Injured Spouse Claim and Allocation Form

Department of the Treasury

Internal Revenue Service

Name(s) shown on return Your social security number

Are You an Injured Spouse?

You are an injured spouse if all or part of your share of the overpayment shown on your joint return was, or is expected to be,

applied against your spouse’s past-due child or spousal support payments or certain Federal debts such as student loans. You

may file Form 8379 to claim your part of the refund if all three of the following apply:

How Do I File Form 8379?

● If you have already filed the joint tax return, mail Form 8379 by itself to the Internal Revenue Service Center for the place

where you lived when you filed the joint return. See your tax return instruction booklet for the address. Note: Include copies of

all W-2 forms of both spouses and any Forms 1099-R showing income tax withheld. If you do not include these copies, the

processing of your claim may be delayed.

● If you have not filed the joint return, attach Form 8379 behind your return in order of the attachment sequence number. Enter

“Injured Spouse” in the upper left corner of the return. Note: You cannot request direct deposit of your refund if you file Form

8379.

Information About the Joint Tax Return for Which This Claim Is Filed

Enter the following information exactly as it is shown on the tax return for which you are filing this claim.

The spouse’s name and social security number shown first on that tax return must also be shown first below.

First name, initial, and last name shown first on the return

If Injured Spouse,

check here ©

Current home address

Do you want the refund check to be payable to the injured spouse only?

Was your main home in a community property state (Arizona, California, Idaho, Louisiana, Nevada, New

Mexico, Texas, Washington, or Wisconsin) at any time during the tax year for which you are filing this claim?

If “Yes,” which community property state(s)?

Note: Overpayments involving community property states will be allocated by the IRS according to state law.

Go to Part II on the back.

8379

Part I

1

Social security number shown first If Injured Spouse,

check here ©

Social security number shown second

City State ZIP code

3

5

6

Yes No

Yes No

Cat. No. 62474Q Form 8379 (Rev. 12-96)

OMB No. 1545-1210

The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is:

Recordkeeping, 13 min.; Learning about the law or the form, 8 min.; Preparing the form, 58 min.; and Copying, assembling, and sending

the form to the IRS, 31 min.

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, see How Do I File Form 8379? below.

(Rev. December 1996)

Attachment

Sequence No. 104

1. You are not required to pay the past-due amount.

2. You received and reported income (such as wages, taxable interest, etc.) on the joint return, OR your main home was in a

community property state (see line 6) other than Arizona.

3. You made and reported payments such as Federal income tax withheld from your wages or estimated tax payments, OR

you claimed the earned income credit or other refundable credit, on the joint return.

First name, initial, and last name shown second on the return

If you are filing Form 8379 with your tax return, skip to line 5.

2 Enter the tax year for which you are filing this claim © 19____

If all three of the above apply and you want your share of the overpayment shown on the joint return refunded to you,

complete this form. The IRS will figure your part of the overpayment and send you any refund that is due. However, if you also

owe past-due child support or a Federal agency debt, part or all of your share of the overpayment may be applied to that debt.

Allow at least 8 weeks for the processing of this claim.

Privacy Act and Paperwork Reduction Act Notice.—Our legal right to ask for the information on this form is Internal Revenue Code sections

6001, 6011, 6109, and 6402 and their regulations. You are required to give us the information so that we can process your claim for refund of

your share of an overpayment shown on the joint return with your spouse. We need it to ensure that you are allocating items correctly and to

allow us to figure the correct amount of your claim for refund. If you do not provide all of the information, we may not be able to process your

claim. We may give this information to the Department of Justice as provided by law. We may also give it to cities, states, and the District of

Columbia to carry out their tax laws.

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.

4 Is the address on your joint return different from the address shown above? Yes No
Form 8379 (Rev. 12-96)

Allocation Between Spouses of Items on the Joint Tax Return

Income. Enter the separate income that each spouse

earned. Allocate joint income, such as interest earned on

a joint bank account, as you determine. But be sure to

allocate all income shown on the joint return.

Wages

All other income. Identify the type and amount ©

Adjustments to income. Enter each spouse’s separate

adjustments, such as an IRA deduction. Allocate other

adjustments as you determine

Standard deduction. If you itemized your deductions, go

to line 10. Otherwise, enter in both columns (b) and (c) 1⁄2

of the amount shown in column (a) and go to line 11

Itemized deductions. Enter each spouse’s separate

deductions, such as employee business expenses.

Allocate other deductions as you determine

Number of exemptions. Allocate the exemptions claimed

on the joint return to the spouse who would have claimed

them if separate returns had been filed. Enter whole

numbers only (for example, you cannot allocate 3

exemptions by giving 1.5 exemptions to each spouse)

Credits. Allocate business credits to the spouse who had

the business. Allocate any child and dependent care credit

claimed for a dependent to the spouse who has been

allocated the dependent’s exemption. Do not include the

earned income credit; the IRS will allocate it. Allocate any

other credits as you determine

Other taxes. Allocate self-employment tax to the spouse

who earned the self-employment income. Allocate any

alternative minimum tax as you determine

Federal income tax withheld. Enter Federal income tax

withheld from each spouse’s income as shown on Forms

W-2 and 1099-R. Be sure to attach copies of these forms

to your tax return, or to Form 8379 if you are filing it by

itself. (Also, include on this line any excess social security,

Medicare, and RRTA tax withheld.)

Payments. Allocate joint estimated tax payments as you

determine

Note: The IRS will figure the amount of any refund due the injured spouse.

Page 2

Part II

7

a

b

9

11

12

13

14

15

Allocated Items (a) Amount Shown

on Joint Return

(b) Allocated to

Injured Spouse

(c) Allocated to

Other Spouse

Under penalties of perjury, I declare that I have examined this form and any accompanying schedules or statements and to the best of my knowledge and belief, they

are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Keep a copy of

this form for

your records

Injured spouse’s signature

Date

Phone number (optional)

Check if

self-employed

Preparer’s

signature

Firm’s name (or yours

if self-employed) and

address

Paid

Preparer’s

Use Only

( )

Preparer’s social security no. ©

© EIN

ZIP code

Part III Signature. Complete this part only if you are filing Form 8379 by itself and not with your tax return.

Date

8

10