Carney & Associates, LLC ~ Child Tax Credit

Carney & Associates, LLC
Child Tax Credit
The IRS is requiring tax preparers to request additional information from clients to ensure that they qualify for the credits. This questionnaire requires completion and signature in order for you to claim the folllowing credits on your tax return:

Child Tax Credit (CTC)

Other Dependent Credit (ODC)

All dependent related credits:

• You (and spouse if married filing jointly - MFJ) must have SSN OR ITIN issued by due date of return (including extensions)

• You (and your spouse if MFJ) do not qualify as a dependent of another person (even if they don’t claim you)

• You (and your spouse if MFJ) provided over half of the dependent person’s support for the current tax year

• The dependent(s) did not file a joint tax return for the current tax year
Taxpayer Name*

First NameLast Name
Qualifying child/dependent for CTC/ODC:

Please list the children (dependents) who live with you below, if more than 3 complete the form again
Child 1   First Name   Last Name
Are they under age 19 as of 12/31:   Yes    No
Are they a full time student (age 19-24):   Yes     No
Are they disabled:   Yes   No
Relationship to you:   Son   Daughter Other:
In the current tax year, how many months did they live with you:
In the current tax year, did you pay more than 1/2 of their care / living expenses:   Yes   No
Do they have a SSN:   Yes   No
Are they a US Citizen:   Yes   No
Child 2   First Name   Last Name
Are they under age 19 as of 12/31:   Yes    No
Are they a full time student (age 19-24):   Yes     No
Are they disabled:   Yes   No
Relationship to you:   Son   Daughter Other:
In the current tax year, how many months did they live with you:
In the current tax year, did you pay more than 1/2 of their care / living expenses:   Yes   No
Do they have a SSN:   Yes   No
Are they a US Citizen:   Yes   No
Child 3   First Name   Last Name
Are they under age 19 as of 12/31:   Yes    No
Are they a full time student (age 19-24):   Yes     No
Are they disabled:   Yes   No
Relationship to you:   Son   Daughter Other:
In the current tax year, how many months did they live with you:
In the current tax year, did you pay more than 1/2 of their care / living expenses:   Yes   No
Do they have a SSN:   Yes   No
Are they a US Citizen:   Yes   No
If necessary, can you provide proof of residency for the above qualifying dependents listed above (i.e. school or medical records)?*

YesNo
If any of the children listed above are not your biological children or can be claimed by someone else as a qualifying child, please explain the relationship and circumstances for each child. Include why the biological parents are not claiming the child. If not applicable, type N/A.*
Were any child tax credits disallowed or reduced by the IRS in a previous year? (You should have received a notice of disallowance from the IRS which either reduced any refund or required a re-payment.)*

Yes - Please provide a copy of IRS correspondence/letters.No
If Child Tax Credit was previously denied, there are required recertification forms to complete to qualify for future child tax credits. Have you complete the required recertification forms?

Yes - Please provide copies of recertification documents.No
Is there an active Form 8332 "Release/Revocation of Claim to Exemption for Child by Custodial Parent" (or similar agreement) in place? Note: This form is only required if there is shared custody of a child by separated or divorced parents, or if someone other than the biological parents has custody. Mark "No" if you are both the biological parents of the child.*

Yes - Provide a copy of the form 8332 if not on file.No
Date

MonthDayYear
Date
By my signature below, I confirm that I have answered the above questions to the best of my knowledge*

Clear
Printed Name*

First NameLast Name
Email*
example@example.com
Please verify that you are human (please type the word you see in the box):*
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Carney & Associates, LLC

Child Tax Credit

Qualifying child/dependent for CTC/ODC: