EITC Questionnaire
(Use for 13 and Under & Non-biological Children)
In the event you were ever audited, which of the following document(s) would you be able to provide for proof that your dependents live with you (residency test) and are related to you (relationship test)? Select all that apply
Birth Certificate
School Records
Landlord or Property Statement
Medical Records
Healthcare Provider Statement
Social Service Records
Place of Worship Statement
Indian Tribal Official Statement
Employer Statement
Childcare Provider Records
Placement Agency Records
Other (Must Specify) ____________________________
For Children Under Age 13
Who takes care of the child(ren) while you are at work?
Where is childcare provided?
Do you pay the childcare provider? If not, who does?
Signature
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Should be Empty: