Fillable T2201-fill-18e Disability Tax Credit Certificate

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T2201-fill-18e Disability Tax Credit Certificate

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6729
Protected B
when completed
Disability Tax Credit Certificate
Use this form to apply for the disability tax credit (DTC). The Canada Revenue Agency (CRA) will use this information to make a decision on
eligibility for the DTC. See the "General information" on page 6 for more information.
Step 1 – Fill out and sign the sections of Part A that apply to you.
Step 2 – Ask a medical practitioner to fill out and certify Part B.
Step 3 – Send the form to the CRA.
Part A – To be filled out by the taxpayer
Section 1 – Information about the person with the disability
First name and initial Last name Social insurance number
Mailing address (Apt No. – Street No. Street name, PO Box, RR)
City Province or territory Postal code
Date
of birth:
Year Month Day
Section 2 – Information about the person claiming the disability amount (if different from above)
First name and initial Last name Social insurance number
The person with the disability is:
my spouse/common-law partner my dependant (specify):
Answer the following questions for all of the years that you are claiming the disability amount for the person with the disability.
1. Does the person with the disability live with you?
Yes No
If yes, for which year(s)?
2. If you answered no to Question 1, does the person with the disability regularly and consistently depend
on you for one or more of the basic necessities of life such as food, shelter, or clothing?
Yes No
If yes, for which year(s)?
Give details about the regular and consistent support you provide for food, shelter or clothing to the person with the disability (if you need
more space, attach a separate sheet of paper). We may ask you to provide receipts or other documents to support your request.
Section 3 – Adjust your income tax and benefit return
Once eligibility is approved, the CRA can adjust your returns for all applicable years to include the disability amount for yourself or
your dependant under the age of 18. For more information, see Guide RC4064, Disability-Related Information.
Yes, I want the CRA to adjust my returns, if possible. No, I do not want an adjustment.
Section 4 – Authorization
As the person with the disability or their legal representative, I authorize the following actions:
•
Medical practitioner(s) can give information to the CRA from their medical records or discuss the information on this form.
•
The CRA can adjust my returns, as applicable, if the "Yes" box has been ticked in Section 3.
Sign here:
Telephone Year Month Day
Personal information is collected under the Income Tax Act to administer tax, benefits, and related programs. It may also be used for any purpose related to the enforcement of the Act
such as audit, compliance and collection activities. It may be shared or verified with other federal, provincial, territorial or foreign government institutions to the extent authorized by law.
Failure to provide this information may result in interest payable, penalties or other actions. The social insurance number is collected under section 237 of the Act and is used for
identification purposes. Under the Privacy Act, individuals have the right to access, or request correction of, their personal information, or to file a complaint with the Privacy
Commissioner of Canada regarding the handling of their personal information. Refer to Personal Information Bank CRA PPU 218 at canada.ca/cra-info-source
.
T2201 E (18)
(Ce formulaire est disponible en français.)
Clear Data
Validate and Print Part A
Protected B when completed
Patient's name:
Part B – Must be filled out by the medical practitioner
Step 1 – Fill out only the section(s) on pages 2 to 4 that apply to your patient. Each category states which medical practitioner(s) can certify
the information in this part.
Note
Whether filling out this form for a child or an adult, assess your patient compared to someone of similar age with no impairment.
Step 2 – Fill out the "Effects of impairment", "Duration", and "Certification" sections on page 5. If more information is needed,
the Canada Revenue Agency (CRA) may contact you.
Eligibility for the DTC is based on the effects of the impairment, not on the medical condition itself. For definitions and examples of impairments
that may qualify for the DTC, see Guide RC4064, Disability-Related Information. For more information, go to canada.ca/disability-tax-credit
.
2
Vision – Medical doctor, nurse practitioner, or optometrist
Your patient is considered blind if, even with the use of corrective lenses or medication, their vision meets any of the following criteria:
•
The visual acuity in both eyes is 20/200 (6/60) or less, with the Snellen Chart (or an equivalent).
•
The greatest diameter of the field of vision in both eyes is 20 degrees or less.
1. Is your patient blind, as described above?
Yes No
If yes, when did your patient become blind (this is not necessarily the year of the diagnosis, as is often
the case with progressive diseases)?
Year
2. What is your patient's visual acuity after correction?
Right eye Left eye
3. What is your patient's visual field after correction (in degrees if possible)?
Right eye Left eye
Speaking – Medical doctor, nurse practitioner, or speech-language pathologist
Your patient is considered markedly restricted in speaking if, even with appropriate therapy, medication, and devices, they meet both of
the following criteria:
•
They are unable or take an inordinate amount of time to speak so as to be understood by another person familiar with the patient,
in a quiet setting.
•
This is the case all or substantially all of the time (at least 90% of the time).
Is your patient markedly restricted in speaking, as described above?
Yes No
If yes, when did your patient's restriction in speaking become a marked restriction (this is not necessarily
the year of the diagnosis, as is often the case with progressive diseases)?
Year
Hearing – Medical doctor, nurse practitioner, or audiologist
Your patient is considered markedly restricted in hearing if, even with appropriate devices, they meet both of the following criteria:
•
They are unable or take an inordinate amount of time to hear so as to understand another person familiar with the patient,
in a quiet setting.
•
This is the case all or substantially all of the time (at least 90% of the time).
Is your patient markedly restricted in hearing, as described above?
Yes No
If yes, when did your patient's restriction in hearing become a marked restriction (this is not necessarily
the year of the diagnosis, as is often the case with progressive diseases)?
Year
Walking – Medical doctor, nurse practitioner, occupational therapist, or physiotherapist
Your patient is considered markedly restricted in walking if, even with appropriate therapy, medication, and devices, they meet both of
the following criteria:
•
They are unable or take an inordinate amount of time to walk.
•
This is the case all or substantially all of the time (at least 90% of the time).
Is your patient markedly restricted in walking, as described above?
Yes No
If yes, when did your patient's restriction in walking become a marked restriction (this is not necessarily
the year of the diagnosis, as is often the case with progressive diseases)?
Year
Clear Data
Protected B when completed
Patient's name:
Eliminating (bowel or bladder functions) – Medical doctor or nurse practitioner
Your patient is considered markedly restricted in eliminating if, even with appropriate therapy, medication, and devices, they meet both of
the following criteria:
•
They are unable or take an inordinate amount of time to personally manage bowel or bladder functions.
•
This is the case all or substantially all of the time (at least 90% of the time).
Is your patient markedly restricted in eliminating, as described above?
Yes No
If yes, when did your patient's restriction in eliminating become a marked restriction (this is not necessarily
the year of the diagnosis, as is often the case with progressive diseases)?
Year
Feeding – Medical doctor, nurse practitioner, or occupational therapist
Your patient is considered markedly restricted in feeding if, even with appropriate therapy, medication, and devices, they meet both of
the following criteria:
•
They are unable or take an inordinate amount of time to feed themselves.
•
This is the case all or substantially all of the time (at least 90% of the time).
Feeding yourself does not include identifying, finding, shopping for, or obtaining food.
Feeding yourself does include preparing food, except when the time spent is related to a dietary restriction or regime, even when
the restriction or regime is needed due to an illness or medical condition.
Is your patient markedly restricted in feeding, as described above?
Yes No
If yes, when did your patient's restriction in feeding become a marked restriction (this is not necessarily
the year of the diagnosis, as is often the case with progressive diseases)?
Year
Dressing – Medical doctor, nurse practitioner, or occupational therapist
Your patient is considered markedly restricted in dressing if, even with appropriate therapy, medication, and devices, they meet both of
the following criteria:
•
They are unable or take an inordinate amount of time to dress themselves.
•
This is the case all or substantially all of the time (at least 90% of the time).
Dressing yourself does not include identifying, finding, shopping for, or obtaining clothing.
Is your patient markedly restricted in dressing, as described above?
Yes No
If yes, when did your patient's restriction in dressing become a marked restriction (this is not necessarily
the year of the diagnosis, as is often the case with progressive diseases)?
Year
Mental functions necessary for everyday life – Medical doctor, nurse practitioner, or psychologist
Your patient is considered markedly restricted in performing the mental functions necessary for everyday life (described below) if, even
with appropriate therapy, medication, and devices (for example, memory aids and adaptive aids), they meet both of the following criteria:
•
They are unable or take an inordinate amount of time to perform these functions by themselves.
•
This is the case all or substantially all of the time (at least 90% of the time).
Mental functions necessary for everyday life include:
•
adaptive functioning (for example, abilities related to self-care, health and safety, abilities to initiate and respond to social interactions,
and common, simple transactions)
•
memory (for example, the ability to remember simple instructions, basic personal information such as name and address, or material
of importance and interest)
•
problem-solving, goal-setting, and judgment taken together (for example, the ability to solve problems, set and keep goals, and make
the appropriate decisions and judgments)
Note
A restriction in problem-solving, goal-setting, or judgment that markedly restricts adaptive functioning, all or substantially all of the time
(at least 90% of the time), would qualify.
Is your patient markedly restricted in performing the mental functions necessary for everyday life, as
described above?
Yes No
If yes, when did your patient's restriction in performing the mental functions necessary for everyday life
become a marked restriction (this is not necessarily the year of the diagnosis, as is often the case with
progressive diseases)?
Year
3
Clear Data
Protected B when completed
Patient's name:
Life-sustaining therapy – Medical doctor or nurse practitioner
Life-sustaining therapy for your patient must meet both of the following criteria:
•
Your patient needs this therapy to support a vital function, even if this therapy has eased the symptoms.
•
Your patient needs this therapy at least 3 times per week, for an average of at least 14 hours per week.
The 14-hour per week requirement
Include only the time your patient must dedicate to the therapy – that is, the patient has to take time away from normal, everyday activities
to receive it.
If a child cannot do the activities related to the therapy because of their age, include the time spent by the child's primary caregivers to do
and supervise these activities.
Do not include the time a portable or implanted device takes to deliver the therapy, the time spent on activities related to dietary
restrictions or regimes (such as carbohydrate calculation) or exercising (even when these activities are a factor in determining the daily
dosage of medication), travel time to receive therapy, medical appointments (other than appointments where the therapy is received),
shopping for medication, or recuperation after therapy.
1. Does your patient need this therapy to support a vital function?
Yes No
2. Does your patient need this therapy at least 3 times per week?
Yes No
3. Does this therapy take an average of at least 14 hours per week?
Yes No
If yes, when did your patient's therapy begin to meet the above criteria (this is not necessarily the year of
the diagnosis, as is often the case with progressive diseases)?
Year
It is mandatory that you describe how the therapy meets the criteria as stated 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 practitioner, or occupational therapist
Note: An occupational therapist can only certify limitations for walking, feeding and dressing.
Answer all the following questions to certify the cumulative effect of your patient's significant restrictions.
1. Even with appropriate therapy, medication, and devices, does your patient have a significant restriction, that
is not quite a marked restriction, in two or more basic activities of daily living or in vision and one or more of
the basic activities of daily living?
Yes No
If yes, tick at least two of the following, as they apply to your patient:
vision speaking hearing walking
eliminating (bowel or bladder functions) feeding dressing mental functions necessary for everyday life
Note
You cannot include the time spent on life-sustaining therapy.
2. Do these restrictions exist together, all or substantially all of the time (at least 90% of the time)?
Yes No
3. Is the cumulative effect of these significant restrictions equivalent to being markedly restricted in one basic
activity of daily living?
Yes No
4. When did the cumulative effect described above begin (this is not necessarily the year of the diagnosis, as is
often the case with progressive diseases)?
Year
4
Clear Data
Protected B when completed
Patient's name:
Effects of impairment – Mandatory
The effects of your patient's impairment must be those which, even with therapy and the use of appropriate devices and medication, cause
your patient to be restricted all or substantially all of the time (at least 90% of the time).
Note
Working, housekeeping, managing a bank account, and social or recreational activities are not considered basic activities of daily living.
Basic activities of daily living are limited to walking, speaking, hearing, dressing, feeding, eliminating (bowel or bladder functions), and
mental functions necessary for everyday life.
It is mandatory that you describe the effects of your patient's impairment on his or her ability to do each of the basic activities of daily living
that you indicated are or were markedly or significantly restricted. If you need more space, use a separate sheet of paper, sign it and attach it
to this form. You may include copies of medical reports, diagnostic tests, and any other medical information, if needed.
Duration – Mandatory
Has your patient's impairment lasted, or is it expected to last, for a continuous period of at least 12 months?
For deceased patients, was the impairment expected to last for a continuous period of at least 12 months?
Yes No
If yes, has the impairment improved, or is it likely to improve, to such an extent that the patient
would no longer be blind, markedly restricted, in need of life-sustaining therapy, or have
the equivalent of a marked restriction due to the cumulative effect of significant restrictions?
Unsure Yes No
If yes, enter the year that the improvement occurred or may be expected to occur.
Year
Certification – Mandatory
1. For which year(s) have you been the attending medical practitioner for your patient?
2. Do you have medical information on file supporting the restriction(s) for all the year(s) you certified
on this form?
Yes No
Tick the box that applies to you:
Medical doctor Nurse practitioner Optometrist Occupational therapist
Audiologist Physiotherapist Psychologist Speech-language pathologist
As a medical practitioner, I certify that the information given in Part B of this form is correct and complete. I understand that this information
will be used by the CRA to make a decision if my patient is eligible for the DTC.
Sign here:
It is a serious offence to make a false statement.
Name (print)
Date:
Year Month Day Telephone
Address
5
Clear Data
Validate and Print Part B
General information
What is the DTC?
The disability tax credit (DTC) is a non-refundable tax credit that
helps persons with disabilities or their supporting persons reduce the
amount of income tax they may have to pay. The disability amount
may be claimed once the person with a disability is eligible for the
DTC. This amount includes a supplement for persons under 18 years
of age at the end of the year. Being eligible for this credit may open
the door to other programs.
For more information, go to canada.ca/disability-tax-credit
or see
Guide RC4064, Disability-Related Information.
Are you eligible?
You are eligible for the DTC only if we approve your application. On
this form, a medical practitioner has to indicate and certify that you
have a severe and prolonged impairment and must describe its
effects.
To find out if you may be eligible for the DTC, fill out
the self-assessment questionnaire in Guide RC4064,
Disability-Related Information. If we have already told you that you
are eligible, do not send another form unless the previous period of
approval has ended or if we tell you that we need one. You should
tell us if your medical condition improves.
If you receive Canada Pension Plan or Quebec Pension Plan
disability benefits, workers' compensation benefits, or other types of
disability or insurance benefits, it does not necessarily mean you are
eligible for the DTC. These programs have other purposes and
different criteria, such as an individual's inability to work.
You can send the form at any time during the year. By sending
your form before you file your income tax and benefit return, you may
prevent a delay in your assessment. We will review your form before
we assess your return. Keep a copy for your records.
Fees – You are responsible for any fees that the medical practitioner
charges to fill out this form or to give us more information. However,
you may be able to claim these fees as medical expenses on
line 330 or line 331 of your income tax and benefit return.
What happens after you send Form T2201?
After we receive Form T2201, we will review your application.
We will then send you a notice of determination to inform you of
our decision. Our decision is based on the information given by the
medical practitioner. If your application is denied, we will explain why
on the notice of determination. For more information, see
Guide RC4064, Disability-Related Information, or go
to canada.ca/disability-tax-credit.
Where do you send this form?
Send your form to the Disability Tax Credit Unit of your tax centre.
Use the chart below to get the address.
If your tax services office is
located in:
Send your correspondence
to the following address:
Alberta, British Columbia,
Hamilton, Kitchener/Waterloo,
London, Manitoba, Northwest
Territories, Regina, Saskatoon,
Thunder Bay, Windsor, or Yukon
Winnipeg Tax Centre
Post Office Box 14000
Station Main
Winnipeg MB R3C 3M2
Barrie, Belleville, Kingston,
Montréal, New Brunswick,
Newfoundland and Labrador,
Nova Scotia, Nunavut, Ottawa,
Outaouais, Peterborough,
St. Catharines, Prince Edward
Island, Sherbrooke, Sudbury, or
Toronto
Sudbury Tax Centre
Post Office Box 20000,
Station A
Sudbury ON P3A 5C1
Chicoutimi, Laval,
Montérégie-Rive-Sud, Québec,
Rimouski, Rouyn-Noranda, or
Trois-Rivières
Jonquière Tax Centre
2251 René-Lévesque Blvd
Jonquière QC G7S 5J2
Deemed residents, non-residents,
and new or returning residents of
Canada
Sudbury Tax Centre
Post Office Box 20000,
Station A
Sudbury ON P3A 5C1
CANADA
or
Winnipeg Tax Centre
Post Office Box 14000
Station Main
Winnipeg MB R3C 3M2
CANADA
What if you need help?
If you need more information after reading this form, go
to canada.ca/disability-tax-credit or call 1-800-959-8281.
Forms and publications
To get our forms and publications, go to canada.ca/cra-forms or
call 1-800-959-8281.
6
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T2201-fill-18e Disability Tax Credit Certificate

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Completed 3 March 2020

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