Form 9452 - Filing Assistance Program - 2011
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1
2Filing Assistance Program
OMB No. 1545-1316
9452
Form
(Do you have to file a Federal Income Tax Return?)
Department of the Treasury
See instructions on back.
Do not send to IRS.
Keep for your records.
Internal Revenue Service
Caution: Do any of the special situations listed in the general instructions on page 2 apply to you?
( ) Yes. Stop here; you must file a Federal income tax return. Do not use this form.
( ) No. Continue.
Computing Your Total Gross Income (See instructions.)
Part I
1
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
Wages, salaries, tips, etc.
(Do not include social security income)
2
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
Interest income
(Do not include tax-exempt interest, such as from municipal bonds)
3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
Ordinary dividend income
4
Refund of state and local income taxes if, in the year the tax was paid, you itemized your
4
. . . . . . . . . . . . . . . . . . . . . . . . . . .
deductions on Schedule A (Form 1040)
5
. . .
Retirement income (such as income from a taxable pension, annuity, IRA distributions, etc.)
5
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
Other income
6
(Self-employment, such as income from prizes, awards, gambling winnings, lottery, raffles, jury
duty fees, etc.)
. . . . . . . . . . . . . . . . . . . . . .
7
Gross Income. Add amounts on lines 1 through 6
7
Part II
Determining Your Filing Requirement
Can someone claim you as a dependent on their 2011 income tax return?
( ) Yes. See instructions on page 2.
( ) No. Use the following chart to make sure you do not have to file a Federal income tax return for 2011.
2011 Filing Requirements for Most People
Then you do not need to file a
If your filing status would be
And at the end of 2011 you were*
return if the amount on line 7 is
less than
$9,500
under 65
Single
65 or older
10,950
under 65 (both spouses)
$19,000
65 or older (one spouse)
20,150
Married filing jointly**
65 or older (both spouses)
21,300
any age
Married filing separately
$3,700
under 65
$12,200
Head of household
65 or older
13,650
under 65
$15,300
Qualifying widow(er)
65 or older
16,450
with dependent child
*If you were born on January 1, 1947, you are considered to be age 65 at the end of 2011.
**If you did not live with your spouse at the end of 2011 (or on the date your spouse died) and your gross income on line 7 above was at least
$3,700, you must file a return regardless of your age.
9452
Cat. No. 14695J
Form
(2011)
For Paperwork Reduction Act Notice, see back of Form.
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