New EITC Questionnaire

EITC Questionnaire
- Taxpayer's Full Name
  
  First NameMiddle InitialLast Name
- Dependent's Full Name
- Dependent's Date of Birth
  
  MonthDayYear
  Date
- Relationship of Dependent
  
  Other
- Is the dependent related to you?
- Did the dependent live in your household the entire year?
- Is the dependent your child?
- Please select one of the following options
- Please provide proof of the dependent's disability status (e.g., a doctor's letter certifying the dependent is totally and permanently disabled)
  
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- Is the child a citizen or national of the United States?
- Why are the child's parent's not claiming the child?
- Is the child married?
- Will s/he be filing a joint return with his/her spouse?
- Did the child live with you more than six (6) months of the year?
- Please provide proof of your address as the child's address (e.g., school records, medical records, child care records, etc.)
  
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- Can anyone else claim the child lived with them for more than six (6) months of the year?
- If you are filing as Single or as Head of Household, does anyone in your household earn more money than you do?
- Did the dependent earn more than four thousand dollars ($4,000.00) in the year?
- Did you provide more than 50% of the financial support for the dependent listed above?
- Do you want to list this dependent as the Head of Household?
- You agree that your typed name below is the same as your legal signature and that the information you entered above is true and correct to the best of your knowledge.
- Date Signed
  
  MonthDayYear
  Date
- Taxpayer's Full Name
- Should be Empty: