PDF document

- 1 -

Information To Claim Earned Income Credit OMB No. 1545-0074
Form
8862 After Disallowance
(Rev. December 2009)
Attachment
Department of the Treasury � Attach to your tax return. � See instructions on back. Sequence No. 43A
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.
�If you have a qualifying child, complete Schedule EIC before you fill in this form.
�Do notfile this form if you are taking the EIC without a qualifying childand 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, 2009) . . . .. ... ... . �
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” ... . � Yes No
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 person for the year
shown on line 1? .. . . . . . . . .. .. . . . .. . .. ... ... . � Yes No
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 3are the same children you listed as Child 1, Child 2, and Child 3 onSchedule EICfor 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 �
Caution. If you entered less than 183 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.
a Child 1 � (1) Month and day of birth (MM/DD) � / (2) Month and day of death (MM/DD) � /
b Child 2 � (1) Month and day of birth (MM/DD) � / (2) Month and day of death (MM/DD) � /
c Child 3 � (1) Month and day of birth (MM/DD) � / (2) Month and day of death (MM/DD) � /
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:
a Child 1 � Number and street
City or town, state, and ZIP code
b Child 2 � If same as shown for child 1, check this box. � Otherwise, enter below:
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
this is different from address shown for child 1), check this box. � Otherwise, enter below:
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? . . .. ... ... . � 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:
Name
Relationship to child 2
c Other person living with child 3: If same as shown for child 1, check this box. � Or if same as shown
for child 2 (and this is different from the person living with child 1), check this box. �
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.
For Paperwork Reduction Act Notice, see back of form. Cat. No. 25145E Form 8862 (Rev. 12-2009)

- 2 -

Form 8862 (Rev. 12-2009) Page 2
Part III Filers Without a Qualifying Child
8 Enter the number of days during the year shown on line 1 that you lived in the United States . . . �
Caution. If you entered less than183,stop. You cannot take the EIC. See the instructions.
9 If married filing a joint return, enter the number of days during the year shown on line 1 that your spouse
lived in the United States . . .. . .. . .. . ... . . . . . . . . . . . . �
Caution. If you entered less than183 , stop.You cannot take the EIC. See the instructions.

General Instructions Lines 4 and 5
Temporary absences, such as for school, vacation, medical
Purpose of Form care, or detention in a juvenile facility, count as time lived at
You must complete Form 8862 and attach it to your tax return if home.
both of the following apply. Child born or died. If your child was born or died during the
1. Your EIC was reduced or disallowed for any reason other year entered on line 1 and your home was the child’s home for
than a math or clerical error for a year after 1996. the entire time he or she was alive during that year, replace the
number entered on line 4 for that child with “365” and complete
2. You now want to take the EIC and you meet all the line 5.
requirements.
Exception 1. Do not file Form 8862 if either of the following Lines 8 and 9
applies. Enter the number of days you lived in the United States during
� After your EIC was reduced or disallowed in an earlier year (a) the year shown on line 1.
you filed Form 8862 (or other documents) and your EIC was Example. You are single and are filing Form 8862 for 2009.
then allowed, and (b) your EIC has not been reduced or Your home was in the United States for all of 2009. On line 8,
disallowed again for any reason other than a math or clerical you would enter “365.”
error.
Members of the military. If you were on extended active duty
� You are taking the EIC without a qualifying child and the only outside the United States, your home is considered to be in the
reason your EIC was reduced or disallowed in the earlier year United States during that duty period. Include your active duty
was because it was determined that a child listed on Schedule time on line 8 and your spouse’s, if applicable, on line 9. See
EIC was not your qualifying child. Pub. 596 for the definition of extended active duty.
In either of these cases, you can take the EIC without filing
Form 8862 if you meet all the EIC eligibility requirements. Paperwork Reduction Act Notice. We ask for the information
Exception 2. Do not file Form 8862 and do not take the EIC for on this form to carry out the Internal Revenue laws of the United
the: States. You are required to give us the information. We need it
to ensure that you are complying with these laws and to allow
� 2 years after the most recent tax year for which there was a us to figure and collect the right amount of tax.
final determination that your EIC claim was due to reckless or
intentional disregard of the EIC rules, or You are not required to provide the information requested on
a form that is subject to the Paperwork Reduction Act unless
� 10 years after the most recent tax year for which there was a the form displays a valid OMB control number. Books or
final determination that your EIC claim was due to fraud. records relating to a form or its instructions must be retained as
long as their contents may become material in the
You also must attach Schedule EIC to your return if administration of any Internal Revenue law. Generally, tax
you have a qualifying child or children. In addition to returns and return information are confidential, as required by
CAUTION
�! filing Form 8862 and, if required, Schedule EIC, you Internal Revenue Code section 6103.
may be asked to provide other information before any
refund claimed on your return is issued. The process of The average time and expenses required to complete and file
establishing your eligibility to take the EIC will delay your refund. this form will vary depending on individual circumstances. For
the estimated averages, see the instructions for your income tax
Additional Information return.
For more details on the EIC, including the definition of a If you have suggestions for making this form simpler, we
qualifying child and who is eligible to take the EIC, see your tax would be happy to hear from you. See the instructions for your
return instructions or Pub. 596, Earned Income Credit (EIC), for income tax return.
the year for which you are filing Form 8862.

Specific Instructions
Need More Space for an Item?
If you do, attach a statement that is the same size as Form
8862. Number each entry on the statement to correspond with
the line number on Form 8862. Put your name and social
security number on the statement and attach it at the end of
your return.

PDF file checksum: 1806612034