2024 TAXPAYER INTERVIEW FORM

TAXPAYER INFORMATION

Name(Required)

SSN(Required)

Date Of Birth(Required)

Spouse Name

Spouse SSN

Spouse Date Of Birth

Taxpayer Occupation

Spouse’s Occupation

CONTACT INFORMATION

Taxpayer Phone

Taxpayer Cell

Taxpayer Email

Spouse's Phone

Spouse's Cell

Spouse's Email

BANKING INFORMATION

Routing#

Account#

SOCIAL SECURITY BENEFIT

Benefit Amount

DAYCARE (UNDER AGE 13)

Name

SSN# / EIN #(Required)

Amount

Other

Amount

EDUCATION

Educational Institution Name

Tuition paid

Books

Fed Tax ID #

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 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 eligibility for, 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. 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 2022 tax return(s). I / We agree to hold this company harmless for any errors that they may make on my / our tax return. I / 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. All expenses listed above are true and I have documentations to show proof if needed by IRS.

Taxpayer Signature

Date

Spouse’s Signature

Date

MEDICAL EXPENSES

Insurance Premium

Hosp./Nursing Home

Co Payment

Prescription Drugs

Dental

Glasses/Hearing Aid

Other

CHARITABLE CONTRIBUTION

Church Name

Red Cross

United Way

Goodwill

Fair market value of goods donated

Charitable miles

Other

HOUSEHOLD INCOME

Wages earned as a household employee (Not on W-2)

BUSINESS PROFIT AND LOSS FOR INDEPENDENT CONTRACTOR AND SELF-EMPLOYED

Taxpayer Name

Business Name

Tax ID#

Occupation

EXPENSES

Accounting

Advertising

Answering Service

Bad Debts

Bank Charges

Car and Truck Expenses

Commissions

Delivery and Freight

Contract Labor

Dues and Subscriptions

Insurance (other than health)

Mortgage Interest

Other Interest

Uniforms

Utilities

Other

Laundry and Cleaning

Legal and Professional

Miscellaneous

Office Expenses

Parking and Tolls

Tools

Postage

Printing

Travel

Rent – vehicles, machinery & equipment

Repairs

Rent – other

Security

Supplies

Taxes – payroll

Taxes – real estate

Total Meals and Entertainment

Outside Services

Required Telephone

Other

Business Miles

Commuting Miles

ENERGY EFFICIENCY

Type:

Amount Paid

Type:

Amount Paid

Type:

Amount Paid

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 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 eligibility for, 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. 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 2022 tax return(s). I / We agree to hold this company harmless for any errors that they may make on my / our tax return. I / 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. All expenses listed above are true and I have documentations to show proof if needed by IRS.

Taxpayer Signature

Date

Spouse’s Signature

Date

DUE DILIGENCE REQUIREMENTS – PREPARER

Does the income that the taxpayer is reporting seem sufficient to support the tax payer and the qualifying children that are being claimed?

If no, additional questions pertaining to both the income and the children should be asked.

How long have you owned your business?

Do you have any documentation to substantiate your business?

Who maintains the business records for your business?

Do you have separate banking accounts for personal and business transactions?

Have you been issued a 1099-MISC to support the income?

Did the client provide satisfactory records of all income and expenses?

Are the expenses being reported consistent with this type of business?

In your opinion, is the amount of expenses being reported reasonable?

Does anything seem missing?

Have you ever been married?

Is your spouse deceased?

Are you divorced? – Can you provide a copy of your divorce decree if requested by the IRS?

Are you separated? – Can you provide a copy of your divorce decree if requested by the IRS?

Are you married but living apart from your spouse?

Have you lived apart from your spouse for the last 6 months of the year? Can you provide a copy of any documentation verifying that you lived apart from your spouse (such as a lease agreement, utility bill, etc.) if requested by the IRS?

Did you maintain more than half of the cost of the home? – Can you provide a copy of any documentation verifying that you maintained more than half the cost of the home (utility bill, property tax bill, rent receipts, grocery receipts, etc.) if requested by the IRS?

Do you have any children over 18 years of age who are full time students, or who are permanently and totally disabled? Please list them using box to the right.

What school did the child attend? – Can you provide a copy of any documentation verifying that the child was a full-time student (student records, medical records, etc.) if requested by the IRS?

Did the child provide more than half of his or her own support for the year?

What type of disability does the child have?

Does the child receive SSI or other disability payments?

Do you have a letter from the child’s doctor, healthcare provider stating that the child is permanently and totally disabled?

Do the child’s biological parents live with the child? If no, where are the biological parents?

Are you related by marriage?

What is their story?

Did you receive form 1098T? It is required if claiming AOTC.

How many years has the student claimed education credit, either HOPE or AOTC?

How many academic terms did the student attend school during the tax years?

Is the student an undergraduate?

Is the student enrolled in a program that will result in a degree or another professional credential?

Has the student been convicted of a felony for possessing or distributing an illegal substance?

What is the amount of educational expenses paid during the year?

Tuition: $_______________ Books: $_______________ Fees: $_______________

Can you document the expenses paid and what were they for?