Schedule CT-EITC Connecticut Earned Income Tax Credit 2021 Department of Revenue Services State of Connecticut (Rev. 12/21) EITC 1221W 01 9999 If you were a nonresident or part-year resident of Connecticut during 2021 - STOP HERE. You do not qualify for the Connecticut earned income tax credit (CT EITC) and you must file Form CT‑1040NR/PY. Complete Lines 6 through 16 on the back. Your Social Security Number  Complete this form in blue or black ink only. Attach completed Schedule CT‑EITC to the back of Form CT‑1040 or Form CT‑1040X or your credit will be disallowed. Please note that each form is year specific. To prevent any delay in processing your return, the correct year’s form must be submitted to the Department of Revenue Services (DRS). Do not use staples. 1. Did you claim the federal earned income credit for 2021? Yes No Stop; you do not qualify for the CT EITC. 2. Is your investment income greater than $10,000? Yes Stop; you do not qualify for the CT EITC. No 3. Did you already file a 2021 Form CT‑1040, Connecticut Resident Income Tax Return? Yes No If Yes, you must file Form CT‑1040X, Amended Connecticut Income Tax Return for Individuals, to claim the EITC. See instructions. 4. Did you claim qualifying children on your 2021 federal Schedule EIC? Yes Complete Line 5. No Skip to Line 6. 5. List up to three children you claimed on federal Schedule EIC. If you claimed more than three, see instructions. MI Last name (If two last names, insert a space between names.) Child 1 - First name Child 1 - Social Security Number Year of Birth Relationship Number of months living with you 1 = son/daughter/stepchild 2 = niece/nephew 3 = grandchild 4 = foster child 5 = other Child 1 Check the box if this child was identified as a student on federal Schedule EIC, box 4a. Check the box if this child was identified as being disabled on federal Schedule EIC, box 4b. Child 2 Check the box if this child was identified as a student on federal Schedule EIC, box 4a. Check the box if this child was identified as being disabled on federal Schedule EIC, box 4b. MI Last name (If two last names, insert a space between names.) Child 2 - First name Child 2 - Social Security Number Year of Birth Relationship Number of months living with you 1 = son/daughter/stepchild 2 = niece/nephew 3 = grandchild 4 = foster child 5 = other Child 3 Check the box if this child was identified as a student on federal Schedule EIC, box 4a. Check the box if this child was identified as being disabled on federal Schedule EIC, box 4b. MI Last name (If two last names, insert a space between names.) Child 3 - First name Child 3 - Social Security Number Year of Birth Relationship Number of months living with you 1 = son/daughter/stepchild 2 = niece/nephew 3 = grandchild 4 = foster child 5 = other Visit us at portal.ct.gov/DRS for more information.

Attach completed Schedule CT-EITC to the back of Form CT-1040. 7. Were you self-employed or did you have income not reported on a W‑2 or 1099? Yes No

If YES, complete Lines 7a, 7b, and 7c. Taxpayers using 2019 earned income to calculate their 2021 federal earned income credit should enter 2019 business information. See instructions. If NO, go to Line 8. Column C Income or (loss) Column A Business’s federal ID No. Column B Business’s state ID No. (CT Tax Registration Number) 7a. 7b. 7c. 8. Amount of federal EIC claimed from federal Form 1040, Line 27a, or federal Form 1040-SR, Line 27a. 8. .00 9. Connecticut EITC rate: 30.5% (.305) 9. 10. Connecticut EITC: Multiply Line 8 by Line 9. 10. .00 11. Did you file a federal income tax return as married filing jointly but file a Connecticut return as married filing separately?

Yes Complete Lines 12 through 15. No Skip to Line 16. 12. Enter your separate federal adjusted gross income from Form CT‑1040, Line 1. 12. .00 13. Enter your joint federal adjusted gross income from federal Form 1040, Line 11, or federal Form 1040-SR, Line 11. 13. .00 14. Divide Line 12 by Line 13. If Line 12 is equal to or greater than Line 13, enter 1.0000. 14. 15. Multiply Line 10 by Line 14. Enter here and on Line 16. 15. .00 16. Connecticut Earned Income Tax Credit: Enter the amount from Line 10 or Line 15, if completed, here and on Form CT‑1040, Line 20a, or Form CT‑1040X, Line 22a. 16. .00   Schedule CT-EITC Page 2 (Rev. 12/21) EITC 1221W 02 9999    .305  • Your Social Security Number  6a. 6b. 6c. Column C Wages, tips, etc. 6. Did you have wages but NO Connecticut income tax withheld? Yes No

If YES, enter wages from Forms W‑2 and 1099 by completing Lines 6a, 6b, and 6c. Taxpayers using 2019 earned income to calculate their 2021 federal earned income credit should enter information from 2019 Forms W-2 and 1099. See instructions. If NO, go to Line 7. Column B Employer’s state ID No. from Box 15 of W-2 or payer’s state ID No. from Form 1099 Column A Employer’s federal ID No. from Box b of W-2 or payer’s federal ID No. from Form 1099      Visit us at portal.ct.gov/DRS for more information.