ANSWER THE FOLLOWING QUESTION SO YOU KNOW HOW TO COMPLETE THE FORM CORRECTLY. *

Legal Full Name (same name used on your tax returns): *

Primary Applicant Date of Birth (DOB) *

After the SETC refund is filed with the Treasury you will be provided a link to access the STATUS of your SETC refund (typically within 4 - 6 weeks of filing), Your Date of Birth is required in order to create the account to check on the status of your refund and why we are asking for this piece of information. Only the Primary Applicant's DOB is required.

Phone *

Email *

Enter Address: *

Spouse Details: *

Dependents: *

The dates must be between 4/1/20 -12/31/20

The dates must be between 4/1/21 -9/30/21

This program was created to give a credit to self employed individuals for the days that they took off of work due to COVID related issues, this may include contracting COVID, Quarantining, or taking time off to care for someone with COVID. Please list the 10 days in '20 (anytime between 4/1/20 – 12/31/20, not including Sat/Sun or Federal holidays) and Please list the 10 days in '21 (anytime between 4/1/21 – 9/30/21, not including Sat/Sun or Federal Holidays).