TP-752.0.14 – Information Sheet for Individuals and Health Professionals

Information Sheet

for Individuals and Health Professionals

Certificate Respecting an Impairment

Who should file the Certificate Respecting an Impairment ?

This form must be filed by individuals who are required to enclose, with their income tax return, certification from a health professional that they, or the individual with respect to whom they are claiming a tax credit, has a severe and prolonged impairment in mental or physical functions. This form can also be used to provide confirmation that an individual, whose caregiver is claiming the tax credit for caregivers, is unable to live alone due to a severe or prolonged impairment.

If the impairment is permanent, it is not necessary to file a new certificate each year unless we so request. However, you must notify us if your condition (or the condition of the individual with respect to whom you are claiming a tax credit in your income tax return) has improved since the last time a certificate attesting to the impairment was filed.

On page 6 of this document, you will find a self-evaluation questionnaire to help you determine whether an impairment may constitute a severe and prolonged impairment in mental or physical functions.

For more information on tax measures pertaining to persons with disabilities, see the brochure Tax Benefits and Persons with Disabilities (IN-132-V), available on our website at www.revenuquebec.ca.

Note that a person who wishes to receive amounts from the Régie des rentes du Québec (such as a disability pension or the supplement for handicapped children) must file forms specific to the Régie.

Professional certification of an impairment

An impairment must be certified by one of the following health professionals:

• a physician or optometrist, in the case of a visual impairment;
• a physician or speech-language pathologist, in the case of a speech impairment;
• a physician or audiologist, in the case of a hearing impairment;
• a physician, an occupational therapist or, since February 22, 2005, a physiotherapist, where the person is unable to walk;
• a physician, where the person is unable to manage his or her bowel or bladder functions;
• a physician or occupational therapist, where the person is unable to feed himself or herself;
• a physician or occupational therapist, where the person is unable to dress himself or herself;
• a physician or psychologist, where the person is unable to exercise the mental functions necessary for daily living.
• a physician, in the case of multiple restrictions and their cumulative effect, or an occupational therapist, if the multiple restrictions are related exclusively to the person's ability to walk or to feed or dress himself or herself;
• a physician, in the case of therapy that is essential to sustain a vital function.

Inability to live alone

Only a physician can certify that an individual is unable to live alone.

Severe and prolonged impairment

A person's impairment is considered severe if one of the following conditions are met:

• Even with appropriate therapy and the use of devices and medication, the person is all or substantially all of the time
• • unable to see;
  • unable to perform a basic activity of daily living (speaking, hearing, walking, managing bowel or bladder functions, eating or dressing, or exercising the mental functions necessary for daily living)¹ or requires an inordinate amount of time to do so;
  • significantly restricted in more than one basic activity of daily living, including seeing, to such a degree that the cumulative effect of those restrictions is equivalent to being unable to perform a basic activity of daily living. (This condition is applicable only for 2005 and subsequent years.)
• Because of a chronic disease, the person must undergo, at least twice a week, therapy that
• • is prescribed by a physician;
• is essential to sustain one of the person's vital functions; and
• requires 14 hours per week or more of the person's time, including time for travel, medical appointments, and post-treatment recovery.

A person's impairment is considered prolonged if

• the impairment has lasted for a period of at least 12 consecutive months; or
• the impairment began during the year, if it may reasonably be expected to last for a continuous period of at least 12 months.

A person who receives a disability pension under the Québec Pension Plan (QPP) or similar benefits is not necessarily considered, under the Taxation Act, to be a person with a severe and prolonged impairment in mental or physical functions.

Note

Any person named in the Certificate Respecting an Impairment may receive a written request from us

• for additional information (to be provided in writing) concerning the impairment and its effects on the person with the impairment; or
• concerning the essential therapy that he or she must receive.

Filing the form The individual must either file this form with his or her income tax return or send the form, along with a letter bearing his or her signature, that specifies the nature of the request, to one of the following addresses: C. P. 3000, succursale Place-Desjardins, Montréal (Québec) H5B 1A4 or 3800, rue de Marly, Québec (Québec) G1X 4A5

---

1. Remunerated work, social or recreational activities and housekeeping are not considered basic activities of daily living.