Form 8862 - Information To Claim Earned Income Credit After Disallowance
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38862
Information To Claim Earned Income Credit
OMB No. 1545-0074
Form
After Disallowance
(Rev. December 2012)
Attach to your tax return.
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Attachment
Department of the Treasury
43A
Information about Form 8862 and its instructions is at
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Sequence No.
Internal Revenue Service
Name(s) shown on return
Your social security number
Before you begin: ✓
See your tax return instructions or Pub. 596, Earned Income Credit (EIC), for the year for which you are filing
this form to make sure you can take the earned income credit (EIC) and to find out who is a qualifying child.
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If you have a qualifying child, complete Schedule EIC before you fill in this form.
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Do not file this form if you are taking the EIC without a qualifying child and the only reason your EIC was
reduced or disallowed in the earlier year was because it was determined that a child listed on Schedule
EIC was not your qualifying child.
Part I
All Filers
1
Enter the year for which you are filing this form (for example, 2012) .
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2
If the only reason your EIC was reduced or disallowed in the earlier year was because you incorrectly
reported your earned income or investment income, check “Yes.” Otherwise, check “No”
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Yes
No
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Caution. If you checked “Yes,” stop. Do not fill in the rest of this form. But you must attach it to your tax return to take the
EIC. If you checked “No,” continue.
3
Could you (or your spouse if filing jointly) be claimed as a qualifying child of another taxpayer for the year
shown on line 1? See the instructions before answering
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Yes
No
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Caution. If you checked “Yes,” stop. You cannot take the EIC. If you checked “No,” continue.
Part II
Filers With a Qualifying Child or Children
Note. Child 1, Child 2, and Child 3 are the same children you listed as Child 1, Child 2, and Child 3 on Schedule EIC for the year
shown on line 1 above.
4
Enter the number of days each child lived with you in the United States during the year shown on line 1 above:
a Child 1
b Child 2
c Child 3
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Caution. If you entered less than 183 (184 if the year on line 1 is a leap year) for any child, you cannot take the EIC based on
that child, unless the special rule for a child who was born or died during the year shown on line 1 applies. See the instructions.
5
If your child was born or died during the year shown on line 1, enter the month and day the child was born and/or died.
Otherwise, skip this line.
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a Child 1
(1) Month and day of birth (MM/DD)
(2)
Month and day of death (MM/DD)
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b Child 2
(1) Month and day of birth (MM/DD)
(2)
Month and day of death (MM/DD)
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c Child 3
(1) Month and day of birth (MM/DD)
Month and day of death (MM/DD)
(2)
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6
Enter the address where you and the child lived together during the year shown on line 1. If you lived with the child at more
than one address during the year, attach a list of the addresses where you lived:
Number and street
a Child 1
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City or town, state, and ZIP code
b Child 2
If same as shown for child 1, check this box.
Otherwise, enter below:
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Number and street
City or town, state, and ZIP code
c
Child 3
If same as shown for child 1, check this box.
Or if same as shown for child 2 (and
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this is different from address shown for child 1), check this box.
Otherwise, enter below:
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Number and street
City or town, state, and ZIP code
7
Did any other person (except your spouse, if filing jointly, and your dependents under age 19) live with
child 1, child 2, or child 3 for more than half the year shown on line 1? .
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Yes
No
If “Yes,” enter that person’s name and relationship to the child below. If more than one other person lived
with the child for more than half the year, attach a list of each person’s name and relationship to the child:
a Other person living with child 1:
Name
Relationship to child 1
b Other person living with child 2:
If same as shown for child 1, check this box.
Otherwise, enter below:
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Name
Relationship to child 2
Or if same as shown
c Other person living with child 3:
If same as shown for child 1, check this box.
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for child 2 (and this is different from the person living with child 1), check this box.
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Otherwise, enter below:
Name
Relationship to child 3
Caution. The IRS may ask you to provide additional information to verify your eligibility to claim the EIC.
8862
For Paperwork Reduction Act Notice, see page 3.
Form
(Rev. 12-2012)
Cat. No. 25145E
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