8862 OMB No. 1545-1619

Information To Claim Earned Income Credit

After Disallowance

Department of the Treasury

Internal Revenue Service

Attachment

 Attach to your tax return. Sequence No. 43A

For Paperwork Reduction Act Notice, see page 2 of the separate instructions. Cat. No. 25145E Form 8862 (Rev. 11-2003)

 See separate instructions.

Name(s) shown on return Your social security number

(Rev. November 2003)

Form

Part I All Filers

1

Yes

Enter the year, after 2001, for which you are filing this form (for example, 2003) 

Were you, or your spouse if filing a joint return, a qualifying child of another person during the year entered

on line 1?

2

No

Filers Without a Qualifying Child

3a

Part II

Caution. See your tax return instructions for the year entered on line 1 to be sure you can take the EIC.

Enter the dates during the year shown on line 1 that your home was in the United States 

If married filing a joint return, enter the dates during the year shown on line 1 that your spouse’s home was in the United

States 

b

Part III

Yes

Filers With a Qualifying Child or Children Child 1 Child 2

c

5a

4

Caution. If you have two qualifying children, complete lines

4–8 for one child before going to the next column. List your

children here in the same order as you did on Schedule EIC.

b

b

Is the child your son, daughter, adopted child, stepchild, or a

descendant of any of them (for example, your grandchild)?

Next, if you checked “Yes” for this child, go to line 6a. If you

checked “No,” continue.

Did the child live with you in the United States for more than

half of the year entered on line 1?

Enter the address(es) where you and the child lived during the

year entered on line 1

If the child attended school or day care, enter the name(s) of

the school(s) or care provider(s)

Are you related to the child or was the child placed with you

by an authorized placement agency?

Enter the child’s relationship to you or the name of the

placement agency. Enter both items if the child is related and

was also placed with you by an agency

No Yes No

Yes No Yes No

6a

Next, if you checked “No” on line 5a for this child, go to line

6a. If you checked “Yes,” continue.

Next, if you do not have a qualifying child, go to Part II. If you do have a qualifying child, go to Part III.

c Did you care for the child as you would your own child?

Before you begin: See your tax return instructions for the year for which you are filing this form to make sure you can take

the earned income credit (EIC) and to find out who is a qualifying child.

Yes No Yes No

Yes No Yes No



Do not use this form for a year prior to 2002. Instead, use the November 2000 revision of Form 8862.

Do not file this form if, for a year after 2001, you are taking the EIC without a qualifying child and the

only reason your EIC was reduced or disallowed in the earlier year was because it was determined that

a child listed on Schedule EIC was not your qualifying child.

Form 8862 (Rev. 11-2003) Page 2

Does the child meet the requirements to be a qualifying child

of any other person for the year entered on line 1 (see

instructions before answering)?

Next, if you checked “No” on line 8a for this child, do not fill

in lines 8b–8d for this child. If you checked “Yes,”

continue.

Enter the child’s relationship to the other person(s)

Was the child under age 19 at the end of the year entered on

line 1?

Next, if you checked “Yes” on line 7a for this child, go to line

8a. If you checked “No,” continue.

Was the child under age 24 at the end of the year entered on

line 1 and a student?

Enter the name of the school(s), or the state, county, or local

government agency if an on-farm training course, the child

attended. Do not enter if shown on line 6c. Go to line 8a next.

Was the child permanently and totally disabled?

If you checked “Yes” on line 7d, enter the name(s) of the child’s

health care provider(s) or social worker(s)

Yes No Yes No

7a

b

b

c

d

e

Yes No Yes No

Part III Filers With a Qualifying Child or Children (Continued) Child 1 Child 2

8a

Yes No Yes No

Next, if you checked “No” on line 7b for this child, go to line

7d. If you checked “Yes,” continue.

Form 8862 (Rev. 11-2003)

Enter the name and social security number of the other

person(s)

c

If the tie-breaker rules applied, would the child be treated as

your qualifying child (see instructions before answering)?

d

Yes No Yes No

Yes No Yes No