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Form STATE OF HAWAII — DEPARTMENT OF TAXATION
HW-16 Dependent Care Provider’s Identification and Certification
(REV. 2016) (DO NOT file with your tax return. Keep for your records)
Part I — Dependent Care Provider’s Identification (See Instructions)
Name of dependent care provider Provider’s taxpayer identification number
Address (number and street) If the above number is a social security number,
check this box ä ..............................................£
City, State, and Postal/ZIP code GE/Use I.D. No.
Please print or type GE __ __ __-__ __ __-__ __ __ __ - __ __
Certification and Signature of Dependent Care Provider. Under penalties set forth in section 231-36, HRS, I as the dependent care provider, certify
that my name, address, taxpayer identification number, and general excise tax identification number, as shown above, are correct.
Please Signature of Dependent Care Provider Date
Sign
Here
Part II — Name and Address of Taxpayer Requesting Part I Information (See Instructions)
Name, street address, City, State, and Postal/ZIP code of person requesting information
General Information and a GE/Use I.D. No. below. Part II
If the provider is exempt from federal income
You are required to get the information in Part I tax as an organization described in IRC You only need to complete this part if you give
from anyone who provides care for your child or section 501(c)(3), see If Provider Is an Exempt Form HW-16 to your provider and it is to be
other dependent if: Organization below. returned to you at some later time.
• you intend to claim a tax credit on your tax return How To Get a TIN and a GE/Use Tax I.D. No. — Other Information
for child and dependent care expenses; or Providers who do not have a TIN or a GE/Use
• you receive benefits from a dependent I.D. No. should apply for one immediately. To If No Information Is Reported. — You will not be
care assistance program provided by your apply for an SSN, they should get federal Form allowed the tax credit or the income exclusion for
employer. SS-5, Application for a Social Security Card (for employer-provided dependent care assistance if:
You must report the correct name, address, individuals), from their local office of the Social you do not include the name, address, TIN, or
taxpayer identification number (TIN), and general Security Administration. To apply for an ITIN, they •
GE/Use I.D. No. of the provider on your income
excise tax identification number (GE/Use I.D. should get federal Form W-7, Application for IRS tax return; and
No.) of the dependent care provider (provider) Individual Taxpayer Identification Number, from
on Schedule X, Tax Credits for Hawaii Residents. their local IRS office. To apply for a FEIN, they • you cannot establish, to the Department upon
should get federal Form SS-4, Application for its request, that you exercised due diligence in
You may use Form HW-16 to get this information Employer Identification Number (for businesses obtaining this information.
from each provider or you may use any one of the and other entities), from their local IRS office. To Due Diligence. — You can show that you
other methods described under Due Diligence, apply for a GE/Use I.D. No., they should get Form exercised due diligence in obtaining this
below. A copy of federal Form W-10 may not be BB-1, State of Hawaii Basic Business Application, information by getting and keeping:
submitted for Form HW-16. Do not file Form HW- from their respective district Department office.
16 with your income tax return. Instead, keep it Form BB-1 may also be obtained by calling • a Form HW-16 properly completed by the
for your records. the Department at 808-587-4242 or toll-free provider; or
Section 235-55.6, Hawaii Revised Statutes at 1-800-222-3229, or by downloading it from • a copy of the provider’s social security card
(HRS), requires anyone providing dependent the Department’s website (tax.hawaii.gov). and general excise tax license; or
care services to you to give you this information. NOTE: An ITIN is for tax use only. It does not a recently printed letterhead or printed invoice
The Department of Taxation (Department) uses entitle the individual to social security benefits or •
that has on it the provider’s name, address,
the TIN and GE/Use I.D. No. for identification change employment or immigration status under TIN, and GE/Use I.D. No.; or
purposes and to help verify the accuracy of the U.S. law.
provider’s return as well as your return. Providers If Provider Is an Exempt Organization. — If the • where the employer is the provider, a copy
must give you their TIN and GE/Use I.D. No. provider is a tax-exempt organization of the type of the statement furnished by the employer
whether or not they are required to file a tax described in IRC section 501(c)(3), the provider under a dependent care assistance program,
return. is not required to supply its TIN or GE/Use I.D. showing the employer’s name, address, TIN
No. In such cases, the organization completes and GE/Use I.D. No.; or
Part I the name and address part of Form HW-16 • where the provider is your household employee
and writes “tax-exempt” in the space provided and has given you a properly completed Form
The provider completes this part. for the TIN and GE/Use I.D. No.. Generally, the HW-4 to have income tax withheld, a copy of
The provider’s name, address, TIN, and GE/Use type of exempt organization described in IRC that HW-4.
I.D. No. should be entered in the spaces above. section 501(c)(3) is one organized and operated If your provider does not comply with your request
For individuals and sole proprietors, the TIN is a exclusively for religious, charitable, scientific, for one of these items, you must still furnish the
social security number (SSN). But if the provider testing for public safety, literary, or educational name, address, and, if known, the TIN and GE/
is a nonresident or resident alien who does not purposes, or for the prevention of cruelty to Use I.D. No. of the provider on Schedule X. Also,
have and is not eligible to get an SSN, the TIN children or animals. you should include a statement on Schedule X
is an Internal Revenue Service (IRS) individual Income Tax Reporting Requirements for that you requested the information and that the
taxpayer identification number (ITIN). For other Providers. — The provider must report on his provider did not comply with the request. This
entities, it is the federal employer identification or her income tax return all income received for statement will show that you exercised due
number (FEIN). If the provider does not have a providing care for any person. diligence, unless you know that the statement is
TIN or a GE/Use I.D. No., see How to Get a TIN incorrect.