Equivalent Active 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Employee (Y)                                                                                                     New Full Time                                                                                                           FEDERAL IDENTIFICATION NUMBER                 CITY                                                           ADDRESS                                                          NAME OF ELIGIBLE COMPANY                      Annual Report                                                    Form 9261A
07/2023                                                                                                                                                                                                                                                                                                     Title                                                                               Signature of authorized officer

                                                                                                                                           MAILING ADDRESS: DONNA DUBE, RHODE ISLAND DIVISION OF TAXATION, FORMS, CREDITS & INCENTIVES SECTION, ONE CAPITOL HILL, PROVIDENCE, RI 02908

                                                                                                                                                                                                                                                                                                                                                                                                                               Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete .
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Employee Name

                                                                                                                                                                                                                                                                                         ABOUT THIS RETURN?                                         MAY THE DIVISION CONTACT YOUR PREPARER                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                STATE

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               * * *      ALL INFORMATION IS REQUIRED FOR ALL EMPLOYEES      * * *

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Jobs Development Act Rate Reduction - Annual Report  

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Social Security Number
                                                                                                                                                                                                                                                                                      YES
                                                                                                                                                                                                                                                                                                                                                                                                Date
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          ZIP CODE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   State of Rhode Island 
                                                                                                                                                                                                                                                                                                            NO                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Due September 1, 202
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Division of 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     If additional space is needed, please attach a separate sheet(s) with the additional information.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Taxation 
                                                                                                                                                                                                                                                                                                            Telephone Number                                                                Signature of preparer                                                                                                                                                                                                                                                                                                              Date of Hire                                                                                                                                                                                                                                                                                                                                                                                                        3

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Termination Date 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                (if applicable)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                JULY 1, 202                                TOTAL PAYROLL   DATE                         BASE EMPLOYMENT                  LEVEL                           BASE EMPLOYMENT                  

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  2 JUNE 30, 202

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                as of 7/1/202                                                                           Hourly Wage 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   3                                                                                                                                                                                                              3

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Per Week Within                                                              Hours Worked 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Rhode Island
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          DATE             QUALIFYING                   ACTIVE EMPLOYEES                 TIME EQUIVALENT                 NUMBER OF FULL  

                                                                                                                                                                                                                                                                                                                                                                                            Date
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Insurance 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Health 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Y/N

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Benefits                                                                     Pension 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Y/N

          Instructions for Form 9261A - Jobs Development Act Rate Reduction Annual Report
Complete all informational lines at the top of the form, includ-     This Annual Report is being sent as a guide.  A fillable version 
ing name, address, city, state and ZIP code, and                     can be found online.  You may either complete the fillable ver-
federal identification number.                                       sion on-line, print it out and send it in; send the report as an 
                                                                     Excel spreadsheet or a txt (csv) file (be sure to send in the file 
In addition, please provide your base employment level and           format) via CD-ROM or DVD; or you may send the file via 
base employment date, your active employment level and               secure ftp.  In order to file via secure ftp, send an email to 
qualifying date, and your total payroll for the period of July 1,    Tax.Credits@tax.ri.gov.  Y ou will then be sent an email con-
2022 through June 30,  202.3                                         taining the secure link.   
In the first column, please indicate with a yes if this is the first Regardless of format, the report must contain all required 
year the employee qualifies as a new full time equivalent            information as shown on the Annual Report form. 
active employee. 
                                                                     A fillable version of this form is available online at: 
In the space provided, or on a separate sheet(s), provide the        https://tax.ri.gov/forms/other-forms under Reporting Forms. 

following information for each full-time equivalent active           All Annual Reports, regardless of format, shall be submitted to 
employee: name,  full social security number, date of hire,          Donna Dube by either: 
termination date (if employee no longer works for the compa-
ny, enter date the employee left), hourly wage as of July 1,         mail:     Rhode Island Division of Taxation 
2023 and the  number of hours worked per week within the                       Forms, Credits & Incentives Section 
State of Rhode Island by the employee.                                         One Capitol Hill 
                                                                               Providence, RI 02908 
In the last two columns, please indicate with either a yes or 
                                                                               Attn: Donna Dube 
no, whether or not health insurance benefits and/or pension 
                                                                     or email: Tax.Credits@tax.ri.gov 
benefits are offered to the employee.   
All information is required for all employees.                       Pursuant to RIGL 42-64.5-8, all eligible companies qualifying for a rate reduc-
                                                                     tion pursuant to § 42-64.5-3 shall file an annual report with the tax administra-
                                                                     tor containing each full-time equivalent active employee's information as 
This form must be filed by September 1, annually.                    deemed necessary by the tax administrator.
                                                       Important Definitions: 
"Base employment" means, except as otherwise provided in § 42-64.5-7, the aggregate number of full-time equivalent active employees 
employed within the State by an eligible company and its eligible subsidiaries on July 1, 1994, or at the election of the eligible company, on an 
alternative date as provided by § 42-64.5-5. In the case of a manufacturing company which is ruined by disaster, the aggregate number of full-
time equivalent active employees employed at the destroyed facility would be zero, under which circumstance the base employment date shall 
be July 1 of the calendar year in which the disaster occurred. Only one base employment period can be elected for purposes of a rate reduction 
by an eligible company. 
“Full-time Equivalent Active Employee - Eligible Company Qualifying for the Jobs Development Act Rate Reduction on or after July 1, 
2009” means any employee of an eligible company who: 
1) Works a minimum of thirty (30) hours per week within the state;
2) Earns healthcare insurance benefits
3) Earns retirement benefits
4) Earns no less than two hundred fifty percent (250%) of the hourly minimum wage prescribed by Rhode Island law at the later of:
        a:  The time the employee was first treated as a full-time equivalent active employee during a tax year that the 
        eligible company qualified for a rate reduction pursuant to section 42-64.5-3; or 
        b:  The time the employee first earned at least two hundred fifty percent (250%) of the hourly minimum wage 
        prescribed by Rhode Island law as an employee of the eligible company. 
“Full-time Equivalent Active Employee - Existing Eligible Company Qualifying for the Jobs Development Act Rate Reduction prior to 
July 1, 2009” meansnewany     employee who replaces an existing “full-time equivalent active employee” of an eligible company and who: 
1) Works a minimum of thirty (30) hours per week within the state;
2) Earns healthcare insurance benefits
3) Earns retirement benefits
4) Earns no less than one hundred fifty percent (150%) of the hourly minimum wage prescribed by Rhode Island law at the later of:
        a:  The time the employee was first treated as a full-time equivalent active employee during a tax year that the 
        eligible company qualified for a rate reduction pursuant to RIGL § 42-64.5-3; or 
        b:  The time the employee first earned at least one hundred fifty percent (150%) of the hourly minimum wage 
        prescribed by Rhode Island law as an employee of the eligible company. 
“Health Insurance Benefits” means any health insurance plan offered by the eligible company to its employees regardless of whether or not 
the employee takes advantage of the plan. 
“Retirement Benefits” means any retirement plan offered by the eligible company to its employees regardless of whether or not the employee 
takes advantage of the plan.  This could be in the form of a SEP, a SIMPLE,  a 401K plan, a profit sharing plan, a defined benefit plan, a deferred 
compensation plan or any qualified employer plan. 
“Qualifying Date” means the date the eligible company qualified for the Jobs Development Act Rate Reduction under RIGL § 42-64.5. 
 NOTE:  An employee who is required to complete a reasonable probationary period to be eligible for healthcare or retirement  
        benefits is deemed to have “earned” those benefits from day one of their employment.