OR-PS: Form OR-PS, Care Provider Statement (Revision 2025-12)
Oregon · Oregon DOR · Used for tax years 2024, 2025, 2026
Form OR-PS is Oregon’s Care Provider Statement for documenting care provided to a taxpayer’s dependents. It reports payments received from the taxpayer and third parties, payment details, and provider information, with supporting records of charges, payments, and care hours.
Who files this form
Complete Form OR-PS if you provided care for the dependents of the taxpayers named on the form.
What you'll need
Attach these documents to the completed form:
- A detailed year-end summary for each dependent listed in Part 2. Include amounts paid by the taxpayer or others, who made each payment, and the dates you received payments. Also show individual charges for care, other services, other costs, or late fees, and any refunds or discounts.
- The total hours per month and the typical days and times you provided care.
- A copy of the front and back of your driver license or government-issued ID, if you are an individual operating outside of a facility.
How to file
- Complete Part 1 with the letter ID, tax year, taxpayer and provider information, and the address where care was provided.
- In Part 2, list the dependents and amounts received for their care during that tax year. Report taxpayer payments and third-party payments separately, and complete the totals.
- Complete Part 3 about payments, receipts, your relationship to the dependents, and care provided to other clients’ dependents.
- Complete the provider declaration in Part 4, including your signature, phone number, and date. Attach the required documents.
Return the original form and documents to the taxpayers. Or, if you choose, send the originals to:
Oregon Department of Revenue
Attn: Return Review Team
PO Box 14999
Salem OR 97309-0090
If you send the originals directly to the department, give the taxpayers a copy of the completed form.
Common mistakes
- Use UPPERCASE letters and blue or black ink.
- Print the form at actual size, 100%.
- Don’t submit photocopies of the form or use staples. The required ID attachment is a copy.
- Don’t leave out the required supporting documents.
- The provider declaration states that the reported income is taxable. If you filed a return without including it, your return may be adjusted. If you didn’t file a return, a Notice of Assessment may be issued for failing to file.
Questions people ask
What counts as a third-party payment?
A payment from a source other than the taxpayer. Examples include payments from the Department of Human Services or individuals not listed in the taxpayer information above Part 2.
Do all providers need to attach an ID copy?
The form requires a copy of the front and back of a driver license or government-issued ID if you are an individual operating outside of a facility.
What if I didn’t give a receipt for every payment?
Select “No” for the receipt question in Part 3 and explain why you did not provide a receipt for every payment.
What if I am related to the dependents?
Select “Yes” for the relationship question in Part 3 and explain your relationship.
Can I send the form directly to the Department of Revenue?
Yes. You may send the original form and required documents to the Return Review Team at the address printed on the form. Give the taxpayers a copy of the completed form.