2023 Tax Client Intake Form

UNDERSTAND THAT OMNI CONSULTING GROUP LLC DOES NOT OFFER FREE ESTIMATES. IF YOU ARE SUBMITTING THIS FORM IT IS TO FILE YOUR RETURN OR FOR A QUOTE ($25) PAYMENT DUE PRIOR TO SUBMITTING DOCS FOR QUOTE. YOU MUST HAVE YOUR W2 OR 1099.

Name

First NameLast Name

Today Date

Date

Date of Birth

Date

Social Security

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email Address

example@example.com

Do you receive government assistance (food stamps, SSI, TANF, housing etc.)?

Filing Status

Check all that apply

How did you hear about us?

Who prepared your previous year tax return?

Promo Code

Occupation

If you or your dependent attended college. how did you pay?

1. Do you own and operate a small business/home based business?

3. What is your EIN? (If applicable)

4. Do you have a business bank account? (If applicable)

5. Did you receive a 1099?

If So, how much? Please attach in document section.

If yes, how much did you receive? Please attach in document section.

7. Did you receive any unemployment in 2022?

If yes, how much did you receive? Please attach 1099-G in document section.

11. Are you a homeowner? If Yes, please attach 1098 in document section

Did you, your spouse, or a dependent purchase health insurance via HealthCare.gov or a State Marketplace?

Would you like to apply for the Easy Advance? Up to $9500

How would you like your refund to be deposited when ready? (If you did not opt in to the advance loan)

Would you like to add 6 months of Credit Repair to your fees and get started today?

Would you like to add our Personal Credit Academy to your fees and get started today?

Would you like to add our Business Credit Academy to your fees and get started today?

Are there any other issues or concern regarding this year or any previous year tax returns?

If yes, please explain.

Number of dependents

Did you pay any childcare in 2022?

If so, how much? Please attach document below.

How many months did child reside with you in 2022?

Please enter child(ren)'s name, date of birth and social security number.

W2 or Income Verification Documents/1099

Choose File

Dependents Birth Certificate & Social Security Cards

Choose File

Upload your ID and Social Security Card

Choose File

College/Tuition or Daycare Receipts (If filing for college credits a 1098T must be included)

Choose File

Upload all supporting documents for your business (IF APPLICABLE: business receipts for expenses)

Choose File

Upload form 1098 if you are claiming mortgage interest. (Homeowners Only)

Choose File

Upload form 1099G if you received Unemployment Benefits

Choose File

Upload any additional documents

Choose File

The United States Congress have, as a reaction to the substantial tax fraud resulting from their original error of choosing: to distribute federal social welfare program benefits via the tax return. placed new excessive inappropriate "due diligence" requirements on paid tax return preparers whose clients are claiming certain tax credits. This added to the excessive and inappropriate requirements previously implemented by the Internal Revenue Service. The IRS has forced tax preparers to. In many cases, become Social Workers and verify that their clients qualify to receive certain credits i.e. EIC, CTC, ACTC and now HOH.

We preparers are not compensated by the IRS or the government for doing their job for them but must pass the costs of this required additional work on to our taxpayer clients.

You will be claiming an Earned Income Credit, Child Tax Credit, Addition Tax Child Tax Credit HOH, and/or an American Opportunity Credit on your 2022 tax return. Because of this you must complete, sign, and return this questionnaire to me. I will keep the original signed copy of this questionnaire with my file copy of your 2022 tax return and will include a photocopy of the completed questionnaire in the package I send you with the finished returns.

2. The child(ren) for whom the tax credit(s) will be requested lived with me/us for the year, except for temporary absences.

1. I/we certify that thechild(ren) for whom the tax credit(s) will be requested can be claimed as my/our dependent(s), as per the information provided at the end of this questionnaire.

Attach any additional documents

Choose File

3. I am the custodial parent of the child(ren) for whom the tax credit(s) will be requested, and I released the dependency deduction to my former spouse for 2022 by signing Form 8332 (Release /Revocation of Claim to Exemption for Child by Custodial Parent).

4.I am not the custodial parent of the child(ren) but I have been given a signed Form 8332 by my former spouse. the custodial parent. allowing me to claim the child(ren) as the dependent{s) on my 2022 tax returns(you must give me the Form 8332.)

5. I/We, or my child(ren), have documentation to substantiate the credit(s) being claimed, such as Form 1098-T, bills, statements, and receipts for college tuition, fees, and book and material costs (you are responsible for keeping this documentation and providing it to the IRS if you are audited or questioned).

6. Was a Child Tax Credit, Additional Child Tax Credit. or American Opportunity Credit claimed by you disallowed or reduced by the lRS on a past tax return?•

7. I claim I am unmarried or separated, support a qualifying person as your dependent ,and pay more than half the cost of maintaining your household.

OMNI CONSULTING GROUP LLC is not responsible if the taxpayer provides us with incorrect information (i.e. social security numbers for self, spouse, or dependents, last names, birth dates). This may delay your refund. OMNI CONSULTING GROUP LLC is not responsible for any IRS audits. All information obtained from the taxpayer and/or spouse must be presentable if the IRS audits your tax return. OMNI CONSULTING GROUP LLC is not responsible for any incorrect tax figures provided by the taxpayer and/or spouse. If your tax figures change you will need to do an Amendment. Prices Vary. If you have any federal or government debts (i.e. school loans, child support, DPP, DFCS, etc) there is a chance that your refund will be applied towards your debt. You can call the offset department at 1-800-304-3107 or 1-800 829-7650 to see if your refund will be partially or fully taken. If your refund is fully taken, you are responsible for paying the preparation fees. OMNI CONSULTING GROUP LLC provides the taxpayer with ONE complimentary copy of their tax return. Should you need any additional copies. there is a $15 fee per copy (federal and state included). OMNI CONSULTING GROUP LLC is not responsible for any discussions or changes the IRS or bank may make on disbursement dates, filing status or any other required information from the IRS. OMNI CONSULTING GROUP LLC is not responsible for any IRS glitch problems or IRS problems that may cause a delay in your tax refund. We DO NOT reimburse any bank fees in the event of this occurrence.

Signature

Consent To Use: Federal law requires this consent form be provided to you ("you" refers to each taxpayer, if more than one). Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to complete this form to engage our tax return preparation services. If-obtain your signature on this form by conditioning our tax return preparation services on your consent. Your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature. For your convenience. we have entered into an arrangement with certain companies to offer an Electronic Refund Disbursement Service and/or Loan product. To determine whether these offerings may be of interest to you, we will need to use your tax return information. If you would like us to use your tax return information to determine whether these offerings are relevant to you while we are preparing your return, please sign and date this consent to the use of your tax return information. By signing below, you authorize us to use the information you provide to us during the preparation of your 2022 tax return to determine whether to offer you an opportunity to apply for the Electroic Refund Disbursement Service and/or Loan product.

Signature

Consent to Disclosure Of Tax Return Information Federal law requires this consent form be provided to you ("you" refers to each taxpayer, if more than one). Unless authorized by law. we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent. your consent is valid for one year from the date of signature. You have indicated that you are interested in utilizing the Electronic Refund Disbursement Service and/or Loan product from Refund Advantage. To provide you with the opportunity to apply for and/ or receive the Electronic Refund Disbursement Service and/or Loan product, we must disclose all of your 2022 tax return information to Refund Advantage. You may request a more limited disclosure of tax return information, bot you will not be eligible to submit an application for the Electronic Refund Disbursement Service and/or Loan product. If you would like us to disclose your 2021 tax return information to Refund Advantage for this purpose, please sign and date your consent to the disclosure of your tax return information. By signing below, you authorize us to disclose to the designated bank all of your 2022 tax return information so that it can evaluate and process your application for the Electronic Refund Disbursement Service and/or Loan product. You understand that if you are not willing to authorize us to share your tax information with our designated banks, you will not be able to obtain the Electronic Refund Disbursement Service and/or Loan product, but you can still choose to have your tax return prepared and filed by us for a fee. If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration ( TIGTA) by telephone at 1-800-366-4484, or by email at complaints@ligta.treas.gov.

Signature

PERSONAL INFORMATION

INCOME INFORMATION

REFUND OPTIONS

DEPENDENT INFORMATION

DOCUMENT UPLOAD

DUE DILIGENCE QUESTIONNAIRE

ATTESTATION AND DISCLAIMER