4622: Worksheet for Determining Support (Revision 2018-10)
Michigan · Michigan Treasury · Used for tax years 2024, 2025, 2026
Michigan Form 4622 is a worksheet for determining financial support when your individual income tax return indicates you were claimed as someone else’s dependent. It records savings withdrawals, loans, household and personal expenses, and support received from others to help revi
Who files this form
This worksheet is for a filer whose Michigan income tax return indicates that someone else claimed them as a dependent, but whose total household resources did not include that person's support as gifts, expenses paid on their behalf, or other nontaxable income.
The worksheet accompanies a Request for Information. Check whether you are or are not a dependent, and complete the worksheet. If you dispute being a dependent, you must provide supporting documentation.
What you'll need
Provide your name, tax year, and full Social Security number. Return a copy of the Request for Information with the completed worksheet and required documents.
Depending on the amounts you report, include:
- A bank statement for savings withdrawals used to pay expenses.
- A loan agreement and/or a notarized statement from the person you borrowed from. Also enter the lender's name and address.
- A property tax statement if you owned your home, or a lease agreement if you rented.
- Tuition statements for education expenses.
If you claim you are not a dependent, the form requires:
- A financial aid application showing that your income is the only income used to determine financial aid eligibility.
- Health insurance information for the parent or qualified relative who claimed you, showing that you are not a dependent on their health insurance plan.
- A copy of your federal return.
How to file
Complete the worksheet and check either I AM a dependent or I AM NOT a dependent.
Report savings withdrawals, borrowed money, household expenses, your expenses, and support received from others on the applicable lines.
Return the completed worksheet and required documentation, along with a copy of the Request for Information, to the address noted in the letter. Keep a copy for your records.
Common mistakes
- Sending only a written statement when disputing dependent status. Written statements without supporting documentation will not be accepted.
- Leaving out the Request for Information. Include a copy with your worksheet and documentation.
- Counting rent-included expenses again. Lines 4 and 5 cover utilities and repairs not included in the rent reported on line 3c.
- Including excluded costs on line 6. Do not include mortgage interest, real estate taxes, or insurance there.
- Including medical or dental costs covered by insurance. Line 11 is for expenses not paid for or reimbursed by insurance.
- Not keeping a copy. The form directs you to keep a copy for your records.
Questions people ask
How much support does the form say a claimed dependent must receive from others?
The form says another person or persons must have provided more than 50 percent of your financial support during the year.
What happens if I confirm that I am a dependent?
Report the support you received. That amount will be added to total household resources on your property tax credit and/or home heating credit claim. The credits will then be recalculated and processed.
What if I was claimed as a dependent but say I am not one?
Check I AM NOT a dependent, complete the worksheet, and return it with the required documentation and a copy of the enclosed letter. A written statement alone will not be accepted.
Do I report support from welfare agencies?
Yes. Enter amounts provided by state, local, and other welfare societies or agencies on line 16. Add lines 15 and 16 to calculate the support received on line 17.
Where can I get help?
Call 517-636-4486 or visit www.michigan.gov/incometax.