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 returnYour 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 IAll Filers

1Enter the year for which you are filing this form (for example, 2012) ............a

2If 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”....aYesNo

Caution. If you checked “Yes,” stop. Do not  

EIC. If you checked “No,” continue.

3Could 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 ...............   aYesNo

Caution. If you checked “Yes,” stop. You cannot take the EIC. If you checked “No,” continue. 

Part IIFilers With a Qualifying Child or Children

shown on line 1 above.

4number of days 

aChild 1 ab    Child 2 ac    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

 

5If 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.

aChild 1 a(1) Month and day of birth (MM/DD)  a/(2) Month and day of death (MM/DD)  a/

bChild 2 a(1) Month and day of birth (MM/DD)  a/(2) Month and day of death (MM/DD)  a/

cChild 3 a(1) Month and day of birth (MM/DD)  a/(2) Month and day of death (MM/DD)  a/

6Enter 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:

aChild 1 aNumber and street 

City or town, state, and ZIP code 

bChild 2 aIf same as shown for child 1, check this box. aOtherwise, enter below:

Number and street 

City or town, state, and ZIP code 

cIf same as shown for child 1, check this box. aOr if same as shown for child 2 (and

this is different from address shown for child 1), check this box. aOtherwise, enter below:

Number and street 

City or town, state, and ZIP code 

7Did 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? ...........aYesNo

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:

aOther person living with child 1:Name 

Relationship to child 1 

bOther person living with child 2:If same as shown for child 1, check this box. aOtherwise, enter below:

Name 

Relationship to child 2 

cOther person living with child 3:If same as shown for child 1, check this box. aOr 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. 25145EForm 8862 (Rev. 12-2012)

Child 3 a

Zip CodeState

Zip CodeState

Zip CodeState

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 IIIFilers Without a Qualifying Child

8number of daysa

instructions.

9number 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. 

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