Otc 994 Form PDF Details

Are you a health care provider who is trying to learn more about the Otc 994 form? The Otc 994 form, also known as the Drug Overuse and Abuse Monitoring (DOAM) form, is an important document in many medical settings. It provides information regarding controlled substances—including opioids and other drugs used for pain relief—and serves as a tool to monitor patient use of these medications over time. In this blog post, we'll discuss what the Otc 994 form is and how it's used in healthcare settings. We'll also explore why it's so important for treating certain kinds of chronic illnesses or conditions that may lead to abuse or misuse of medication if not properly monitored and managed.

QuestionAnswer
Form NameOtc 994 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names Resident Individual - Income Tax Forms and Instructions

Form Preview Example

OTC 994

Revised 11-2021

State of Oklahoma

Application for Property Valuation

Limitation and Additional Homestead Exemption

Return to County Assessor by March 15

Tax Year

2022

Applicants Social Security Number (Optional unless requested by assessor)

 

 

Co-applicants Social Security Number (Optional unless requested by assessor)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Name and Initial (if joint application, give first names and initials of both)

 

Last Name

 

Applicants Date of Birth

 

 

 

 

 

 

 

 

Present Home Address (number and street, apartment/condo number, or rural route)

 

 

 

 

Co-applicants Date of Birth (if joint application)

 

 

 

 

 

 

 

 

City and State

Zip Code

Phone Number

Email Address

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART I - LEGAL DESCRIPTION - Address/Legal Description of Homestead Property:

 

 

School

 

 

 

 

 

 

 

 

District

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Was applicant domiciled on the homestead property January 1st of the current year?

 

Yes

No

B. Was the applicant age 65 or over as of January 1st of the current year?

 

 

Yes

No

C. Was the applicant age 65 or over as of March 15 of current year or previously qualified for additional homestead exemption? Yes....

No

 

 

 

 

 

 

 

 

 

PART II - Enter Total Gross Income/Assistance received by ALL members or your household in the previous calendar year.

1.

Enter total wages, salaries, fees, commissions, bonuses, tips, dividends, royalties,

 

(Round to nearest whole dollar)

 

Gross Household Annual Income

 

income from partnerships, estates and trusts, and gains from the sale or exchange

 

 

 

 

 

 

of property (taxable and nontaxable)

1.

 

00

2.

Enter gross rental, business and farm income

2.

 

00

3.

Enter total interest income received

3.

 

00

4.

Other (Specify) ________________________________

 

00

5.

All other household income (Include all other income received from each of the

 

 

 

 

sources listed below:

 

 

 

 

a. Social Security payments (Total including Medicare)

5.a.

 

00

 

b. Railroad Retirement benefits

b.

 

00

 

c. Other pensions and annuities

c.

 

00

 

 

 

 

 

 

d. Workmen’s compensation/Loss of time insurance

d.

 

00

 

 

 

 

 

 

e. Support money

e.

 

00

 

 

 

 

 

 

f. Alimony

f.

 

00

 

g. Public assistance (Including housing assistance)

 

00

 

h. Gross Income from out-of-state sources

h.

 

00

 

i. Unemployment

i.

 

00

 

 

 

 

 

 

j. Earned income credit received in calendar year

j.

 

00

 

 

 

 

 

 

k. Total dependents income

k.

 

00

 

 

 

 

 

 

l. Wages paid in cash

l.

 

00

 

m. Other (Specify) ______________________________________________

 

 

 

 

00

6.

Total Gross Household Income (Add line 1 thru 5 m)

 

00

 

 

 

 

 

SIGNATURE - I understand that if the applicant is not age 65 or over as of March 15th, the application for additional homestead exemption must be filed each year.

Owner (or Agent) Signature: ________________________________________________________

Date: _________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART III - Valuation Limitation - (To Be Completed by the County Assessor)

 

Approved

Denied

The records of

 

 

 

 

 

County indicate this property value is $

 

 

 

as of

January 1,

 

 

.

Parcel ID Number or Account Number:

 

 

 

 

 

 

 

Valuation Limitation Authorized by

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART IV - Additional Homestead - (To Be Completed by the County Assessor)

Approved

Denied

 

 

 

 

 

 

 

1. Enter the amount of gross household income from Part I, line 6 above

 

1.

 

 

00

2. Additional exemption authorized by:

Date

Amount 2.

 

 

 

 

 

00

 

 

 

 

 

 

 

 

Application for Property Valuation Limitation and Additional Homestead Exemption - Page 2

Instructions

Eligibility Requirements:

(1)Head-of-household must be age 65 or over as of January 1st of current year when filing for property valuation limitation, or March 15 when filing for additional homestead.

(2)Head-of-household must be an owner of and occupy the homestead property on January 1.

(3)Valuation Limitation: Gross household income (collective income of all persons living in the homestead residence) must not exceed the amount determined by the United States Department of Housing and Urban Development (H.U.D.) as the qualification income for your individual county of residence. These qualification income levels may be different for each county and are subject to change each year. Contact your county assessor for the exact qual- ification income.

(4)Maximum household income qualification for the Additional Homestead Exemption is $25,000.00 for all counties.

(5)If age 65 or over and have been granted an Additional Homestead Exemption no application is required unless your gross household income exceeded $25,000.00.

Part I. Identification of Real Property Affected by Application

The physical address or legal description should be entered here to properly identify the homestead residence.

The applicant is to sign and date the application.

Part II. Gross Household Income

Income from all sources of each individual who lives on the homesteaded property is to be included in this section.

(See definition for “gross household income” listed below.) The applicant may be required to provide sufficient proof to

substantiate the validity of the income statement.

Part III. Valuation Limitation - (To Be Completed by the County Assessor)

Valuation Limitation: A limitation in valuation for homestead property for persons 65 years of age or over as of Janu- ary 1 with gross household income not exceeding the H.U.D. qualifying income for the preceding year.

You must be age 65 or over as of January 1st to qualify. (Reference 68 O.S. §2890.1)

Part IV. Additional Homestead - (To Be Completed by County Assessor)

The application for the Additional Homestead Exemption and Senior Valuation Limitation shall be made each year before March 15 or thirty (30) days after the receipt of a change in valuation notice, whichever is later. The application must be made to the county assessor of the county where the homestead property is located. If the applicant is six- ty-five (65) years of age or more as of March 15th and who has previously qualified for the exemption or limitation, no annual application is required. If the gross household income for any calendar year exceeds the qualification amount specified, the applicant shall notify the county assessor, and the exemption will not be allowed for the applicable year. (Ref. 68 O.S. Section 2890; 2890.1)

Definitions

“Head-of-household” is defined in 68 O.S. §2890 as “a person who as owner or joint owner maintains a home and furnish- es support for the home, furnishings, and other material necessities.”

“Gross household income” is defined in 68 O.S. §2890 as “the gross amount of income of every type, regardless of the source, received by all persons occupying the same household, whether such income was taxable or nontaxable for fed- eral or state income tax purposes, including pensions, annuities, federal Social Security, unemployment payments, public

assistance payments, alimony, support money, workers’ compensation, loss-of-time insurance payments, capital gains and any other type of income received; and excluding gifts. The term “gross household income” shall not include any veterans’

disability compensation payments.

Part II, III, IV of this form is to be completed by the county assessor.

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Otc 994 Form conclusion process outlined (step 1)

2. After the last section is complete, you're ready to insert the required details in Enter total interest income, sources listed below a Social, d Workmens compensationLoss of, e Support money e, f Alimony f g Public assistance, i Unemployment i, j Earned income credit received in, k Total dependents income k, l Wages paid in cash l m Other, SIGNATURE I understand that if, County indicate this property, as of, Approved, Denied, and January so you're able to progress to the 3rd stage.

County indicate this property, d Workmens compensationLoss of, and SIGNATURE  I understand that if of Otc 994 Form

Regarding County indicate this property and d Workmens compensationLoss of, ensure you get them right in this section. Both of these are surely the most important ones in this form.

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