213001250094 Department of Taxation and Finance Claim for Empire State Child Credit Tax Law – Section 606(c-1) IT-213 Part 2: Enter qualifying child information Enter the name, SSN or individual taxpayer identification number (ITIN), and date of birth for each qualifying child included on lines 1 and 3. Failure to enter information for each qualifying child may result in a denial or delay the processing of your return. Submit this form with Form IT-201. Name(s) as shown on return Your Social Security number (SSN) Use Form IT-213-ATT if you have additional children to report. First name MI SSN or ITIN Suffix Date of birth (mmddyyyy) Last name Part 1: Calculation of credit 1 Number of qualifying children under age 4 ............................................................................................ 1 2 Multiply line 1 by 1,000 .......................................................................................................................... 2 .00 3 Number of qualifying children at least 4 years old but under age 17 ..................................................... 3 4 Multiply line 3 by 330 ............................................................................................................................. 4 .00 5 Add lines 2 and 4 ................................................................................................................................... 5 .00 6 Enter your federal adjusted gross income rounded down to the nearest $1,000 (see instructions) ......... 6 .00 7 Is the amount on line 6 less than the amount for your filing status?:
Married filing a joint return - $110,000
Single, head of household or qualifying surviving spouse - $75,000
Married filing a separate return - $55,000
If yes, enter 0
If no, subtract the amount for your filing status from line 6 and enter the result ................................ 7 .00 8 Multiply line 7 by 1.65% (.0165) ............................................................................................................ 8 .00 9 Subtract line 8 from line 5. This is your Empire State child credit (see instructions) ................................. 9 .00