215001250094 6 Wages, salaries, tips, etc., from Worksheet A line 3, in the instructions. ..................................................................... 6 .00 7 Earned income adjustments (see instructions) ................................................................................................................. 7 .00 8 Business income or loss (see instructions) ....................................................................................................................... 8 .00 Employer identification number (see instructions)... 9 Enter your federal adjusted gross income (from Form IT-201, line 19, or Form IT-203, line 19, Federal amount column) .......... 9 .00 10 Amount of federal EIC claimed (from federal Form 1040, line 27a) .................................................................................. 10 .00 11 New York State earned income credit (NYS EIC) rate 30% (.30) .................................................................................. 11 .30 12 Tentative NYS EIC (multiply line 10 by line 11; see instructions) ........................................................................................... 12 .00 Complete Worksheet B on the back page before continuing. 5 Is the IRS figuring your federal earned income credit (EIC) for you? If Yes, complete lines 6 through 9 (also lines 21,

23, and 24 if you are a part-year New York State resident, and line 28 if you are a part‑year New York City resident).

The Tax Department will calculate your New York State and, if applicable, your New York City earned income credit

for you. If No, complete lines 6 through 17 (and lines 18 through 26 if you are a part-year New York State resident).

New York City residents must complete Worksheet C, New York City earned income credit, in the instructions.

Part‑year New York City residents must also complete line 28 on the back of this claim form. ................................ 5 Yes No 13 Enter the amount from Worksheet B, line 5, on the back of this form................... 13 .00 14 New York State household credit (from Form IT-201, line 40, or Form IT-203, line 39)... 14 .00 15 Enter the smaller of line 13 or line 14 ............................................................................................................................ 15 .00 16 Allowable New York State earned income credit (subtract line 15 from line 12; see instructions) ..................................... 16 .00 17 Complete only if you filed your federal return as Married filing joint, but are required to file your New York State

return as Married filing separate return (see instructions). ........................................................................................... 17 .00

Joint federal adjusted gross income ................................................................... .00 1 Did you claim the federal earned income credit? If No, stop; you do not qualify for these credits. ........................ 1 Yes No 2 Is your investment income (see instructions) greater than $11,950? If Yes, stop; you do not qualify for these credits. . 2 Yes No 3 Is your federal filing status Married filing separate and do you meet the requirements to be considered unmarried

for the purposes of the earned income credit? ........................................................................................................ 3 Yes No 4 Did you claim qualifying children on your federal Schedule EIC? If No, continue with line 5.

If Yes, in the spaces below, list up to three of the same children you claimed on federal Schedule EIC. ................ 4 Yes No

If you claimed more than three, see instructions. IT-215 * Mark an X in these boxes only if you checked Yes in the same box on your federal Schedule EIC (box 4a or 4b). Department of Taxation and Finance Claim for Earned Income Credit New York State • New York City Tax Law - Section 606(d) Whole dollars only Submit this form with Form IT-201 or IT-203. Name(s) as shown on return Your Social Security number

First name MI Last name Suffix Relationship

First name MI Last name Suffix Relationship

First name MI Last name Suffix Relationship

Social Security number Date of birth (mmddyyyy)

Social Security number Date of birth (mmddyyyy)

Social Security number Date of birth (mmddyyyy) No. of months lived with you No. of months lived with you No. of months lived with you Full-time student* Full-time student* Full-time student* Person with disability* Person with disability* Person with disability* 1st Child 2nd Child 3rd Child

215002250094 1 New York State tax (from Form IT-201, line 39, or Form IT-203, line 38) ................................................................................ 1 .00 2 Resident credit (see instructions) ..................................................................................... 2 .00 3 Accumulation distribution credit (see instructions) ........................................................... 3 .00 4 Add lines 2 and 3 ........................................................................................................................................................... 4 .00 5 Subtract line 4 from line 1 (if line 4 is more than line 1, enter 0). Enter here and on line 13 on the front of this form .......... 5 .00 IT-215 (2025) (back) 18 Enter your New York State earned income credit (from line 16 or line 17) ........................................................................ 18 .00 19 Enter the amount from Form IT-203, line 42 .................................................................................................................. 19 .00

– If line 19 is equal to or more than line 18, stop. 20 Subtract line 19 from line 18 .......................................................................................................................................... 20 .00 21 Enter the amount from Form IT-203-ATT, line 31 (If you do not have to file Form IT-203-ATT, leave blank and continue on line 22 below.) 21 .00

– If Form IT-215, line 21, is equal to or more than Form IT-215, line 20, stop. Do not continue

with this calculation. Enter the amount from line 20 above on Form IT-203-ATT, line 32.

– If Form IT-215, line 21, is less than Form IT‑215, line 20, enter the amount from line 20 above on

Form IT-203-ATT, line 32, and continue on line 22 below. 22 Subtract line 21 from line 20........................................................................................................................................... 22 .00 23 Amount from line 19, Column D, of Part-year resident income allocation worksheet,

in Form IT-203-I (see instructions)................................................................................ 23 .00 24 Enter the amount from Form IT-203, line 19, Federal amount column.......................... 24 .00 25 Divide line 23 by line 24 (round the result to the fourth decimal place). This amount cannot exceed 100% (1.0000) (see instr.) 25 26 Multiply line 22 by line 25. Enter the result here and on Form IT-203-ATT, line 10 ................................................... 26 .00 Part-year New York State resident earned income credit Worksheet B Lines 18 through 26 apply only to part-year New York State residents claiming the New York State earned income credit. New York City earned income credit (full-year and part-year New York City residents) 27 Enter the amount from Worksheet C, here and on Form IT-201, line 70,

or Form IT-203-ATT, line 11. ..................................................................................................................................... 27 .00

Part-year New York City residents must also complete line 28 below. 28 Part-year New York City adjusted gross income

Enter the amounts from Worksheet C, lines 6 and 7 ........................................ 28A .00 28B .00