Schedule Eic - Earned Income Credit - Internal Revenue Service - 2009 Page 2
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1
2
3SCHEDULE EIC
Earned Income Credit
OMB No. 1545-0074
1040A
(Form 1040A or 1040)
2009
. . . . . . . . . .
Qualifying Child Information
1040
EIC
Complete and attach to Form 1040A or 1040
Department of the Treasury
Attachment
only if you have a qualifying child.
43
Internal Revenue Service (99)
Sequence No.
Name(s) shown on return
Your social security number
● See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and 64b, to make
Before you begin:
sure that (a) you can take the EIC, and (b) you have a qualifying child.
● Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card.
Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child’s
social security card is not correct, call the Social Security Administration at 1-800-772-1213.
● If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See back of schedule
!
for details.
● It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.
CAUTION
Qualifying Child Information
Child 1
Child 2
Child 3
First name
Last name
First name
Last name
First name
Last name
1 Child’s name
If you have more than three qualifying
children, you only have to list three to get
the maximum credit.
2 Child’s SSN
The child must have an SSN as defined on
page 45 of the Form 1040A instructions or
page 51 of the Form 1040 instructions
unless the child was born and died in
2009. If your child was born and died in
2009 and did not have an SSN, enter
“Died” on this line and attach a copy of
the child’s birth certificate, death
certificate, or hospital medical records.
3 Child’s year of birth
Year
Year
Year
If born after 1990 and the child was younger than you
If born after 1990 and the child was younger than you
If born after 1990 and the child was younger than you
(or your spouse, if filing jointly), skip lines 4a and 4b;
(or your spouse, if filing jointly), skip lines 4a and 4b;
(or your spouse, if filing jointly), skip lines 4a and 4b;
go to line 5.
go to line 5.
go to line 5.
4 a
Was the child under age 24 at the end of
2009, a student, and younger than you (or
Yes.
No.
Yes.
No.
Yes.
No.
your spouse, if filing jointly)?
Go to line 5.
Continue.
Go to line 5.
Continue.
Go to line 5.
Continue.
b
Was the child permanently and totally
Yes.
No.
Yes.
No.
Yes.
No.
disabled during any part of 2009?
The child is not a
Continue.
The child is not a
Continue.
The child is not a
Continue.
qualifying child.
qualifying child.
qualifying child.
5 Child’s relationship to you
(for example, son, daughter, grandchild,
niece, nephew, foster child, etc.)
6 Number of months child lived
with you in the United States
during 2009
● If the child lived with you for more than
half of 2009 but less than 7 months,
enter “7.”
● If the child was born or died in 2009 and
months
months
months
your home was the child’s home for the
Do not enter more than 12
Do not enter more than 12
Do not enter more than 12
entire time he or she was alive during
months.
months.
months.
2009, enter “12.”
Cat. No. 13339M
Schedule EIC (Form 1040A or 1040) 2009
For Paperwork Reduction Act Notice, see Form 1040A
or 1040 instructions.
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