Form 307 - Credit For Employers Of Individuals With Disabilities - 2001 Page 2
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2*VA307A101888*
Schedule 307A (Form 307)
Qualifying Employees With Disabilities
Page ____ of ____
Attach additional schedules as
Receiving Rehabilitative Services
needed
Name as it appears on your tax return
FEIN - OR - Social Security Number
Virginia Account Number
Column A
Column B
Column C
Column D
Column E
Column F
Agency
No. of Years
Employee name and
Date hired
Certifying
Qualifying
Tax Credit
claimed for
social security number
Rehabilitative
Wages
(See
employee-
Services
instructions)
(Enter 1 or 2)
1
2
3
4
5
6
7
8
9
10
11
Total from additional page(s)
12
Grand Total (Add lines 1 through 11 and enter on Form 307, Part II, Line 1.)
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Parent category: Financial