Interview Sheet

(To be filled out by Tax Preparer)

1. Did you get your taxes prepared here last year? YES OR NO 2. Have your address, phone number, jobs, or last name changed since last year?YESORNO 3. Do you have (Circle All That Apply) W2 wages, Self-Employed Wages, or Both? 4. Did you have childcare during the tax year? YES OR NO If yes, who was your provider? 5. Did you receive Social Security Payments? YES OR NO 6. Did you receive unemployment any time during the tax year? YES OR NO 7. Have you withdrawn any money from a retirement plan during the tax year? YES OR NO 8. Were you, your spouse, or dependents enrolled in any college during the tax year? YES OR NO 9. Did you purchase a home last year or do you own a home? YES OR NO 10. Did you have health insurance coverage in tax year for you and your dependents? 11. Do you have any other forms that can be used for tax purposes like interest statements, stocks, etc.? YES OR

DUE DILIGENCE ADDITIONAL QUESTIONING FOR EITC AND CHILD TAX CREDIT

1. Did the dependent(s) live with you (taxpayer) for over 6 months in tax year? YES OR NO 2. Is the dependent(s) that you are claiming your son, daughter, stepchild, foster child, brother, sister, stepbrother, stepsister, or a descendent of any of those? YES OR NO

3. Is the dependent(s) that you are claiming for EITC purposes younger than you (taxpayer)? YES OR NO

4. Did anyone else live with you other than your dependent(s) in tax year? YES ORNO

5. Did you (taxpayer) provide more than 50% of income to take care of your dependent(s) in tax year?

6. Are your dependent(s) totally disabled in tax year? a. Has a doctor determined your dependent is totally disabled? 7. Are you the parent of your dependent(s)? YES OR NO

8. Did the child pay for his/her own support during the tax year, such as food, rent, etc.? YES OR NO

DUE DILIGENCE ADDITIONAL QUESTIONING FOR AOTC

2. Have you been convicted of a felony? YES OR NO

4. Was the student enrolled at least half time for at least one academic period? YES OR NO

DUE DILIGENCE ADDITIONAL QUESTIONING FOR FILING STATUS

2. Have you lived apart from your spouse for the last 6 months of the year? YES OR NO

3. How long have you been separated?

5. Are you getting assistance from: County State Other How much $

Taxpayer) have read and understand all questions asked by the tax preparer and agree knowledge of all questions and answers listed in this Preparer Interview Sheet/Due Diligence Additional Question Document. In Office Interview

Phone/Video Conference Interview