INSTRUCTIONS                  STATE OF HAWAII — DEPARTMENT OF TAXATION 
FORM N-172                   INSTRUCTIONS FOR FORM N-172 
(REV. 2020)       CLAIM FOR TAX EXEMPTION BY PERSON WITH IMPAIRED SIGHT  
                             OR HEARING OR BY TOTALLY DISABLED PERSON 
                              AND PHYSICIAN’S CERTIFICATION

                   (NOTE: References to “married” and “spouse” are also references 
                     to “in a civil union” and “civil union partner,” respectively.)

GENERAL INSTRUCTIONS
Changes to Note   — Section  18-235-1.14, Hawaii  Administrative  Rules, was adopted  in 
final form effective April 20, 2019. Under these rules, a taxpayer with gross earnings from self 
employment for the taxable year of $60,000 or more does not qualify as a totally disabled person.
Purpose of Form N-172 — Use Part I of Form N-172 to notify the Department of Taxation 
that you qualify to claim the special exemptions for persons with impaired sight or hearing or 
persons who are totally disabled.  Part II of Form N-172 is used to certify blindness, deafness, or 
disability for tax purposes.  Copies of Form N-172 should be retained by the taxpayer claiming 
the exemption and the physician, optometrist, etc., certifying the blindness, deafness, or disability.  
For real property tax purposes, contact the Real Property Assessment Division of the county in 
which the property is located.
This form should be submitted only once unless Part II, Section A, item 6; Section B, item 5; 
or Section C, item 4 indicates that the taxpayer needs to be re-examined.  If re-examination is 
indicated, a new Form N-172 should be submitted for the year indicated.
Telephone Service for the Hearing Impaired — Telephone service for the hearing impaired 
(TDD/TTY) is available through the Oahu Taxpayer Services Branch at 808-587-1418 or toll-free 
at 1-800-887-8974.
Applicant’s Social Security Number — The Internal Revenue Service (IRS) issues Individual 
Taxpayer Identification Numbers (ITINs) to certain aliens who are required to have a U. S. taxpayer 
identification number but who do not have, and are not eligible to obtain, a social security number.  
For Hawaii income tax purposes, the ITIN issued by the IRS for these individuals must be used as 
the individual’s identification number.
Signatures Required — Form N-172 must be signed by both the taxpayer-claimant (on the 
front of the form) and by the certifying physician, optometrist, audiologist etc. (on the back of the 
form).  Forms that are not signed are incomplete and will not be processed.

DEFINITIONS
“Blind” means a person whose central visual acuity does not exceed 20/200 in the better eye 
with correcting lenses, or whose visual acuity is greater than 20/200 but is accompanied by a 
limitation in the field of vision such that the widest diameter of the visual field subtends an angle 
no greater than 20 degrees.  
“Deaf” means a person whose average loss in the speech frequencies (500-2000 Hertz) in the 
better ear is 82 decibels, A.S.A., or worse. 

PLEASE NOTE:  For  purposes  of  impairment  certification,  a  qualified  ophthalmologist,  optometrist,  or 
             otolaryngologist may be licensed to practice in any state or a commissioned medical officer 
             in the armed forces.  Hearing impairment may be certified by an audiologist licensed under 
             chapter 468E, Hawaii Revised Statutes (HRS).

INSTRUCTIONS 
FORM N-172 
(REV. 2020)                                                                    PAGE 2

“Person totally disabled” means a person who is totally and permanently disabled, either 
physically or mentally, which results in the person’s inability to engage in any substantial gainful 
business or occupation. The disability of a person claiming to be totally disabled must be certified  
in a three-step process.
First, there must be a medical determination that the person is totally disabled, either physically 
or mentally.
Second,  the  disability  must  be  permanent. This  means  that  at  the  time  of  certification  the 
disability can be expected to result in death or has lasted or can be expected to last for a continuous 
period of not less than 12 months. The 12 month requirement is inapplicable when the disability 
is determined to be a terminal state or where it does actually result in death.
Third, there must be a determination that the permanent and total disability results in the person’s 
inability to engage in any substantial gainful business or occupation. A taxpayer is engaged in 
substantial business or occupation if the work requires significant physical or mental activity. 
It shall be presumed that an individual whose net earned income is greater than $30,000 for the 
taxable year, or whose gross earnings from self employment for the year are $60,000 or more, is 
engaged in a substantial gainful business or occupation.
The disability shall be certified by (1) a physician licensed under chapter 453, HRS, (2) a 
qualified out-of-state physician who is currently licensed to practice in the state in which the 
physician  resides,  or  (3)  a  commissioned  medical  officer  in  the  United  States Army,  Navy, 
Marine Corps, or Public Health Service, engaged in the discharge of one’s official duty. See Tax 
Information Release No. 89-3 for more information.
Corporations, partnerships, or limited liability companies all of whose shareholders, partners, 
or members are blind, deaf, or totally disabled may also qualify for general excise tax benefits.  
The  entity’s  information  should  be  completed  on  each  shareholder’s,  partner’s,  or  member’s 
certification form.

HOW AND WHERE TO FILE
Submit  the  original  and  one  copy  of  Form  N-172  to  the  Hawaii  Department  of  Taxation, 
ATTN: Licensing Section, P.O. Box 259, Honolulu, HI 96809-0259. Corporations, partnerships, 
or limited liability companies all of whose shareholders, partners, or members are blind, deaf, 
or totally disabled are to submit all Forms N-172 at one time. If the taxpayer has more than one  
general excise tax account that qualifies for the disability treatment, submit a separate Form 
N-172 for each such account.
If you are submitting Form N-172 in response to an adjustment letter denying the disability 
exemption because no exemption is on file, please send a copy of the adjustment letter along with 
Form N-172 to the address shown above.

TAX BENEFITS
For information on tax benefits that are available under the General Excise Tax and/or Income 
Tax Laws for persons with impaired sight, impaired hearing, or who are totally disabled, refer to 
Tax Information Release No. 89-3.