N-172: Claim for Tax Exemption by Person with Impaired Sight or Hearing or by Totally Disabled Person and Physician’s Certification (Revision 2020)
Hawaii · Hawaii DoTax · Used for tax years 2024, 2025, 2026
Hawaii Form N-172 claims benefits under the General Excise Tax and/or Income Tax Laws for people who meet the state's definitions of blind, deaf, or totally disabled. It records the claimant's information and includes certification of the impairment or disability by a qualified m
Who files this form
Form N-172 is used to claim benefits under Hawaii’s General Excise Tax and/or Income Tax laws by:
- An individual who is blind, deaf, or totally disabled as defined in section 235-1, Hawaii Revised Statutes.
- A corporation, partnership, or LLC whose shareholders, partners, or members are all individuals in those categories.
The disability or impairment must be certified on page 2 by an appropriate qualified professional. The form refers to separate instructions for the legal definitions, but those instructions were not provided here.
What you'll need
Have the following information ready to complete the form:
- Individual claim: Name, Social Security number, address, and applicable disability category.
- Business entity claim: Entity name, federal employer identification number, address, and applicable disability categories for its shareholders, partners, or members.
- General Excise Tax claim: General Excise Hawaii Tax ID number, doing-business-as name, business address, business activity, and the individual’s and spouse’s ownership percentages.
- Professional certification: The appropriate examination or disability report on page 2, including the requested diagnosis, findings, dates, and signed certification. The certifying professional must also provide licensing and contact information.
If the eye examination section is completed, the blind applicant must also sign the authorization to release information at the bottom of page 2.
Common mistakes
- Completing more than one medical section. Complete only one section on page 2, even if the applicant has multiple disabilities.
- Leaving the medical section or certification incomplete. The form warns that it may be rejected if the appropriate section and certification are not fully completed.
- Missing the release authorization for an eye examination. If Section A is completed, sign the authorization at the bottom of page 2.
- Using an unauthorized signer for a business entity. A corporation, partnership, or LLC must have an officer, partner, member, or duly authorized agent sign the form.
- Certifying an applicant who does not meet the definition. The professional is instructed to sign the certification only if the applicant meets the applicable State definition.
Questions people ask
Who can complete the eye or hearing examination?
The eye examination must be done by a qualified ophthalmologist or optometrist. The hearing examination must be done by a qualified otolaryngologist, described as a Board-certified ear, nose, and throat specialist, or a licensed audiologist.
What if I am sending this form in response to an adjustment letter or collection notice?
Check the box near the top of the form indicating that you are submitting it in response to an adjustment letter or collection notice.
Does “spouse” include a civil union partner?
Yes. The form states that references to “married” and “spouse” also mean “in a civil union” and “civil union partner,” respectively.
What does the blind applicant’s release authorization cover?
It authorizes the Department of Taxation to share the applicant’s name, Social Security number, address, eye-condition information, and legal-blindness certification with Ho’opono Services for the Blind Branch. The stated purposes are to maintain a State register of legally blind persons and inform the applicant about available services. If the applicant signs with an X, two witnesses must sign.