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Research Corporation of the University of Hawaii (RCUH)
Affidavit of Dependency for Tax Purposes
Please complete this form if:
1. Your Domestic Partner qualifies as a dependent for Federal and State tax purposes OR
2. Your Civil Union Partner qualifies as a dependent for Federal tax purposes.
We, ____________________________, (the “Employee”) and, ____________________________,
(the “Domestic Partner/Civil Union Partner”), being duly sworn, under penalty of perjury say:
1. For the current taxable year of the Employee, over half of the Domestic Partner/Civil Union
Partner’s support is received from the Employee.
2. For the current taxable year of the Employee, the Domestic Partner/Civil Union Partner has as
his or her principal place of abode the home of the Employee.
3. For the current taxable year of the Employee, the Domestic Partner/Civil Union Partner is a
member of the Employee’s household.
4. The Domestic Partner/Civil Union Partner is a citizen of _____________________________.
(Country)
5. The Domestic Partner/Civil Union Partner is currently a “resident” of
___________________________________.
(Country)
EXPLANATION: Under Section 152 of the Internal Revenue Code, as it pertains to health benefit plans, an
individual may qualify as a “dependent” of an employee for tax purposes if: (a) the employee provides over
one-half of the individual’s support for the employee’s taxable year, (b) the individual has the same principal
place of abode as the employee for the entire taxable year, (c) the individual is a member of the employee’s
household for the entire taxable year, and (d) the individual is a citizen or national of the UNITED STATES
or a resident of the UNITED STATES or a country contiguous to the UNITED STATES
If the answer to Question 4 was “United States”, skip to Question 8. If not, continue on to Question 5:
EXPLANATION: Under Section 7701(b) of the Internal Revenue Code, an alien is treated as a “resident” of
the United States for tax purposes is such individual is lawfully admitted for permanent residence in the
United States or meets the “substantial presence” test. To meet the “substantial presence” test, an individual
must generally: (a) be present in the United States for at least 31 days during the current calendar year, and
(b) the sum of the number of days on which the individual was present in the United States during the
current calendar year and the 2 preceding calendar years (when multiplied by the applicable multipliers)
equals or exceeds 183. The applicable multipliers are: 1 for the current year, 1/3 for the 1
st
preceding year,
and 1/6 for the 2
nd
preceding year. The following individuals are not “residents” of the United States for tax
purposes and, thus, can never be “dependents” for tax purposes:
A foreign government-related individual temporarily present in the United States on a diplomatic or
consular VISA, a full-time employee of an International organization, or a family member of such
person.
A teacher or trainee temporarily present in the United States.
A student temporarily in the United States.
A professional athlete temporarily in the United States to compete in a charitable sports event.
