What information should I provide to my agency to make the RITA calculation possible under the one-year process?

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§ 302-17.50 What information should I provide to my agency to make the RITA calculation possible under the one-year process?

You should provide the information required in the “Statement of Income and Tax Filing Status” as follows:

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Statement of Income and Tax Filing Status - One-Year Process

The following information, which my agency will use in calculating the RITA to which I am entitled, was shown on the Federal, state, and local income tax returns that I (or my spouse and I) filed for the 20 ____ tax year (this should be the most recent year in which you filed).
Federal Filing status:
☐ Single ☐ Head of Household
☐ Married Filing Jointly ☐ Qualifying Widow(er)
☐ Married Filing Separately
(a) Taxable income as shown on my (our) IRS Form 1040: $ ____
Significant future changes in income (including cost of living raises) that you can foresee for the current year:
__Increase __Decrease __No Foreseeable Changes
(b) Approximate net amount of this (these) change(s): $ ____
(c) Predicted taxable income for the current tax year 20 ____ = Sum of (a) and (b) = $ ____
State you are moving out of: ________
Filing status for the state moving out of: ________
Marginal Tax Rate: ____%
State you are moving into: ________
Filing status for the state moving into: ________
Marginal Tax Rate: ____%
Locality you are moving out of: ________
Filing status for the locality moving out of: ________
Marginal Tax Rate: ____%
Locality you are moving into: ____
Filing status for the locality moving into: ________
Marginal Tax Rate: ____%
The above information is true and accurate to the best of my (our) knowledge. I (we) agree to notify the appropriate agency official of any significant changes to the above so that appropriate adjustments to the RITA can be made.
__________________ __________
Employee's signature Date
__________________ __________
Spouse's signature (if filing jointly) Date


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