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Form 6497 Information Return of Nontaxable Energy Grants or Subsidized Energy Financing (Rev. July 1998) Department of the Treasury Internal Revenue Service 1 Please Type or Print For calendar year
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G. E.O. 12974 or E.O. 13292) (a) Enter (b) Type of information reported. (2) Include, if appropriate, other pertinent information as necessary to make sure your request is complete. 3 Enter in the space provided the title and type of energy payment under which the program is being administered (for example, EI, ETC, or OAS). Enter the following information in the box provided, if applicable: 1 Name of beneficiary: 2 Date of birth: 3 D.O.B.: 4 Occupation: 5 Number of dependents in the month with the highest gross income. Enter a blank if not applicable. Enter the last two digits of the tax year the beneficiary earned the highest earnings from a source of primary income. Enter a blank if not applicable. 6 Income in the year for which the beneficiary was receiving cash payments other than those described in boxes 1, 4 and 6. Enter the following information in the same box as in (a): 5 Type of payments received in the year: 7 For example, pensions, other income such as earnings on interest, dividends or royalties, etc. For any other information you may have, enter “Other” in the applicable box. For the name, address, telephone number and T4 number, see the instructions for line 13 or check the appropriate box on line 10. Enter the following information on line 9: 8 Date the benefit is to begin, or will begin, or the date the beneficiary dies (if applicable). 9 The beneficiary's T4 number. 10 The beneficiary's social insurance number (for individuals and for Canada and Quebec for tax purposes only). 11 For more information on T4s, go to t4ssa.gc.ca/t4ssa/index/recensement_forms.asp. If the (payer) of these benefits is not an individual, the name, employment income, tax filing status and number of dependents of the payer should be entered on line 1, even if the beneficiary will be a child; and, if the payment is the OAS (Employment Insurance) benefit, the name, employment income, tax filing status and number of the beneficiary should be on the T4 form (see Note, EI, ETC, and OAS Benefits).

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