Documentos de Académico
Documentos de Profesional
Documentos de Cultura
DATE:__________/______/ 2018
Do the taxpayer, and spouse if married filing joint or claiming spouse exemption, and all qualifying children have a valid SSN for work?
Yes c No c If any person is filing with an ITIN or ATIN, you must answer NO.
Could the taxpayer, or spouse if married filing joint, be the qualifying child of another person? Yes c No c
If taxpayer is unsure of the answer, review the qualifying child questions on page 3.
Did the IRS Disallowed or Reduced EIC in a previous year? No c Yes c File form 8862 Re-Certification.
Was the taxpayer either: a US citizen or resident alien for the entire year,
or filing a joint return and the spouse is a US citizen or resident alien? Yes c No c
Was the taxpayer, or the taxpayer’s spouse if filing jointly, at least age 25 but under 65 at the end of 2017? Yes c No c
Is the taxpayer eligible to be claimed as a dependent on anyone else’s federal income tax return for 2017? If the taxpayer’s filing status is
married filing jointly check “no”. Yes c No c
ADDITIONAL NOTES:
RELATIONSHIP:
Qualifying Child’s relationship to taxpayer:
c Son c Daughter c Grandchild c Niece c Nephew c Brother c Sister c Other:___________________________
c Foster Child c Step Sister c Step Brother c Step Child c Half Brother c Half Sister
Adopted Children are treated as your son or daughter.
Can you provide documentation of the qualifying child’s relationship to you? (birth certificate, marriage license, etc.) Yes c No c Cant take credits
RESIDENCY:
Did the child live with the taxpayer in the U.S. for more than half of the year? Yes c No c
Did the child reside at the SAME address during 2017? Yes c No c Why Not?________________________
When did the child start living with you: ___________________ Number of days/months lived in the taxpayer’s home:___________
Can you provide any of the following written documentation to determine the RESIDENCY of the child and that the child live with you more than
one year to substantiate the eligibility?
Landlord or Property Management Statement c Childcare Provider Statement c
Healthcare Provider Statement c Social Services or Human Resources Records or Statement c
School Records or School Statement c Placement Agency Statement c
Medical Records c Other (Please Specify) c
_______________________________________________________
SELF SUPPORT:
Did the qualifying child provide more than half of their own support (self-supporting) including social security? No c Yes c
JOINT RETURN:
Is the child unmarried and not filing a joint return, OR the child is married and filing a joint return only to claim a refund of withheld taxes?
Yes c No c
TIE BREAKER
Could another person, for whom child lived with for over 6 months, and is related to, claim this child as a qualifying child?
Yes c (Explain Tie Breaker Rules) No c
If Yes, Who?________________What is their relationship?______________________What is their AGI:_____________
Under the Tie Breaker Rule, the child is treated as a qualifying child only by:
w The parents, if they file a joint return;
w The parent, if only one of the persons is the child’s parent;
w The parent with whom the child lived the longest during the tax year, if two of the persons are the child’s parent and they do not file a joint return together;
w The parent with the highest AGI if the child lived with each parent for the same amount of time during the tax years, and they do not want to file a joint return;
w The person with the highest AGI, if no parent can claim the child as a qualifying child; or
w A person who has a higher AGI than any parent who CAN also claim the child as a qualifying child BUT chooses not to.
Adopted children:
Is the adoption:
Final c Pending c
If adoption is final, do you have documentation from the court stating the adoption is final? Yes c No c
If adoption is pending, do you have a letter from an authorized adoption agency? Yes c No c
Foster children:
Do you have a letter from the authorized placement agency or applicable court document? Yes c No c
When was the qualifying child placed with you?_____________________
Who placed the child with you?_________________________
Brother, sister, niece/nephew, Stepchildren or descendent of them, step sister, step brother, half brother, half sister,
step-great-grandchildren, grandchildren, great-grandchildren:
Can you provide a birth certificate of the child? Yes c No c If No, cannot take credit.
Can you provide the birth certificate of the parents of the qualifying child? Yes c No c If No, cannot take credit.
Can you provide marriage certificates (where applicable) verifying your relationship to the child?
Yes c No c If No, cannot take credit.
ADDITIONAL NOTES:
__________________________________________________
How long has the dependent been disabled? ______________
What Grade or College Level was the student? ____________
Is the dependent able to engage in substantially gainful
employment? Did the student attend school any of the 5 months of the year?
Yes c No c Yes c No c
The person cannot take part in any substantial gainful activity
because of a physical or mental condition. Dates/Months school was attended: _____________________
Do you have a letter from the child’s doctor, other healthcare Can you provide any of the following written documentation?
provider, or any social service program, or agency verifying that the c School Records
child is permanently and totally disabled? c College Records/Transcripts
Yes c No c c Other records showing the student attended school
You must have a statement from a doctor or a statement signed by
an authorized person in the Department of Veterans Affairs or the Qualifying Student:
Social Security Administration. To qualify as a student, during some part of any five calendar
months of the calendar year (does not have to consecutive months
Has a physician determined the condition has lasted or is expected and does not need to be the same school) you must be:
to last continuously for at least a year or can be expected to result Ÿ Attending a school that has a regular teaching staff and course of
in death? study and normally has a regularly enrolled student body where its
Yes c No c educational activities take place or
Ÿ Taking a full-time course of institutional on-farm training under the
Can you provide any of the following written documentation: supervision of an accredited agent of a school described above or a
state, county, or local government.
Doctor Statement c
Other Healthcare Provider Statement c
Social Services Agency or Program Statement c
Other Healthcare Provider Statement c
ADDITIONAL NOTES:
RELATIONSHIP:
Qualifying Child’s relationship to taxpayer:
c Son c Daughter c Grandchild c Niece c Nephew c Brother c Sister c Other:___________________________
c Foster Child c Step Sister c Step Brother c Step Child c Half Brother c Half Sister
Adopted Children are treated as your son or daughter.
Can you provide documentation of the qualifying child’s relationship to you? (birth certificate, marriage license, etc.) Yes c No c Cant take credits
RESIDENCY:
Did the child live with the taxpayer in the U.S. for more than half of the year? Yes c No c
Did the child reside at the SAME address during 2017? Yes c No c Why Not?________________________
When did the child start living with you: ___________________ Number of days/months lived in the taxpayer’s home:___________
Can you provide any of the following written documentation to determine the RESIDENCY of the child and that the child live with you more than
one year to substantiate the eligibility?
Childcare Provider Statement c
Landlord or Property Management Statement c
Social Services or Human Resources Records or Statement c
Healthcare Provider Statement c
Placement Agency Statement c
School Records or School Statement c
Other (Please Specify) c
Medical Records c
_______________________________________________________
SELF SUPPORT:
Did the qualifying child provide more than half of their own support (self-supporting) including social security? No c Yes c
JOINT RETURN:
Is the child unmarried and not filing a joint return, OR the child is married and filing a joint return only to claim a refund of withheld taxes?
Yes c No c
TIE BREAKER
Could another person, for whom child lived with for over 6 months, and is related to, claim this child as a qualifying child?
Yes c (Explain Tie Breaker Rules) No c
If Yes, Who?________________What is their relationship?______________________What is their AGI:_____________
Under the Tie Breaker Rule, the child is treated as a qualifying child only by:
w The parents, if they file a joint return;
w The parent, if only one of the persons is the child’s parent;
w The parent with whom the child lived the longest during the tax year, if two of the persons are the child’s parent and they do not file a joint return together;
w The parent with the highest AGI if the child lived with each parent for the same amount of time during the tax years, and they do not want to file a joint return;
w The person with the highest AGI, if no parent can claim the child as a qualifying child; or
w A person who has a higher AGI than any parent who CAN also claim the child as a qualifying child BUT chooses not to.
Adopted children:
Is the adoption:
Final c Pending c
If adoption is final, do you have documentation from the court stating the adoption is final? Yes c No c
If adoption is pending, do you have a letter from an authorized adoption agency? Yes c No c
Foster children:
Do you have a letter from the authorized placement agency or applicable court document? Yes c No c
When was the qualifying child placed with you?_____________________
Who placed the child with you?_________________________
Brother, sister, niece/nephew, Stepchildren or descendent of them, step sister, step brother, half brother, half sister,
step-great-grandchildren, grandchildren, great-grandchildren:
Can you provide a birth certificate of the child? Yes c No c If No, cannot take credit.
Can you provide the birth certificate of the parents of the qualifying child? Yes c No c If No, cannot take credit.
Can you provide marriage certificates (where applicable) verifying your relationship to the child?
Yes c No c If No, cannot take credit.
ADDITIONAL NOTES:
__________________________________________________
How long has the dependent been disabled? ______________
What Grade or College Level was the student? ____________
Is the dependent able to engage in substantially gainful
employment? Did the student attend school any of the 5 months of the year?
Yes c No c Yes c No c
The person cannot take part in any substantial gainful activity
because of a physical or mental condition. Dates/Months school was attended: _____________________
Do you have a letter from the child’s doctor, other healthcare Can you provide any of the following written documentation?
provider, or any social service program, or agency verifying that the c School Records
child is permanently and totally disabled? c College Records/Transcripts
Yes c No c c Other records showing the student attended school
You must have a statement from a doctor or a statement signed by
an authorized person in the Department of Veterans Affairs or the Qualifying Student:
Social Security Administration. To qualify as a student, during some part of any five calendar
months of the calendar year (does not have to consecutive months
Has a physician determined the condition has lasted or is expected and does not need to be the same school) you must be:
to last continuously for at least a year or can be expected to result Ÿ Attending a school that has a regular teaching staff and course of
in death? study and normally has a regularly enrolled student body where its
Yes c No c educational activities take place or
Ÿ Taking a full-time course of institutional on-farm training under the
Can you provide any of the following written documentation: supervision of an accredited agent of a school described above or a
state, county, or local government.
Doctor Statement c
Other Healthcare Provider Statement c
Social Services Agency or Program Statement c
Other Healthcare Provider Statement c
ADDITIONAL NOTES:
RELATIONSHIP:
Qualifying Child’s relationship to taxpayer:
c Son c Daughter c Grandchild c Niece c Nephew c Brother c Sister c Other:___________________________
c Foster Child c Step Sister c Step Brother c Step Child c Half Brother c Half Sister
Adopted Children are treated as your son or daughter.
Can you provide documentation of the qualifying child’s relationship to you? (birth certificate, marriage license, etc.) Yes c No c Cant take credits
RESIDENCY:
Did the child live with the taxpayer in the U.S. for more than half of the year? Yes c No c
Did the child reside at the SAME address during 2017? Yes c No c Why Not?________________________
When did the child start living with you: ___________________ Number of days/months lived in the taxpayer’s home:___________
Can you provide any of the following written documentation to determine the RESIDENCY of the child and that the child live with you more than
one year to substantiate the eligibility?
Landlord or Property Management Statement c Childcare Provider Statement c
Healthcare Provider Statement c Social Services or Human Resources Records or Statement c
School Records or School Statement c Placement Agency Statement c
Medical Records c Other (Please Specify) c
_______________________________________________________
Were there childcare expenses incurred in 2017?
Yes c See IRS Form 2441 if claiming the credit. No c No 2441 Filed.
Who cared for the child while you were working?_________________________________________
Did the child attend school? Yes c No c
Name of the School: _______________________ Grade:___________
SELF SUPPORT:
Did the qualifying child provide more than half of their own support (self-supporting) including social security? No c Yes c
JOINT RETURN:
Is the child unmarried and not filing a joint return, OR the child is married and filing a joint return only to claim a refund of withheld taxes?
Yes c No c
TIE BREAKER
Could another person, for whom child lived with for over 6 months, and is related to, claim this child as a qualifying child?
Yes c (Explain Tie Breaker Rules) No c
If Yes, Who?________________What is their relationship?______________________What is their AGI:_____________
Under the Tie Breaker Rule, the child is treated as a qualifying child only by:
w The parents, if they file a joint return;
w The parent, if only one of the persons is the child’s parent;
w The parent with whom the child lived the longest during the tax year, if two of the persons are the child’s parent and they do not file a joint return together;
w The parent with the highest AGI if the child lived with each parent for the same amount of time during the tax years, and they do not want to file a joint return;
w The person with the highest AGI, if no parent can claim the child as a qualifying child; or
w A person who has a higher AGI than any parent who CAN also claim the child as a qualifying child BUT chooses not to.
Adopted children:
Is the adoption:
Final c Pending c
If adoption is final, do you have documentation from the court stating the adoption is final? Yes c No c
If adoption is pending, do you have a letter from an authorized adoption agency? Yes c No c
Foster children:
Do you have a letter from the authorized placement agency or applicable court document? Yes c No c
When was the qualifying child placed with you?_____________________
Who placed the child with you?_________________________
Brother, sister, niece/nephew, Stepchildren or descendent of them, step sister, step brother, half brother, half sister,
step-great-grandchildren, grandchildren, great-grandchildren:
Can you provide a birth certificate of the child? Yes c No c If No, cannot take credit.
Can you provide the birth certificate of the parents of the qualifying child? Yes c No c If No, cannot take credit.
Can you provide marriage certificates (where applicable) verifying your relationship to the child?
Yes c No c If No, cannot take credit.
ADDITIONAL NOTES:
__________________________________________________
How long has the dependent been disabled? ______________
What Grade or College Level was the student? ____________
Is the dependent able to engage in substantially gainful
employment? Did the student attend school any of the 5 months of the year?
Yes c No c Yes c No c
The person cannot take part in any substantial gainful activity
because of a physical or mental condition. Dates/Months school was attended: _____________________
Do you have a letter from the child’s doctor, other healthcare Can you provide any of the following written documentation?
provider, or any social service program, or agency verifying that the c School Records
child is permanently and totally disabled? c College Records/Transcripts
Yes c No c c Other records showing the student attended school
You must have a statement from a doctor or a statement signed by
an authorized person in the Department of Veterans Affairs or the Qualifying Student:
Social Security Administration. To qualify as a student, during some part of any five calendar
months of the calendar year (does not have to consecutive months
Has a physician determined the condition has lasted or is expected and does not need to be the same school) you must be:
to last continuously for at least a year or can be expected to result Ÿ Attending a school that has a regular teaching staff and course of
in death? study and normally has a regularly enrolled student body where its
Yes c No c educational activities take place or
Ÿ Taking a full-time course of institutional on-farm training under the
Can you provide any of the following written documentation: supervision of an accredited agent of a school described above or a
state, county, or local government.
Doctor Statement c
Other Healthcare Provider Statement c
Social Services Agency or Program Statement c
Other Healthcare Provider Statement c
ADDITIONAL NOTES:
I certify that the information on all these forms and the above information is true and correct
and that I have verified this for my electronic filer/tax preparer.