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The Access NY Supplement A form plays a crucial role in helping individuals access essential benefits in New York. This form is specifically designed for those applying for various assistance programs, including Medicaid, food assistance, and other public benefits. It collects important information about the applicant's household, income, and expenses, which helps determine eligibility for assistance. The form also requires details about any disabilities or chronic illnesses that may affect the applicant's ability to work. By providing this information, applicants can ensure that they receive the support they need. Understanding how to fill out the Access NY Supplement A form correctly can significantly impact the outcome of an application, making it vital for applicants to approach it with care and attention. Whether you are applying for yourself or assisting someone else, knowing the ins and outs of this form can pave the way for accessing much-needed resources.

Similar forms

  • Medicaid Application Form: Similar to the Access NY Supplement A form, the Medicaid Application Form collects personal and financial information to determine eligibility for Medicaid benefits. Both forms require detailed information about income, assets, and household composition.
  • Food Stamp Application: This form is used to apply for food assistance. Like the Access NY Supplement A, it assesses household income and expenses to determine eligibility for benefits.
  • Temporary Assistance Application: This document is for individuals seeking temporary financial assistance. It shares similarities with the Access NY Supplement A in the requirement for personal and financial details to evaluate eligibility.
  • Supplemental Security Income (SSI) Application: The SSI application is for individuals with disabilities seeking financial assistance. Both forms require comprehensive information about income, resources, and living arrangements.
  • Medicare Application: This application is for those seeking Medicare benefits. It parallels the Access NY Supplement A in its need for personal information and health-related details to establish eligibility.
  • Home Energy Assistance Program (HEAP) Application: This form helps individuals apply for energy assistance. It is similar to the Access NY Supplement A in that it evaluates household income and size to determine eligibility for benefits.
  • Child Health Plus Application: This application is for enrolling children in health insurance. Like the Access NY Supplement A, it requires information about family income and household size to assess eligibility.
  • Public Assistance Program Application: This form is used for applying for various public assistance programs. It shares the requirement for detailed personal and financial information, similar to the Access NY Supplement A.

Form Preview

NEW for 2020! Do you have less than or equal to $100,000.00 in Philadelphia taxable gross receipts? If yes,

you are not required to file the BIRT return. (See BIRT Instructions)

No

CITY OF PHILADELPHIA

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DEPARTMENT OF REVENUE

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2020 BIRT-EZ

DUE DATE: APRIL 15, 2021

2020 BUSINESS INCOME & RECEIPTS TAX

For business conducted 100% in Philadelphia

Taxpayer Name and Address

City Account Number

EIN

SSN Taxpayer E-mail Address

If this is a change of address, check this box:

 

 

If your business terminated in 2020, enter the termination date AND file a CHANGE FORM.

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YOU MUST COMPLETE WORKSHEET "S-EZ"

COMPUTATION OF TAX DUE OR OVERPAYMENT

If this is an amended return place an "X" here:

1. NET INCOME PORTION OF TAX (from Page 2, Line 6).

 

 

If there is no tax due, enter "0"

1.

2. GROSS RECEIPTS PORTION OF TAX (from Page 2, Line 11).

 

 

If there is no tax due, enter "0"

2.

3. Tax Due for the 2020 Business Income & Receipts Tax (Line 1 plus Line 2)

3.

4.

MANDATORY 2021 BIRT Estimated Payment (See Instructions)

4.

5.

Total Due by 4/15/2021 (Line 3 plus Line 4)

5.

ESTIMATED PAYMENTS AND OTHER CREDITS

 

6a.

Include any estimated and/or extension payments of 2020 BIRT previously made,

 

 

and any credit from overpayment of the 2019 BIRT and/or 2020 NPT return

6a.

6b.

Credit from Special Credit Schedule (SC). (Cannot exceed amount on Line 3)

6b.

6c.

Total payments and credits. (Line 6a plus Line 6b)

6c.

7.

Net Tax Due (Line 5 less Line 6c).

 

 

If Line 6c is greater than Line 5, enter "0"

7.

8.

Interest and Penalty

 

 

Refer to web site for current percentage

8.

9.

TOTAL DUE including Interest and Penalty (Line 7 plus Line 8).

 

 

Use payment coupon. Make check payable to: "City of Philadelphia"

9.

OVERPAYMENT OPTIONS If Line 6C is greater than Line 5, enter the amount to be:

10a.

Refunded. Do not file a separate Refund Petition

10a.

10b.

Applied to the 2020 Net Profits Tax Return

10b.

10c. Applied to the 2021 Business Income & Receipts Tax

10c.

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Under penalties of perjury, as set forth in 18 PA C.S. §§ 4902-4903 as amended, I swear that I have reviewed this return and accompanying statements and schedules, and to the best of my knowledge and belief, they are true and complete.

Taxpayer Signature________________________________________ Date_______________________Phone #_________________________

Preparer Signature_________________________________________ Date_______________________Phone #_________________________

2020 BIRT-EZ P1 (Fillable) 10-14-2020

BIRT-EZ Page 1

2020 BIRT-EZ

TAX COMPUTATION SCHEDULES

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City Account Number

If business is operated inside and outside of Philadelphia, you must file the BIRT Regular return available at www.phila.gov/revenue. Reminder - You MUST use the same method (METHOD I or METHOD II) that you elected on the first Business Income & Receipts Tax return filed.

NET INCOME PORTION

Place "X" in box to indicate a loss.

 

 

1.

METHOD II. Net Income (or loss) as properly reported to the Federal Government

1.

 

OR

 

2.

METHOD I. Net Income (or loss) in accordance with Accounting System

2.

3. Statutory Net Income Deduction from Worksheet S-EZ, Line S5, below

3.

4.

Loss Carry Forward, if any

4.

5.

Taxable Income or loss. (Amount on Line 1 OR Line 2 minus Line 3 minus Line 4)

5.

6.

TAX DUE (Line 5 X .0620). If Line 5 is a loss, enter zero here and on Page 1, Line 1

6.

GROSS RECEIPTS PORTION

 

Do not report negative numbers for gross receipts.

TAXABLE GROSS RECEIPTS from:

7a.

 

 

 

 

 

 

7a.

Sales and/or rentals of tangible personal property

 

 

 

7b.

Services

7b.

 

 

 

 

 

 

 

7c.

Rentals of real property

7c.

 

 

 

 

 

 

 

7d.

Royalties

7d.

 

 

 

 

 

 

 

7e.

Gains on sales of capital business assets

7e.

 

 

 

 

 

 

 

7f.

Gains on sales of stocks, bonds, etc. (Not applicable to individuals.)

7f.

 

 

 

 

 

 

 

7g.

Dividends. (Not applicable to individuals.)

7g.

 

 

 

 

 

 

 

7h.

Interest. (Not applicable to individuals.)

7h.

 

 

 

 

 

 

 

7 i. Other. (Describe) ____________________________________________

7i.

 

 

 

 

 

 

 

8. TAXABLE GROSS RECEIPTS before Statutory Exclusion. (Add Lines 7a through 7i.)

8.

 

 

 

 

 

 

 

 

9. Statutory Exclusion (Lower of Line 8 or $100,000.00)

9.

 

 

 

 

 

 

 

 

10.

Net taxable Gross Receipts (Line 8 minus Line 9)

10.

 

 

 

 

 

 

 

 

11.

TAX DUE. (Line 10 X .001415). Enter here and on Page 1, Line 2

11.

 

 

 

 

 

 

 

 

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Worksheet S-EZ - Use to calculate Statutory Net Income Deduction

 

 

 

 

 

 

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S1.

Enter the lower of Line 8 above or $100,000.00

S1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S2.

Enter Net Income from Line 1 or Line 2. If loss, enter zero

S2.

 

 

 

 

 

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S3.

Enter Taxable Gross Receipts from Line 8 above

S3.

 

 

 

 

 

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S4.

Divide Line S2 by Line S3. (Cannot be greater than 1.0000)

S4.

 

 

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S5.

Statutory Net Income Deduction (Line S1 times Line S4. Cannot exceed $100,000)

 

 

 

 

 

 

 

S5.

 

 

 

 

 

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Enter here and on Line 3, above.

 

 

 

 

 

 

 

2020 BIRT-EZ P2 (Fillable) 10-14-2020

BIRT-EZ Page 2

CITY OF PHILADELPHIA - DEPARTMENT OF REVENUE

2020 BIRT SCHEDULE SC

SPECIAL CREDIT SCHEDULE

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Important Note

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City Account Number

Schedule SC is to be used by a taxpayer participating in any of the BIRT Tax Credit Programs (listed below) in order to claim the applicable credit on their 2020 BIRT return. A taxpayer must have made an application to participate in and been accepted into the respective program by the Revenue Department. Also, the taxpayer must fulfill all statutory and regulatory requirements to participate in the respective Tax Credit Program (e.g., entering into commitment agreements with the Department and complying with its terms and conditions, tax compliance, etc.). A taxpayer not meeting all the requirements for participation in the respective BIRT Tax Credit Program will not receive the applicable credit.

For more information on the various BIRT Tax Credit Programs, please refer to the Department's website at http://www.phila.gov/Revenue/taxpro/Pages/TaxCredits.aspx.

1.Credit for Contributions to Community Development Corporations,

 

(Nonprofit Organizations engaged in developing and implementing

1.

 

Healthy Food Initiatives and Nonprofit Intermediaries)

2.

Credit for New Job Creation

2.

3.

Green Roof Tax Credit

3.

4.

Philadelphia Re-Entry Employment Program for

 

 

Returning Citizens Tax Credit ("PREP")

4.

5.

Sustainable Business Tax Credit

5.

6.

Credit for Employment of Returning Veterans of the Armed Forces

6.

7.

Life Partner and Transgender Care Health Benefits Tax Credits

7.

8.

Distressed Business Tax Credit

8.

9.

Keystone Opportunity Zones Tax Credits (KOZ/KOEZ/KOIZ)

 

 

from KOZ Worksheet Line 10

9.

10.

Strategic Development Area Tax Credit

10.

11.

Economic Development District Tax Credit

11.

12.

Healthy Beverage Tax Credit

12.

13.

TOTAL CREDITS (Add Lines 1 through 12)

13.

Enter the amount of Line 13 on Page 1, Line 6b of the 2020 BIRT or BIRT-EZ Return. (Cannot exceed amount on Page 1, Line 3.)

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2020 Sch. SC (Fillable) 10-19-2020

BIRT - Sch. SC

Common mistakes

Filling out the Access NY Supplement A form can be a complex process, and many individuals make mistakes that can delay their application or lead to denial of benefits. One common mistake is failing to provide accurate personal information. Applicants must ensure that their name, address, and contact information are correct. Inaccuracies can lead to confusion and miscommunication, which may hinder the processing of the application.

Another frequent error is incomplete income reporting. It is essential to report all sources of income, including wages, benefits, and any other financial support. Omitting income can result in an inaccurate assessment of eligibility, potentially disqualifying the applicant from receiving assistance. Additionally, applicants should be aware of the specific income limits applicable to their situation.

Many individuals also struggle with not understanding the documentation requirements. The form often requires supporting documents to verify income, residency, and other factors. Failing to include necessary documentation can lead to delays in processing or outright denial of the application. It is advisable to carefully review the checklist provided with the form and ensure all required documents are included.

Another mistake is not signing the application. A signature is a critical part of the application process, as it certifies that the information provided is true and complete. Without a signature, the application may be considered invalid and could be returned to the applicant for correction.

Furthermore, applicants sometimes overlook the importance of reviewing their application before submission. Taking the time to double-check for errors or omissions can save significant time and effort later. A thorough review can help catch mistakes that might otherwise lead to complications in the application process.

Lastly, not seeking assistance when needed is a mistake that many make. The application process can be daunting, and individuals should not hesitate to reach out for help. Whether it’s contacting a local assistance office or seeking guidance from a trusted friend or family member, support can make the process smoother and increase the likelihood of a successful application.

More About Access Ny Supplement A

  1. What is the Access NY Supplement A form?

    The Access NY Supplement A form is a document used in New York State to apply for various public assistance programs, including Medicaid. It collects essential information about the applicant's financial situation, household composition, and health needs.

  2. Who needs to fill out the Access NY Supplement A form?

    This form is required for individuals applying for Medicaid or other public assistance programs. If you are seeking financial support due to disability or chronic illness, you will need to complete this form as part of your application process.

  3. What information is required on the form?

    The Access NY Supplement A form asks for personal details such as:

    • Your name and contact information.
    • Household members and their income.
    • Details about your medical conditions and any disabilities.
    • Assets and resources, including bank accounts and property.
  4. How do I submit the Access NY Supplement A form?

    You can submit the form either by mailing it to your local Department of Social Services or by delivering it in person. Ensure that you keep a copy for your records. If you are submitting it electronically, follow the instructions on the official website.

  5. What happens after I submit the form?

    After submission, your application will be reviewed by the local Department of Social Services. They may contact you for additional information or clarification. You will receive a notice regarding the approval or denial of your application.

  6. How long does it take to process the Access NY Supplement A form?

    The processing time can vary. Typically, it takes about 30 days to receive a decision. However, if additional information is needed, this timeline may be extended. It's advisable to follow up with your local office if you have not heard back within this period.

  7. Can I appeal if my application is denied?

    Yes, if your application is denied, you have the right to appeal the decision. The notice you receive will include information on how to file an appeal. It's essential to act quickly, as there are deadlines for submitting appeals.

  8. Where can I get help filling out the Access NY Supplement A form?

    If you need assistance, you can contact your local Department of Social Services for guidance. Additionally, many community organizations and legal aid services offer support in completing the form and understanding the application process.

Misconceptions

Misconception 1: The Access NY Supplement A form is only for those who are unemployed.

This is not true. The form is designed for individuals who may be working but still require assistance due to low income or other qualifying factors. It is crucial for anyone who meets the eligibility criteria, regardless of employment status, to apply.

Misconception 2: Filling out the Access NY Supplement A form is a complicated process.

While the form may seem lengthy, it is structured to guide applicants through the necessary information step by step. Support is available to help individuals understand the process and complete the form accurately.

Misconception 3: You cannot receive benefits if you have savings.

This is a common misunderstanding. The Access NY Supplement A form considers various factors, including income and expenses. Having savings may not disqualify someone from receiving benefits, depending on the total financial situation.

Misconception 4: The Access NY Supplement A form is only for people with disabilities.

In reality, the form is available to a broader group of individuals, including families and seniors. It aims to assist anyone facing financial hardships, not just those with disabilities.

Misconception 5: Submitting the Access NY Supplement A form guarantees immediate approval.

Approval is not guaranteed upon submission. Each application is reviewed based on eligibility criteria, and processing times may vary. Applicants should be prepared for potential follow-up questions or requests for additional information.

Key takeaways

Key Takeaways for Filling Out and Using the Access NY Supplement A Form:

  • Ensure all personal information is accurate and up-to-date.
  • Provide detailed information about your income and expenses.
  • Include any relevant medical documentation to support your claims.
  • Double-check for any missing signatures or dates before submission.
  • Keep a copy of the completed form for your records.
  • Contact your local Medicaid office if you have questions or need assistance.

Access Ny Supplement A: Usage Guide

Completing the Access NY Supplement A form is an important step in the application process for Medicaid. This form collects necessary information about your household and financial situation. Follow these steps to fill it out accurately.

  1. Obtain the form: Download the Access NY Supplement A form from the official website or request a paper copy from your local Medicaid office.
  2. Personal information: Fill in your name, address, and contact information at the top of the form.
  3. Household details: List all household members, including their names, ages, and relationships to you. Be thorough and include everyone who lives with you.
  4. Income information: Provide details about all sources of income for each household member. Include wages, Social Security, unemployment benefits, and any other income.
  5. Expense information: Document your monthly expenses, such as rent, utilities, and childcare costs. This helps determine your financial need.
  6. Signature: Sign and date the form at the bottom. This certifies that the information you provided is true and complete.
  7. Submission: Submit the completed form to your local Medicaid office. You can do this in person, by mail, or sometimes online, depending on your location.

After submitting the form, you may need to provide additional documentation or attend an interview. Stay in contact with your local Medicaid office to ensure your application is processed smoothly.