Wisconsin Intake Questionnaire

1

Name* This field is required.Please enter your name as it would appear on your Social Security card. This will allow us to match this questionnaire with your return.

First Name

Last Name

2

Wisconsin Residence: How long did you live in Wisconsin in 2022?* This field is required.

Resident of WI for all of 2022

Resident of WI for part of the year (moved to or from Wisconsin to another state)

3

When did you live in Wisconsin in 2022?* This field is required.

From (mm/dd)

To (mm/dd)

4

What other states did you live in?* This field is required.

5

What Wisconsin County did you live in?* This field is required.

6

What school district did you live in?* This field is required.

7

What type of municipality did you live in?* This field is required.

City

Village

Town

8

What is the name of the municipality that you lived in?* This field is required.

9

Did you pay rent or property tax while living in Wisconsin?* This field is required.

Paid rent

Paid property tax

Paid both rent and property tax

Did not pay either rent or property tax

10

Amount of Rent paid* This field is required.

11

Did the rent include heat?* This field is required.

YESNO

12

Amount of property tax paid* This field is required.

13

Did you spread federal income tax on a distribution from a retirement account over 3 years in 2021?If you are unsure please do not choose an option just move to the next question.

YESNO

14

Did you work in a different state while living in Wisconsin?If you are unsure please do not choose an option just move to the next question.

YESNO

15

Did you telecommute in Wisconsin for a job in a different state?If you are unsure please do not choose an option just move to the next question.

YESNO

16

Did you receive a Homestead Credit in 2022?If you are unsure please do not choose an option just move to the next question.

YESNO

17

Did you have a 2021 Wisconsin Capital Loss carryover from Schedule WD?If you are unsure please do not choose an option just move to the next question.

YESNO

18

Did you pay any Medical Insurance premiums?If you are unsure please do not choose an option just move to the next question.

YESNO

19

Did you have Long Term Care Insurance?If you are unsure please do not choose an option just move to the next question.

YESNO

20

Did you pay private school tuition for a dependent child?If you are unsure please do not choose an option just move to the next question.

YESNO

21

Did you work and live on an Indian reservation where you are an enrolled member?If you are unsure please do not choose an option just move to the next question.

YESNO

22

Did you receive pay for active service as a member of the National Guard or Reserves?If you are unsure please do not choose an option just move to the next question.

YESNO

23

Did you receive military retirement benefits?If you are unsure please do not choose an option just move to the next question.

YESNO

24

Did you receive an Americorps Education award?If you are unsure please do not choose an option just move to the next question.

YESNO

25

Did you pay any college tuition or fees for yourself (or a dependent)?If you are unsure please do not choose an option just move to the next question.

YESNO

26

Did you make any contributions to an Edvest or Tomorrow's Scholar College Savings accounts?If you are unsure please do not choose an option just move to the next question.

YESNO

27

Did you (or a dependent) take distributions from an Edvest or Tomorrow's Scholar College Savings account?If you are unsure please do not choose an option just move to the next question.

YESNO

28

Did you make any Wisconsin estimated tax payments?If you are unsure please do not choose an option just move to the next question.

YESNO

29

Wisconsin Homestead Credit RequirementsThe next question will ask if you think you are eligible for this credit.

30

Can you claim the Wisconsin Homestead credit?If you are unsure please do not choose an option just move to the next question.

YESNO

31

For each month in 2022, did you (or a spouse) receive Wisconsin Works (W2) payments of any amount or county relief payments of $400 or more?If you are unsure please do not choose an option just move to the next question.

YESNO

32

Did you receive Supplemental Security Income (SSI), Supplemental Security Income – Exceptional expense (SSI-E), Social Security Disability (SSD) or Caretaker Supplement payments (CTS)?If you are unsure please do not choose an option just move to the next question.

YESNO

33

Did you receive Wisconsin Works (W2), county relief, kinship care or other cash public assistance?If you are unsure please do not choose an option just move to the next question.

YESNO

34

Did you receive Veterans benefits or non-taxable military pay?If you are unsure please do not choose an option just move to the next question.

YESNO

35

Did you receive Workers compensation benefits?If you are unsure please do not choose an option just move to the next question.

YESNO

36

Did you receive any nontaxable scholarship or educational grants?If you are unsure please do not choose an option just move to the next question.

YESNO

37

Did you make any employee contributions to a medical expense account like a Flexible Spending Account?If you are unsure please do not choose an option just move to the next question.

YESNO

38

Did you have a nontaxable gain on the sale of a home?If you are unsure please do not choose an option just move to the next question.

YESNO

39

Did you have a spouse that did not live with you for the entire year?If you are unsure please do not choose an option just move to the next question.

YESNO

40

Did you receive child support?If you are unsure please do not choose an option just move to the next question.

YESNO

41

Did you have any other nontaxable income?If you are unsure please do not choose an option just move to the next question.

YESNO

42

Any other information about your tax situation?