2021 Individual Taxpayer Ouestionaire

Filing Status*

SingleMarried Filing JointlyMarried Filing SeparateHead Of HouseholdWidow
Basic Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Date of Birth*

MonthDayYear
Date
Occupation
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
Type Of ID*
ID Number*
Identity Protection Pin (if applicable)
Spouse
Spouse Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Occupation
Phone Number

Area CodePhone Number
Email Address
example@example.com
Type Of ID
ID Number*
Identity Protection Pin (if applicable)
Dependent(s)

Other dependents or people who lived with you

	Name	Social Security	IP PIN	Date of birth	Relationship	Income
1
2
3
4

Income

Please Provide Proof of All Income
Please select all forms of Income*

W21099-MISC1099-R1099-SSA1099-K1099-G1099-DIVW2G1099-CStimulus PaymentOther
Deductions

Please Provide All Documentation
Adjustments

Medical Saving AccountEducator ExpenseHealth Saving AccountPenalty on Withdraw of SavingIRA DeductionAlimony PaidStudent Loan Int DeductionOther
Itemized Deductions

Medical and Dental ExpensesMortgage Interest and ExpensesTaxes You PaidGifts To CharityOther
Health Insurance Questionnaire
Earned Income Credit

Additional Due Diligence
Areas of Emphasis

Around 60% of all mistakes in EITC are results of 3 main areas:

1. The child might not meet the age, residency, or relationship requirement.

2. The case might be that someone is filing as single or HOH when he/she is actually married.

3. A mistake might arise when reporting income or expenses. Special attention has to be paid when the client is answering these questions.

The people who are eligible for EITC:

1. Have earned income
2. Have a valid Social Security Number
3. Are filing separately and not as married
4. Are not a nonresident alien
5. Are not a qualifying child of another person
6. Are not filing Form 2555 or Form 2555-EZ
7. Have limited investment income
Select type of assistance received.

Government HousingSNAP BenefitsFinancial AidCash ContributionsOtherOther
Child Care Credit

Basic Provider Information
Please select if ID Number is a SSN, ITIN, or EIN

SSN/ITINEINType option 3Type option 4
Provider's EIN
SSN/ITIN Number
Provider's name
Provider's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount Paid to Provider for Child Care
Provider's Phone Number

Area CodePhone Number
EDUCATION

(Please provide 1098-T and Supporting Documents)
Eligible Student

First NameLast Name
Business Expenses
Schedule C Supporting Documents Statement

Dear Taxpayer,

To comply with IRS EITC due diligence requirements, as a paid preparer I am required to make adequate inquiries to be satisfied that the taxpayer is carrying on a business and that the income and expenses reported on the tax return are substantially correct and complete. In the event of a loss of client records or due to poor recordkeeping, a paid preparer I may need to help you as a client reconstruct the records. The reconstruction will demonstrate that the paid preparer exercised due diligence and it will also teach the client about recordkeeping. The goal of record reconstruction is to use available documentation to develop a sound and reasonable estimate of the taxpayer's business income and expenses to support the Schedule C prepared. Although the taxpayer may not have formal books and records with supporting documentation, they may have partial records that can be used as a basis for reconstruction. Knowledgeable tax preparers can guide their client on how to use these partial records to develop support for the Schedule C. This reconstruction can also provide support for the return in the case of an audit. Numerous court cases exist that support the use of reasonable estimates and reconstruction of income and expenses to determine a taxpayer's correct tax liability. However, if the tax preparer is not
satisfied with the accuracy of the reconstructed records, you have the right to refuse to prepare the return.

By signing the acknowledgment, you affirm that I have communicated my professional responsibility to prepare returns that are accurate. The taxpayer is ultimately responsible for the figures computed through record reconstruction, and you are informed as the taxpayer of possible repercussions of filing a false EITC claim whether with or without my assistance. However, as a tax preparer I must exercise due
diligence and apply reasonableness as I may be subject to penalties and additional consequences.
Type of formation

SoleSole ProprietorLLCS-CorpC-CorpPartnership
Name of Business
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number

Area CodePhone Number
Business Email Address
example@example.com
Type of Business
EIN or SSN Number
Schedule C - Expenses

(Please provide ALL supporting documentation)

Advertising
Contract Labor
Commission and fees
Depletion
Employee benefit programs
Insurance (other than health)
Mortgage interest
Other interest
Legal and professional services
Office expense
Pension and profit sharing
Rent or lease of equipment
Rent or lease of property
Repairs and maintenance
Supplies
Taxes and licenses
Travel
Meals (50%) Enter 100% of the expenses
Utilities

Car and Truck Expenses

Please Note: Actual car or truck expenses must be entered in the depreciation menu for this business. You cannot claim both actual expenses and mileage for the same vehicle.

Description of Vehicle

Date you placed your vehicle in service for business purposes   Date

Of the total number of miles you drove your vehicle during the tax year, enter the number of miles you used your vehicle for each of the following.

Business miles
Other
Tax Preparation Checklist

Please provide the following documentation:
- All Forms W-2 (wages), 1099-INT (interest), 1099-DIV (dividends), 1099-B (proceeds from broker or barter transactions), 1099-R (pensions and IRA distributions), Schedules K-1 from partnerships, S corporations, estates and trusts, and other income reporting
  statements, including all copies provided from the payer.
- Form 1095-A (for health insurance purchased through a public exchange), Form 1095-B (for health insurance purchased outside
  of a public exchange), or Form 1095-C (for employer-provided healtinsurance coverage).
- If you are a new client, provide copies of last year’s tax returns.
- The completed Individual Income Tax Organizer. Note: If you choose not to fill out the organizer, you must at least answer the “Yes” or “No” questions under “Questions — All Taxpayers.”
- Copy of the closing statement if you bought or sold real estate.
- Mileage figures for any automobile expenses claimed, including total mileage, commuting mileage, and business mileage.
- Detail of estimated tax payments made, if any.
- Income and deductions categorized on a separate sheet for business or rental activities.
- List of itemized deductions categorized on a separate sheet for medical, taxes, interest, charitable, and miscellaneous deductions.
- Copy of all acknowledgement letters received from charitable organizations for contributions made in 2020.
Tax Return Preparation

We will prepare your tax return based on information you provide. In the event your return is audited, you will be responsible for verifying the items reported. It is important that you review the return carefully before signing to make sure the information is
correct. Unless otherwise stated, the services for preparation of your return do not include auditing, review, or any other verification or assurance.
Taxpayer Responsibilities
- You agree to provide us all income and deductible expense information. If you receive additional information after we begin
  working on your return, you will contact us immediately to ensure your completed tax returns contain all relevant information.
- You affirm that all expenses or other deduction amounts are accurate and that you have all required supporting written records. In some cases, we will ask to review your documentation.
- You must be able to provide written records of all items included on your return if audited by either the IRS or state tax authority.
  We can provide guidance concerning what evidence is acceptable.
- You must review the return carefully before signing to make sure the information is correct.
- Fees must be paid before your tax return is delivered to you or filed for you. If you terminate this engagement before completion,
  you agree to pay a fee for work completed. A retainer is required for preparation of late returns.
- You should keep a copy of your tax return and any related tax documents. You may be assessed a fee if you request a copy in the
  future.
Signatures. By signing below, you acknowledge that you have read, understand, and accept your obligations and responsibilities.

For a joint return, both taxpayers must sign.
Taxpayer Signature*

Clear
Date*

MonthDayYear
Date
Spouse Signature

Clear
Date

YearMonthDay
Date
Should be Empty:

Basic Information

Spouse

Dependent(s)

Income

Deductions

Health Insurance Questionnaire

Earned Income Credit

Child Care Credit

EDUCATION

Business Expenses

Schedule C - Expenses

Car and Truck Expenses