*** Transcriber's Note: Please set your voice synthesizer to read most punctuation. When you encounter the caret sign at the end of a line, please enter the applicable information, if necessary. *** Canada Revenue Agency RC66 E (07) (Page 1 of 4) Canada Child Benefits Application Complete this form to apply for all child benefit programs. The information you give on this form will be used for all programs, unless you indicate otherwise on a note attached to your application. For information about our programs, see pamphlet T4114, Canada Child Benefits, pamphlet RC4210, GST/HST Credit, visit our Web site at www.cra.gc.ca/benefits, or call us at 1-800-387-1193. How to apply? Complete this form and send it, along with any other required documents, to one of our tax offices listed on page 2 of this information sheet. Complete and submit your application as soon as possible after the child is born or begins to live with you, or when you become a resident of Canada for income tax purposes. Part 1 – Information about the applicant Who should complete Part 1? For Canada Child Tax Benefit (CCTB) purposes, there is a presumption that when both a male and a female parent live in the same home as the child, the female parent is considered to be primarily responsible (see the definition on page 2 of this information sheet) for the child and should apply. However, if the male parent is primarily responsible, he can apply if a signed note from the female parent is attached to the application which states that the male parent is primarily responsible for the child(ren). The person who is primarily responsible for the care and upbringing of the child(ren) should complete Part 1. Does your application include a period that started more than 11 months ago? You must attach photocopies of proof of your and your spouse or common-law partner's citizenship status (e.g., Canadian birth certificate) and/or immigration status in Canada for the period that started more than 11 months ago. The photocopies must be legible and include both sides of all pages of your documents. What is your current marital status? Check "Married" if you have a spouse, or "Living common-law" if you have a common-law partner. If you have been separated for less than 90 days, you are still considered to be married or living common-law. For more information, see the definitions on page 2 of this information sheet. Part 2 – Information about your spouse or common-law partner Complete Part 2 of the application only if you checked box 1 or 2 in Part 1. Part 3 – Information about the child(ren) Complete this part to provide information about the child(ren). Do not provide information about a child for whom you have already applied, or for whom you receive benefits. Note If a child left your care and has now returned to your care, you have to provide information about that child again. When do you need to provide proof of birth? You need to attach proof of birth for the child if we have not previously paid benefits to anyone for this child, and any of the following applies: - the child was born outside Canada; or - the child was born in Canada and is one year of age or older. Attach legible photocopies of all sides of all pages of one of the following documents for proof of birth: - baptismal or cradle roll certificate or other church record; - birth certificate or birth registration; - hospital record of birth or record of the physician, nurse, or midwife who attended the birth; - passport; - Record of Landing or Confirmation of Permanent Residence issued by Citizenship and Immigration Canada; - citizenship certificate; or - Notice of Decision or a Temporary Resident's Permit issued under the Immigration and Refugee Protection Act. Shared Eligibility There are situations where a child may reside with two different individuals on a more or less equal basis, and both of these individuals share equally in the child's care and upbringing. If this situation applies to you, attach a note to your application that clearly states your parenting arrangement. For more information, visit our Web site at www.cra.gc.ca/benefits, or call us at 1-800- 387-1193. Part 4 – Change of recipient Complete this part if the child(ren) had been living with another individual or maintained by an agency. Part 5 – Certification You have to sign and complete this part. If you completed Part 2, your spouse or common-law partner also has to sign and complete this part. RC66 E (07) (Page 2 of 4) Additional information Direct deposit You can have your payments deposited directly into your account at a financial institution in Canada. To get this service, the applicant must complete and attach Form T1-DD(1), Direct Deposit Request - Individuals, to his or her application. Service standards for processing applications We will issue a payment, notice, or explanation to you within 80 calendar days. Benefits online calculator You can use our online calculator to get an estimate of your child benefits by visiting our Web site at www.cra.gc.ca/benefits-calculator. Definitions Common-law partner This applies to a person who is not your spouse, with whom you are living in a conjugal relationship, and to whom at least one of the following situations applies. He or she: a) has been living with you in a conjugal relationship for at least 12 continuous months; b) is the parent of your child by birth or adoption; or c) has custody and control of your child (or had custody and control immediately before the child turned 19 years of age) and your child is wholly dependent on that person for support. In addition, an individual immediately becomes your common-law partner if you previously lived together in a conjugal relationship for at least 12 continuous months and you have resumed living together in such a relationship. Under proposed changes, this condition will no longer exist. The effect of this proposed change is that a person (other than a person described in b) or c) above) will be your common-law partner only after your current relationship with that person has lasted at least 12 continuous months. This proposed change will apply to 2001 and later years. Reference to "12 continuous months" in this definition includes any period that you were separated for less than 90 days because of a breakdown in the relationship. Primarily responsible Primarily responsible for the care and upbringing of a child means that you are responsible for such things as supervising the child's daily activities and needs, making sure the child's medical needs are met, and arranging for child care when necessary. If there is a female parent who lives with the child, we usually consider her to be this person. However, it could be the father, a grandparent, or a guardian. Separated You are separated when you start living separate and apart from your spouse or common-law partner because of a breakdown in the relationship and this separation lasts for at least 90 days during which time you have not reconciled. Note: Once you have been separated for 90 days (due to a breakdown in the relationship), the effective day of your separated status is the day you started living separate and apart. Spouse This applies only to a person to whom you are legally married. Tax office addresses Send us your completed Form RC66, Canada Child Benefits Application, and any required documents in the envelope included with your package. If you do not have the preprinted envelope, send the information to one of the following addresses: Jonquière Tax Centre PO Box 1900 Station LCD Jonquière QC G7S 5J1 Shawinigan-Sud Tax Centre PO Box 3000 Station Main Shawinigan-Sud QC G9N 7S6 St. John's Tax Centre PO Box 12071 Station A St. John's NL A1B 3Z1 Sudbury Tax Services Office PO Box 20000 Station A Sudbury ON P3A 5C1 Summerside Tax Centre 102-275 Pope Road Summerside PE C1N 5Z7 Surrey Tax Centre 9755 King George Highway Surrey BC V3T 5E1 Winnipeg Tax Centre PO Box 14005 Station Main Winnipeg MB R3C 0E3 Checklist We want to process your Form RC66, Canada Child Benefits Application, as soon as we can. Be sure to do the following: - Complete all of the Parts of the application that apply to you and your spouse or common-law partner. - Complete schedule RC66SCH, Status in Canada/Statement of Income, if it applies to you or to your spouse or common-law partner and attach it with your application. - Attach legible photocopies of all required documents (such as immigration documents and proof of birth). - Sign and date the application form. If you are married or living common-law, your spouse or common-law partner also needs to sign the form. RC66 (07) (Page 3 of 4) Canada Revenue Agency Do not use this area CANADA CHILD BENEFITS APPLICATION To apply for all child benefit programs, complete this application and send it, along with any other required documents, to one of our tax offices listed on the attached information sheet. Complete the parts that apply to you (please print). Part 1 – Information about the applicant When both a male and female parent reside in the same home, we usually consider the female parent to be the applicant. First name and initial ^ Last name ^ Social insurance number (enter 9-digit number) ^ Last name at birth (if different from last name above) ^ Female or Male. ^ Date of birth (Year/Month/Day) ^ Language of correspondence English or Français. ^ Mailing address: Apartment Number – Street Number Street name ^ P.O. Box ^ Rural Route ^ City ^ Province or territory (or country, if outside Canada) ^ Postal code ^ Home address (if different from above): Apartment Number – Street Number Street name ^ City ^ Province or territory (or country, if outside Canada) ^ Postal code ^ Telephone numbers: Home (including area code) ^ Work (including area code) ^ If you moved to this address within the last 12 months, enter the date you moved. (Year/Month/Day) ^ If you moved from a different province or territory, name the previous province or territory. ^ Does your application include a period that started more than 11 months ago? Yes or No. ^ If yes, see page 1 of the attached information sheet to find out which documents you need to attach. Have you been a Canadian citizen for the last 12 months? Yes or No. ^ If no, you must complete and attach schedule RC66SCH, Status in Canada/Statement of Income, to your application. You must also complete and attach schedule RC66SCH, Status in Canada/Statement of Income, if you or your spouse or common-law partner: - became a new resident or returned as a resident of Canada in the last 2 years; or - are, as defined in the Immigration and Refugee Protection Act, a permanent resident, protected person (refugee), or temporary resident who has lived in Canada for the previous 18 months. Check (enter an "X") the box that applies to your current marital status. (Check only one box) See page 2 of the attached information sheet for the definitions. Box 1 Married ^ Box 2 Living common-law ^ Box 3 Widowed ^ Box 4 Divorced ^ Box 5 Separated ^ Box 6 Single ^ Enter the date your current marital status began. (If you checked box 2 or 5, see the definitions for common-law partner and separated on page 2 of the attached information sheet to determine the date you must enter) (Year/Month/Day) ^ RC66 E (07) (Page 4 of 4) Part 2 – Information about your spouse or common-law partner First name and initial ^ Last name ^ Social insurance number (enter 9-digit number) ^ Last name at birth (if different from last name above) ^ Female or Male. ^ Date of birth (Year/Month/Day) ^ If your spouse or common-law partner's address is different from your address, please explain: ^ Has your spouse or common-law partner been a Canadian citizen for the last 12 months? Yes or No. ^ If no, you must complete and attach schedule RC66SCH, Status in Canada/Statement of Income, to your application. Part 3 – Information about the child(ren) To find out if you need to attach proof of birth, see page 1 of the attached information sheet. Do you share the care and upbringing of the child(ren) listed below? Yes or No. ^ If yes, see "Shared Eligibility" on page 1 of the attached information sheet. Child information - (Do not include children for whom you have already applied.) First name and initial ^ Last name ^ Place of birth: City ^ Province or territory (or country, if outside Canada) ^ Female or Male. ^ Date of birth (Year/Month/Day) ^ Have you been primarily responsible for this child since birth? (see the definition on page 2 of the attached information sheet) Yes or No. ^ If no, when did you become primarily responsible for the child? (Year/Month/Day) ^ Child information - (Do not include children for whom you have already applied.) First name and initial ^ Last name ^ Place of birth: City ^ Province or territory (or country, if outside Canada) ^ Female or Male. ^ Date of birth (Year/Month/Day) ^ Have you been primarily responsible for this child since birth? (see the definition on page 2 of the attached information sheet) Yes or No. ^ If no, when did you become primarily responsible for the child? (Year/Month/Day) ^ If you are applying for more than two children, use a separate sheet of paper to give the information requested above for the additional child(ren). Sign the sheet, and attach it to this form. Part 4 – Change of recipient Complete this part if the child(ren) had been living with another individual or maintained by an agency. Name, address, and telephone number of previous caregiver or agency ^ Name of child(ren) ^ Date the child(ren) left the previous recipient's care (Year/Month/Day) ^ Name, address, and telephone number of previous caregiver or agency ^ Name of child(ren) ^ Date the child(ren) left the previous recipient's care (Year/Month/Day) ^ Previous caregiver's signature ^ Part 5 – Certification We cannot process this form unless it is signed. If you have a spouse or common- law partner, he or she also needs to sign this form. I certify that the information given on this form is, to the best of my knowledge, correct and complete. Applicant's signature ^ It is a serious offence to make a false statement. Date (Year/Month/Day) ^ Spouse or common-law partner's signature ^ It is a serious offence to make a false statement. Date (Year/Month/Day) ^ If you cannot get your spouse or common-law partner's signature, please explain: ^ Privacy Act Personal Information Bank number CRA/P-PU-140