Intake/Interview and Quality Review Sheet

Intake/Interview and Quality Review Sheet
You will need:
- Tax Information such as Forms W-2, 1099, 1098, 1095.
- Social Security Cards or ITIN letters for all persons on your tax return.
- Picture ID (such as valid driver's license) for you and your spouse.
- Please complete pages 1-4 of this form.
- You are responsible for the information on your return. Please provide complete and accurate information.
- If you have questions, please ask the IRS-certified preparer.
We are trained to provide high-quality service and uphold the highest ethical standards.

To report unethical behavior to Alpha Omega Tax Center, email us at elonmiree@gmail.com 334.525.5300 OFFICE 334.492.2486 DIRECT
Part I – Your Personal Information (If you are filing a joint return, enter your names in the same order as last year’s return)
1. Your first name*
M.I.
Last name*
Best contact number*
Are you U.S. citizen?

YESNO
2. Your spouse’s first name
M.I.
Last name
Best contact number
Is your spouse a U.S. citizen?

YESNO
3. Mailing address*
Apt
City*
State*
ZIP code*
4. Your Date of Birth*

MonthDayYear
Date
5. Your job title
6. Last year, were you: a. Full-time student

YesNo
b. Totally and permanently disabled

YesNo
c. Legally blind

YesNo
7. Your spouse’s Date of Birth

MonthDayYear
Date
8. Your spouse’s job title
9. Last year, was your spouse : a. Full-time student

YesNo
b. Totally and permanently disabled

YesNo
c. Legally blind

YesNo
10. Can anyone claim you or your spouse as a dependent?

YesNoUnsure
11. Have you, your spouse, or dependents been a victim of tax related identity theft or been issued an Identity Protection PIN?

YesNo
12. Provide an email address (optional) (this email address will not be used for contacts from the Internal Revenue Service)
example@example.com
Part II – Marital Status and Household Information
1. As of December 31, 2023, what was your marital Status?

Never MarriedMarriedDivorcedLegally SeparatedWidowed
( This includes registered domestic partnerships, civil unions, or other formal relationships under state law) a. If Yes, Did you get married in 2023

YesNo
b. Did you live with your spouse during any part of the last six months of 2023?

YesNo
Date of final decree

MonthDayYear
Date
Date of separate maintenance decree

MonthDayYear
Date
Year of spouse's death

MonthDayYear
Date
List the names below of:
- everyone who lived with you last year (other than your spouse)
- anyone you supported but did not live with you last year
Name (First, Last) Do not enter your name or Spouse's name below
Date of Birth

MonthDayYear
Date
Relationship to you ( For Example: son, daughter, parents, none, etc.)
Number of months lived in your home last year
US Citizen (yes/no)
Resident of US, Canada, or Mexico last year (yes/no)
Single or Married as of 12/31/23 ( S/ M)
Full-time Student last year (yes/no)
Totally and Permanently Disabled (yes/no)
Name (First, Last) Do not enter your name or Spouse's name below
Date of Birth

MonthDayYear
Date
Relationship to you ( For Example: son, daughter, parents, none, etc.)
Number of months lived in your home last year
US Citizen (yes/no)
Resident of US, Canada, or Mexico last year (yes/no)
Single or Married as of 12/31/23 ( S/ M)
Full-time Student last year (yes/no)
Totally and Permanently Disabled (yes/no)
Name (First, Last) Do not enter your name or Spouse's name below
Date of Birth

MonthDayYear
Date
Relationship to you ( For Example: son, daughter, parents, none, etc.)
Number of months lived in your home last year
US Citizen (yes/no)
Resident of US, Canada, or Mexico last year (yes/no)
Single or Married as of 12/31/23 ( S/ M)
Full-time Student last year (yes/no)
Totally and Permanently Disabled (yes/no)
To be completed by a Certified Preparer
Is this person a qualifying child/relative of any other person? (Yes/No)
Did this person provide more than 50% of his/ her own support? (yes/No)
Did this person have a less $4,700 of income? (yes,no,n/a)
Did the taxpayer(s) provide more than 50% of support for this person? (yes,no,n/a)
Did the taxpayer(s) pay more than half the cost of maintaining a home for this person? (yes,no)
Is this person a qualifying child/relative of any other person? (Yes/No)
Did this person provide more than 50% of his/ her own support? (yes/No/n/a)
Did this person have a less $4,700 of income? (yes,no,n/a)
Did the taxpayer(s) provide more than 50% of support for this person? (yes,no,n/a)
Did the taxpayer(s) pay more than half the cost of maintaining a home for this person? (yes,no)
Is this person a qualifying child/relative of any other person? (Yes/No)
Did this person provide more than 50% of his/ her own support? (yes, no, n/a )
Did this person have a less $4,700 of income? (yes,no,n/a)
Did the taxpayer(s) provide more than 50% of support for this person? (yes,no,n/a)
Did the taxpayer(s) pay more than half the cost of maintaining a home for this person? (yes,no)
Part III – Income – Last Year, Did You (or Your Spouse) Receive

Check appropriate box for each question in each section
1. (B) Wages or Salary? (Form W-2)

YesNoUnsure
If yes, how many jobs did you have last year?
2. (A) Tip Income?

YesNoUnsure
3. (B) Scholarships? (Forms W-2, 1098-T)?

YesNoUnsure
4. (B) Interest/Dividends from: checking/savings accounts, bonds, CDs, brokerage? (Forms 1099-INT, 1099-DIV)

YesNoUnsure
5. (B) Refund of state/local income taxes? (Form 1099-G)

YesNoUnsure
6. (B) Alimony income or separate maintenance payments?

YesNoUnsure
7. (A) Self-Employment income? (Forms 1099-MISC, 1099-NEC, 1099-K, cash, digital assets, or other property or services)

YesNoUnsure
8. (A) Cash/check/digital assets, or other property or services for any work performed not reported on Forms W-2 or 1099?

YesNoUnsure
9. (A) Income (or loss) from the sale or exchange of stocks, bonds, digital assets or real estate? (including your home) (Forms 1099-S, 1099-B)

YesNoUnsure
10. (B) Disability income? (such as payments from insurance, or workers compensation) (Forms 1099-R, W-2)

YesNoUnsure
11. (A) Retirement income or payments from pensions, annuities, and or IRA? (Form 1099-R)

YesNoUnsure
12. (B) Unemployment Compensation? (Form 1099-G)

YesNoUnsure
13. (B) Social Security or Railroad Retirement Benefits? (Forms SSA-1099, RRB-1099)

YesNoUnsure
14. (M) Income (or loss) from rental property?

YesNoUnsure
15. (B) Other income? (gambling, lottery, prizes, awards, jury duty, digital assets, Sch K-1, royalties, foreign income, etc.)

YesNoUnsure
Part IV – Expenses – Last Year, Did You (or Your Spouse) Pay

Check appropriate box for each question in each section
1. (B) Alimony or separate maintenance payments? If yes, do you have the recipient’s SSN?

YesNoUnsure
If yes, do you have the recipient’s SSN?

YesNo
2. Contributions or repayments to a retirement account?

YesNoUnsureIRA (A)ROTH IRA (B)401K(B)OTHER
3. (B) College or post secondary educational expenses for yourself, spouse or dependents? (Form 1098-T)

YesNoUnsure
4. Any of the following?

YesNoUnsure(A) Medical & Dental (including insurance premiums)(A) Mortgage Interest (Form 1098)(A) Taxes (State, Real Estate, Personal Property, Sales)(B) Charitable Contributions
5. (B) Child or dependent care expenses such as daycare?

YesNoUnsure
6. (B) For supplies used as an eligible educator such as a teacher, teacher’s aide, counselor, etc.?

YesNoUnsure
7. (A) Expenses related to self-employment income or any other income you received?

YesNoUnsure
8. (B) Student loan interest? (Form 1098-E)

YesNoUnsure
Part V – Life Events – Last Year, Did You (or Your Spouse)

Check appropriate box for each question in each section
1. (A) Have a Health Savings Account? (Forms 5498-SA, 1099-SA, W-2 with code W in box 12)

YesNoUnsure
2. (A) Have credit card, student loan or mortgage debt cancelled/forgiven by a lender or have a home foreclosure? (Forms 1099-C, 1099-A)

YesNoUnsure
3. (A) Adopt a child?

YesNoUnsure
4. (B) Have Earned Income Credit, Child Tax Credit or American Opportunity Credit disallowed in a prior year?

YesNoUnsure
If yes, for which tax year?
5. (A) Purchase and install energy-efficient home items? (such as windows, furnace, insulation, etc.)

YesNoUnsure
6. (A) Receive the First Time Homebuyers Credit in 2008?

YesNoUnsure
7. (B) Make estimated tax payments or apply last year’s refund to this year’s tax?

YesNoUnsure
If so how much?
8. (A) File a federal return last year containing a “capital loss carryover” on Form 1040 Schedule D?

YesNoUnsure
9. (A) Have health coverage through the Marketplace (Exchange)? [Provide Form 1095-A]

YesNoUnsure
Additional Information and Questions Related to the Preparation of Your Return
1. Would you like to receive written communications from the IRS in a language other than English?

YesNo
If yes, which language?
2. Presidential Election Campaign Fund (If you check a box, your tax or refund will not change) Check here if you, or your spouse if filing jointly, want $3 to go to this fund

YouSpouse
3. If you are due a refund, would you like
a. Direct deposit

YesNo
b. To purchase U.S. Savings Bonds

YesNo
c. To split your refund between different accounts

YesNo
4. If you have a balance due, would you like to make a payment directly from your bank account?

YesNo
5. Did you live in an area that was declared a Federal disaster area?

YesNo
If yes, where?
6. Did you, or your spouse if filing jointly, receive a letter from the IRS?

YesNo
7. Would you like information on how to vote and/or how to register to vote?

YesNo
Your answer will be used only for statistical purposes. These questions are optional.
8. Would you say you can carry on a conversation in English, both understanding & speaking?

Very wellWellNot wellNot at allPrefer not to answer
9. Would you say you can read a newspaper or book in English?

Very wellWellNot wellNot at allPrefer not to answer
10. Do you or any member of your household have a disability?

YesNoPrefer not to answer
11. Are you or your spouse a Veteran from the U.S. Armed Forces?

YesNoPrefer not to answer
12. Your race?

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhitePrefer not to answer
13. Your spouse’s race?

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhitePrefer not to answerNo spouse
14. Your ethnicity?

Hispanic or LatinoNot Hispanic or LatinoPrefer not to answer
15. Your spouse’s ethnicity?

Hispanic or LatinoNot Hispanic or LatinoPrefer not to answerNo Spouse
Additional comments
File Upload-W2, 1099, Drivers License, Social Security Cards, etc

AFTER UPLOAD GO TO THE BOTTOM AND SIGN AND SUBMIT YOUR FILE.
Cancelof
Privacy Act and Paperwork Reduction Act Notice
The Privacy Act of 1974 requires that when we ask for information we tell you our legal right to ask for the information, why we are asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for information is 5 U.S.C. 301. We are asking for this information to assist us in contacting you relative to your interest and/or participation in the IRS volunteer income tax preparation and outreach programs. The information you provide may be furnished to others who coordinate activities and staffing at volunteer return preparation sites or outreach activities. The information may also be used to establish effective controls, send correspondence and recognize volunteers. Your response is voluntary. However, if you do not provide the requested information, the IRS may not be able to use your assistance in these programs. The Paperwork Reduction Act requires that the IRS display an OMB control number on all public information requests. The OMB Control Number for this study is 1545-1964. Also, if you have any comments regarding the time estimates associated with this study or suggestion on making this process simpler, please write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224
Department of the Treasury - Internal Revenue Service
Consent to Disclose Tax Return Information to Tax Preparation Sites
Federal Disclosure:
Federal law requires this consent form be provided to you. 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.
Terms:
Global Carry Forward of data allows TaxSlayer LLC, the provider of the VITA/TCE tax software, to make your tax return information available to ANY volunteer site participating in the IRS's VITA/TCE program that you select to prepare a tax return in the next filing season. This means you will be able to visit any volunteer site using TaxSlayer next year and have your tax return populate with your current year data, regardless of where you filed your tax return this year. This consent is valid through November 30, 2025. The tax return information that will be disclosed includes, but is not limited to, demographic, financial and other personally identifiable information, about you, your tax return and your sources of income, which was input into the tax preparation software for the purpose of preparing your tax return. This information includes your name, address, date of birth, phone number, SSN, filing status, occupation, employer's name and address, and the amounts and sources of income, deductions and credits that were claimed on, or contained within, your tax return. The tax return information that will be disclosed also includes the name, SSN, date of birth, and relationship of any dependents that were claimed on your tax return. You do not need to provide consent for the VITA/TCE partner preparing your tax return this year. Global Carry Forward will assist you only if you visit a different VITA or TCE partner next year that uses TaxSlayer. You have the right to receive a signed copy of this form. Limitation on the Duration of Consent: I/we, the taxpayer, do not wish to limit the duration of the consent of the disclosure of tax return information to a date earlier than presented above (November 30, 2025 If I/we wish to limit the duration of the consent of the disclosure to an earlier date, I/we will deny consent.

Limitation on the Scope of Disclosure: I/we, the taxpayer, do not wish to limit the scope of the disclosure of tax return information further than presented above. If I/we wish to limit the scope of the disclosure of tax return information further than presented above, I/we will deny consent.
Consent:
I/we, the taxpayer, have read the above information.

I/we hereby consent to the disclosure of tax return information described in the Global Carry Forward terms above and allow the tax return preparer to enter a PIN in the tax preparation software on my behalf to verify that I/we consent to the terms of this disclosure.
Primary taxpayer printed name and signature
Signature

Clear
Date

MonthDayYear
Date
Secondary taxpayer printed name and signature
Signature

Clear
Date

MonthDayYear
Date
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. Report a Crime or IRS Employee Misconduct - U.S. Treasury Inspector General for Tax Administration (TIGTA) (https://www.tigta.gov/reportcrime-misconduct
Should be Empty:

Part II – Marital Status and Household Information

To be completed by a Certified Preparer

Part III – Income – Last Year, Did You (or Your Spouse) Receive

Part IV – Expenses – Last Year, Did You (or Your Spouse) Pay

Part V – Life Events – Last Year, Did You (or Your Spouse)

Additional Information and Questions Related to the Preparation of Your Return

3. If you are due a refund, would you like

Privacy Act and Paperwork Reduction Act Notice

Consent to Disclose Tax Return Information to Tax Preparation Sites

Federal Disclosure:

Terms:

Consent: