5213 Election to Postpone Determination As to Whether the Pre

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
If you have any comments on this draft form, you can
submit them to us on our web site. Include the word
DRAFT in your response. You may make comments
anonymously, or you may include your name and
e-mail address or phone number. We will be unable
to respond to all comments due to the high volume
we receive. However, we will carefully consider
each suggestion. So that we can properly consider
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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 8901, PAGE 1 of 2
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 203 mm (8") 3 279 mm (11")
PERFORATE: NONE

8901

Information on Qualifying Children
Who Are Not Dependents

●

§

OMB No. 1545-0074

2006

8901

Attachment
Sequence No.

59

●

Do not use this form for any child who is claimed as your dependent on Form 1040A or
Form 1040, line 6c, or Form 1040NR, line 7c.
It will take us longer to process your return and issue your refund if you do not complete all
columns for each qualifying child.
Be sure the child’s name and social security number (SSN) agree with the child’s social security
card. Otherwise, at the time we process your return, we may reduce or disallow your child tax
credit. 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

(a) First name

Child 1

1040
1040A
..........
1040NR
..........

Your social security number

●

CAUTION

Revised proofs
requested

Complete and attach to Form 1040, Form 1040A, or Form 1040NR.

Name(s) shown on return

Signature

f
o
s
a
6
t
0
f
0
a
2
r
/
D /21
7
0

(For Child Tax Credit)
Department of the Treasury
Internal Revenue Service (99)

Date

O.K. to print

PRINTS: HEAD TO HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form

Action

Last name

(b) Child’s
social security number

(c) Child’s relationship to you
(son, daughter, etc.)

Child 2

Child 3

Child 4

For Paperwork Reduction Act Notice, see above.

Cat. No. 37710J

Form

8901

(2006)