TEST 1 – RI-1040 
 
Scenario: RI Residents Jason and Lily Bourne (deceased – 6/25/2023) of 1724 Ashe Street, Warwick, RI 
02889 (new address) filing an amended Joint return with Federal AGI of $125,600.00.  TPs have a 
balance due of $1,623.00. 
  
Additional information: 
SSN(s): 132-45-9779 & 143-45-8789 
Electoral Contribution :  YES 
Specific Party: YES   D  
Exemption(s)  3 
Use tax certification checkbox is checked. 
Full year coverage checkbox is checked. 
Estimates $0.00 
Other Payments $223.00 
Previously issued overpayments $130.00 
Primary license number and state: 123456789 - RI 
Spouse license number and state (if applicable): 213456789 - RI 
PTIN  P45678955 
Contact Preparer    YES 
Line 20 Child and dependent care expenses  $500.00 
Checkoff Contributions: 
 Drug program                  $10.00 
 Olympic                       $2.00 
 RI Organ                      $12.00 
 RI Council on the Arts        $14.00 
 Nongame Wildlife              $11.00 
 Childhood Disease             $12.00 
 Military Family               $20.00 
 Behavioral Health             $14.00 
 
This test will use the following additional schedule(s) and form(s).  Use the data provided below 
to populate the schedule(s) and form(s).: 
RI Schedule CR 
RI Schedule E 
RI Schedule M 
RI Schedule MU 
RI Schedule U 
RI Schedule W 
Form RI-2210  
Form RI-6238 
 
RI Schedule CR 
 RI-0715          $177.00 
 RI-2276          $125.00 
 RI-286B          $140.00 
 RI-5442          $150.00 
 RI-6754          $175.00 
 RI-7253          $125.00 
 RI-8201          $110.00 
 RI-9283          $210.00 
 Recap #1         286B  Historic   $235.00 
 Recap #2         2276  Scholar    $165.00 
 
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                                   TEST 1 – RI-1040 (continued) 
  
 RI Schedule E 
   “Yourself” checkbox is checked 
   “Spouse” checkbox is checked 
  Name of Dependent Social Security Number      Date of Birth         Relationship 
  James Bourne      123457777                   07032017              Son 
    
 RI Schedule M 
   Line 1a          $125.00                                           $0.00 
   Line 1b          $110.00                      Line 1t              08/08/1930 
   Line 1c          $400.00                                           06/18/1934 
   Line 1d          $350.00                                           $0.00 
   Line 1e          $185.00                      Line 1u              $250.00 
   Line 1f          $0.00                        Line 1v              $0.00 
   Line 1g          $250.00                                            
   Line 1h          $650.00                      Line 2a              $165.00 
   Line 1i          $575.00                      Line 2b              $214.00 
   Line 1j          $740.00                      Line 2c              $134.00 
   Line 1k          $385.00                      Line 2d              $114.00 
   Line 1l          $165.00                      Line 2e              $302.00 
   Line 1m          $215.00                      Line 2f              $285.00 
   Line 1n          $320.00                      Line 2g              $177.00 
   Line 1o          $0.00                                  Line 2h            $103.00 
   Line 1p          $365.00                      Line 2i              $141.00 
   Line 1q          $205.00                      Line 2j              $130.00 
   Line 1r          $170.00                      Line 2k              BLANK 
   Line 1s          08/08/1930                   
                    06/18/1934 

 RI Schedule MU 
   Income from MA            $500.00    
   Taxes paid to MA            $25.00 
   Income from CT         $1,000.00 
   Taxes paid to CT            $21.00 
  
 RI Schedule U 
   Line 1           $6,500.00 
   Line 3           $155.00 
   
 RI Schedule W  
   Line 1                          Employer 1 129876543         157.00
   Line 2           N              Employer 2 126789034         122.00
   Line 3       S   E              Employer 3 121234567         128.00
   Line 4           D              Employer 4 126677889         55.00
   Line 5       S   M              Employer 5 124443335         65.00
   Number of withholding documents – 5 
  
 RI-2210 
 Farmer Fishermen checkbox is checked. 
 Underestimating amount is $13.00. 
  
 RI-6238 
   Total Credit     $500.00                      

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                                       TEST 2 – RI-1040 
  
Scenario: RI Resident Alex DeLarge with a new address of 81 Clockwork Drive in Providence, RI 
02910 filing a Single return with Federal AGI of $35,000.00. TP did not have a healthcare exemption 
for 3 months and has a penalty amount due of $174 on line 12b. TP has an overpayment of $5,541.00 
and is applying $541 of the overpayment to 2025 estimated tax with the rest being refunded. 
 
Additional information: 
SSN(s): 999-01-1234 
Exemption(s)  1 
Use tax certification checkbox is checked. 
Estimates $35.00 
Other Payments $102.00 
Primary license number and state:      8675309   RI 
Spouse license number and state (if applicable): 
PTIN  P12345678 
Contact Preparer    YES 
Line 20 Child and dependent care expenses  $0.00 
Credit for taxes paid to CT 
 Income derived from CT                $1,000.00 
 Taxes paid to CT                           $50.00 
Checkoff Contributions 
 Drug program                          $1.00 
 Olympic                               $1.00 
 RI Organ                              $2.00 
 RI Council on the Arts                $2.00 
 Nongame Wildlife                      $5.00 
 Childhood Disease                     $6.00 
 Military Family                       $7.00 
 Behavior Health                       $4.00 
 
This test will use the following additional schedule(s) and form(s).  Use the data provided below to 
populate the schedule(s) and form(s).: 
RI Schedule CR 
RI Schedule E 
RI Schedule M 
RI Schedule U 
RI Schedule W 
RI-1040H 
Form RI-6238 
Form IND-HEALTH 
 
RI Schedule CR 
 RI-0715            $10.00 
 RI-2276            $15.00 
 RI-286B            $17.00 
 RI-5442            $0.00 
 RI-6754            $20.00 
 RI-7253            $22.00 
 RI-8201            $23.00 
 RI-9283            $25.00 
 Recap #1           8201   Film              $20.00    
 Recap #2           286B  Historic           $30.00 

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                            TEST 2 – RI-1040 (continued) 
 
RI Schedule E 
   “Yourself” checkbox is checked. 
 
RI-1040H 
   A Checkbox  YES                                    1a                 $225.00 
   B Checkbox  YES                                    1b                 $35,000.00 
   C Checkbox  YES                                    1c                 11/09/1940 
   D Checkbox  YES                                    1e checkbox  YES 
   E Checkbox  YES                                    2                  $3,000.00 
    
 RI Schedule M 
   Line 1a      $355.00                               Line 1s            11/09/1940 
   Line 1b      $75.00                                                   $50.00 
   Line 1c      $110.00                               Line 1t            11/09/1940 
   Line 1d      $80.00                                                   $90.00 
   Line 1e      $195.00                               Line 1u            $45.00 
   Line 1f      $0.00                                 Line 1v            0.00 
   Line 1g      $135.00                            
   Line 1h      $85.00                                Line 2a            $305.00 
   Line 1i      $140.00                               Line 2b            $200.00 
   Line 1j      $100.00                               Line 2c            $300.00 
   Line 1k      $65.00                                Line 2d            $120.00 
   Line 1l      $365.00                               Line 2e            $325.00 
   Line 1m      $200.00                               Line 2f            $310.00 
   Line 1n      $240.00                               Line 2g            $185.00 
   Line 1o      $0.00                                         Line 2h           $150.00 
   Line 1p      $55.00                                Line 2i            $125.00 
   Line 1q      $55.00                                Line 2j            $220.00 
   Line 1r      $445.00                               Line 2k            BLANK
 
RI Schedule U 
   Line 5       $35,000.00                            Line 7b            $40.00 
   Line 6       $25.00                                Line 8             $85.00 
   Line 7a      $20.00 
 
RI Schedule W 
   Line 1       P               Employer 1       991234567         120.00
   Line 2                       Employer 2       997654321         200.00
   Line 3       E               Employer 3       991357924         150.00
   Line 4       D               Employer 4       111234567         85.00
   Line 5       R               Employer 5       117654321         65.00
   Number of withholding documents – 5 
 
RI-6238 
   Total Credit  $5,000.00 
 
Form IND-HEALTH 
Exemption Number: RI123456 
Minimum Essential Coverage for the months of January through April 
HSRI hardship for the months of May through September 
No coverage or exemption for the remainder of the year 
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                                  TEST 3 – RI-1040 
  
Scenario: RI Residents Hawkeye Pierce and Rosemary Pierce with an address of 194 Mash 
Street in Johnston, RI 02919 filing an Amended Joint return with Federal AGI of $62,000.00. TP 
did not have minimum essential coverage or a healthcare exemption for 6 months.  One 
dependent (under 18) also did not have minimum essential coverage or a healthcare exemption 
for 5 months. The other two dependents had full year coverage as did the spouse.  The penalty 
amount due on line 12b is $492.00. TP has a balance due of $538.00. 
 
Additional information: 
SSN(s): 123-12-1234 & 845-22-1289 
Electoral Contribution :  YES 
Exemption(s)  5 
Estimates $0.00 
Other Payments $0.00 
Previously issued overpayments $46.00  
Primary license number and state: 1223445   RI 
Spouse license number and state (if applicable): 
PTIN  P34125687 
Contact Preparer    YES 
Line 20 Child and dependent care expenses  $200.00 
Checkoff Contributions 
 Drug program                     $4.00 
 Olympic                          $2.00 
 RI Organ                         $4.00 
 RI Council on the Arts           $5.00 
 Nongame Wildlife                 $6.00 
 Childhood Disease                $6.00 
 Military Family                  $5.00 
 Behavior Health                  $4.00 
 
Line 38 Federal EIC  $1,200.00 
 
This test will use the following additional schedule(s) and form(s).  Use the data provided below 
to populate the schedule(s) and form(s).: 
RI Schedule CR 
RI Schedule E 
RI Schedule M 
RI Schedule MU 
RI Schedule U 
RI Schedule W 
Form RI-2210 
Form IND-HEALTH 
 
RI Schedule CR 
RI-0715 $25.00                                   RI-7253  $13.00 
RI-2276 $35.00                                   RI-8201  $18.00 
RI-286B      $15.00                              RI-9283  $12.00 
RI-5442 $17.00                                   Recap #1 0715  HistRes   $125.00 
RI-6754 $20.00                                   Recap #2 8201  Film        $75.00 

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                          TEST 3 – RI-1040 (continued) 
  
 RI Schedule E 
   “Yourself” checkbox is checked. 
   “Spouse” checkbox is checked. 
     
  Name of Dependent Social Security Number  Date of Birth Relationship 
  JANE PIERCE       123451233               05272011      DAUGHTER
  JESSE PIERCE      521443222               02012016      DAUGHTER
  JADE PIERCE       992119364               01312010      DAUGHTER
    
 RI Schedule M 
   Line 1a          $240.00                  Line 1s      12/26/1950      
   Line 1b          $230.00                               02/12/1952 
   Line 1c          $220.00                               $140.00 
   Line 1d          $210.00                  Line 1t      12/26/1950 
   Line 1e          $200.00                               02/12/1952 
   Line 1f          $0.00                                 $150.00 
   Line 1g          $300.00                  Line 1u      $100.00 
   Line 1h          $290.00                  Line 1v      750.00 
   Line 1i          $280.00                  Line 2a      $305.00 
   Line 1j          $270.00                  Line 2b      $355.00 
   Line 1k          $260.00                  Line 2c      $140.00 
   Line 1l          $310.00                  Line 2d      $200.00 
   Line 1m          $320.00                  Line 2e      $325.00 
   Line 1n          $200.00                  Line 2f      $315.00 
   Line 1o          $0.00                    Line 2g      $230.00 
   Line 1p          $350.00                            Line 2h            $135.00 
   Line 1q          $230.00                  Line 2i      $100.00 
   Line 1r          $100.00                  Line 2j      $210.00 
                                             Line 2k      BLANK 
  
 RI Schedule MU 
   Income from DE         $3,000.00  
   Taxes paid to DE       $50.00 
   Income from VT         $2,005.00 
   Taxes paid to VT       $30.00 
   Income from ME         $4,022.00 
   Taxes paid to ME       $150.00 
   Income from AZ         $5,000.00 
   Taxes paid to AZ       $90.00 
  
 RI Schedule U 
   Line 1           $3,500.00 
   Line 3           $145.00 
                                      
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                   TEST 3 – RI-1040 (continued) 
  
 RI Schedule W 
   Line 1        P Employer 1          999199999          117.00
   Line 2          Employer 2          882888888          113.00
   Line 3        R Employer 3          774777777          65.00
   Line 4        B Employer 4          667666666          35.00
   Number of withholding documents – 4 
  
 RI-2210 
   Annualization of Income checkbox is checked  
   
 Form IND-HEALTH 
 Primary - No Minimum Essential Coverage for the months of January through June; Minimum 
 Essential Coverage from July through the end of the year 
 Spouse – Full Year Minimum Essential Coverage 
 Dependent 1 - No Minimum Essential Coverage for the months of January through May: 
 Minimum Essential Coverage from June through the end of the year  
 Dependent 2 & 3 – Full Year Minimum Essential Coverage  
                                         
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                                   TEST 4 – RI-1040 
  
 Scenario: RI Resident Harry Potter of 21 Hogwarts Avenue, Providence, RI 02908 filing Married 
 Filing Separately with federal AGI of negative $67,500.00 and a decreasing modification of 
 $1,215.00 for Railroad Retirement benefits on line 1d of RI Schedule M.  TP has an 
 overpayment of $500.00 to be refunded. 
    
 Additional information: 
 SSN(s): 246-12-1234 
 Electoral Contribution :  No 
 Specific Party: No 
 Exemption(s)  1 
 Use tax certification checkbox is checked. 
 Full year coverage checkbox is checked. 
 Estimates $500.00 
 Primary license number and state: 7764221 - RI 
 Spouse license number and state (if applicable): 
 PTIN  P45678899 
 Contact Preparer    YES 
  
 This test will use the following additional schedule(s) and form(s).  Use the data provided below 
 to populate the schedule(s) and form(s).: 
 RI Schedule E 
 RI Schedule M 
  
 RI Schedule E 
   “Yourself” checkbox is checked 
     
 RI Schedule M 

   Line 1d           $1,215.00 

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