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Appendices

Appendix 1

List of Members1,2

Sherri Torjman (co-chair), Vice-President of the Caledon Institute of Social Policy, a national social policy research organization.

Robert Brown (co-chair), tax policy and economic consultant, a former Chair of Price Waterhouse and former Clifford Clark Visiting Economist — a key advisory position in the Department of Finance — from 1998 until 2001.

Brian J. Arnold, tax lawyer with Goodmans LLP and Professor Emeritus at the University of Western Ontario.

Michael Bach, Executive Vice-President of the Canadian Association for Community Living, a national advocacy organization for persons with intellectual disabilities.

Laurie Beachell, National Coordinator, Council of Canadians with Disabilities, a national advocacy association of persons with disabilities.

Harry Beatty, lawyer and consultant specializing in disability law and policy.

Gail Beck, M.D., C.M., F.R.C.P.C., Director, Youth Inpatient Psychiatry of the

Royal Ottawa Hospital.

Gary Birch, Executive Director, Neil Squire Foundation, a national non-profit organization providing education, technology and career development for people with physical disabilities.

Lembi Buchanan, public relations consultant and Chair of the Coalition for Disability Tax Credit Reform.

Karen R. Cohen, Ph.D., C. Psych., Associate Executive Director and Registrar Accreditation, Canadian Psychological Association.

Yude M. Henteleff, C.M., Q.C., Senior Counsel to the Winnipeg law firm Pitblado and past President and current Honourary Solicitor of the Learning Disabilities Association of Canada.

Guy Lord, Senior Partner of the law firm Osler, Hoskin & Harcourt LLP.

1 Dr. Claude A. Renaud, former Associate Secretary General and Chief Medical Officer with the Canadian Medical Association, was an original member of the Committee.

2 Members represent themselves as individuals and not the organizations with which they are associated.

Appendix 2

List of Submissions

To the Sub-Committee of the House of Commons Standing Committee on Human Resources Development and the Status of Persons with Disabilities

Adèle Furrie Consulting Inc.

Alzheimer Society of Canada

ARCH: A Legal Resource Centre for Persons with Disabilities

Canadian Alliance on Mental Illness and Mental Health

Canadian Association for Community Living

Canadian Hard of Hearing Association

Canadian Medical Association

Canadian Mental Health Association

Canadian National Institute for the Blind

Canadian Psychiatric Association

Canadian Psychological Association

Confédération des organismes de personnes handicapées du Québec

Council of Canadians with Disabilities

Multiple Sclerosis Society of Canada

Learning Disabilities Association of Canada

Lembi Buchanan

Schizophrenia Society of Canada

To the Technical Advisory Committee on Tax Measures for Persons with Disabilities

Organizations

ARCH: A Legal Resource Centre for Persons with Disabilities

Autism Society of PEI

British Columbia Coalition of People with Disabilities

Canadian AIDS Society

Canadian Association of the Deaf

Canadian Association of Occupational Therapists

Canadian Association of Speech-Language Pathologists and Audiologists

Canadian Cystic Fibrosis Foundation

Canadian Diabetes Association

Canadian Hearing Society

Canadian Labour Congress

Canadian Life and Health Insurance Association Inc.

Canadian National Institute for the Blind

Canadian Paraplegic Association

Canadian Physiotherapy Association

Coalition for Disability Tax Credit (DTC) Reform

Diabetes Advocacy

Disability Services (University of Manitoba)

Epilepsy Canada

Mississauga Homes for Independent Living

Multiple Sclerosis Society of Canada

National Federation of the Blind

NWT Council of Persons with Disabilities

Office of the Commissioner of Review Tribunals (CPP/OAS)

Ontario Brain Injury Association

Opportunities through Rehabilitation and Work Society

Planned Lifetime Advocacy Network

Prince Edward Island Association for Community Living

Richmond Hill Fibromyalgia and Chronic Fatigue Syndrome Wellness Support Group

Schizophrenia Society of Canada

Voice for Hearing Impaired Children Ontario (Health Committee)

Individuals

Monique Beaudoin

Mark Bernier

Kelvin Blais

Carl Broughton

Angela Falkowska

Carolyn Forbes

Marla Hayes

Coleen Howey

Margaret Kraak

Anne Kramer

Penny Leclair

Rosemary Leslie

John Macdonald

Ellie McCaig

Lori Montcalm

Charlie Morgan

Lauri Morris

Kennedy O’Brien

Eileen Reppenhagen

Hans Rupprecht

Gord Shapley

Chris Stark

Libby Thaw

Beryl Williams

M. Kathleen Williams

Appendix 3

Research and Expert Consultation

In order to obtain background information and input for its review, the Committee undertook an extensive program of research and expert consultation on the important issues identified in its mandate. These activities, carried out in the initial year of the Committee’s term, enabled us to benefit from work done by others in the field; new information, data and thoughts developed in the research process; and important input from experts and knowledgeable organizations.

We undertook the research process by commissioning studies on four major areas of interest. The research papers developed in this process focused upon economic principles and positive options for the reform of disability tax measures; the role of federal tax measures in advancing the inclusion of persons with disabilities in Canadian society; disability-related federal tax measures supporting education, training and employment; and tax issues with respect to Aboriginal Canadians with disabilities. The research papers were prepared by leading experts in their respective fields, most of whom then met with the Committee to discuss their reports and recommendations.

Officials from the Department of Finance and the Canada Revenue Agency were very helpful in providing relevant data and documentation requested by the Committee, and in supporting us in our work. Committee members themselves prepared discussion papers on a wide range of issues, including such topics as the design of new eligibility criteria for various tax provisions, the refundability of tax credits, administrative and communication issues relating to current tax provisions, the legal interpretation of terms, an overview of decisions arising from relevant court cases and dispute resolution procedures around current tax measures.

The Committee also consulted with selected experts when we felt it necessary to explore certain issues in more depth. We met, for example, with a professor from the University of Ottawa to review the distinction between ‘physical and mental functions’ and ‘activities of daily living’ in order to create a conceptually rigorous eligibility screen for the disability tax credit. The Committee also sought opinions from seven independent specialists in mental function on possible reforms of the disability tax credit.

An informal discussion was held with representatives from RBC Financial on their accommodation practices in hiring and retaining employees with disabilities. We also met with representatives from the Canadian Labour Congress to discuss various work-related tax provisions.

We consulted with a Montreal-based lawyer who specializes in mediation and alternative dispute resolution. Members of the Committee also met informally with representatives of a number of organizations representing different segments of the disability community to discuss issues and concerns, and to review alternative proposals for reform.

Finally, representatives of the Committee met in Quebec City with three researchers at Laval University who were carrying out a study on behalf of l’Office des personnes handicapées du Québec on disability-related income security programs and tax provisions. Two of these individuals subsequently made a presentation to our Committee.

The research and expert consultations carried out by the Committee provided the basis for discussions on the issues that we addressed. We are grateful for this invaluable support, and we hope that this work will provide not only a foundation for our recommendations in this report, but also a useful bank of information for further studies and consideration.

Appendix 4

Description of Federal Personal Income Tax Measures for Persons with Disabilities and Caregivers

Disability Tax Credit

The disability tax credit (DTC) provides tax relief to individuals who, due to the effects of a severe and prolonged mental or physical impairment, are markedly restricted in their ability to perform a basic activity of daily living as certified by a qualified health practitioner, or would be markedly restricted were it not for extensive therapy to sustain a vital function. Individuals are markedly restricted if, all or substantially all of the time, even with therapy or the use of appropriate devices and medication, they are blind or unable to perform a basic activity of daily living or require an inordinate amount of time to perform the activity. The basic activities of daily living are: walking; feeding or dressing oneself; perceiving, thinking and remembering; speaking; hearing; and eliminating bodily waste.

The DTC recognizes the impact of non-itemizable disability-related costs on an individual’s ability to pay tax. For 2004, the credit is 16 percent of $6,486, which provides a federal tax reduction of up to $1,038. This credit can be transferred to a supporting spouse, parent, grandparent, child, grandchild, brother, sister, aunt, uncle, nephew or niece of the individual. The credit amount is fully indexed to inflation.

DTC Supplement for Children

Families caring for children with severe and prolonged impairments may receive additional tax relief through a supplement to the DTC. This additional tax relief was introduced in the 2000 budget. For 2004, the supplement provides an additional federal tax reduction of up to $605, or 16 percent of $3,784. The $3,784 supplement amount is reduced dollar-for-dollar by the amount of child care expenses or attendant care expenses claimed for tax purposes over $2,216. Both this income threshold and the supplement amount ($3,784) are fully indexed.

Medical Expense Tax Credit

The medical expense tax credit (METC) recognizes the effect of above-average disability-related and medical expenses on an individual’s ability to pay tax. For 2004, the credit equals 16 percent of qualifying expenses in excess of the lesser of $1,813 and 3 percent of net income. The net income threshold is used to determine above-average expenses and it is fully indexed to inflation. There is no upper limit on the amount of eligible expenses that may be claimed.

The list of eligible disability-related and medical expenses is regularly reviewed and expanded in light of new technologies and other disability-specific or medically related items.

Taxpayers may claim the medical expenses that they or their spouses incur. The 2004 budget proposed to allow caregivers to claim more of the medical and disability-related expenses they incur on behalf of dependent relatives. Specifically, for medical expenses paid on behalf of dependent relatives, such as a grandparent, niece or nephew, taxpayers will be able to claim qualifying medical expenses that exceed the lesser of 3 percent of the dependant’s net income and $1,813 (for 2004). The maximum eligible amount that can be claimed on behalf of dependent relatives will be $5,000.

Caregiver Credit

This credit was introduced in the 1998 budget to provide tax relief to individuals providing in-home care for a parent or grandparent 65 years of age or over, or an infirm dependent relative, including an adult child or grandchild, brother, sister, aunt, uncle, niece or nephew. For 2004, the maximum credit is $605 (16 percent of $3,784). The credit is reduced when the dependant’s net income exceeds $12,921 and is fully phased out when the dependant’s net income reaches $16,705.

The caregiver credit amount and the income threshold at which the credit starts to be reduced are fully indexed to inflation.

Infirm Dependant Credit

The infirm dependant credit provides tax relief to individuals providing support to an infirm relative who lives in a separate residence. More specifically, the infirm dependant credit may be claimed by taxpayers supporting a child or grandchild 18 years of age or over, parent, grandparent, brother, sister, aunt, uncle, niece, or nephew, who is dependent due to a mental or physical infirmity. This non-refundable credit has a maximum value of $605 (16 percent of $3,784). The credit can be claimed by a supporting relative when the net income of the dependant is less than $9,152. The credit is reduced when the dependant’s net income exceeds $5,368. This credit amount and the income threshold at which the credit starts to be reduced are fully indexed to inflation.

Disability Supports Deduction

The 2004 budget proposed to replace the attendant care deduction with a broader disability supports deduction that will allow expenses in respect of disability supports (e.g., sign language interpreters and talking textbooks) to be deducted from income if they are incurred for education or employment purposes. As a result, income used to pay for these expenses will not be taxed and will not affect income-tested benefits.

In the case of an employee, the deduction will generally be limited to the lesser of the amounts paid for eligible expenses and the taxpayer’s earned income. A similar limit also applies to students, except that they can claim the deduction against non-earned income, subject to the length of their education program.

The list of expenses eligible for this deduction is specified. The need for some of these supports has to be certified by a medical practitioner.

Individuals need not be eligible for the disability tax credit in order to claim expenses under the disability supports deduction.

Expenses claimed under the disability supports deduction will not be claimable under the medical expense tax credit. Persons who purchase disability supports for purposes other than education or employment will still be able to claim them under the medical expense tax credit.

Other Personal Income Tax Measures

Persons with disabilities or those who care for them benefit from a number of special enhancements to other tax measures.

Home Buyers’ Plan

Persons with disabilities or their relatives may withdraw up to $20,000 from a registered retirement savings plan (RRSP) on a tax-free basis to buy a home that is more accessible for, or better suited for the care of, an individual with a disability, even if the purchaser is not a first-time home buyer. Amounts withdrawn under the Home Buyers’ Plan are required to be repaid to the individual’s RRSP over a period of 15 years.

RRSP/RRIF Rollovers for an Infirm Child

When the annuitant under a RRSP or registered retirement income fund (RRIF) dies, the existing income tax rules generally provide that the value of the RRSP or RRIF is included in computing the deceased’s income for the year of death. However, preferential tax treatment on RRSP or RRIF distributions made after death is provided in certain cases, including where the proceeds are distributed to a child or grandchild who was financially dependent on the deceased annuitant by reason of physical or mental infirmity. In this case, the RRSP or RRIF proceeds may be transferred without tax to the RRSP of the child or may be used to purchase an immediate life annuity.

For 2004, a child or grandchild is considered to be financially dependent if the child’s income for the year preceding the year of death was below $14,035 (this threshold is indexed to inflation). A child with income above this amount may also be considered to be financially dependent, but only if the dependency can be demonstrated based on the particular facts of the situation.

Education Amount

Students with disabilities can claim the full-time education amount ($400 per month) for each month of part-time study at a post-secondary institution or occupational training program certified by the Minister of Human Resources and Skills Development. Eligible students include those who qualify for the DTC and those who cannot reasonably be expected to be enrolled as a full-time student because of a certified mental or physical impairment. In order to meet the part-time requirement, the student’s program must be at least three weeks long and involve at least 12 hours of coursework per month.

Registered Education Savings Plans

Generally, a student has to be registered full time at a qualifying post-secondary institution in order to receive a payment out of a registered education savings plan (RESP) to further his/her post-secondary education. The full-time requirement is waived for students who qualify for the DTC and those who cannot reasonably be expected to be enrolled as a full-time student because of a certified mental or physical impairment.

Lifelong Learning Plans

Under the Lifelong Learning Plan (LLP), participants can access up to $10,000 in a calendar year, and up to a maximum of $20,000, from their registered retirement savings plans (RRSPs). Withdrawals can be made over four consecutive years. These funds are not subject to tax upon withdrawal, as would usually be the case for RRSP withdrawals, and remain untaxed as long as they are repaid to the RRSP over a period of no more than 10 years after the conclusion of studies.

In general, this provision applies only to full-time students. However, persons with disabilities are often unable to attend a post-secondary institution on a full-time basis because of their disability. Consequently, students who qualify for the DTC and those who cannot reasonably be expected to be enrolled as a full-time student because of a certified mental or physical impairment can be enrolled on a part-time basis and participate in the LLP. The program in which the student is enrolled must still be a qualifying educational program that normally requires a student to spend 10 hours or more per week on courses or work in the program.

Child Care Expense Deduction

The child care expense deduction (CCED) recognizes the child care costs incurred by single parents and two-earner families in the course of earning business or employment income, pursuing education or performing research. The child care costs of couples may also be recognized when one or both parents are pursuing education, or when one parent is incapable of caring for children due to a mental or physical infirmity. The infirmity needs to be certified in writing by a medical doctor.

The CCED limit is more generous in respect of children who qualify for the DTC ($10,000), and DTC-eligible children are considered eligible for the purposes of the CCED at any age. For children who do not qualify for the DTC, the limit is $7,000 for children under 7 years of age and $4,000 for other children.

Benefits delivered through the tax system

Refundable Medical Expense Supplement

The supplement improves work incentives for Canadians with disabilities and others with above-average medical expenses by helping to offset the loss of disability-related support when they enter the paid labour force. It provides assistance for above-average disability and medical expenses to low-income working Canadians. For 2004, the maximum supplement is the lesser of $562 and 25 percent of the medical expense tax credit and the disability supports deduction claims. The credit is available to workers with earnings above $2,809. To target assistance to those with low incomes, the credit is reduced by five percent of family income in excess of $21,301. Individuals claiming the refundable supplement may also claim the non-refundable medical expense tax credit and/or the disability supports deduction. This supplement was introduced in the 1997 budget and is fully indexed to inflation.

Child Disability Benefit

In recognition of the special needs of low- and modest-income families with a child with a disability, the 2003 budget introduced the Child Disability Benefit (CDB). The CDB is a supplement of the Canada Child Tax Benefit (CCTB), and is paid for children who meet the eligibility criteria for the DTC. For the July 2004 to June 2005 benefit year, eligible recipients receive their annual CDB entitlement of up to $1,653 per qualified child as part of their monthly CCTB issuance.

The full $1,653 Child Disability Benefit is provided for each eligible child to families with net income below the amount at which the National Child Benefit (NCB) supplement is fully phased out ($35,000 in July 2004 for families having three or fewer children). Beyond that income level, the CDB is reduced based on family income at the same rates as the NCB supplement. For the 2004-2005 benefit year, benefits are reduced by 12.2 percent for one disabled child, 22.7 percent for two disabled children and 32.5 percent for three or more disabled children. Accordingly, the CDB will be reduced to zero as net family income reaches $48,549 for a family caring for one disabled child, $49,564 for a family caring for two disabled children and $50,258 for a family caring for three disabled children. The CDB amount and income thresholds are indexed to inflation.

Appendix 5

The Disability Tax Credit and Horizontal Equity

Assume there are two individuals: Paul who has a severe disability, and Anne who does not. Both Paul and Anne have a total income of $25,000. However, due to his disability, Paul incurs non-itemizable expenses of $6,486, leaving him with less disposable income than Anne.

The principle of horizontal equity would suggest that because Paul incurs non-itemizable disability-related expenses that Anne does not, Paul should pay less tax than Anne. If there were no disability tax credit, this principle would be violated, since Paul would pay the same amount of federal tax as Anne. With the disability tax credit, Paul is able to receive tax relief for the non-itemizable disability-related expenses he incurs, lowering his tax bill relative to Anne’s. Thus, in this example, horizontal equity is achieved.

How the Disability Tax Credit (DTC) Works

 
Anne
Paul
(no DTC)
Paul
(with DTC)
Total income (A))
$25, 000
$25,000
$25,000

Gross federal tax payable (16% of A)

$4,000
$4,000
$4,000

Gross federal tax payable (16% of $8,012)

$1,282
$1,282
$1,282
Less: basic personal credit (16% of $6,486)    
$1,038
Basic federal tax (B)
$I2,718
$2,718
$1,680
After-tax income (A-B)
$22,282
$22,282
$23,320

It should be noted that, in this example, horizontal equity is achieved only for individuals who pay tax at the lowest tax rate (i.e., who have incomes up to $35,000 in 2004). This situation arises because the tax relief offered by the disability tax credit is delivered as a non-refundable credit rather than a deduction. A credit ensures the same amount of tax relief regardless of income while a deduction, by contrast, affords greater tax relief for those with higher incomes.

Appendix 6

T2201, Disability Tax Credit Certificate

T2201 E (03) (Page 1 of 8)

Canada Customs and Revenue Agency

DISABILITY TAX CREDIT CERTIFICATE

Box 6729

Applicants: Read this page for information on the disability amount. See page
2 for instructions on how to apply.

Qualified persons: Read this page for information on the disability amount.
See page 3 for instructions on completing Part B.

If you have a mental or physical impairment that is severe and prolonged, use
this certificate for the following tax purposes:

- to determine if you can claim the disability amount (or to support related
claims). The disability amount is a non-refundable tax credit used to reduce
income tax payable on your return. This amount includes a supplement for
persons under 18 at the end of the year. All or part of this amount may be
transferred to your spouse or common-law partner, or another supporting
person. For details on the disability amount, visit our Web site at
www.ccra.gc.ca/disability, or see guide RC4064, Information Concerning People
With Disabilities.

- to determine eligibility for the Child Disability Benefit, an amount
available under the Canada Child Tax Benefit for a child with a disability
under 18. For details, visit our Web site at www.ccra.gc.ca/benefits or see
pamphlet T4114, Your Canada Child Tax Benefit.

If we have already determined that you are eligible, do not send another form
unless the previous period of approval has ended, or we ask you to send in a
new form. In the meantime, you must tell us if your condition improves.

When are you eligible?

A qualified person must certify on this form that you have a prolonged
impairment, and that the effects of the impairment are such that one of the
following applies (see definitions on this page):

- You are blind, even with the use of corrective lenses or medication.

- You are markedly restricted in any of the following basic activities of
daily living:
- walking
- speaking
- hearing
- dressing
- feeding
- elimination (bowel or bladder functions)
- perceiving, thinking, and remembering

- You need, and must dedicate a certain amount of time specifically for, life-
sustaining therapy.

If you receive Canada Pension Plan or Quebec Pension Plan disability benefits,
workers' compensation benefits, or other types of disability or insurance
benefit s, it does not necessarily mean you are eligible for the disability
amount. These programs have other purposes and different criteria, such as an
individual's inability to work.

The Canada Customs and Revenue Agency must validate this certificate for you
to be eligible for either the disability amount or the Child Disability
Benefit.

Definitions

Qualified person - Qualified persons are medical doctors, optometrists,
audiologists, occupational therapists, psychologists, and speech-language
pathologists. The table on page 2 lists which sections of the form each can
certify.

Prolonged - An impairment is prolonged if it has lasted, or is expected to
last, for a continuous period of at least 12 months.

Markedly restricted - You are markedly restricted if, all or substantially all
the time, you are unable (or it takes you an inordinate amount of time) to
perform a basic activity of daily living, even with therapy (other than life-
sustaining therapy) and the use of appropriate devices and medication.

Life-sustaining therapy - Life-sustaining therapy is therapy you need to
support a vital function. You must also need to dedicate time specifically for
this therapy-at least three times per week, for an average of at least 14
hours per week. Examples of life-sustaining therapy include chest
physiotherapy to help in breathing, or kidney dialysis to filter your blood.
It does not include implanted devices such as a pacemaker, or special programs
of diet, exercise, hygiene, or medication. Eligibility under this criterion
applies only to 2000 and later years.

Note: You are responsible for any fees that the qualified person charges to
complete this form or to give us more information. However, you may be able to
claim these fees as medical expenses on line 330 of your tax return. See your
tax guide for details.

If you want more information or need to contact us, call 1-800-959-8281

Visually impaired persons can get this form in braille, large print, or etext
(computer diskette), or on audio cassette by visiting our Web site at
www.ccra.gc.ca/alternate or by calling 1-800-267-1267 weekdays from 8:15 a.m.
to 5:00 p.m. (Eastern Time).


T2201 E (03) (Page 2 of 8)

Box 6729

Part A - To be completed by the person with the disability (or a
representative)

Step 1: Complete this page (please print). Remember to sign the authorization
area below.

Step 2: Take this form to a qualified person (use the table below to find out
who can certify the section(s) that applies).

Qualified person:
Medical doctors Can certify: all sections (pages 3 and 7)
Optometrists Can certify: vision
Audiologists Can certify: hearing
Occupational therapists Can certify: walking; feeding; dressing
Psychologists Can certify: perceiving, thinking, and remembering
Speech-language pathologists Can certify: speaking

Step 3: Send the completed form to one of the offices listed at the bottom of
this page.

Keep a copy for your records.

When reviewing your claim, we may contact you or a qualified person (named on
this certificate or attached document) who knows about your impairment, if we
need more information.

Information about the person with the disability

First name and initial ^
Last name ^
Maiden name (if applicable) ^
Male or Female ^
Address: Apartment Number - Street Number and name ^
Post Office Box, Rural Route ^
Social insurance number ^

City ^
Province/Territory ^
Postal code ^
Date of birth (Year/Month/Day) ^

Information about the applicant (if different from above)

First name and initial ^
Last name ^
Social insurance number ^

The person with the disability is: my spouse or common-law partner or other
(specify) ^

Does the person with the disability live with you? yes or no ^

If no, does the person with the disability depend on you for one or more of
the basic necessities of life (such as food, shelter, or clothing)? yes or no
^
If yes, provide details: ^
If you need more space, attach a separate sheet of paper.

Authorization

As the person with the disability or their representative, I authorize the
qualified person(s) having relevant clinical records, to provide the
information contained in those records on or with this certificate, to the
Canada Customs and Revenue Agency for the purpose of determining eligibility.

Sign here ^
Telephone (Included area code) ^
Date ((Year/Month/Day) ^

St. John's Tax Centre
Post Office Box 12071 Station A
St. John's NL A1B 3Z1

Summerside Tax Centre
102-275 Pope Road
Summerside PE C1N 5Z7

International Tax Services Office
2204 Walkley Road
Ottawa ON K1A 1A8

Shawinigan-Sud Tax Centre
Post Office Box 3000 Station Main
Shawinigan-Sud QC G9N 7S6

Sudbury Tax Services Office
Post Office Box 20000 Station A
Sudbury ON P3A 5C1

Jonquière Tax Centre
Post Office Box 1900 Station LCD
Jonquière QC G7S 5J1

Winnipeg Tax Centre
Post Office Box 14000 Station Main
Winnipeg MB R3C 3M2

Surrey Tax Centre
9755 King George Highway
Surrey BC V3T 5E1


T2201 E (03) (Page 3 of 8)

Part B - To be completed by qualified persons (see chart on page 2)

You must assess the following two criteria of your patient's impairment
separately:

- Effects of the impairment - they must be such that the patient is blind,
markedly restricted, or needs life-sustaining therapy (as described on pages 3
to 7). Eligibility is based on the effects of your patient's impairment in
addition to the presence of that impairment.

- Duration of the impairment - the impairment must b e prolonged (it must have
lasted, or be expected to last, for a continuous period of at least 12
months).

Step 1: Answer the questions in the section(s) on pages 3 to 7 that apply to
your patient (refer to the table below).

Section:
Vision Page: 3
Walking Page: 4
Speaking Page: 4
Hearing Page: 5
Dressing Page 5
Feeding Page 6
Elimination (bowel or bladder functions) Page 6
Perceiving, thinking, and remembering Page 7
Life-sustaining therapy Page 7

Note:
Whether completing this form for a child or an adult, assess your patient
relative to someone of a similar chronological age who does not have the
marked restriction.

Step 2: Complete the "Effects of impairment," "Duration," and "Certification"
sections on page 8.

Vision
Not applicable ^

Your patient is considered blind if, all or substantially all the time, even
with the use of corrective lenses or medication:

- visual acuity in both eyes is 20/200 (6/60) or less with the Snellen Chart
(or an equivalent); or

- the greatest diameter of the field of vision in both eyes is 20 degrees or
less.

Is your patient blind, as described above? yes or no ^
If yes, when did your patient's blindness begin? Year ^

What is your patient's visual acuity after correction? Right eye or Left eye ^

What is your patient's visual field after correction (in degrees if possible)?
Right eye or Left eye ^


T2201 E (03) (Page 4 of 8)

Part B - (continued)

Walking
Not applicable ^

Your patient is considered markedly restricted in walking if, all or
substantially all the time, he or she:

- is unable to walk even with appropriate therapy, medication, and devices; or
- requires an inordinate amount of time to walk, even with appropriate
therapy, medication, and devices.

Notes:
- Devices for walking include canes, walkers, etc.
- An inordinate amount of time means that walking takes significantly longer
than for an average person who does not have the impairment.

Examples of markedly restricted in walking (examples are not exhaustive):

- Your patient must always rely on a wheelchair, even for short distances
outside of his home.

- Your patient can walk 100 metres (or approximately one city block), but only
by taking a significant amount of time, stopping because of shortness of
breath or because of pain, all or substantially all the time.

Is your patient markedly restricted in walking, as described above? yes or no
^

If yes, when did your patient's marked restriction in walking begin? Year ^

Speaking
Not applicable ^
q
Your patient is considered markedly restricted in speaking if, all or
substantially all the time, he or she:

- is unable to speak so as to be understood by another person familiar with
the patient, in a quiet setting, even with appropriate therapy, medication,
and devices; or

- takes an inordinate amount of time to speak so as to be understood by a
person familiar with the patient, in a quiet setting, even with appropriate
therapy, medication, and devices.

Notes:
- Devices for speaking include tracheoesophageal prostheses, vocal
amplification devices, etc.

- An inordinate amount of time means that speaking so as to be understood
takes significantly longer than for an average person who does not have the
impairment.
l
Examples of markedly restricted in speaking (examples are not exhaustive):

- Your patient must rely on other means of communication, such as sign
language or a symbol board, all or substantially all the time.

- In your office, you must ask your patient to repeat words and sentences
several times, and it takes a significant amount of time for her to make
herself understood.

Is your patient markedly restricted in speaking, as described above? yes or no
^

If yes, when did your patient's marked restriction in speaking begin? Year ^


T2201 E (03) (Page 5 of 8)

Part B - (continued)

Hearing
Not applicable ^

Your patient is considered markedly restricted in hearing if, all or
substantially all the time, he or she:

- is unable to hear so as to understand another person familiar with the
patient, in a quiet setting, even with the use of appropriate devices; or

- takes an inordinate amount of time to hear so as to understand another
person familiar with the patient, in a quiet setting, even with the use of
appropriate devices.

Notes:
- Devices for hearing include hearing aids, cochlear implants, etc.
- An inordinate amount of time means that hearing so as to understand takes
significantly longer than for an average person who does not have the
impairment.

Examples of markedly restricted in hearing (examples are not exhaustive):

- Your patient must rely completely on lip reading or sign language, despite
using a hearing aid, in order to understand a spoken conversation, all or
substantially all the time.

- In your office, you must raise your voice and repeat words and sentences
several times, and it takes a significant amount of time for your patient to
understand you, despite using a hearing aid.

Is your patient markedly restricted in hearing, as described above? yes or no
^

If yes, when did your patient's marked restriction in hearing begin? Year ^

Dressing
Not applicable ^

Your patient is considered markedly restricted in dressing if, all or
substantially all the time, he or she:

- is unable to dress himself or herself, even with appropriate therapy,
medication, and devices; or

- requires an inordinate amount of time to dress himself or herself, even with
appropriate therapy, medication, and devices.

Notes:
- Dressing oneself does not include identifying, finding, and shopping for or
otherwise procuring clothing.

- Devices for dressing include specialized buttonhooks, long-handled
shoehorns, grab rails, safety pulls, etc.

- An inordinate amount of time means that dressing takes significantly longer
than for an average person who does not have the impairment.

Examples of markedly restricted in dressing (examples are not exhaustive):
- Your patient cannot dress without daily assistance from another person.
- Due to pain, stiffness, and decreased dexterity, your patient requires an
inordinate amount of time to dress on a daily basis.

Is your patient markedly restricted in dressing, as described above? yes or no
^

If yes, when did your patient's marked restriction in dressing begin? Year ^


T2201 E (03) (Page 6 of 8)

Part B - (continued)

Feeding
Not applicable ^
Your patient is considered markedly restricted in feeding if, all or
substantially all the time, he or she:

- is unable to feed himself or herself, even with appropriate therapy,
medication, and devices; or

- requires an inordinate amount of time to feed himself or herself, even with
appropriate therapy, medication, and devices.

Notes:
- Feeding oneself does not include identifying, finding, shopping for or
otherwise procuring food.

- Feeding oneself does include preparing food, except when the time associated
is related to a dietary restriction or regime.

- Devices for feeding include modified utensils, etc.

- An inordinate amount of time means that feeding takes significantly longer
than for an average person who does not have the impairment.

Examples of markedly restricted in feeding (examples are not exhaustive):

- Your patient requires tube feedings, all or substantially all the time, for
nutritional sustenance.

- Your patient requires an inordinate amount of time to prepare meals or to
feed herself, on a daily basis, due to significant pain and decreased strength
and dexterity in her upper limbs.

Is your patient markedly restricted in feeding, as described above? yes or no
^

If yes, when did your patient's marked restriction in feeding begin? Year ^

Elimination (bowel or bladder functions)
Not applicable ^

Your patient is considered markedly restricted in elimination if, all or
substantially all the time, he or she:

- is unable to personally manage bowel or bladder functions, even with
appropriate therapy, medication, and devices; or

- requires an inordinate amount of time to personally manage bowel or bladder
functions, even with appropriate therapy, medication, and devices.

Notes:
- Devices for elimination include catheters, ostomy appliances, etc.
- An inordinate amount of time means that personally managing elimination
takes significantly longer than for an average person who does not have the
impairment.

Examples of markedly restricted in elimination (examples are not exhaustive):

- Your patient needs the assistance of another person to empty and tend to his
colostomy appliance on a daily basis.

- Your patient is incontinent of bladder functions, all or substantially all
the time, and requires an inordinate amount of time to manage and tend to her
incontinence pads on a daily basis.

Is your patient markedly restricted in elimination, as described above? yes or
no ^

If yes, when did your patient's marked restriction in elimination begin? Year
^


T2201 E (03) (Page 7 of 8)

Part B - (continued)

Perceiving, thinking, and remembering
Not applicable ^

Your patient is considered markedly restricted in perceiving, thinking, and
remembering if, all or substantially all the time, he or she:

- is unable to perform the mental functions necessary for everyday life, by
himself or herself, even with appropriate therapy, medication, and devices; or

- requires an inordinate amount of time to perform the mental functions
necessary for everyday life, by himself or herself, even with appropriate
therapy, medication, and devices.

Notes:
- Mental functions necessary for everyday life include:

- Memory (for example, the ability to remember simple instructions, basic
personal information such as name and address, or material of importance and
interest);

- Problem-solving, goal-setting, and judgement (for example, the ability to
solve problems, set and keep goals, and make appropriate decisions and
judgements); and

- Adaptive functioning (for example, abilities related to self-care, health
and safety, social skills and common, simple transactions).

- Devices for perceiving, thinking, and remembering include memory aids,
adaptive aids, etc.

- An inordinate amount of time means that perceiving, thinking, and
remembering takes significantly longer than for an average person who does not
have the impairment.

Examples of markedly restricted in perceiving, thinking, and remembering
(examples are not exhaustive):

- Your patient is unable to leave the house, all or substantially all the
time, due to anxiety, despite medication and therapy.

- Your patient is independent in some aspects of everyday living; however,
despite medication and therapy, needs daily support and supervision due to an
inability to accurately interpret her environment.

- Your patient is incapable of making a common, simple transaction without
assistance, all or substantially all the time.

- Your four-year-old patient cannot play interactively with his peers or
understand simple requests.

Is your patient markedly restricted in perceiving, thinking, and remembering?
yes or no ^

If yes, when did your patient's marked restriction in perceiving, thinking,
and remembering begin? Year ^

Life-sustaining therapy (applies to 2000 and later years)
Not applicable ^

Your patient must need life-sustaining therapy to support a vital function,
even if the therapy has alleviated the symptoms. Examples of life-sustaining
therapy are chest physiotherapy to facilitate breathing and kidney dialysis to
filter blood. However, implanted devices such as a pacemaker, or special
programs of diet, exercise, hygiene, or medication do not qualify.

Your patient must specifically dedicate the time needed for this therapy-at
least three times per week, for an average of at least 14 hours per week (do
not include time needed for travel, medical appointments, or to recuperate
after therapy).

Does your patient meet the conditions for life-sustaining therapy, as
described above? yes or no ^

If yes, answer the following two questions:

When did your patient's need for life-sustaining therapy begin? Year ^
Specify the type of therapy: ^


T2201 E (03) (Page 8 of 8)

Part B - (continued: complete all areas below)

Effects of impairment

Describe the effects of your patient's impairment on his or her ability to
perform a basic activity of daily living. If you need more space below, attach
a separate sheet of paper.

Notes:
- Effects must be those which, even with therapy and the use of appropriate
devices and medication, cause your patient to be markedly restricted all or
substantially all of the time.

- Basic activities of daily living are limited to: walking; speaking; hearing;
dressing; feeding; elimination; and perceiving, thinking, and remembering.

- Working, housekeeping, and social or recreational activities are not
considered basic activities of daily living.

- This section may not be relevant for patients who are blind or in need of
life-sustaining therapy.

Examples of effects of impairment (examples are not exhaustive):

- For a patient with a walking impairment, you might state the number of hours
spent in bed or in a wheelchair each day.

- For a patient with impairment in perceiving, thinking, and remembering, you
might describe the degree to which your patient needs support and supervision.
^

Diagnosis (if available): ^

Duration

Has your patient's impairment lasted, or is it expected to last, for a
continuous period of at least 12 months? yes or no ^

If yes, has the impairment improved, or is it likely to improve, such that the
patient would no longer be markedly restricted, blind, or in need of life-
sustaining therapy? yes, no or unsure ^

If yes, state the year that the improvement occured, or may be expected to
occur ^

Certification

Check whichever of the following applies to you: (Enter "X" to the
application)
Medical doctor ^
Optometrist ^
Audiologist ^
Occupational therapist ^
Psychologist ^
Speech-language pathologist ^

As a qualified person, I certify that to the best of my knowledge the
information given in Part B is correct and complete.

Sign here ^
Print your name ^
Date (Year/Month/Day) ^
Telephone number (Included area code) ^

Address ^

Note: If further information or clarification is needed, the CCRA may contact you.

Appendix 7

Departmental and Agency Staff and Others Assisting in the Preparation of the Report

Committee Secretary:

Charles Smyth, Department of Finance

Department of Finance and Canada Revenue Agency Ex-officio Participants on the Committee:

Chris Forbes, Department of Finance

Maureen Tapp, Canada Revenue Agency

Research Staff:

Annik Bordeleau, Department of Finance

Christopher Camp, Consultant

Galen Countryman, Department of Finance

Pierre LeBlanc, Department of Finance

Glenda Stark, Canada Revenue Agency

Hope Walton, Canada Revenue Agency

Administrative Staff:

Christine Hamel, Department of Finance

Marika Stamos, Canada Revenue Agency

Editors:

Maurice Michaud, NéoScript enr., Gatineau

Judith Richer of the gordongroup, Ottawa

Translation:

Société Gamma Inc., Ottawa

Graphic Design:

Ryan/Smith Design Associates Inc., Ottawa


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