Form 8839

Department of the Treasury 

Internal Revenue Service (99)

Qualified Adoption Expenses

▶ Attach to Form 1040 or 1040NR.

▶ For information about Form 8839 and its separate instructions, see www.irs.gov/form8839.

OMB No. 1545-0074

2016

Attachment 

Sequence No. 38

Name(s) shown on return Your social security number

Part I Information About Your Eligible Child or Children—You must complete this part. See instructions for 

details, including what to do if you need more space.

1

(a) 

Child’s name (b) 

Child’s year 

of birth

Check if child was—

(c) 

born before

1999 and

disabled

(d) 

a child 

with special 

needs

(e) 

a 

foreign 

child

(f) 

Child’s 

identifying number

(g) 

Check if 

adoption 

became final in 

2016 or earlier First Last 

Child 

1

Child 

2

Child 

3

Caution: If the child was a foreign child, see Special rules in the instructions for line 1, column (e), before you complete Part II or 

Part III. If you received employer-provided adoption benefits, complete Part III on the back next.

Part II Adoption Credit

Child 1 Child 2 Child 3 

2 Maximum adoption credit per 

child . . . . . . . . 2 

3 Did you file Form 8839 for a 

prior year for the same child?

No. Enter -0-.

Yes. See instructions for 

the amount to enter. } 3 

4 Subtract line 3 from line 2 . 4 

5 Qualified adoption expenses 

(see instructions) . . . .

Caution: Your qualified 

adoption expenses may not be 

equal to the adoption expenses 

you paid in 2016.

5 

6 Enter the smaller of line 4 or line 5 6 

7 Enter modified adjusted gross income (see instructions) . . . . . . 7

8 Is line 7 more than $201,920?

No. Skip lines 8 and 9, and enter -0- on line 10.

Yes. Subtract $201,920 from line 7 . . . . . . . . . . . 8

9 Divide line 8 by $40,000. Enter the result as a decimal (rounded to at least three places). 

Do not enter more than 1.000 . . . . . . . . . . . . . . . . . . . . . . 9 × . 

10 Multiply each amount on line 6 

by line 9 . . . . . . . 10

11 Subtract line 10 from line 6 . 11

12 Add the amounts on line 11 . . . . . . . . . . . . . . . . . . . . . . . 12

13 Credit carryforward, if any, from prior years. See your Adoption Credit Carryforward Worksheet 

in the 2015 Form 8839 instructions . . . . . . . . . . . . . . . . . . . . 13

14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Enter the amount from line 5 of the Credit Limit Worksheet in the instructions . . . . . . 15

16 Adoption Credit. Enter the smaller of line 14 or line 15 here and on Form 1040, line 54, or Form

1040NR, line 51. Check box c on that line and enter “8839” in the space next to box c. If line 15 

is smaller than line 14, you may have a credit carryforward (see instructions) . . . . . . . 16

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 22843L Form 8839 (2016) 
Form 8839 (2016) Page 2 

Part III Employer-Provided Adoption Benefits

Child 1 Child 2 Child 3 

17 Maximum exclusion per child 17

18 Did you receive employerprovided adoption benefits for a 

prior year for the same child?

No. Enter -0-.

Yes. See instructions for 

the amount to enter. } 18

19 Subtract line 18 from line 17 19

20 Employer-provided adoption 

benefits you received in 2016. 

This amount should be shown 

in box 12 of your 2016 Form(s) 

W-2 with code T . . . . 20

21 Add the amounts on line 20 . . . . . . . . . . . . . . . .

 . . . . . . . 21

22 Enter the smaller of line 19 or 

line 20. But if the child was a 

child with special needs and the 

adoption became final in 2016, 

enter the amount from line 19 22

23 Enter modified adjusted gross income (from 

the worksheet in the instructions) . . . . 23

24 Is line 23 more than $201,920?

No. Skip lines 24 and 25, and enter -0- 

on line 26.

Yes. Subtract $201,920 from line 23 24

25 Divide line 24 by $40,000. Enter the result as a decimal (rounded to 

at least three places). Do not enter more than 1.000 . . . . . 25 × . 

26 Multiply each amount on line 22 

by line 25 . . . . . . . 26

27 Excluded benefits. Subtract 

line 26 from line 22 . . . . 27

28 Add the amounts on line 27 . . . . . . . . . . . . . . . . . . . . . . . 28

29 Taxable benefits. Is line 28 more than line 21?

No. Subtract line 28 from line 21. Also, include this amount, if more than zero, on 

line 7 of Form 1040 or line 8 of Form 1040NR. On the dotted line next to line 

7 of Form 1040 or line 8 of Form 1040NR, enter “AB.”

Yes. Subtract line 21 from line 28. Enter the result as a negative number. Reduce 

the total you would enter on line 7 of Form 1040 or line 8 of Form 1040NR by

the amount on Form 8839, line 29. Enter the result on line 7 of Form 1040 or 

line 8 of Form 1040NR. Enter “SNE” on the dotted line next to the entry line.

} . . 29

TIP

You may be able to claim the adoption credit in Part II on the front of this form if any of the following apply. 

• You paid adoption expenses in 2015, those expenses were not fully reimbursed by your employer or otherwise, and 

the adoption was not final by the end of 2015. 

• The total adoption expenses you paid in 2016 were not fully reimbursed by your employer or otherwise, and the 

adoption became final in 2016 or earlier. 

• You adopted a child with special needs and the adoption became final in 2016.

Form 8839 (2016)