Schedule Ct-Eitc - Connecticut Earned Income Tax Credit - 2015
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1
2Department of Revenue Services
Schedule CT-EITC
2015
State of Connecticut
Connecticut Earned Income Tax Credit
(Rev. 12/15)
EITC 00 15W 01 9999
Your Social Security Number
If you were a nonresident or part-year resident of Connecticut during 2015 - STOP HERE.
You do not qualify for the Connecticut earned income tax credit (CT EITC) and you must fi le Form CT-1040NR/PY.
Complete return in blue or black ink only.
Attach completed Schedule CT-EITC to the back of Form CT-1040 or Form CT-1040X.
1
. Did you claim the federal earned income credit for 2015?
Yes
No Stop; you do not qualify for the CT EITC.
2. Is your investment income greater than $3,400?
Yes Stop; you do not qualify for the CT EITC.
No
3. Did you already fi le a 2015 Form CT-1040, Connecticut Resident Income Tax Return?
Yes
No
If Yes, you must
fi le Form CT-1040X, Amended Connecticut Income Tax Return for Individuals, to claim the EITC. See instructions.
4. Did you claim qualifying children on your 2015 federal Schedule EIC?
Yes Complete Line 5.
No Skip to Line 6.
5. List up to three children you claimed on federal Schedule EIC. If you claimed more than three, see instructions.
Child 1
MI
Child 1 - First name
Last name (If two last names, insert a space between names.)
Child 1 - Social Security Number
Year of Birth
Relationship
Number of months living with you
1 = son/daughter/stepchild
2 = niece/nephew
3 = grandchild
4 = foster child
5 = other
Check the box if this child was identifi ed as a student on federal Schedule EIC, box 4a.
Check the box if this child was identifi ed as being disabled on federal Schedule EIC, box 4b.
Child 2
MI
Child 2 - First name
Last name (If two last names, insert a space between names.)
Child 2 - Social Security Number
Year of Birth
Relationship
Number of months living with you
1 = son/daughter/stepchild
2 = niece/nephew
3 = grandchild
4 = foster child
5 = other
Check the box if this child was identifi ed as a student on federal Schedule EIC, box 4a.
Check the box if this child was identifi ed as being disabled on federal Schedule EIC, box 4b.
Child 3
MI
Child 1 - First name
Last name (If two last names, insert a space between names.)
Child 1 - Social Security Number
Year of Birth
Relationship
Number of months living with you
1 = son/daughter/stepchild
2 = niece/nephew
3 = grandchild
4 = foster child
5 = other
Check the box if this child was identifi ed as a student on federal Schedule EIC, box 4a.
Check the box if this child was identifi ed as being disabled on federal Schedule EIC, box 4b.
6.
Did you have wages but NO Connecticut income tax withheld?
Yes
No
If YES, enter wages from Forms W-2 and 1099 by completing Lines 6a, 6b, and 6c. If NO, go to Line 7, or if Connecticut tax was
withheld, enter Forms W-2 and 1099 information on Form CT-1040, Lines 18a through 18f.
Column A
Column B
Column C
Employer’s federal ID No. from Box b of W-2
Employer’s state ID No. from Box 15 of W-2
Wages, tips, etc.
or payer’s federal ID No. from Form 1099
or payer’s state ID No. from Form 1099
6a.
6b.
6c.
See instructions on Page 34.
Para instrucciones en Español, refi érase a la Página 36.
Complete Lines 7 through 16 on the back.
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