Tax Intake Form 2022

Client Intake Questions

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How did you hear about us?

FacebookInstagramReferralPrevious Client
If someone referred you, please type his or her name here.
Tax Period(s) or Tax Year(s) for preparation
Are you trying to buy a new home within the next 2 years?

YesNoOther
Tax Payers Name*

First NameLast Name
Taxpayer's SSN*
Example: xxx-xx-xxxx
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's Phone Number*
Example: xxx-xxx-xxxx
Taxpayer's Email Address
Taxpayer's Job Title
Taxpayer Driver License Number*
DL State*
DL Issue Date*

MonthDayYear
Date
DL Expiration Date*

MonthDayYear
Date
Spouse Name

First NameLast Name
Spouse's SSN
Example: xxx-xx-xxxx
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse Job Title
Spouse's Email Address
Example: example@example.com
Spouse Driver License Number
DL State
DL Issue Date

MonthDayYear
Date
DL Expiration Date

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you and your spouse live apart during the year?

YesNoNot Applicable
What is your marital status as of December

Single (Not Married)Married living with SpouseMarried not living with spouse
Did you pay over half the expenses of maintaining your residence for the entire year?

YesNo
Did you support a child or family member for more than 6 months out of the year?

YesNo
If yes, did you live together at any time after June 30, 2022?

YesNoNot Applicable
Are you self employed?

YesNo
Are you on any Government Assistance*

YesNoNot Applicable
Do you have a business?

YesNo
What Type of Business?
Business Name
Business Tax ID
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many dependents are you claiming?*
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2022? (If all year, enter 12)
Dependent #2

First NameLast Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
How many months did Dependent #2 live with you in 2022? (If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Dependent #3

First NameLast Name
Dependent #3's Date of Birth
01/01/2001
How many months did Dependent #3 live with you in 2022? (If all year, enter 12)
Dependent #3s SSN
Example: xxx-xx-xxxx
Dependent's #3 SSN
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Dependent #4's First Name
First Name
Dependent #4's Last Name
Last Name
Dependent #4's Date of Birth
01/01/2001
Dependent #4's SSN
Example: xxx-xx-xxxx
What is Dependent #4's Relationship to you (son, daughter, etc.)?
How many months did Dependent #4 live with you in 2022? (If all year, enter 12)
Dependent #5's First Name
First Name
Dependent #5's Last Name
Last Name
Dependent #5's Date of Birth
01/01/2001
Dependent #5's SSN
Example: xxx-xx-xxxx
What is Dependent #5's Relationship to you (son, daughter, etc.)?
How many months did Dependent #5 live with you in 2022? (If all year, enter 12)
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo
Upload a copy of your daycare form here.

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How would you like to receive your tax refund?

Check (In mail)Direct Deposit
Name of Bank
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Can someone else claim you as a dependent?

YesNo
Did you have health insurance in 2022?

YesNo
Did you have health insurance for the entire year?

YesNo
Who was your insurance cover through in 2021?
Was your insurance through your employer?

YesNo
Was your insurance through Medicaid?

YesNo
Was your insurance through the Affordable Care Act (The Marketplace) aka Obamacare?

YesNo
Did your dependents have health insurance for the entire year?

YesNoNot Appliable
Was YOUR DEPENDENTS' insurance through your employer?

YesNoNot Applicable
Who was your Dependents insured with in 2021?
Upload Taxpayer & Dependent(s)Insurance Documents (Form 1095 A/B/C)

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Was YOUR DEPENDENTS' insurance through Medicaid?

YesNoNot Applicable
Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?

YesNoNot Applicable
Have you ever been denied the Earned Tax Credit (EITC)?

YesNo
Were you or any of your dependents in college in 2022?

YesNo
Do you have a 1098-T Form for either you or your dependents?

YesNo
If you have a 1098-T form, upload it here.

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Did you trade any Virtual/Crypto Currency

YesNo
Did you engage in any stock or exchange activity?

YesNo
If yes and received 1099B, upload it here.

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Did you buy or sell real estate in 2022?

YesNo
If yes bought real estate, upload Closing Disclosure/HUD-1; If yes sold real estate, upload Form 1099-S

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Did you receive Advance Child Tax Payments in 2021?

YesNo
Did you receive notices from the IRS or State/ (ex. Advance Child Tax Credit Letter 6419, Economic Impact Payments, etc)

YesNo
If yes, upload IRS or State Notice(s)/Letter(s)

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Did you have a foreign account that exceeds over $10,000?

YesNo
Did you make contributions for the 2022 tax year to an IRA account?

YesNo
If yes, please provide details and the amount of contribution
Did you receive the 1st Economic Stimulus Payment?

YesNo
How much did you receive from the 1st Economic Stimulus Payment? (up to $1200 per taxpayer and $500 per dependent)
Did you receive the 2nd Economic Stimulus Payment?

YesNo
How much did you receive from the 2nd Economic Stimulus Payment? (up to $600 per taxpayer and per dependent)
Did you receive the 3rd Economic Stimulus Payment?

YesNo
How much did you receive from the 3rd Economic Stimulus Payment? (up to $1400 per taxpayer and dependent)
Are you interested in AUDIT PROTECTION?

YesNo
CLIENT NON PAYMENT/OFFSET CLAUSE At Troubled Tax Experts, we strive to assist all of our clients in their tax needs, however we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return. By signing this agreement you acknowledge that if payment is not made in full with in 30 days legal actions will be sought to resolve payment and informaiton gathered for preparation of tax returns can be used to collect unpaid fees.
Primary Taxpayer's Signature*

Clear
Date

MonthDayYear
Date
I am giving Troubled Tax Experts and associated affiliates permission to prepare all forms related to my tax return and I have signed all necessary forms, and/or have provided permision, to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that Troubled Tax Experts and associated affiliates hold no responsibility for any misrepresentation or false claims.
Taxpayer's Signature *

Clear
Spouse's Signature (If no spouse, leave blank)

Clear
Date

MonthDayYear
Date
Additional information for tax preparation
Taxpayer's W-2/ 1099'S

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Additional Forms and Documents

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Dependent(s) Birth Certificate(s)

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Client Intake Questions