disability tax credit certificate note€¦ · disability tax credit certificate 6729 step 1–...

continue on next pageT2201 – 1

DISABILITY TAX CREDIT CERTIFICATE

6729

Step 1 – Fil l out and sign the sections of Part A that apply to you.

Step 2 – Ask a medical practi t ioner to fi l l out and cert i fy Part B.

Use this form to apply for the disabil i ty tax credit (DTC). The CanadaRevenue Agency (CRA) wil l use this information to make a decision oneligibi l i ty for the DTC. See the "General information" on page 25 [6] formore information.

Step 3 – Send the form to the CRA.

Protected B when completedT2201 E (17)

NOTE: In this form, the text inserted between square brackets representsthe regular print information.

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Social insurance number

Part A – To be filled out by the taxpayerSection 1 – Information about the person with the disability

Last name

First name and init ial

Mail ing address (Apt No. – Street No. Street name, PO Box, RR)

City Province or terr i tory Postal code

Date of birthYear Month Day


Section 2 – Information about the person claimingthe disability amount ( i f dif ferent from page 2 [above] )First name and init ial Last name

Social insurance number

The person with the disabil i ty is:

my spouse/common-law partner

Answer the fol lowing questions for all of the years that you are claimingthe disabil i ty amount for the person with the disabil i ty.

Does the person with the disabil i ty l ive with you?1. NoYes

my dependant (specify):

I f yes, for which year(s)?

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If you answered no to Question 1, does theperson with the disabil i ty regularly andconsistently depend on you for one or moreof the basic necessit ies of l i fe such as food,shelter, or clothing?

2.

NoYes

If yes, for which year(s)?

Give detai ls about the regular and consistent support you provide forfood, shelter or clothing to the person with the disabil i ty ( i f you needmore space, attach a separate sheet of paper). We may ask you toprovide receipts or other documents to support your request.


Section 3 – Adjust your income tax and benefit returnOnce eligibi l i ty is approved, the CRA can adjust your returns for al lapplicable years to include the disabil i ty amount for yourself oryour dependant under the age of 18 . For more information, see GuideRC4064, "Disabil i ty-Related Information".

Yes, I want the CRA to adjust my returns, i f possible.

No, I do not want an adjustment.

Section 4 – AuthorizationAs the person with the disability or their legal representative ,I authorize the fol lowing actions:

Sign here:

Area code Year Month DayTelephone number

–

Medical practi t ioner(s) can give information to the CRA from theirmedical records or discuss the information on this form.The CRA can adjust my returns, as applicable, i f the "Yes" box hasbeen ticked in section 3.

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Part B – Must be filled out by the medical practitionerStep 1 –

Step 2 – Fil l out the "Effects of impairment", "Duration", and"Certification" sections on pages 20 to 23 [5]. I f moreinformation is needed, the Canada Revenue Agency (CRA)may contact you.

NoteWhether f i l l ing out this form for a child or an adult, assessyour patient compared to someone of similar age with noimpairment.

Eligibi l i ty for the DTC is based on the effects of the impairment, not onthe medical condit ion itself. For definit ions and examples of impairmentsthat may quali fy for the DTC, see Guide RC4064, "Disabil i ty-RelatedInformation". For more information, goto canada.ca/disability-tax-credit .

Patient's name

Fil l out only the section(s) on pages 7 to 20 [2 to 4] that applyto your patient. Each category states which medicalpracti t ioner(s) can cert i fy the information in this part.


Vision – Medical doctor, nurse practi t ioner, or optometrist

Your patient is considered blind i f , even with the use of correctivelenses or medication:

the visual acuity in both eyes is 20/200 (6/60) or less, with the SnellenChart (or an equivalent); or

the greatest diameter of the field of vision in both eyes is 20 degreesor less.

Is your patient blind , as described above? NoYes

If yes , when did your patient become blind, (this is notnecessari ly the year of the diagnosis, as is often thecase with progressive diseases)?

Year

1.

What is your patient 's visual acuityafter correction?

Left eyeRight eye

What is your patient 's visual f ieldafter correction ( in degrees if possible)?

2.

3. Left eyeRight eye

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Speaking – Medical doctor, nurse practi t ioner, orspeech-language pathologist

Your patient is considered markedly restricted in speaking if, even withappropriate therapy, medication, and devices:

they are unable or take an inordinate amount of time to speak so asto be understood by another person famil iar with the patient, in a quietsett ing; and

this is the case all or substantially all of the time (at least 90% ofthe time).

Is your patient markedly restricted in speaking, asdescribed above? NoYes

If yes , when did your patient 's restr ict ion in speakingbecome a marked restr ict ion (this is not necessari lythe year of the diagnosis, as is often the case withprogressive diseases)?

Year


Hearing – Medical doctor, nurse practi t ioner, or audiologist

Your patient is considered markedly restricted in hearing if, even withappropriate devices:

they are unable or take an inordinate amount of time to hear so asto understand another person famil iar with the patient, in a quietsett ing; and


Is your patient markedly restricted in hearing, asdescribed above? NoYes

If yes , when did your patient 's restr ict ion in hearingbecome a marked restr ict ion (this is not necessari lythe year of the diagnosis, as is often the case withprogressive diseases)?

Year

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Walking – Medical doctor, nurse practi t ioner, occupationaltherapist, or physiotherapistYour patient is considered markedly restricted in walking if, even withappropriate therapy, medication, and devices:

they are unable or take an inordinate amount of timeto walk; and


Is your patient markedly restricted in walking, asdescribed above? NoYes

If yes , when did your patient 's restr ict ion in walkingbecome a marked restr ict ion (this is not necessari lythe year of the diagnosis, as is often the case withprogressive diseases)?

Year


Eliminating (bowel or bladder functions) – Medical doctor ornurse practi t ioner

Your patient is considered markedly restricted in el iminating if, evenwith appropriate therapy, medication, and devices:

they are unable or take an inordinate amount of time to personallymanage bowel or bladder functions; and


Is your patient markedly restricted in el iminating, asdescribed above? NoYes

If yes , when did your patient 's restr ict ion in eliminatingbecome a marked restr ict ion (this is not necessari ly theyear of the diagnosis, as is often the case withprogressive diseases)?

Year

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Feeding – Medical doctor, nurse practi t ioner, or occupationaltherapist

Your patient is considered markedly restricted in feeding if, even withappropriate therapy, medication, and devices:

they are unable or take an inordinate amount of time to feedthemselves; and


Feeding yourself does not include identifying, f inding, shopping for, orobtaining food.

Feeding yourself does include preparing food, except when the timespent is related to a dietary restr ict ion or regime, even when therestr ict ion or regime is needed due to an il lness or medical condit ion.Is your patient markedly restricted in feeding, asdescribed above? NoYes


If yes , when did your patient 's restr ict ion in feedingbecome a marked restr ict ion (this is not necessari lythe year of the diagnosis, as it is often the case withprogressive diseases)?

Year

Dressing – Medical doctor, nurse practi t ioner, or occupationaltherapistYour patient is considered markedly restricted in dressing if, even withappropriate therapy, medication, and devices:

they are unable or take an inordinate amount of time to dressthemselves; and


Dressing yourself does not include identifying, f inding, shopping for, orobtaining clothing.Is your patient markedly restricted in dressing, asdescribed above? NoYes

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If yes , when did your patient 's restr ict ion in dressingbecome a marked restr ict ion (this is not necessari lythe year of the diagnosis, as is often the case withprogressive diseases)?

Year

Your patient is considered markedly restricted in performing the mentalfunctions necessary for everyday li fe (described below) if, even withappropriate therapy, medication, and devices (for example, memory aidsand adaptive aids):

they are unable or take an inordinate amount of time to performthese functions by themselves; and


Mental functions necessary for everyday life – Medical doctor,nurse practi t ioner, or psychologist


Mental functions necessary for everyday li fe include:

adaptive functioning (for example, abil i t ies related to self-care, healthand safety, abil i t ies to init iate and respond to social interactions, andcommon, simple transactions);memory (for example, the abil i ty to remember simple instructions,basic personal information such as name and address, or material ofimportance and interest); andproblem-solving, goal-sett ing, and judgment taken together (forexample, the abil i ty to solve problems, set and keep goals, and makethe appropriate decisions and judgments).

A restr ict ion in problem-solving, goal-sett ing, or judgment thatmarkedly restr icts adaptive functioning, al l or substantial ly al l of thetime (at least 90% of the time), would quali fy.

Note

Is your patient markedly restricted in performing themental functions necessary for everyday li fe, asdescribed above? NoYes

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If yes , when did your patient 's restr ict ion in performingthe mental functions necessary for everyday li febecome a marked restr ict ion (this is not necessari ly theyear of the diagnosis, as is often the case withprogressive diseases)?

Year

Life-sustaining therapy – Medical doctor or nurse practi t ioner

Life-sustaining therapy for your patient must meet both of thefol lowing criteria:

your patient needs this therapy to support a vital function, even if thistherapy has eased the symptoms; and

your patient needs this therapy at least 3 times per week, for anaverage of at least 14 hours per week.

Include only the time your patient must dedicate to the therapy – that is,the patient has to take time away from normal, everyday activit ies toreceive it.

The 14-hour per week requirement


If a child cannot do the activit ies related to the therapy because of theirage, include the time spent by the child's primary caregivers to do andsupervise these activit ies.

Do not include the time a portable or implanted device takes to deliverthe therapy, the time spent on activit ies related to dietary restr ict ions orregimes (such as carbohydrate calculation) or exercising (even whenthese activit ies are a factor in determining the daily dosage ofmedication), travel t ime to receive therapy, medical appointments (otherthan appointments where the therapy is received), shopping formedication, or recuperation after therapy.

Does your patient need this therapyto support a vital function? NoYes

1.

Does your patient need this therapyat least 3 times per week? NoYes

2.

Does this therapy take an average ofat least 14 hours per week? NoYes

3.

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If yes , when did your patient 's restr ict ion in performingthe mental functions necessary for everyday li febecome a marked restr ict ion (this is not necessari ly theyear of the diagnosis, as is often the case withprogressive diseases)?

Year

It is mandatory that you describe how the therapy meets the criteria asstated above. If you need more space, use a separate sheet of paper,sign it and attach it to this form.


Cumulative effect of significant restrictions – Medical doctor,nurse practi t ioner, or occupational therapist

Note: An occupational therapist can only cert i fy l imitat ion for walking,feeding and dressing.Answer all the fol lowing questions to cert i fy the cumulative effect of yourpatient 's signif icant restr ict ions.

Even with appropriate therapy, medication, anddevices, does your patient have a significantrestriction , that is not quite a marked restriction ,in two or more basic activit ies of daily l iving or invision and one or more of the basic activit ies ofdaily l iving? NoYes

1.

If yes, t ick at least two of the fol lowing, as they apply to your patient.

vision speaking

walking dressing

elimination (bowel or bladder functions)

hearing

feeding

mental functions necessary for everyday li fe

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Do these restr ict ions exist together, all orsubstantially all of the time (at least 90% ofthe time)? NoYes

2.

You cannot include the time spent on li fe-sustaining therapy.Note

Is the cumulative effect of these signif icantrestr ict ions equivalent to being markedly restrictedin one basic activity of daily l iving? NoYes

3.

When did the cumulative effect described abovebegin (this is not necessari ly the year of thediagnosis, as is often the case with progressivediseases)?

4.

Year

Effects of impairment – MandatoryThe effects of your patient 's impairment must be those which, even withtherapy and the use of appropriate devices and medication, cause yourpatient to be restr icted all or substantially all of the time (at least 90%of the time).


Working, housekeeping, managing a bank account, and social orrecreational activit ies are not considered basic activit ies of dailyl iving. Basic activit ies of daily l iving are l imited to walking, speaking,hearing, dressing, feeding, el iminating (bowel or bladder functions),and mental functions necessary for everyday li fe.

Note

I t is mandatory that you describe the effects of your patient 's impairmenton his or her abil i ty to do each of the basic activit ies of daily l ivingthat you indicated are or were markedly or signif icantly restr icted. If youneed more space, use a separate sheet of paper, sign it and attach itto this form. You may include copies of medical reports, diagnostic tests,and any other medical information, i f needed.

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Duration – Mandatory

If yes , enter the year that the improvement occurred ormay be expected to occur.

Has your patient 's impairment lasted, or is it expectedto last, for a continuous period of at least 12 months?For deceased patients, was the impairment expectedto last for a continuous period of at least 12 months? NoYes

Year

If yes , has the impairment improved, or isit l ikely to improve, to such an extent thatthe patient would no longer be blind,markedly restr icted, in need ofl i fe-sustaining therapy, or have theequivalent of a marked restr ict ion due tothe cumulative effect of signif icantrestr ict ions? NoYesUnsure


Certification – Mandatory

Tick the box that applies to you:

Speech-language pathologist

Medical doctor Nurse practi t ioner Optometrist

Physiotherapist

For which year(s) have you been the attendingmedical practi t ioner for this patient?

1.

Do you have medical information on fi le support ingthe restr ict ion(s) for al l the year(s) you cert i f ied onthis form? NoYes

2.

As a medical practitioner , I cert i fy that the information given in Part Bof this form is correct and complete. I understand that this informationwil l be used by the CRA to make a decision if my patient is el igible forthe DTC.

Psychologist

AudiologistOccupationaltherapist

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Sign here

I t is a serious offence to make a false statement.

Address

City Province/Terri tory Postal code

Area code Year Month DayTelephone number

–

Name (print)


The disabil i ty tax credit (DTC) is a non-refundable tax credit that helpspersons with disabil i t ies or their support ing persons reduce the amountof income tax they may have to pay. The disabil i ty amount may beclaimed once the person with a disabil i ty is el igible for the DTC.This amount includes a supplement for persons under 18 years of ageat the end of the year. Being eligible for this credit may open the doorto other programs.

What is the DTC?

For more information, go to canada.ca/disability-tax-credit or seeGuide RC4064, "Disabil i ty-Related Information".

You are eligible for the DTC only if we approve your application. Onthis form, a medical practi t ioner has to indicate and cert i fy that youhave a severe and prolonged impairment and must describe its effects.

Are you eligible?

To find out if you may be eligible for the DTC, fi l l out theself-assessment questionnaire in Guide RC4064, "Disabil i ty-RelatedInformation". If we have already told you that you are eligible, do notsend another form unless the previous period of approval has ended orif we tel l you that we need one. You should tell us if your medicalcondition improves .

General Information

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If you receive Canada Pension Plan or Quebec Pension Plan disabil i tybenefits, workers' compensation benefits, or other types of disabil i ty orinsurance benefits, i t does not necessari ly mean you are eligible for theDTC. These programs have other purposes and different cri teria, such asan individual 's inabil i ty to work.You can send the form at any time during the year . By sending yourform before you fi le your income tax and benefit return, you may preventa delay in your assessment. We wil l review your form before we assessyour return. Keep a copy for your records.

Fees – You are responsible for any fees that the medical practi t ionercharges to fi l l out this form or to give us more information. However,you may be able to claim these fees as medical expenses on line 330or l ine 331 of your income tax and benefit return.What happens after you send Form T2201?After we receive Form T2201, we wil l review your application. We wil lthen send you a notice of determination to inform you of our decision.Our decision is based on the information given by the medicalpracti t ioner. If your application is denied, we wil l explain why on thenotice of determination. For more information, see Guide RC4064,"Disabil i ty-Related Information", or goto canada.ca/disability-tax-credit .


Where do you send this form?Send your form to the Disabil i ty Tax Credit Unit of your tax centre. Usethe chart below to get the address.

If your tax services office islocated in:

Alberta, Brit ish Columbia,Hamilton, Kitchener/Waterloo,London, Manitoba, NorthwestTerri tories, Regina, Saskatoon,Thunder Bay, Windsor, or Yukon

Send your correspondenceto the following address:

Winnipeg Tax Centre66 Stapon RoadWinnipeg MB R3C 3M2

Barrie, Bellevi l le, Kingston,Montréal, New Brunswick,Newfoundland and Labrador, NovaScotia, Nunavut, Ottawa,Outaouais, Peterborough, St.Catharines, Prince Edward Island,Sherbrooke, Sudbury, TorontoCentre, Toronto East, TorontoNorth, or Toronto West

Sudbury Tax CentrePost Off ice Box 20000,Station ASudbury ON P3A 5C1

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Chicoutimi, Laval,Montérégie-Rive-Sud, Québec,Rimouski, Rouyn-Noranda, orTrois-Rivières

Jonquière Tax Centre2251 René-Lévesque BlvdJonquière QC G7S 5J2

Send your correspondenceto the following address:

Deemed residents, non-residents,and new or returning residents ofCanada

Sudbury Tax CentrePost Off ice Box 20000,Station ASudbury ON P3A 5C1CANADAorWinnipeg Tax Centre66 Stapon RoadWinnipeg MB R3C 3M2CANADA

If your tax services office islocated in:

T2201 – 29

If you need more information after reading this form, goto canada.ca/disability-tax-credit or call 1-800-959-8281 .

What if you need help?

To get our forms and publications, go to canada.ca/cra-forms orcall 1-800-959-8281 .

Forms and publications

Personal information is collected under the "Income Tax Act" toadminister tax, benefits, and related programs. It may also be used forany purpose related to the administrat ion or enforcement of the Act suchas audit, compliance and the payment of debts owed to the Crown. Itmay be shared or verif ied with other federal, provincial/ terr i torialgovernment insti tut ions to the extent authorized by law. Failure toprovide this information may result in interest payable, penalt ies or otheractions. Under the "Privacy Act", individuals have the right to accesstheir personal information and request correction if there are errors oromissions. Refer to Info Source at canada.ca/cra-info-source , PersonalInformation Bank CRA PPU 218.

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