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 $1,795.00. 
  
Additional information: 
SSN(s): 123-45-9999 & 123-45-8888 
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                  $13.00 
 Olympic                       $2.00 
 RI Organ                      $12.00 
 RI Council on the Arts        $14.00 
 Nongame Wildlife              $16.00 
 Childhood Disease             $18.00 
 Military Family               $20.00 
 
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 
 

                                  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 W2s – 5 
 
RI-2210 
Farmer Fishermen checkbox is checked. 
Underestimating amount is $58.00. 
 
RI-6238 
 Total Credit      $500.00                     

                                       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 $5,486.00 
and is applying $486 of the overpayment to 2024 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                              $4.00 
 RI Council on the Arts                $4.00 
 Nongame Wildlife                      $5.00 
 Childhood Disease                     $6.00 
 Military Family                       $7.00 
 
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 
 

                           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 W2s – 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                          

                                  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 $619.00. 
 
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                $7.00 
 Military Family                  $8.00 
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-2276          $35.00 
 RI-286B          $15.00 
 RI-5442          $17.00 
 RI-6754          $20.00 
 RI-7253          $13.00 
 RI-8201          $18.00 
 RI-9283          $12.00 
 

 Recap #1          0715  HistRes   $125.00 
 Recap #2          8201  Film      $75.00 
 
                         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 
 

                   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         E  Employer 4  667666666                 35.00 
 Number of W2s – 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  
                                                                   

                                  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