Additional EIC Questions
Please answer all questions below regarding your Earned Income Credit eligibility.
Taxpayer Name
*
Were You Married During The Tax Year
*
Yes
No
If Married, When Did You Stop Living With Your Spouse?
-
Month
-
Day
Year
Date
Did You Live With Any Other Relative During The Tax Year?
*
Yes
No
If Yes, How Many Months?
How Many Months Did Each Child Live With You During The Tax Year?
What Is The Relationship With Each Child You Are Claiming:
*
Son
Daughter
Stepchild
Foster child
Brother
Sister
Stepbrother
Stepsister
Half brother
Half sister
Other
If Other Relationship, Specify:
Were Any Dependents Placed In Your Home For Adoption Or As A Foster Child By A Government Agency?
*
Yes
No
Did You Live With Your Parents Or Grandparents During The Tax Year?
*
Yes
No
When Did You Move In With Your Parents Or Grandparents
-
Month
-
Day
Year
Date
Can Any Dependent You Are Claiming Be A Qualifying Child Of Any Of Your Relatives?
*
Yes
No
If The Dependent Is Your Child, Where Did The Child's Other Parent Live During The Tax Year?
If The Dependent Is Your Child, Explain Why The Other Parent Will Not Claim EIC For This Child
If The Dependent Is Not Your Child, Explain Why The Parents Are Not Claiming EIC For This Child
Any additional information regarding the child’s residency, support, or custody that may affect Earned Income Credit:
Taxpayer Signature
Date
-
Month
-
Day
Year
Date
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