Catalog Number 69807V www.irs.gov
Form
15112 (Rev. 3-2021)
Form 15112
(March 2021)
Department of the Treasury - Internal Revenue Service
Earned Income Credit Worksheet (CP 27)
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 describes you or that describes 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
Sign and date the statement if you are eligible for the credit.
Under penalties of perjury, I declare that this information is true and correct to the best of my knowledge.
Your signature Date
Your spouse’s signature Date
