?*

YesNo
Attach Tax Forms (If Applicable)

Attaching your complete IRS Form 1040's for years 2019 through 2021 will speed the processing time up significantly. Schedule C and Schedule SE should be attached. Be sure to upload ALL pages.
2019 IRS Form 1040 with Attached Schedules

(must be pdf, jpg, jpeg, png, gif)
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2020 IRS Form 1040 with Attached Schedules

(must be pdf, jpg, jpeg, png, gif)
Cancelof
2021 IRS Form 1040 with Attached Schedules

(must be pdf, jpg, jpeg, png, gif)
Cancelof
A Copy of the front of my drivers license (for verification purposes)*

(must be pdf, jpg, jpeg, png, gif)
Cancelof
I certify that the information I have provided in this form is true and accurate to the best of my knowledge.*

Yes
Please Sign below certifying the above.*

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Self Employed Tax Credit Sign-Up Form

Tax Information

COVID Information

Attach Tax Forms (If Applicable)