and 
Do not
Form  
 
8862
(Rev. December 2012) 
Department of the Treasury  
Internal Revenue Service 
Information To Claim Earned Income Credit  
After Disallowance
a
 
Attach to your tax return.             
a
 
.
OMB No. 1545-0074 
Attachment   
Sequence No. 
43A
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) 
to find out who is a qualifying child.

Schedule EIC 

 
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, 2012) 
............
a
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”
....
a
Yes
No
Caution. 
If you checked “Yes,” 
stop. Do not 
 
EIC. If you checked “No,” continue.
3
Could you (or your spouse if filing jointly) be claimed as a qualifying child of another taxpayer for the year 
shown on line 1? See the instructions before answering 
...............   
a
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
shown on line 1 above.
4
number of days 
a
Child 1 
a
b    Child 2
 
a
c    Child 3
 
a
Caution. 
If you entered less than 
183 
(184 if the year on line 1 is a leap year) for any child, you cannot take the EIC based on
 
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 
a
(1)
 Month and day of birth (MM/DD)  
a
/
(2)
 
Month and day of death (MM/DD)  
a
/
b
Child 2 
a
(1)
 Month and day of birth (MM/DD)  
a
/
(2)
 
Month and day of death (MM/DD)  
a
/
c
Child 3 
a
(1)
 Month and day of birth (MM/DD)  
a
/
(2)
 
Month and day of death (MM/DD)  
a
/
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 
a
Number and street 
City or town, state, and ZIP code 
b
Child 2 
a
If same as shown for child 1, check this box.
 
a
Otherwise, enter below:
Number and street 
City or town, state, and ZIP code 
c
If same as shown for child 1, check this box.
 
a
Or if same as shown for child 2 (and
this is different from address shown for child 1), check this box. 
a
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? 
...........
a
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. 
a
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.
 
a
Or if same as shown
for child 2 (and this is different from the person living with child 1), check this box. 
 
a
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 page 3.
Cat. No. 25145E
Form 
8862 
(Rev. 12-2012)
Child 3 
a
Zip Code
State
Zip Code
State
Zip Code
State
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.
 
and
 
Note. Child 1, Child 2,
  
Child 3
 
Schedule EIC
 
Information about Form 8862 and its instructions is at www.irs.gov/form8862
If you have a qualifying child, complete 
before you fill in this form.
file this form if you are taking the EIC without a qualifying child 
the only reason your EIC was 
fill in the rest of this form. But you must attach it to your tax return to take the
and
 
are the same children you listed as Child 1, Child 2, and Child 3 on
 
for the year 
Enter the
 
each child lived with you in the United States during the year shown on line 1 above:
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Form 8862 (Rev. 12-2012) 
Page 
2 
Part III
Filers Without a Qualifying Child
8
number of days
a
instructions.
9
number of days
lived in the United States 
..........................
a
instructions.
Form 
8862 
(Rev. 12-2012)
If you entered less than
 
You cannot take the EIC. See the
If married filing a joint return, enter the
                             
during the year shown on line 1 that your spouse 
If you entered less than
 
You cannot take the EIC. See the
Enter the
                             
during the year shown on line 1 that you lived in the United States   .    .    .
Caution.
 
183 (184 if the year on line 1 is a leap year), stop. 
Caution.
 
183 (184 if the year on line 1 is a leap year), stop. 
----------------Page (1) Break----------------