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2022 Virginia Schedule 760PY ADJ
Page 1 *VAPADJ122888*
Your Name Your SSN

Additions to Adjusted Gross Income B Spouse A You
Filing Status 4 ONLY Include Spouse if Filing Status 2
1. Interest earned while a Virginia resident on obligations of other states,
exempt from federal income tax, but not from state tax. ............................... 1 00 00

2. Other additions to adjusted gross income.
2a Fixed date conformity addition. See instructions. ................................. 2a 00 00
Code
2b - 2c Refer to Form 760PY Instructions for Other 00 00
Addition Codes. 2b 2b
00 00
2c 2c
3. Total Additions. Add Lines 1, 2a - 2c. 00 00
Enter here and on Form 760PY, Line 2. ....................................................... 3

Subtractions from Adjusted Gross Income B Spouse A You
4. Income (interest, dividends or gains) received while a Virginia resident from
obligations or securities of the U.S. exempt from state income tax, but not 00 00
from federal tax. ............................................................................................. 4
5. Disability income received while a Virginia resident and reported as wages
(or payments in lieu of wages) on your federal return. If claiming this
subtraction you cannot also claim Age Deduction. Claim the one that
benefits you most.
5a Enter YOUR disability subtraction on Line 5a, Column A. .................... 5a 00
5b Enter SPOUSE’S disability subtraction on Line 5b, Column B if claiming
Filing Status 4 or Line 5b, Column A if claiming Filing Status 2. ........... 5b 00 00
6. Other subtractions as provided in instructions.
6a Fixed date conformity subtraction. ........................................................ 6a 00 00
6b - 6d See Form 760PY Instructions for Other Subtraction Codes.
Certification Number Code
00 00
6b 6b
00 00
6c 6c
00 00
6d 6d
7. Total subtractions. Add Lines 4, 5a, 5b, and 6a - 6d. 00 00
Enter here and on Form 760PY, Line 8. ........................................................ 7

Deductions from Virginia Adjusted Gross Income B Spouse A You
8. Deduction codes. See Form 760PY Instructions for Deduction Codes.
Code
00 00
8a 8a
00 00
8b 8b
00 00
8c 8c
9. Total Deductions. Add Lines 8a - 8c. 00 00
Enter here and on 760PY, Line 14. ................................................................ 9
Use Schedule PY ADJS if you are claiming more additions, subtractions or
deductions than the Schedule 760PY ADJ allows. Refer to the instructions for
Other Codes.
Check this box. ............................................................................................

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2022 Virginia Schedule 760PY ADJ
Page 2 *VAPADJ222888*
Your Name Your SSN

Tax Credit for Low-Income Individuals or Virginia Earned Income Credit
• List below the name, Social Security Number (SSN) and Guideline Income for you, your spouse and each dependent.
• If more room is needed, enclose a schedule with the name, SSN and Guideline Income for each additional dependent.
• Failure to complete Lines 10 - 17 may result in this credit being reduced or disallowed.
Family VAGI Name Social Security Number (SSN) Guideline Income
You - - 00

Spouse - - 00

Dependent - - 00

Dependent - - 00
10. Total Family Guideline Income (Be sure to include information from enclosed schedule, if
applicable) 10 00
11. Enter the total number of exemptions reported in the table above and on any enclosed schedule.
Based on this total, the total Family Guideline Income from Line 10 and the poverty guidelines in
the instructions, determine your eligibility. .................................................................................. 11
12. If you qualify, enter the number of personal and dependent exemptions reported on your Form
760PY (see instructions)............................................................................................................. 12
13. Multiply Line 12 by $300. Enter the result on Line 13 and proceed to Line 14. .......................... 13 00
14. Enter the amount of Earned Income Credit claimed on your federal return. If you did not claim
an Earned Income Credit on your federal return, enter $0. If you are married filing separately, 00
see the instructions. 14
15. Multiply Line 14 by 20% (.20). .................................................................................................... 15 00

16. Enter the greater of Line 13 or Line 15. ...................................................................................... 16 00
17. Compare the amount on Line 16 above to the amount of tax on Form 760PY, Line 18. Enter the
lesser of the two amounts here and on Form 760PY, Line 23. This is your credit amount. ........ 17 00

Addition to Tax, Penalty and Interest
18. Addition to tax....................................................................................................... ....................... 18 00
19. Penalty. ................................................................. Late Filing Penalty Extension Penalty 19 00
20. Interest (accrued on the tax you owe). ........................................................................................ 20 00
21. Total Addition to Tax, Penalty and Interest (add Lines 18-20). Enter here and on Form 760PY,
Line 32 ......................................................................................................................................... 21 00

VA Dept. of Taxation 2601038 760PYADJ Rev. 07/22

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