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Department of the Treasury - Internal Revenue Service

Form 15112 
(January 2023)
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 2022.

-- I (or my spouse and I) had a principal place of abode in the United States for 6 months or less in 2022. (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 2022 (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 ----

Catalog Number 69807V
www.irs.gov
Form 15112 (Rev. 1-2023)
