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CP 09 Sample Content Page 3

EIC Eligibility Check-Sheet
Step 1
Read and answer each question below and check the correct box
YES    NO

Does your Social Security card (or your spouse's, if you filed a joint return) read Not Valid for Employment AND was the Social Security Number (SSN) issued so that you (or your spouse could get a federally funded benefit, such as Medicaid?

[ ]     [ ] 

Do you (or your spouse, if you filed a joint return meet the age, relationship, and residency tests to be an EIC qualifying child of another person? (For more information on these tests, see Step 3.)

[ ]     [ ]  
Attention
If
Then
You answered NO to both questions in Step 1 Go! Continue on to Step 2
You answered YES to either questions in Step 1, Stop! You do not qualify. Do not answer this notice.

Step 2

Write the name and SSN for no more than two children who lived with you during [tax year]. Then go to Step 3. Do not list the child if:

  • The child has a Social Security card that reads Not Valid for Employment AND the SSN was issued so that the child could get a federally funded benefit, such as Medicaid.
  • The child was married and you are not entitled to claim the child as a dependent on your [tax year] return (you can list the child if you are not entitled to the child's exemption under the rules for children of divorced or separated parents).

Child # 1

First and Last Name Social Security Number

Child # 2

First and Last Name Social Security Number
Page Last Reviewed or Updated: 2012-08-13