8836 Qualifying Children Residency Statement

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Form

I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8836, PAGE 1 OF 4
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 11"x17"; FOLD TO 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Date

Revised proofs
requested

OMB No. 1545-0074

(for the earned income credit)
䊳

Department of the Treasury
Internal Revenue Service

Esta forma está disponible en español. Por favor, llame al 1-800-829-6088.
䊳

Signature

O.K. to print

Qualifying Children Residency Statement

8836

Part I

Action

See instructions beginning on page 2.

2005
Attachment
Sequence No.

136

Taxpayer Information

Your first name and initial

Last name

Your social security number

If you are filing a joint return for 2005, spouse’s first name
and initial

Last name

Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions

Your daytime phone number
(
)

City, town or post office, state, and ZIP code

Your evening phone number
(
)

Part II

Qualifying Children Information
Caution. Enter each child’s first and last name exactly as it appears on the child’s social security card.

䊳
Child 2 䊳
Child 1

Part III

Child’s first name

Last name

Child’s social security number

Child’s first name

Last name

Child’s social security number

Proof of Residency (see instructions)

You must prove your child lived with you for more than half of 2005. For details and exceptions, see Residency Test on
page 2.
The proof you must give us is a Third Party Affidavit or other document(s) showing the child lived with you for more than
half of 2005. For details on the documents to provide, what the documents must show, and who can provide documents,
see page 3. Note. The IRS may contact any person or organization that provides documents you attach to this form.
Check one or more boxes below and attach the required documents.
1

One or more third parties have completed the Third Party Affidavit, which I have attached. If the affidavit(s) shows that
the residency test has been met, do not check any other boxes or attach additional information.
Note. The Third Party Affidavit was sent to you with Form 8836 and is designated either Schedule A (Form 8836) or
Schedule B (Form 8836). Use only the version of the schedule you received with Form 8836.

2

I have attached a signed letter on official letterhead from one or more of the following third parties (see page 3 for details
on the information the letter must contain):
Attorney
Childcare provider
Clergy
Community-based organization official
Court or placement agency official

3

School official
Social service agency or
other government official
Utility company

Employer
Health-care provider
Indian tribal official
Landlord or property manager
Law enforcement officer

I have attached copies of one or more of the following records (see page 3 to find out which records to send and the
information these records must contain):
Childcare records
Community-based organization records
Court or placement agency records
Employment records
Indian tribal records

Keep a
copy of
Form 8836
and
attachments
for your
records.

Law enforcement reports
Leases
Legal records
Medical records

Religious records
School records
Social service agency records
Utility bills

Under penalties of perjury, I declare that I have examined this statement, and to the best of my knowledge and belief, it is true, correct, and
complete.

Taxpayer
Sign Here

䊳

Spouse Named in
Part I Sign Here

䊳

For Privacy Act and Paperwork Reduction Act Notice, see page 4.

Date

䊳

Date

䊳

Cat. No. 14955C

Form

8836

(2005)

7
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8836, PAGE 2 OF 4
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
1
FLAT SIZE: 216mm (8 ⁄2 ") x 279mm (11")
PERFORATE:
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8836 (2005)

Page

2

How To Get Help
Call 1-800-829-6088 if you need help completing this form or you cannot get the documents you need to send
with this form. Help is available Monday through Friday from 8:00 a.m. to 8:00 p.m. local time.
You may also visit any IRS Taxpayer Assistance Center. To find out the location and hours of the nearest
center, call 1-800-829-1040 or visit the IRS website at www.irs.gov/localcontacts. You also can contact the
Taxpayer Advocate Service at 1-877-777-4778 or the local Taxpayer Advocate office in your area.
After you file this form, you can find out whether we received and approved it. Go to www.irs.gov/eitc and
click on the link for the EITC Certification Application, or you can call 1-800-829-6088. Allow at least 30 days
after filing the form before you do this. You will need information from your last tax return to access this
information.

Instructions

Where To File

Purpose of Form

Send Form 8836 to:
Internal Revenue Service
EITC Operations, Stop 4300, Annex R2
Kansas City, MO 64999-0065
After December 31, 2005, you can either file it at the
above address or attach it to your tax return. If you file it with
your return, send it to:

We need this form to show that your child met the residency
test (defined on this page) for the earned income credit (EIC)
for 2005.

Who Must File
File this form only if:
● The IRS sent this form to you with a letter directing you to
file it, and
● You are claiming or expect to claim the EIC with a
qualifying child for 2005. A qualifying child is one who meets
the age, relationship, and residency tests for the EIC.

Internal Revenue Service Center
Kansas City, MO 64999-0002

CAUTION

The relationship test has changed for 2005. To
meet the relationship test, the child must be your
child (including an adopted child, stepchild, or
CAUTION
eligible foster child), brother, sister, stepbrother,
stepsister, or a descendant of one of these relatives. An
adopted child includes a child lawfully placed with you for
legal adoption. An eligible foster child is any child who is
placed with you by an authorized placement agency or by
judgment, decree, or other order of any court of competent
jurisdiction.
If you are required to, but do not file Form 8836, the IRS
will not allow the EIC with a qualifying child for 2005. If the
IRS does not allow your EIC, we will notify you of your
appeal rights.
Do not file Form 8836 if your child does not meet the
residency test for 2005, because we will not allow the EIC
based on a qualifying child.
For details on the EIC eligibility rules, see Pub. 596,
Earned Income Credit (EIC). You can order Pub. 596 by
calling 1-800-TAX-FORM (1-800-829-3676) or you can
download it from the IRS website at www.irs.gov. You can
also use the EITC Assistant at www.irs.gov/eitc to find out if
you are eligible for EIC.
Pre-recorded information about the EIC is also available by
phone 24 hours a day, 7 days a week. Call 1-800-829-4477
and select TeleTax topic No. 601. Have paper and a pen or
pencil handy to take notes.

Do not send your tax return to the address listed
in your tax return instructions if that address is
different from the address just given.

File Form 8836 by fax. You can also file Form 8836 and any
supporting documents by fax at 1-913-266-9640 (not a
toll-free number). You cannot file your tax return by fax.

Electronic Filers
You cannot file Form 8836 electronically. However, you may
still file your tax return electronically. If you do so, send Form
8836 and all required attachments to:
Internal Revenue Service
EITC Operations, Stop 4300, Annex R2
Kansas City, MO 64999-0065

Residency Test
Your child must have lived with you in the United States for
more than half of 2005 (at least 183 days). Include any time
that you and your child were temporarily living apart due to
special circumstances, such as military service, school
attendance, hospitalization, or juvenile detention. It does not
matter where you lived with your child. For example, you
may live with your child in a homeless shelter. For more
details on the residency test, see Pub. 596.
Special rule for a child who was born or died in 2005. A
child is considered to have lived with you for more than half
of 2005 if the child was born or died in 2005 and your home
was the child’s home for the entire time he or she was alive
in 2005.

When To File

What We Will Do After We Receive This
Form

There are two different time periods for filing Form 8836 for
2005. You can file Form 8836 either:
● Before January 1, 2006. If you file the form during this
period, you may be able to avoid a delay in receiving the EIC
part of your tax refund for 2005.
● After December 31, 2005, but no later than the date you
file your 2005 tax return. Under this option, the EIC part of
your refund will be delayed while we review the information
you submitted.

We will review the information you send us. We will send you
a letter to let you know if your child has met the residency
test. If we need more information, we will contact you.
If one or more of your children do not meet the residency
test, we will send you a letter to let you know. The IRS will
not allow the EIC based on that child. If you have other
children for whom you can provide documents, you will have
the opportunity to do so. If the IRS does not allow all of your
EIC, we will notify you of your appeal rights.

7
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8836, PAGE 3 OF 4
PRINTS: HEAD TO HEAD
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE:
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8836 (2005)

If you move after you file Form 8836, notify us in writing of
your new address. To do this, use Form 8822, Change of
Address.
For more information, see How to Get Help, at the top of
page 2.

Part I
P.O. Box. Enter your box number only if your post office
does not deliver mail to your home. Otherwise, enter your
home street address.
Daytime and evening phone numbers. Providing your
daytime and evening phone numbers may help speed the
processing of this form. We may have questions about the
information you provided. If you answer our questions over
the phone, we may be able to continue processing the form
without mailing you a letter. You may list a mobile phone
number as your daytime or evening phone number (or both).
If you will be filing a joint return, you may enter either
spouse’s phone numbers.

Part II
Be sure that any child named on this form is your qualifying
child and you are listing or expect to list that child on
Schedule EIC of your 2005 tax return.
Your qualifying child must have a valid social security
number (SSN), unless the child was born and died in 2005. If
the qualifying child was born and died in 2005 and did not
have an SSN, attach a copy of that child’s birth certificate to
Form 8836 and enter “Died” instead of the child’s SSN.
For EIC purposes, a valid SSN is a number issued by the
Social Security Administration unless “Not Valid for
Employment” is printed on the social security card and the
number was issued solely to receive a federally funded
benefit.
We will not allow the EIC based on a qualifying child who
has, instead of an SSN:
● An individual taxpayer identification number (ITIN), which
the IRS issues to noncitizens who cannot get an SSN, or
● An adoption taxpayer identification number (ATIN), which
the IRS issues to adopting parents who cannot get an SSN
for the child being adopted until the adoption is final.

Part III
You must attach a Third Party Affidavit or other documents
showing that each qualifying child listed on Schedule EIC
lived with you for more than half of 2005. You may need to
send more than one affidavit or other document to show that
your child lived with you for more than half of 2005.
If you and your spouse are filing a joint return, you only
need to show that your child lived with one of you for more
than half of 2005.
What kind of documents you must provide. You may
provide any of the following:
● The Third Party Affidavit. Use only the version of the
affidavit (schedule) you received with Form 8836. Keep a
copy for your records.
● A signed letter on official letterhead. Keep a copy for your
records.
● A copy of a record (such as school records, medical
records, childcare records, a lease, or a pay stub). Do not
send any original records.
Temporary absences. Attach documents if you and your
child were temporarily living apart due to special
circumstances and you need to count the temporary
absences to prove that your child met the residency test.
See Residency Test on page 2. For example, if you were
away from home on military duty, attach a copy of your

Page

3

military orders showing the dates you were away and where
you were stationed.
If you cannot obtain a completed Third Party Affidavit,
records, or a signed letter from one or more third parties
to show that your child lived with you for more than half
of 2005, call 1-800-829-6088 and we will help you.
What the documents must show. If you send an official
record or letter, it must clearly show:
● Your name, your child’s name, or both names,
● A street address and the dates that you or your child lived
at that address during 2005, and
● The name, address, and phone number of the person or
organization that provided the record or letter.
Who can provide documents to you. You can submit a
Third Party Affidavit from any third party eligible to complete
it. You can submit copies of records or signed letters on
official letterhead from any of the following third parties (other
than you, your spouse, your dependent, your qualifying child
for the earned income credit, or a parent of that qualifying
child).
● School official (such as a teacher, principal, or
administrative assistant). A school includes Head Start, pre-K
programs, and before or after school care provided by a
school.
● Health-care provider (such as your doctor, your nurse
practitioner, or a clinic official).
● Member of the clergy (such as your minister, priest, rabbi,
or imam).
● Childcare provider who is age 18 or older (such as a
babysitter or daycare provider).
● Your employer (such as a personnel official, supervisor, or
work leader).
● Landlord or property manager (including a building
superintendent, public housing official, or rental agent).
● Social service agency or other government official (such as
a social worker, case worker at a public assistance office, or
operator of a homeless shelter).
● Community-based organization official (such as an official
from the YMCA, YWCA, Boy Scouts, Girl Scouts, Boys and
Girls Clubs, 4-H, Little League, Police Athletic League,
immigrant advocacy groups, neighborhood associations,
homeowners and condominium associations, and other
nonprofit groups).
● Indian tribal official.
● Attorney who handled your divorce or child custody case.
● Official of the court or agency that issued a decision or
order involving your divorce or custody, support, or
placement of your child.
● Law enforcement officer (such as a police officer or parole
officer).
● Utility company (such as an electric or gas company).
How many documents do you need? You can submit any
combination of the documents listed on this page as long as
they show, when taken together, that your child lived with
you for more than half of 2005. In some cases, a single
document will show that you and your child lived at the same
address. In other cases, you may need to provide one
document showing your name and address as well as a
second document showing your child’s name with the same
address. You may need more than one document to show
that your address and your child’s address were the same
for more than half of 2005.
Here are examples of acceptable document combinations:
● One document that shows that both you and your child
lived at the same address for more than half of 2005.

7
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8836, PAGE 4 OF 4
PRINTS: HEAD TO HEAD
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: None
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8836 (2005)

● One document that shows that you lived at an address for
more than half of 2005 and a second document that shows
that your child lived at the same address during the same
period of time.
● One document that shows that you and your child lived at
the same address for part of 2005 and a second document
that shows that you and your child lived together for the rest
of 2005.
● If you have two children, separate documents for each
child to show that each one lived with you for more than half
of 2005.
● If you have two children, one document to show that both
of your children lived with you for more than half of 2005.
Example 1. You attach a letter on official letterhead from
Acme Medical Clinic showing that your child lived with you
from January 1, 2005, through March 31, 2005. You also
have Reverend Smith, your clergyman, complete a Third
Party Affidavit showing that you and your child lived together
from April 1, 2005, through July 31, 2005. You check the first
and second boxes in Part III. Because the total time shown is
more than half of the year, the residency test is met.
Example 2. You attach a transcript of your child’s grades
from the Washington Elementary School showing that your
child lived with you from January 1, 2005, through May 31,
2005. You also attach a letter on official letterhead from the
principal of the Lincoln Middle School. The letter shows the
dates of school attendance and that the child’s address was
the same as yours. The letter covers the period from
September 1, 2005, through December 31, 2005. You check
the second and third boxes in Part III. Because the total time
shown is more than half of the year, the residency test is
met.
Example 3. You attach seven electric bills from the Edison
Electric Company for the months of January through May,
September, and October of 2005 showing your name and
address on them. You also attach transcripts of your child’s
grades from the Roosevelt Grade School showing your
child’s name and the same address shown on your electric
bills. The transcripts cover the periods January through May
2005 and September through November 2005. You
check the third box in Part III. Because you have shown that
the total time you and your child lived together was more
than half the year, the residency test is met.
Signing the form. You must sign and date Part III under
penalties of perjury before you send it to us with the
documents. Criminal penalties may be imposed for making a
false statement.

Page

4

Privacy Act and Paperwork Reduction Act Notice. The
Privacy Act of 1974 and the Paperwork Reduction Act of
1980 require that when we ask you for information we must
first tell you our legal right to ask for the information, why we
are asking for it, and how it will be used. We must also tell
you what could happen if we do not receive it and whether
your response is voluntary, required to obtain a benefit, or
mandatory under the law.
This notice applies to all papers you file with us. It also
applies to any questions we need to ask you so we can
complete, correct, or process your return; figure your tax;
and collect tax, interest, or penalties.
Our legal right to ask for information is Internal Revenue
Code sections 6001, 6011, and 6012(a), and their regulations.
They say that you must file a return or statement with us for
any tax for which you are liable. Your response is mandatory
under these sections. Code section 6109 and its regulations
say that you must provide your taxpayer identification
number on what you file. This is so we know who you are,
and can process your return and other papers.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be
retained as long as their contents may become material in
the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as stated in
Code section 6103.
We ask for tax return information to carry out the tax laws
of the United States. We need it to figure and collect the
right amount of tax.
We may give the information to the Department of Justice
and to the other federal agencies, as provided by law. We
may give it to cities, states, the District of Columbia, and
U.S. commonwealths or possessions to carry out their tax
laws. We may also disclose this information to other
countries under a tax treaty, or to federal and state agencies
to enforce federal nontax criminal laws and to combat
terrorism.
If you do not file a return or give fraudulent information,
you may be charged penalties and be subject to criminal
prosecution.
Please keep this notice with your records. It may help you
if we ask you for other information. If you have any questions
about the rules for filing and giving information, please call or
visit any Internal Revenue Service office.
The average time and expenses required to complete
and file this form will vary depending on individual
circumstances. For the estimated averages, see the
instructions for your income tax return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. You can write to the
Internal Revenue Service, Tax Products Coordinating
Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave.
NW, IR-6406, Washington, DC 20224. Do not send the form
to this address. Instead, see Where To File on page 2.