Header
Taxpayer's name and address, an "In reply refer to" box, the tax year and the last four digits of the Social Security number.
9212
Income Questionnaire
- Agency
- IRS
- Revision
- Rev. 4-2015
- Fillable fields
- 27
- Pages
- 2
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 9212: Income Questionnaire
Form 9212, Income Questionnaire, is an Internal Revenue Service form used in the examination of a tax return. The form says: "To assist us in the examination of your tax return, complete all parts of this questionnaire and provide the requested information."
It has three parts. Part I asks for documents for each Form 2555 filed with the return, such as the employment contract and itemized compensation statements from the U.S. employer and the foreign employer. Part II asks about income from a partnership that employs the taxpayer. Part III asks whether the taxpayer, a family member or another related party owns stock in, or controls, the entity that employs the taxpayer.
The taxpayer signs a certification under penalty of perjury, and the spouse signs too if a joint return was filed. You can fill out the PDF free in your browser on this page and download it without an account.
What's on Form 9212
Part I: Form 2555
The employment contract or signed letter of agreement, a U.S. employer compensation statement, a reconciliation to any Form W-2, a foreign employer compensation statement, and the enclosed Compensation Questionnaire and Form 8768.
Part II: Partnership Income
Whether the taxpayer is a partner, with the partnership agreement, annual income summary statement and foreign tax return, then any guaranteed salary, allowances, profit or loss percentage and U.S. income percentage.
Part III: Income from A Closely Held Business
Ownership held directly, indirectly or constructively in the employing entity, with each owner's name, relationship, Social Security number, number, percentage and type of shares.
Remarks and certification
A remarks space, then the certification under penalty of perjury with the taxpayer's signature, the spouse's signature if a joint return was filed, and the date.
How to fill out Form 9212
- 1
Header
Confirm the name and address, the tax year and the last four digits of the Social Security number at the top.
- 2
Part I
For each Form 2555 filed, collect the employment contract or letter of agreement, the U.S. employer's itemized compensation statement, a reconciliation to any Form W-2, the foreign employer's statement, the Compensation Questionnaire and Form 8768.
- 3
Part II
Check Yes or No for being a partner. If Yes, the form asks for the partnership agreement, annual income summary and foreign tax return. Enter any guaranteed salary in dollars, show allowances on the Compensation Questionnaire, and give the percentages asked.
- 4
Part III
Check Yes or No on ownership of the employing entity. If Yes, give each owner's name, relationship (including self), Social Security number, number and percentage of shares, and check the share type.
- 5
Sign
Add remarks if needed, then sign and date. The spouse signs too if a joint return was filed.
Why fill Form 9212 on indox
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Where it goes and what to attach
Who receives it
The form says it is to assist the IRS ("us") in the examination of your tax return. It prints no mailing address.
Deadline
The form prints no due date.
What to attach
The Part I documents for each Form 2555, the Compensation Questionnaire and Form 8768, and for a partner the partnership agreement, annual income summary statement and the partnership's foreign tax return.
Who signs
The taxpayer, plus the spouse if a joint return was filed, under a certification made under penalty of perjury.
Related forms
Who fills out Form 9212?
The form is addressed to the taxpayer whose return is being examined. The taxpayer completes it and returns it with the documents it lists to the IRS, which the form calls "us".
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Questions about Form 9212
What is Form 9212?
An IRS income questionnaire. The form says it is to assist in the examination of your tax return and asks for all parts to be completed.
How does Form 9212 relate to Form 2555?
Part I asks for documents for each Form 2555 filed with the return, including compensation statements from the U.S. employer and the foreign employer.
What other questionnaires does it mention?
Part I lists the enclosed Compensation Questionnaire and Form 8768, Questionnaire-Dividends, Interest, Rents, Royalties, and Other Income.
Who signs Form 9212?
The taxpayer signs. The spouse also signs if a joint return was filed.
Does it ask for Social Security numbers?
The header asks for the last four digits of the taxpayer's number. Part III asks for the Social Security number of each person who owns shares in the employing entity.