Instructions

What Is the EIC?

You may have only one Form W-5 in effect at one time.

If you and your spouse are both employed, you should file

separate Forms W-5.

 Give the bottom part to your employer; keep the top part for your records. 

Detach here

Form W-5

This certificate expires on December 31, 2003.

Print or type your full name Your social security number

Note: If you get advance payments of the earned income credit for 2003, you must file a 2003 Federal income tax return. To get advance

payments, you must have a qualifying child and your filing status must be any status except married filing a separate return.

Yes No

I expect to have a qualifying child and be able to claim the earned income credit for 2003, I do not have

another Form W-5 in effect with any other current employer, and I choose to get advance EIC payments

1

3 If you are married, does your spouse have a Form W-5 in effect for 2003 with any employer?

Under penalties of perjury, I declare that the information I have furnished above is, to the best of my knowledge, true, correct, and complete.

Signature Date 

(continued on page 2)

Earned Income Credit Advance Payment Certificate

Department of the Treasury

Internal Revenue Service

Cat. No. 10227P

The EIC is a credit for certain workers. It reduces the tax

you owe. It may give you a refund even if you do not owe

any tax.

If you are eligible to get advance EIC payments, fill in the

2003 Form W-5 at the bottom of this page. Then, detach

it and give it to your employer. If you get advance

payments, you must file a 2003 Federal income tax

return. Who Is Eligible To Get Advance EIC

Payments?

How To Get Advance EIC Payments

OMB No. 1545-1342

2 Check the box that shows your expected filing status for 2003:

You are eligible to get advance EIC payments if all three

of the following apply.

1. You expect to have at least one qualifying child. If

you do not expect to have a qualifying child, you may still

be eligible for the EIC, but you cannot receive advance

EIC payments. See Who Is a Qualifying Child? on

page 2.

3. You expect to be able to claim the EIC for 2003. To

find out if you may be able to claim the EIC, answer the

questions on page 2.

Give this certificate to your employer.

2. You expect that your 2003 earned income and AGI

will each be less than $29,666 ($30,666 if you expect to

file a joint return for 2003). Include your spouse’s income

if you plan to file a joint return. As used on this form,

earned income does not include amounts inmates in

penal institutions are paid for their work, amounts

received as a pension or annuity from a nonqualified

deferred compensation plan or a nongovernmental

section 457 plan, or nontaxable earned income.

If you do not choose to get advance payments, you can

still claim the EIC on your 2003 tax return.

Form W-5 Department of the Treasury

Internal Revenue Service

Use the current year’s certificate only.

Purpose of Form

Use Form W-5 if you are eligible to get part of the EIC in

advance with your pay and choose to do so. See Who Is

Eligible To Get Advance EIC Payments? below. The

amount you can get in advance generally depends on

your wages. If you are married, the amount of your

advance EIC payments also depends on whether your

spouse has filed a Form W-5 with his or her employer.

However, your employer cannot give you more than

$1,528 throughout 2003 with your pay. You will get the

rest of any EIC you are entitled to when you file your tax

return and claim the EIC.

Yes No

Single, head of household, or qualifying widow(er) Married filing jointly

2003

2003
Form W-5 (2003) Page 2

Questions To See if You May Be Able To Claim the EIC for 2003

2

3

1

5

Do you expect your 2003 filing status to be married filing a separate return?

Yes. You cannot claim the EIC.

Do you expect that your 2003 earned income and AGI will each be less than: $29,666 ($30,666 if married filing jointly) if you

expect to have 1 qualifying child; $33,692 ($34,692 if married filing jointly) if you expect to have 2 or more qualifying children?

No. You cannot claim the EIC.

Do you expect to have a qualifying child? Read Who Is a Qualifying Child? that starts below before you answer this question.

If the child is married, be sure you also read Married child on page 3.

No. You may be able to claim the EIC but you cannot get advance EIC payments.

If the child meets the conditions to be a qualifying child for both you and another person, see Qualifying child of more

than one person on page 3.

Do you expect that you, or your spouse if filing a joint return, will be a qualifying child of another person for 2003?

No. You may be able to claim the EIC.

Yes. You cannot claim the EIC.

Yes. Continue.

Yes. Continue. But remember, you cannot get advance EIC payments if you expect your 2003 earned income or AGI will

be $29,666 ($30,666 or more if married filing jointly) or more.

No. Continue.

You cannot claim the EIC if you plan to file either Form 2555 or Form 2555-EZ (relating to foreign earned income) for

2003. You also cannot claim the EIC if you are a nonresident alien for any part of 2003 unless you are married to a U.S.

citizen or resident and elect to be taxed as a resident alien for all of 2003.

4 Do you expect that your 2003 investment income will be more than $2,600? For most people, investment income is the total

of their taxable interest, ordinary dividends, capital gain distributions, and tax-exempt interest. However, if you plan to file a

2003 Form 1040, see the 2002 Form 1040 instructions to figure your investment income.

Yes. You cannot claim the EIC.

No. Continue.

If you expect to file a joint return for 2003, include your spouse’s income when answering questions 3 and 4.

Who Is a Qualifying Child?

You may be able to get a larger credit when you file

your 2003 return. For details, see Additional Credit

on page 3.

Any child who meets all three of the following conditions

is a qualifying child.

This Form W-5 expires on December 31, 2003. If you

are eligible to get advance EIC payments for 2004, you

must file a new Form W-5 next year.

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(continued on page 3)
Form W-5 (2003) Page 3

Additional Information

How To Claim the EIC

Additional Credit

Privacy Act and Paperwork Reduction Act Notice. We

ask for the information on this form to carry out the

Internal Revenue laws of the United States. Internal

Revenue Code sections 3507 and 6109 and their

regulations require you to provide the information

requested on Form W-5 and to give it to your employer if

you want advance payment of the EIC. As provided by

law, we may give the information to the Department of

Justice and other Federal agencies. In addition, we may

give it to cities, states, and the District of Columbia so

they may carry out their tax laws. We may also disclose

this information to other countries under a tax treaty or to

Federal and state agencies to enforce Federal nontax

criminal laws and to combat terrorism. Failure to provide

the requested information may prevent processing of this

form; providing false information may subject you to

penalties.

What if My Situation Changes?

If your situation changes after you give Form W-5 to your

employer, you will probably need to file a new Form W-5.

For example, you must file a new Form W-5 if any of the

following applies for 2003.

● You no longer expect to be able to claim the EIC for

2003. Check “No” on line 1 of your new Form W-5.

If you have comments concerning the accuracy of

these time estimates or suggestions for making this form

simpler, we would be happy to hear from you. You can

write to the Tax Forms Committee, Western Area

Distribution Center, Rancho Cordova, CA 95743-0001. Do

not send the form to this address. Instead, give it to your

employer.

● Your spouse files Form W-5 with his or her employer.

Check “Yes” on line 3 of your new Form W-5.

If you are eligible, claim the EIC on your 2003 tax return.

See your 2003 tax return instruction booklet.

The time needed to complete this form will vary

depending on individual circumstances. The estimated

average time is: Recordkeeping, 6 min.; Learning about

the law or the form, 12 min.; and Preparing the form,

25 min.

You may be able to claim a larger credit when you file

your 2003 tax return because your employer cannot give

you more than $1,528 throughout the year with your pay.

You may also be able to claim a larger credit if you have

more than one qualifying child. But you must file your

2003 tax return to claim any additional credit.

● You no longer expect to have a qualifying child. Check

“No” on line 1 of your new Form W-5.

● You no longer want advance payments. Check “No” on

line 1 of your new Form W-5.

You are not required to provide the information

requested on a form that is subject to the Paperwork

Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or its

instructions must be retained as long as their contents

may become material in the administration of any Internal

Revenue law. Generally, tax returns and return information

are confidential, as required by Code section 6103.

Reminder. A qualifying child must have a social security

number unless he or she was born and died in 2003.

Note: If you get the EIC with your pay and find you are

not eligible, you must pay it back when you file your 2003

Federal income tax return.

Qualifying child of more than one person. If the child

meets the conditions to be a qualifying child of more than

one person, only one person may treat that child as a

qualifying child for 2003. If you and the other person(s)

cannot agree on who will treat that child as a qualifying

child for 2003, special rules apply to determine who may

do so. For details, see the 2002 revision of Pub. 596,

Earned Income Credit (EIC). However, these rules do not

apply if the only other person is your spouse and you

plan to file a joint return for 2003.

2. You have a pre-1985 divorce decree or separation

agreement that allows the noncustodial parent to claim

the child and he or she gives at least $600 for the child’s

support in 2003.

Note: An adopted child is any child placed with you by

an authorized placement agency for legal adoption even if

the adoption is not final. An authorized placement agency

includes any person authorized by state law to place

children for legal adoption. A grandchild is any

descendant of your son, daughter, adopted child, or

stepchild.

2. At the end of 2003, the child is under age 19, or

under age 24 and a full-time student, or any age and

permanently and totally disabled.

3. The child lives with you in the United States for over

half of 2003.

Married child. A child who is married at the end of 2003

is a qualifying child only if you may claim him or her as

your dependent, or the following Exception applies to

you.

Exception. You are the custodial parent and would be

able to claim the child as your dependent, but the

noncustodial parent claims the child as a dependent

because—

1. You signed Form 8332, Release of Claim to

Exemption for Child of Divorced or Separated Parents, or

a similar statement, agreeing not to claim the child for

2003 or

Exception to “Time Lived With You” Condition. The

child does not have to live with you for over half of 2003

if either of the following applies.

1. The child was born or died during the year and your

home was this child’s home for the entire time he or she

was alive in 2003.

2. The child is presumed by law enforcement authorities

to have been kidnapped by someone who is not a family

member and the child lived with you for over half of the

part of the year before he or she was kidnapped.

Note: Temporary absences, such as for school, vacation,

medical care, or detention in a juvenile facility, count as

time lived at home. Members of the military on extended

active duty outside the United States are considered to be

living in the United States.

1. The child is:

● Your son, daughter, adopted child, stepchild, or

grandchild; or

● Your brother, sister, stepbrother, stepsister, or a

descendant of your brother, sister, stepbrother, or

stepsister (for example, your niece or nephew), whom you

cared for as your own child; or

● A foster child (any child placed with you by an

authorized placement agency whom you cared for as your

own child).