Catalog Number 69806K www.irs.gov
Form
15111 (Rev. 3-2021)
Form 15111
(March 2021)
Department of the Treasury - Internal Revenue Service
Earned Income Credit Worksheet (CP 09)
Contact information
Your name Social Security Number
Your spouse’s name Spouse Social Security Number
If your address has changed, provide the current address below, call 800-829-0922 or visit www.irs.gov.
Address City State ZIP code
Primary telephone number Best time to call
a.m.
p.m.
Secondary telephone number Best time to call
a.m.
p.m.
Step 1
Read each statement listed below, and place a check mark next to any statement that describe you or that describe your spouse if you
and your spouse filed a joint return for tax year 2020.
I (or my spouse and I) had a principal place of abode in the United States for 6 months or less in 2020. (U.S. military personnel
stationed outside the United States on extended active duty are considered to have a principal place of abode in the U.S. during that
period for purposes of the Earned Income Credit (EIC)).
I (or my spouse and I) did not have earned income or had excess investment income in 2020 (see Pub. 596 for a list of what is
earned income and what is excess investment income for EIC purposes).
I (or my spouse or I) may be claimed as a dependent by another person.
My Social Security card or the Social Security card of my spouse reads “Not Valid for Employment,” and was issued so one of us
could receive a federally funded benefit, such as Medicaid.
I am or my spouse is an EIC qualifying child of another person. Being an EIC qualifying child of another person means that you
meet all of the following criteria:
– You are that person’s son, daughter, stepchild, grandchild, or “eligible foster child.” Or, you are that person’s brother, sister, half-
brother, half-sister, stepbrother, or stepsister (or the child or grandchild of that person’s brother, sister, half-brother, half-sister,
stepbrother, or stepsister).
– You were under age 19 at the end of the year and younger than that person (or that person’s spouse, if the person files jointly).
Or, you were under age 24 at the end of the year, a “student,” and younger than that person (or that person’s spouse, if the
person files jointly). Or, you were “permanently and totally disabled,” regardless of age.
– You had the same principal place of abode as that person in the United States for more than half of the year.
– You are not filing a joint return for the year (or are filing a joint return only as a claim for refund of withheld tax or estimated tax).
• If you checked any of the above boxes, you’re not eligible for the credit. Please do not continue completing this worksheet.
• If you did not check any of the above boxes, please continue to Step 2.
Step 2
Provide the information requested below for no more than three of your children who lived with you or your spouse in 2020, and met the
relationship test to be a qualifying child of you or your spouse. A child meets the relationship test to be your qualifying child if the child is
your son, daughter, stepchild, “adopted child,” brother, sister, stepbrother, stepsister, or any of their descendants, or an “eligible foster
child.”
Your qualifying child must have a Social Security number (SSN) issued on or before the due date of your tax return (including
extensions), unless the child was born and died in 2019. If so, you must attach to your notice a copy of the child's birth certificate, death
certificate, or hospital records showing a live birth.
Do not provide information if:
• The dependent has a Social Security card that reads “Not Valid for Employment” and the Social Security number was issued so the
dependent could receive a federally funded benefit, such as Medicaid.
• The dependent filed a joint return for reasons other than claiming a tax refund.
