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. 11-2000)

 See separate instructions.

Name(s) shown on return Your social security number

(Rev. November 2000)

Form

Part I All Filers

1

Yes

Enter the year for which you are filing this form (for example, 1999, 2000, etc.) 

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

6a

4

Caution. If you have two qualifying children, complete lines

4–8 for one child before going to the next column. Be sure

you list your children here in the same order as you did on

Schedule EIC.

b

b

Is the child your son, daughter, adopted child, grandchild, or

stepchild?

Next, if you checked “Yes” for this child, go to line 5a. If you

checked “No,” go to line 6a.

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)

Next, go to line 7a on the back for this child.

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

Yes No Yes No

5a

Next, if you checked “No” on line 6a for this child, go to line

6c. 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 if he or she were your own child

during the entire year entered on line 1? Yes No Yes No

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.
Form 8862 (Rev. 11-2000) Page 2

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

the school(s) or care provider(s)

Did the child live with any other person for more than half of

the year entered on line 1 (see instructions before answering)?

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

8a. If you checked “Yes,” continue.

Was this person the child’s parent or grandparent?

Did this person live with the child for the entire year entered

on line 1 and care for the child as if the child were his or her

own? 

Enter this person’s name and social security number (see

instructions)

Is your modified AGI (adjusted gross income) for the year

entered on line 1 higher than the modified AGI of every person

listed on line 7f?

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

line 1?

Next, if you checked “Yes” on line 8a for this child, do not fill

in lines 8b–8e for this child. If you checked “No,”

continue.

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

line 1 and a student?

If you checked “Yes” on line 8b, 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 5c or 6f

If you checked “No” on line 8b, was the child permanently and

totally disabled?

If you checked “Yes” on line 8d, enter the name of the child’s

health care provider or social worker

Yes No Yes No

Yes No Yes No

Yes No Yes No

Yes No Yes No

Yes No Yes No

8a

b

c

f

g

b

c

d

e

Yes No Yes No

Yes No Yes No

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

7f. If you checked “No,” continue.

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

f

7a

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

8a. If you checked “Yes,” continue.

d Did the child live with you in the United States for the entire

year entered on line 1?

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

year entered on line 1

Yes No Yes No

e

Next, if you checked “No” on line 8b for this child, go to line

8d. If you checked “Yes,” continue.

Form 8862 (Rev. 11-2000)

d Was this person related to the child or was the child placed

with this person by an authorized placement agency? Yes No Yes No

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

7f. If you checked “Yes,” continue.

Enter the child’s relationship to this person or the name of the

placement agency. Enter both items if the child was related

and was also placed with this person by an agency

e