Taxpayer Questionnaire

PERSONAL INFORMATION

Step 1

Primary Taxpayer

First Name
Middle Initial

Last Name

Home address
Apt. #

City
State
Zip Code

S.S.N.
Birthdate (mm-dd-yyyy)
Taxpayer's PIN

Home Phone
Cell Phone
Occupation

Dependent on another return? YesNo
Legally Blind? YesNo
Disabled? YesNo

Your email

Text message
YesNo
Taxpayer´s gender MaleFemale

Cell Phone Carrier

Preferred Contact

Preferred Language

Step 2

Select Your Status

Spouse

First Name
Middle Initial
Last Name

S.S.N.
Birthdate (mm-dd-yyyy)
Spouse´s PIN

Home Phone
Cell Phone
Occupation

Dependent on another return? YesNo
Legally Blind? YesNo
Disabled? YesNo

Email (spouse)
Text message YesNo

Cell Phone Carrier
Preferred Contact

Spouse MaleFemale

Taxpayer Signature

Date

Spouse Signature

Date

Earned Income Credit

Part I: Qualifications

Could you, OR your spouse if filing jointly, be considered a "Qualifying Child" on another persons tax return during tax year?
YesNo

NOTE: If you answered "Yes", you are not able to qualify for the earned income credit (skip Part II and Part III).

Part II: Qualifying Children

Non Dependents claimed for EIC and Disabled person's dependent care expenses

First

First Name
Last Name
Birthdate (mm-dd-yyyy)

S.S.N.
Relationship
M.I.

Number Of Months
Dep. Code
EIC

Second

First Name
Last Name
Birthdate (mm-dd-yyyy)

S.S.N.
Relationship
M.I.

Number Of Months
Dep. Code
EIC

Need more fields?YesNo

Third

First Name
Last Name
Birthdate (mm-dd-yyyy)

S.S.N.
Relationship
M.I.

Number Of Months
Dep. Code
EIC

Fourth

First Name
Last Name
Birthdate (mm-dd-yyyy)

S.S.N.
Relationship
M.I.

Number Of Months
Dep. Code
EIC

The above information is true and correct, and I / we understand that the information given on this questionnaire will be used to complete my / our tax return(s). I / We agree to hold this company harmless for any errors that they may make on my / our tax return. We also understand that error on my / our return will cause a delay in the processing of the return and the receipt of the refund, if any.

NOTE: If you checked "No" on any of the first four questions above, then:

The child is not the taxpayer's qualifying child. If the taxpayer does not have a qualifying child, go to "Part III" to see if the taxpayer can claim the EIC for people who do not have qualifying children.

Part III: Earned Income Credit for Taxpayers without a Qualifying Child

Was your main home, and your spouse if filing jointly, in the United States for more than half the year? (Military personnel on extended active duty outside the U.S. are considered to be living in the U.S. during that period.)
YesNo

NOTE: If you answered "No" , you are not able to qualify for the earned income credit (skip Part II and Part III).

Part IV - Due Diligence Requirements

To comply with the EIC knowledge requirement, you must not know OR have reason to know that any information used to determine the taxpayer’s eligibility for, and the amount of, the EIC is incorrect. You may not ignore the implications of information furnished to OR known by you, and you must make reasonable inquires if the information furnished appears to be incorrect, inconsistent, OR incomplete. At the time you make these inquiries, you must document in your files the inquiries made and the taxpayer's responses.

Step 3