Excerpt from Accessible IRS 1040a tax form
Suitable for use with screen reader devices

24 June 2002

IRS tax form 1040A in PDF

NOTE: Below is an example of U.S. Tax Form 1040A (standard PDF version shown at right) prepared to meet Section 508 accessibility requirements; this is not the complete form, only an excerpt to show how such a form would look to a sighted person. The text-only format is designed to work with appropriate screen reader devices. For more information, visit the IRS Web site's Accessible IRS Tax Products section. View the Standard PDF version of the same form. or download the 1040A form in PDF.


2001 FORM 1040A
U.S. Individual Income Tax Return Package
includes SCHEDULES and INSTRUCTIONS

Print pages:
Form 1040A 1-2
Schedule 1 1
Schedule 2 1-2
Schedule 3 1-2
Schedule EIC 1-2
Form 8812 1-2
Instructions for Form 1040A 1-61 
Instructions for Schedule 2 1-3 
Instructions for Schedule 3 1-4

Department of the Treasury
Internal Revenue Service
Cat. No. 12085

Provided in braille by:
MSMT Braille Center
A Division of Goodwill Industries of the Redwood Empire
651 Yolanda Avenue
Santa Rosa, CA 95404

PLEASE NOTE: Form 1040A, Schedule 1, Schedule 2, Schedule 3, 
Schedule EIC, and Form 8812 are located in the center (following 
print page 36) of the print version of this package. These pages 
were moved to the beginning of the text version.

Table of Contents

2001 Form 1040A 1
Label 1
Filing Status 1
Exemptions 1
Income 1
Adjusted Gross Income 1
Tax Credits and Payments 2
Refund 2
Amount You Owe 2
Third Party Designee 2
2001 Schedule 1. Interest and Ordinary Dividends for Form 1040A 
Filers 12
Part I. Interest 12
Part II. Ordinary Dividends 13
2001 Schedule 2. Child and Dependent Care Expenses for Form 
1040A Filers 1
Part I. Persons or Organizations Who Provided The Care 1
Part II. Credit for Child and Dependent Care Expenses 1
Part III. Dependent Care Benefits 2
2001 Schedule 3. Credit for the Elderly or the Disabled for Form 
1040A Filers 1
Part I. Filing Status 1
Part II. Statement of Permanent and Total Disability 1
Part III. Figure Your Credit 2
2001 Schedule EIC (Form 1040A or 1040) Earned Income Credit 1
Qualifying Child Information 1
Purpose of Schedule 2
2001 Form 8812 Additional Child Tax Credit 1
Part I. All Filers 1
Part II. Certain Filers Who Have Three or More Qualifying 
Children 1
Part III. Your Additional Child Tax Credit 1
Instructions 2
Taxpayer News 1
A Message from the Commissioner 2
IRS e-file 3
2001 Form 1040A--Tax Return Page Reference 4
IRS Customer Service Standards 6
Help With Unresolved Tax Issues 6
Quick and Easy Access to Tax Help and Forms 7
Partial List of Forms Available by Fax 8
Partial List of Publications 9
What Is TeleTax? 10
TeleTax Topics 10
Calling the IRS 12
Before You Fill In Form 1040A 13
Filing Requirements 14
Chart A--For Most People 15
Chart B--For Children and Other Dependents 16
Chart C--Other Situation When You Must File 17
Would it Help You to Itemize Deductions on Form 1040? 17
Where to Report Certain Items From 2001 Forms W-2, 1098, and 
1099 18
Who Can Use Form 1040A? 19
When Must You Use Form 1040? 19
Line Instructions for form 1040A 19
Social Security Number 20
Presidential Election Campaign Fund 20
Filing Status 20
Exemptions 22
Income 24
Simplified Method Worksheet 27
Adjusted Gross Income 28
Social Security Benefits Worksheet--Lines 14a and 14b 29
IRS Deduction Worksheet--Line 16 30
Student Loan Interest Deduction Worksheet--Line 17 31
Tax, Credits, and Payments 32
Standard Deduction Chart for People Age 65 or Older or Blind--
Line 22 32
Standard Deduction Worksheet for Dependents--Line 22 32
Tax Computation Worksheet for Certain Dependents--Line 26 33
Capital Gain Tax Worksheet--Line 26 34
Alternative Minimum Tax Worksheet 35
Rate Reduction Credit Worksheet--Line 30 36
Child Tax Credit Worksheet--Line 31 37
Lines 39a and 39b--Earned Income Credit (EIC) 39
Earned Income Credit (EIC) Worksheet 43
Refund 47
Amount You Owe 48
Third Part Designee 49
Attach Required Forms and Schedules 49
General Information 50
IRS e-file 51
TeleFile 51
Direct Deposit 52
EFTPS(TM) Electronic Federal Tax Payment 52
Other Ways to Get Help 52
Interest and Penalties 52
Disclosure, Privacy Act, and Paperwork Reduction Act 
Notice 53
Order Blank for Forms and Publications 54
Instructions for Schedule 1 61
Purpose of Schedule 61 
Part I. Interest 61
Part II. Ordinary Dividends 61
Instructions for Schedule 2 101
Purpose of Schedule 101
Definitions 102
Who May Take the Credit or Exclude Dependent Care Benefits? 
208
Part I. Persons or Organizations Who Provided the Care 210
Part II. Credit for Child and Dependent Care Expenses 212
Part III. Dependent Care Benefits 316
Instructions for Schedule 3 119
Purpose of Schedule 119
Who Can Take the Credit 119
Married Persons Filing Separate Returns 120
Income Limits 120
Want the IRS to Figure Your Credit? 121
What is Permanent and Total Disability? 123
Disability Income 125
Part II. Statement of Permanent and Total Disability 225
Part III. Figure Your Credit 328
Physician's Statement 432
Major Categories of Federal Income and Outlays for Fiscal Year 
2000 334
Where Do You File? 338
Peel-off Label Instructions 343
Index 345

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2001 Form 1040A
U.S. Individual Income Tax Return

Department of the Treasury
Internal Revenue Service
OMB No. 1545-0085
Cat. No. 11327A

IRS Use Only--Do not write or staple in this space.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, 
see page 53.

Label (See page 19.)

Use the IRS label. Otherwise please print or type.
Numbers appearing in brackets are print page numbers.

Label Here

Your first name and initial: ____; Last name: ____. 

If a joint return, spouse's first name and initial: ____; Last name: 
____. 

Home address (number and street). If you have a P.O. box, see
page 20: ____; Apt. no.: ____. 

City, town or post office, state, and ZIP code. If you have a 
foreign address, see page 20: ____. 

Your social security number: ____. 
Spouse's social security number: ____. 
Important! You must enter your SSN(s) above.

Presidential Election Campaign (See page 20.)

Note. Checking "Yes" will not change your tax or reduce your 
refund.

Do you, or your spouse if filing a joint return, want $3 to go to 
this fund? You: ____ Yes; ____ No. Spouse: ____ Yes; ____ No.

Filing status 
Check only one box 

1. ____ Single.
2. ____ Married filing joint return (even if only one had income).

3. ____ Married filing separate return. Enter spouse's social 
security number above and full name here.

4. ____ Head of household (with qualifying person). (See page 
21.) If the qualifying person is a child but not your dependent, 
enter this child's name here.

5. ____ Qualifying widow(er) with dependent child (year spouse 
died ). (See page 22.)

Exemptions 

If more than seven dependents see page 22. 

6a. ____ Yourself. If your parent (or someone else) can claim you 
as a dependent on his or her tax return, do not check box 6a. 
6b. ____ Spouse
6c. ____ Dependents:
(1) First name: ____; Last name: ____. 
(2) Dependent's social security number: ____. 
(3) Dependent's relationship to you: ____. 
(4) Check if qualifying child for child tax credit (see page 23): 
____.
No. of boxes checked on 6a and 6b: ____. 
No. of your children on 6c who: 
 lived with you: ____. 
 did not live with you due to divorce or separation (see page 24): 
____. 
Dependents on 6c not entered above: ____. 
Add numbers entered on lines above: ____. 

6d. Total number of exemptions claimed: ____. 

Income 

Attach Form(s) W-2 [49] here. Also attach Form(s) 1099-R if tax 
was withheld.

If you did not get a W-2 see page 25. 

Enclose, but do not attach, any payment. 

7. Wages, salaries, tips, etc. Attach Form(s) W-2: ____. 
8a. Taxable interest. Attach Schedule 1 if required: ____. 
8b. Tax-exempt interest. Do not include on line 8a: ____. 
9. Ordinary dividends. Attach Schedule 1 if required: ____. 
10. Capital gain distributions (see page 25): ____. 
11a. Total IRA distributions: ____. 
11b. Taxable amount (see page 25): ____. 
12a. Total pensions and annuities: ____. 
12b. Taxable amount (see page 26): ____. 
13. Unemployment compensation, qualified state tuition program 
earnings, and Alaska Permanent Fund dividends: ____. 
14a. Social security benefits: ____. 
14b. Taxable amount (see page 28): ____. 
15. Add lines 7 through 14b (far right column). This is your total 
income: ____. 

Adjusted Gross Income
16. IRA deduction (see page 28): ____. 
17. Student loan interest deduction (see page 31): ____. 
18. Add lines 16 and 17. These are your total adjustments: ____. 
19. Subtract line 18 from line 15. This is your adjusted gross 
income: ____. 

--------------------------------------------------------------------2

Tax, credits, and payments

20. Enter the amount from line 19 (adjusted gross income): ____. 

21a. Check if:
____ You were 65 or older ____ Blind.
____ Spouse was 65 or older ____ Blind.
____ Enter number of boxes checked: ____. 

21b. If you are married filing separately and your spouse itemizes
deductions, see page 32 and check here: ____. 

22. Enter your standard deduction (see left margin): ____. 

Standard Deduction for:
People who checked any box on line 21a or 21b or who can be 
claimed as a dependent, see page 33.

All others:
Single: $4,550;
Head of household: $6,650;
Married filing jointly or Qualifying widow(er): $7,600;
Married filing separately: $3,800.

23. Subtract line 22 from line 20. If line 22 is more than line 20, 
enter 0: ____. 

24. Multiply $2,900 by the total number of exemptions claimed on 
line 6d: ____. 

25. Subtract line 24 from line 23. If line 24 is more than line 23, 
enter 0. This is your taxable income: ____. 

26. Tax, including any alternative minimum tax (see page 33): ____. 

27. Credit for child and dependent care expenses. Attach 
Schedule 2: ____. 

28. Credit for the elderly or the disabled. Attach Schedule 3: ____. 
29. Education credits. Attach Form 8863: ____. 
30. Rate reduction credit. See the worksheet on page 36: ____. 
31. Child tax credit (see page 36): ____. 
32. Adoption credit. Attach Form 8839: ____. 
33. Add lines 27 through 32. These are your total credits: ____. 

34. Subtract line 33 from line 26. If line 33 is more than line 26, 
enter 0: ____. 

35. Advance earned income credit payments from Form(s) W-2: ____. 
36. Add lines 34 and 35. This is your total tax: ____. 
37. Federal income tax withheld from Forms W-2 and 1099: ____. 
38. 2001 estimated tax payments and amount applied from 2000 
return: ____. 

39a. Earned income credit (EIC): ____. 
If you have a qualifying child, attach Schedule EIC.

39b. Nontaxable earned income: ____. 
40. Additional child tax credit. Attach Form 8812: ____. 
41. Add lines 37, 38, 39a, and 40. These are your total payments: 
____. 

Refund

Direct deposit? See page 47 and fill in 43b, 43c, and 43d.

42. If line 41 is more than line 36, subtract line 36 from line 41.
This is the amount you overpaid: ____. 

43a. Amount of line 42 you want refunded to you: ____. 
43b. Routing number: ____. 
43c. Type: Checking Savings: ____. 
43d. Account number: ____. 

44. Amount of line 42 you want applied to your 2002 estimated 
tax: ____. 

Amount You Owe
45. Amount you owe. Subtract line 41 from line 36. For details on 
how to pay, see page 48: ____. 

46. Estimated tax penalty (see page 48): ____. 

Third party designee 

Do you want to allow another person to discuss this return with 
the IRS (see page 49)? ____ Yes: Complete the following. ____ 
No.

Designee's name: ____. 
Phone no.: ____. 

Personal identification number (PIN): ____. 

Sign Here

Joint return? See page 20. 

Keep a copy for your records.

Under penalties of perjury, I declare that I have examined this 
return and accompanying schedules and statements, and to the 
best of my knowledge and belief, they are true, correct, and 
accurately list all amounts and sources of income I received 
during the tax year. Declaration of preparer (other than the 
taxpayer) is based on all information of which the preparer has 
any knowledge.

Your signature: ____; Date: ____; Your occupation: ____; 
Daytime phone number: ____. 

Spouse's signature. If a joint return, both must sign: ____; 
Date: ____; Spouse's occupation: ____. 

Paid Preparer's Use Only
Preparer's signature: ____. 
Date: ____. 
Check if self-employed: ____. 
Preparer's SSN or PTIN: ____. 

Firm's name (or yours if self-employed), address, and ZIP code: ____. 
EIN: ____. 
Phone no.: ____. 

--------------------------------------------------------------------1

2001 Schedule 1 (Form 1040A)
Interest and Ordinary Dividends for Form 1040A Filers
OMB No. 1545-0085
Cat. No. 12075R

For Paperwork Reduction Act Notice, see Form 1040A instructions. 

Name(s) shown on Form 1040A: ____. 
Your social security number: ____. 

Part I. Interest 

(See page 61 and the instructions for Form 1040A, line 8a.)

Note. If you received a Form 1099-INT, Form 1099-OID, or 
substitute statement from a brokerage firm, enter the firm's name 
and the total interest shown on that form.


1. List name of payer. If any interest is from a seller-financed 
mortgage and the buyer used the property as a personal 
residence, see page 61 and list this interest first. Also, show that 
buyer's social security number and address: ____; Amount: ____. 

Text description of line 1: There are 14 blank lines for your 
response to line 1.

2. Add the amounts on line 1: ____. 

3. Excludable interest on series EE and I U.S. savings bonds 
issued after 1989 from Form 8815, line 14. You must attach Form 
8815: ____. 

4. Subtract line 3 from line 2. Enter the result here and on Form 
1040A, line 8a: ____. 

Part II. Ordinary Dividends

(See page 61 and the instructions for Form 1040A, line 9.)

Note. If you received a Form 1099-DIV or substitute statement 
from a brokerage firm, enter the firm's name and the ordinary 
dividends shown on that form.

5. List name of payer. Include only ordinary dividends. If you 
received any capital gain distributions, see the instructions for 
Form 1040A, line 10: ____; Amount: ____. 

Text description of line 5: There are 17 blank lines for your 
response to line 5.

6. Add the amounts on line 5. Enter the total here and on Form 
1040A, line 9: ____. 

--------------------------------------------------------------------1

2001 Schedule 2 (Form 1040A)
Child and Dependent Care Expenses for Form 1040A Filers
Cat. No. 10749I
OMB No. 1545-0085

For Paperwork Reduction Act Notice, see Form 1040A instructions.

Name(s) shown on Form 1040A: ____. 
Your social security number: ____. 


Before you begin: 

You need to understand the following terms. See Definitions on 
page 1 of the separate instructions.

Dependent Care Benefits
Qualifying Person(s)
Qualified Expenses
Earned Income

Part I. Persons or Organizations Who Provided the Care

You must complete this part.

1. (a) Care provider's name: ____; (b) Address (number, street, 
apt. no., city, state, and ZIP code): ____; (c) Identifying 
number (SSN or EIN): ____; (d) Amount paid (see instructions):
____. 

Text description of line 1: Lettered items above, (a)-(d) are 
column headings. There are 2 blank lines for your response to 
line 1.

(If you need more space, use the bottom of page 2.)

Did you receive dependent care benefits?

No. Complete only Part II below.
Yes. Complete Part III on the back next.


Caution. If the care was provided in your home, you may owe 
employment taxes. If you do, you must use Form 1040. See 
Schedule H and its instructions for details.

Part II. Credit for Child and Dependent Care Expenses

2. Information about your qualifying person(s). If you have more 
than two qualifying persons, see the instructions:

(a) Qualifying person's name: First ____; Last: ____. 
(b) Qualifying person's social security number: ____. 
(c) Qualified expenses you incurred and paid in 2001 for the 
person listed in column (a): ____. 

Text description of line 2: Lettered items above, (a)-(c), are 
columns headings. There are 2 blank lines for your response to 
line 2.

3. Add the amounts in column (c) of line 2. Do not enter more 
than $2,400 for one qualifying person or $4,800 for two or more 
persons. If you completed Part III, enter the amount from line 
24: ____. 

4. Enter your earned income: ____. 

5. If married filing a joint return, enter your spouse's earned 
income (if your spouse was a student or was disabled, see the 
instructions); all others, enter the amount from line 4: ____. 

6. Enter the smallest of line 3, 4, or 5: ____. 

7. Enter the amount from Form 1040A, line 20: ____. 

8. Enter on line 8 the decimal amount shown below that applies 
to the amount on line 7: ____. 
If line 7 is over:
$0, but not over 10,000 the decimal amount is .30;
$10,000, but not over 12,000 the decimal amount is .29;
$12,000, but not over 14,000 the decimal amount is .28;
$14,000, but not over 16,000 the decimal amount is .27;
$16,000, but not over 18,000 the decimal amount is .26;
$18,000, but not over 20,000 the decimal amount is .25;
$20,000, but not over 22,000 the decimal amount is .24;
$22,000, but not over 24,000 the decimal amount is .23;
$24,000, but not over 26,000 the decimal amount is .22;
$26,000, but not over 28,000 the decimal amount is .21;
$28,000, but not over No limit the decimal amount is .20.

9. Multiply line 6 by the decimal amount on line 8. Enter the 
result here and on Form 1040A, line 27. But if this amount is 
more than the amount on Form 1040A, line 26, or you paid 2000 
expenses in 2001, see the instructions for the amount to enter on 
line 27: ____. 

--------------------------------------------------------------------2

Part III. Dependent Care Benefits

10. Enter the total amount of dependent care benefits you 
received for 2001. This amount should be shown in box 10 of 
your W-2 form(s). Do not include amounts that were reported to 
you as wages in box 1 of Form(s) W-2.

11. Enter the amount forfeited, if any. See the instructions: ____. 
12. Subtract line 11 from line 10: ____. 

13. Enter the total amount of qualified expenses incurred in 2001 
for the care of the qualifying person(s): ____. 

14. Enter the smaller of line 12 or 13: ____. 
15. Enter your earned income: ____. 

16. If married filing a joint return, enter your spouse's earned 
income (if your spouse was a student or was disabled, see the 
instructions for line 5); if married filing a separate return, see the 
instructions for the amount to enter; all others, enter the amount 
from line 15: ____. 

17. Enter the smallest of line 14, 15, or 16: ____. 

18. Excluded benefits. Enter here the smaller of the following:
The amount from line 17; or $5,000 ($2,500 if married filing a 
separate return and you were required to enter your spouse's 
earned income on line 16): ____. 

19. Taxable benefits. Subtract line 18 from line 12. Also, include 
this amount on Form 1040A, line 7. In the space to the left of line 
7, enter "DCB.": ____. 

To claim the child and dependent care credit, complete lines 20-
24 below.

20. Enter $2,400 ($4,800 if two or more qualifying persons): ____. 
21. Enter the amount from line 18: ____. 
22. Subtract line 21 from line 20. If zero or less, stop. You cannot 
take the credit. Exception. If you paid 2000 expenses in 2001, 
see the instructions for line 9: ____. 

23. Complete line 2 on the front of this schedule. Do not include 
in column (c) any benefits shown on line 18 above. Then, add the 
amounts in column (c) and enter the total here: ____. 

24. Enter the smaller of line 22 or 23. Also, enter this amount on 
line 3 on the front of this schedule and complete lines 4-9: ____. 

--------------------------------------------------------------------1

2001 Schedule 3 (Form 1040A)
Credit for the Elderly or the Disabled for Form 1040A Filers
OMB No. 1545-0085
Cat. No. 12064K

For Paperwork Reduction Act Notice, see Form 1040A 
instructions.

Name(s) shown on Form 1040A: ____. 
Your social security number: ____. 

You may be able to take this credit and reduce your tax if by the 
end of 2001:

You were 65 or older, or

You were under age 65, you retired on permanent and total 
disability, and you received taxable disability income.

But you must also meet other tests. See the separate instructions 
for Schedule 3.

Tip. In most cases, the IRS can figure the credit for you. See the 
instructions.

Part I

Check the box for your filing status and age. Check only one box.

If your filing status is: 

Single, Head of household, or Qualifying widow(er) with 
dependent child, and by the end of 2001:

1. You were 65 or older: ____. 

2. You were under 65 and you retired on permanent and total 
disability: ____. 

Married filing a joint return, and by the end of 2001:

3. Both spouses were 65 or older: ____. 

4. Both spouses were under 65, but only one spouse retired on 
permanent and total disability: ____. 

5. Both spouses were under 65, and both retired on permanent 
and total disability: ____. 

6. One spouse was 65 or older, and the other spouse was under 
65 and retired on permanent and total disability: ____. 

7. One spouse was 65 or older, and the other spouse was under 
65 and not retired on permanent and total disability: ____. 

Married filing a separate return, and by the end of 2001:

8. You were 65 or older and you lived apart from your spouse for 
all of 2001: ____. 

9. You were under 65, you retired on permanent and total 
disability, and you lived apart from your spouse for all of 2001: 
____. 

Did you check box 1, 3, 7, or 8?
Yes. Skip Part II and complete Part III on the back.
No. Complete Parts II and III.

Part II. Statement of Permanent and Total Disability

Complete this part only if you checked box 2, 4, 5, 6, or 9 above.

If: 

1. You filed a physician's statement for this disability for 1983 or 
an earlier year, or you filed or got a statement for tax years after 
1983 and your physician signed line B on the statement, and

2. Due to your continued disabled condition, you were unable to 
engage in any substantial gainful activity in 2001, check this box: 
____.

If you checked this box, you do not have to get another 
statement for 2001.

If you did not check this box, have your physician complete the 
statement on page 4 of the instructions. You must keep the 
statement for your records.

--------------------------------------------------------------------2

Part III. Figure Your Credit

10. If you checked (in Part I):
Box 1, 2, 4, or 7 enter $5,000;
Box 3, 5, or 6 enter $7,500;
Box 8 or 9 enter $3,750: ____. 

Did you check box 2, 4, 5, 6, or 9 in Part I?
Yes. You must complete line 11.

No. Enter the amount from line 10 on line 12 and go to line 13.

11. If you checked box 6 in Part I, add $5,000 to the taxable 
disability income of the spouse who was under age 65. Enter the 
total.

If you checked box 2, 4, or 9 in Part I, enter your taxable 
disability income.

If you checked box 5 in Part I, add your taxable disability income 
to your spouse's taxable disability income. Enter the total: ____. 

Tip. For more details on what to include on line 11, see the 
instructions.

12. If you completed line 11, enter the smaller of line 10 or line 
11; all others, enter the amount from line 10: ____. 

13. Enter the following pensions, annuities, or disability income 
that you (and your spouse if filing a joint return) received in 
2001.

a. Nontaxable part of social security benefits and Nontaxable part 
of railroad retirement benefits treated as social security. See 
instructions: ____. 

b. Nontaxable veterans' pensions and Any other pension, annuity, 
or disability benefit that is excluded from income under any other 
provision of law: ____. 

c. Add lines 13a and 13b. (Even though these income items are 
not taxable, they must be included here to figure your credit.) If 
you did not receive any of the types of nontaxable income listed 
on line 13a or 13b, enter 0 on line 13c: ____. 

14. Enter the amount from Form 1040A, line 20: ____. 

15. If you checked (in Part I) Box 1 or 2 enter $7,500;
If you checked (in Part I) Box 3, 4, 5, 6, or 7 enter $10,000;
If you checked (in Part I) Box 8 or 9 enter $5,000: ____. 

16. Subtract line 15 from line 14. If zero or less, enter 0: ____. 
17. Enter one-half of line 16: ____. 
18. Add lines 13c and 17: ____. 

19. Subtract line 18 from line 12. If zero or less, stop; you cannot 
take the credit. Otherwise, go to line 20: ____. 

20. Multiply line 19 by 15% (.15). Enter the result here and on 
Form 1040A, line 28. But if this amount is more than the amount 
on Form 1040A, line 26, or you are filing Schedule 2 (Form 
1040A), see the instructions for the amount of credit you may 
take: ____. 

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2001 SCHEDULE EIC (Form 1040A or 1040) 
Earned Income Credit Qualifying Child Information
OMB No. 1545-0074 
Cat. No. 13339M
Attachment Sequence No. 43

Complete and attach to Form 1040A or 1040 only if you have a 
qualifying child.

For Paperwork Reduction Act Notice, see Form 1040A or 1040 
instructions.

Name(s) shown on return: ____. 
Your social security number: ____. 

Before you begin: 

See the instructions for Form 1040A, lines 39a and 39b, or Form 
1040, lines 61a and 61b, to make sure that (a) you can take the 
EIC and (b) you have a qualifying child.

Caution!

If you take the EIC even though you are not eligible, you may not 
be allowed to take the credit for up to 10 years. See back of 
schedule for details.

It will take us longer to process your return and issue your refund 
if you do not fill in all lines that apply for each qualifying child.

Be sure the child's name on line 1 and social security number 
(SSN) on line 2 agree with the child's social security card. 
Otherwise, at the time we process your return, we may reduce or 
disallow your EIC. If the name or SSN on the child's social 
security card is not correct, call the Social Security Administration 
at 1-800-772-1213.

Qualifying Child Information

1. Child's name. 
If you have more than two qualifying children, you only have to 
list two to get the maximum credit.
Child 1: First name ____; Last name ____. 
Child 2: First name ____; Last name ____. 

2. Child's SSN. 
The child must have an SSN as defined on page 42 of the Form 
1040A instructions or page 44 of the Form 1040 instructions 
unless the child was born and died in 2001. If your child was born 
and died in 2001 and did not have an SSN, enter "Died" on this 
line and attach a copy of the child's birth certificate:
Child 1 ____; Child 2 ____. 

3. Child's year of birth:
Child 1: Year ____. If born after 1982, skip lines 4a and 4b; go to 
line 5.
Child 2: Year ____. If born after 1982, skip lines 4a and 4b; go to 
line 5.

4. If the child was born before 1983:
a. Was the child under age 24 at the end of 2001 and a student?
Child 1: ____ Yes. Go to line 5. ____ No. Continue.
Child 2: ____ Yes. Go to line 5. ____ No. Continue.

b. Was the child permanently and totally disabled during any part 
of 2001?
Child 1: ____ Yes. Continue. ____ No. The child is not a 
qualifying child.
Child 2: ____ Yes. Continue. ____ No. The child is not a 
qualifying child.

5. Child's relationship to you (for example, son, daughter, 
grandchild, foster child, etc.): Child 1 ____; Child 2 ____. 

6. Number of months child lived with you in the United States 
during 2001. If the child lived with you for more than half of 2001 
but less than 7 months, enter "7". If the child was born or died in 
2001 and your home was the child's home for the entire time he 
or she was alive during 2001, enter "12".
Child 1: ____ months. Do not enter more than 12 months.
Child 2: ____ months. Do not enter more than 12 months.

Tip. You may also be able to take the additional child tax credit if 
your child (a) was under age 17 at the end of 2001, (b) is claimed 
as your dependent on line 6c of Form 1040A or Form 1040, and 
(c) is a U.S. citizen or resident alien. For more details, see the 
instructions for line 40 of Form 1040A or line 63 of Form 1040.


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Two Passwords Are Better Than One: The Low-Down On PDF Security

For people who don't spend their time looking at PDF files in text editors*, PDF security is a sometimes misunderstood beast.

For example, those document restrictions that PDF files sometimes have -- no Printing, Content Copying, Page Extraction, etc -- are essentially useless unless the PDF also has a User Password.

January 09, 2014
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Adding a PDF Stamp Comment

OK, so you want to stamp your document. Maybe you need to give reviewers some advice about the document's status or sensitivity. This tip from author Ted Padova demonstrates how to add stamps with the Stamp Tool along with related comments.