Form R-10605 "Application for Deduction for Employment of Certain Qualified Disabled Individuals" - Louisiana

Form R-10605 or the "Application For Deduction For Employment Of Certain Qualified Disabled Individuals" is a form issued by the Louisiana Department of Revenue.

The form was last revised in January 1, 2019 and is available for digital filing. Download an up-to-date Form R-10605 in PDF-format down below or look it up on the Louisiana Department of Revenue Forms website.

ADVERTISEMENT

Download Form R-10605 "Application for Deduction for Employment of Certain Qualified Disabled Individuals" - Louisiana

959 times
Rate
(4.7 / 5) 48 votes
R-10605 (1/19)
Louisiana Department of Health (LDH)
Application for Deduction for Employment
Office for Citizens with Developmental Disabilities (OCDD)
of Certain Qualified Disabled Individuals
PO Box 3117, Baton Rouge, LA 70821-3117
I. Employer Information
LA Revenue Account Number or SSN
FEIN
Date of Application
(mm/dd/yyyy)
Legal Name
Trade Name
Address
City
State
ZIP
II. Employee Information
I, the employer, am hereby applying for one of the 100 slots for the employment of the following individual:
Employee’s Name
SSN
Address
City
State
ZIP
III. Employer Declaration
I declare that to the best of my knowledge of all available information, this application is true and complete and complies with all statutes, rules and regulations, and any
other policy pronouncements related to the deduction for employment of certain qualified disabled individuals program.
Signature
Name
Date
(mm/dd/yyyy)
IV. Department of Health Review
Signature
Date
(mm/dd/yyyy)
Printed Name
Printed Title
Appointing Authority Signature
Printed Name
Meets Qualifications as of Date Signed by LDH:
Application Number
Yes
No
V. Employment Information – To be completed by employer.
Employment Start Date
Employment End Date
Hourly Rate of Pay
(mm/dd/yyyy)
(mm/dd/yyyy)
Average Number of Hours Worked in a Week
Position
Location of Employment (City and State)
Disability
VI. Calculation of Deduction for Tax Year
___________
Gross wages paid to qualified individual for employment during month 1
$
X 50%
$
through 4 of employment.
Gross wages paid to qualified individual for employment during month 5 through
$
X 30%
$
end of tax year or amount paid during tax year after first year of employment.
Total Amount of Deduction
$
R-10605 (1/19)
Louisiana Department of Health (LDH)
Application for Deduction for Employment
Office for Citizens with Developmental Disabilities (OCDD)
of Certain Qualified Disabled Individuals
PO Box 3117, Baton Rouge, LA 70821-3117
I. Employer Information
LA Revenue Account Number or SSN
FEIN
Date of Application
(mm/dd/yyyy)
Legal Name
Trade Name
Address
City
State
ZIP
II. Employee Information
I, the employer, am hereby applying for one of the 100 slots for the employment of the following individual:
Employee’s Name
SSN
Address
City
State
ZIP
III. Employer Declaration
I declare that to the best of my knowledge of all available information, this application is true and complete and complies with all statutes, rules and regulations, and any
other policy pronouncements related to the deduction for employment of certain qualified disabled individuals program.
Signature
Name
Date
(mm/dd/yyyy)
IV. Department of Health Review
Signature
Date
(mm/dd/yyyy)
Printed Name
Printed Title
Appointing Authority Signature
Printed Name
Meets Qualifications as of Date Signed by LDH:
Application Number
Yes
No
V. Employment Information – To be completed by employer.
Employment Start Date
Employment End Date
Hourly Rate of Pay
(mm/dd/yyyy)
(mm/dd/yyyy)
Average Number of Hours Worked in a Week
Position
Location of Employment (City and State)
Disability
VI. Calculation of Deduction for Tax Year
___________
Gross wages paid to qualified individual for employment during month 1
$
X 50%
$
through 4 of employment.
Gross wages paid to qualified individual for employment during month 5 through
$
X 30%
$
end of tax year or amount paid during tax year after first year of employment.
Total Amount of Deduction
$
R-10605i (1/19)
Instructions for
Application for Deduction for
Employment of Certain Qualified Disabled
(R.S. 47:297.13)
Individuals
An income tax deduction is allowed for each taxpayer who provides continuous employment to a qualified individual with a disability
within this state. The amount of the deduction is equal to 50 percent of the gross wages paid to the individual during the first four con-
tinuous months of employment and 30 percent of the gross wages paid during each subsequent continuous month of employment. The
number of qualified individuals for which the deduction may be claimed is limited to 100.
Employers will need to complete Sections I through III and submit the application to Louisiana Department of Health, Office for Citizens
with Developmental Disabilities for review. Please mail the form to:
Louisiana Department of Health (LDH)
Office for Citizens with Developmental Disabilities (OCDD)
PO Box 3117, Baton Rouge, LA 70821-3117
Once LDH/OCDD reviews the form, Section IV will be completed and the form returned to the employer. The employer will need to com-
plete Sections V and VI and attach a copy to their tax return in order to claim deduction. See the table below for tax periods and sched-
ules to enter the deduction on the tax return.
Tax Year
CIFT-620
IT-540
2015
Schedule F, Line 3f.
Schedule E, code 49E
2016
Schedule F, Line 3g.
Schedule E, code 21E
2017
Schedule F, Line 3i.
Schedule E, code 21E
2018
Schedule F, Line 3j.
Schedule E, code 21E
ADVERTISEMENT
Page of 2