2022 Quarterly Payment of                                                                           Arizona Form 
Reduced Withholding for Tax Credits                                                                       A1-QTC 
                                                                 
For information or help, call one of the numbers listed: 
                                                                                 Specific Instructions 
Phoenix                                      (602) 255-3381      
From  area codes 520 and 928, toll-free      (800) 352-4090     Check the box to indicate the calendar quarter for which this 
Tax forms, instructions, and other tax information              form   is completed.  
If you need tax forms, instructions, and other tax information,  Employer Information 
go to the department’s website atwww.azdor.gov.                 Type or print the  employer’s  name,  address, and date the 
Withholding Tax Procedures and Rulings                           payment was made in the spaces provided.   
These instructions may refer to the department’s withholding 
tax procedures and rulings for more information.  To view or    Charitable         Organization,          School      Tuition
print these,  go to our  website and select  Reports  & Legal   Organization,     or Public School  
Research from the main menu, then click on     Legal Research   Type or print the  Entity’s name and  mailing  address in the 
and select a Document Type and a Category  from the drop         spaces provided.   
down  menus.                                                    Enter the payment amount enclosed. This should be the total 
Publications                                                    amount    of all employees’ contributions to the Entity.  
To view or print the department’s publications, go to our 
website, selectReports & Legal Research from the main menu,     Employee     Contributions  
and click on Publications in the left hand column.              Type or print the employee’s name, address, city, state, zip 
                                                                code, phone number, and the amount of contribution to the 
                                                                entity  in the spaces provided.   Total the amount of 
               General Instructions                             contributions made to the entity. Enter the result on the “Total” 
 
Arizona  Revised Statutes § 43-401(G)  provides that an          line. 
employee  may  request his/her employer reduce  his/her         If additional schedules are included, check the box indicating 
withholding in an amount equal to certain income tax credit(s)  “Check this box if additional schedules are included.”  Enter 
the employee  will qualify  for when filing  his/her  Arizona   the total from all additional schedules on the line  labeled 
income tax return.                                               “Enter the total from additional schedules.” 
                                                                Add the amounts  on the  “Total” line and the “Total from 
Purpose   of the Form                                           additional schedules”  line.  Enter the result on the “Total 
This form is optional and  is  provided as a courtesy by  the    Contributions” line.   
Arizona Department of Revenue.  The same result can be          Sign and date Form A1-QTC where indicated. Complete the 
 accomplished using your own form or a letter.                  information boxes  below  your signature, in case the  Entity 
Employers use this form to report contributions made by their   needs  to contact you with any questions.   
employees to qualifying  organizations,  school tuition         Mail the completed form to the Entity indicated in the box 
organizations, and/or public schools (Entity).                  labeled “CHARITABLE ORGANIZATION, SCHOOL 
Please do not mail this form to the Arizona Department of       TUITION ORGANIZATION, OR PUBLIC SCHOOL.”  
Revenue.  Mail the completed form to the Entity listed in the   Keep a copy of the completed form, and any attachments, for 
box labeled “CHARITABLE ORGANIZATION, SCHOOL                    the employer’s records.   
TUITION ORGANIZATION, OR PUBLIC SCHOOL.” Keep 
a copy of the completed form, and any attachments, for the 
 employer’s records.