Schedule IN-EIC                 Schedule IN-EIC: Indiana’s Earned Income Credit                                       Enclosure 
      Form IT-40/IT-40PNR             You must enclose if claiming this credit on Forms IT-40 or IT-40PNR.                 Sequence No. 9
      State Form 49469
      (R22 / 9-22)                                                                                              2022

 Name(s) shown on Form IT-40/IT-40PNR                                                           Your Social Security Number

Section A: Figure Your Indiana Earned Income Credit

 A-1 Enter the earned income credit from your federal income tax return  _______________________                A-1         .00

 A-2 Enter your earned income (see instructions)  _________________________________________                     A-2         .00
 A-3 Enter your Indiana earned income credit (see instructions). 
    Carry this total to Form IT-40, Schedule 5, line 5, or  
    Form IT-40PNR, Schedule F, line 5, Box A _________________ Indiana Earned Income Credit                     A-3         .00

Section B: Complete if you claimed one or more children on your federal Schedule EIC. See instructions.

                                                                 Child 1                                             Child 2
Enter each child’s information
                                      First name                                            First name
                                      Last name                                             Last name

             Child’s Social Security Number(s)

Enter letter (e.g., A, B,  ,Cetc.) in boxes below that describes each child’s relationship, age and location to you. 

                                                                 Child 1                                             Child 2
 B-1 Relationship: 
 A Your Child
 B Grandchild
 C Stepchild
 D Foster Child (not related)
 E Other (related foster child, or other  
  related child - see instructions)

 B-2 Age:
 A Under age 18
 B Age 18
 C Age 19 - 24 and full-time student
 D Age 19 or older and totally
  disabled

 B-3 Location:
 A Child lived with you at 
  least ½ of the year
 B Child was born or died 
  in 2022, and lived with 
  you while alive in 2022.

 Important: You must complete and attach this schedule to your Form IT-40 or IT-40PNR when claiming the earned income credit. 

                                                  *17222111694*
                                                                 17222111694

                                               Instructions for Schedule IN-EIC

 Here are some important things to know when figuring this credit:    Line A-2. Enter your earned income from Worksheet A, Part 1, line 
                                                                      1, or from Worksheet B, Part 4, line 4b.
• You must be eligible for and have claimed an EIC on your 
  federal tax return. If not, STOP. You are not eligible to claim     Line A-3. Enter your earned income credit from Worksheet A, Part 
  Indiana’s EIC.                                                      3, line 11, or from Worksheet B, Part 7, line 16.
• Your income on Form IT-40, line 1 (or Indiana’s Schedule A, 
  line 36A), must be less than $49,399. If it is the same amount      Section B – Qualifying Child (Children)
  or more, STOP. You are not eligible to claim Indiana’s EIC.         You must complete Section B if you are claiming one or two children 
• You must complete Worksheet A or Worksheet B.  See the IT-40        when figuring Indiana’s EIC. 
  or IT-40PNR instruction booklets for further details.
• Schedule IN-EIC must be completed and enclosed by all filers        First, complete Step 3 of the EIC instructions. There you’ll find the 
  claiming the EIC.                                                   descriptions of who is a qualifying child for Indiana EIC purposes. 
• Indiana’s Publication EIC is available for additional information. 
  It may be viewed online at   www.in.gov/dor/tax-forms/2022-         Social Security Number. Your qualifying child must have a valid 
  individual-income-tax-forms/.                                       Social Security number (SSN) unless the child was born and died 
                                                                      in 2022.*

                                                                      Important: Enter information for the same child (or children) you 
Caution:  You must know what your federal earned income credit        entered on your federal Schedule EIC wherever possible.
is before you can figure your Indiana EIC. If you don’t know what 
your federal EIC is by Indiana’s filing due date, go ahead and file   Example. Marie has four children, three of whom she claimed for 
your Indiana return without claiming the EIC. Then, when you find     federal EIC purposes. All three children meet the requirements to 
out what your federal EIC is, file an amended (corrected) Indiana     be a qualified child within Indiana. Since Marie may claim up to two 
tax return to claim your Indiana EIC.                                 qualified children on this schedule, she should list two of the three 
                                                                      she claimed for federal EIC purposes.

                                                                      Example. Tim and Jane claimed their daughter and a foster child 
If, during 2022:                                                      (who lived with them for six months) as qualifying children for federal 
• you were an Indiana resident, and/or                                EIC purposes. Since their foster child did not live with them the entire 
• had income from Indiana sources, and                                year, the child is not a qualifying child for Indiana EIC purposes. 
• you claimed the EIC on your federal                                 They may only claim their daughter as a qualifying child in Section B.
  income tax return, Form 1040, 
then you may be eligible to claim Indiana’s EIC.                      In Section B-1, the ‘Foster Child (not related)’ box (line D) is an 
                                                                      unrelated child who was placed with you by an authorized placement 
STOP. You must get the 2022 IT-40 or IT-40PNR instruction booklet     agency and lived with you the entire year.
before you can continue. The instructions for how to figure Indiana’s 
EIC are located within those booklets. You may find these booklets    In Section B-1, the ‘Other’ box (line F) includes a related foster 
online  www.in.gov/dor/tax-forms/2022-individual-income-tax-forms/.   child who lived with you the entire year, or your brother, sister, 
                                                                      stepbrother, stepsister, or a descendant of your brother and/or sister, 
Once you get the instructions, review Step 1 through Step 7, and      etc. (for example, your niece or nephew), whom you cared for as 
complete either Worksheet A or Worksheet B to figure your Indiana     your own child.
EIC. After you have completed the worksheet, return to these 
instructions and finish Schedule IN-EIC.                              *Exception. If your qualified dependent child was born and died in 
                                                                      2022 and you do not have a SSN for the child, enter the word “Died” 
Caution: Schedule IN-EIC must be filed with your tax return in order  in the third (largest) Social Security Number box associated with your 
for you to be eligible to claim Indiana’s EIC.                        child’s name. You must keep a copy of the child’s birth certificate, 
                                                                      death certificate and/or hospital records with your records as the 
Section A – Figure Your Indiana Earned Income Credit                  Indiana Department of Revenue (DOR) may request this information 
Line A-1. Enter the amount of earned income credit from your federal  at a later date. The documents must show the child was born alive.
income tax return.
                                                                      Exception Example                                Died

                                               *24100000000*
                                                       24100000000