Tax Client Intake Form

Tax Client Intake Form
Returning Client?

YesNo
(Publication 4687 & IRC §6695(g) Compliant)
IMPORTANT NOTICE TO CLIENT

Federal law requires paid tax preparers to ask detailed questions and verify eligibility before claiming certain credits or filing statuses. Incomplete, inaccurate, or inconsistent answers may result in denial of credits or refusal to prepare your return.
Outstanding Federal or Financial Obligations
1. Do you currently have any outstanding balance or financial obligation with the Internal Revenue Service (IRS) or any other government or financial agency (including, but not limited to, IRS tax balances, student loans, or past-due child support)?

YesNoUnsure
If yes, please list the type of obligation and the agency or creditor to whom it is owed (e.g., IRS, Department of Education, State Child Support Agency):
Acknowledgment: I understand that if I have outstanding balances or financial obligations, all tax preparation fees must be paid in full prior to filing my tax return.

Acknowledged
If unsure, please stop here and contact the IRS directly at (800) 304-3107 to confirm your account status before proceeding.
Health Insurance Marketplace Coverage (Form 1095-A)
2. At any time during the 2025 tax year, did you or anyone listed on your tax return receive health insurance coverage through the Health Insurance Marketplace (Affordable Care Act / ACA)?

YesNoUnsure
If yes, do you have Form 1095-A available for upload?

YesNo
Please note: Form 1095-A is available in your IRS.gov account under Tax Records → Information Returns.

Your tax return cannot be electronically filed without this form and will reject if it is missing or incorrect.

If unsure, please contact the Health Insurance Marketplace at (800) 318-2596. They can provide the required figures over the phone.
Identity Protection PIN (IP PIN)
3. Has the IRS issued you an Identity Protection Personal Identification Number (IP PIN) for the 2025 tax year?

YesNoUnsure
If yes, please enter your 6-digit IP PIN below (numbers only):
Prior IRS Credit Disallowance (Due Diligence Requirement)
4. Have any tax credits (including, but not limited to, the Earned Income Tax Credit (EITC), Child Tax Credit (CTC/ACTC/ODC), American Opportunity Tax Credit (AOTC), or Head of Household filing status) ever been disallowed, reduced, or denied by the IRS on a prior tax return?

YesNoUnsure
A: If yes, please identify: The tax year(s) in which the credit was disallowed:
B: The specific credit(s) affected (check all that apply):

EITCChild Tax Credit / ACTC / ODCAmerican Opportunity Tax CrediHead of HouseholdOther
If selected other, please list it here.
C: The reason provided by the IRS for the disallowance (e.g., dependency/residency issues, income mismatch, missing documentation, identity verification, audit or examination findings):
If unsure, please indicate whether you received any IRS notices (CP, Letter, or audit correspondence) related to credits or filing status:

YesNoUnsure
If available, please upload copies of any related IRS notices or correspondence

Cancelof
SECTION 1 — TAXPAYER IDENTIFICATION (ALL CLIENTS)
- Name (exactly as shown on Social Security card)*
  
  First NameLast Name
- SSN:*
- Date of Birth*
  
  MonthDayYear
  Date
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- Address Current physical address (no P.O. Box)*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Did you live at this address for the entire tax year?
  
  YesNo
- If no, list all prior addresses and dates lived at each:
- Marital status as of December 31 of the tax year:*
  
  SingleLegally SeperatedMarriedWidowedDivorce
- If married or separated, Date of marriage or separation:
- Did you live with your spouse at any time during the year?
  
  YesNo
- Are you filing jointly this year?
  
  YesNo
- Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- SSN
- Relationship to you
- Dates lived with you (MM/DD–MM/DD)
- Follow-up (mandatory):
- Who are this child’s biological or legal parents?
- Where did the child live when not with you?
- Did anyone else provide financial support for this person?
- Did this person file a joint return with anyone?
- (Required under “Know the Facts” standard — Pub 4687, pgs. 4, 8–11)
- For each dependent claimed, answer ALL:
- Is this person your:
  
  ChildStepchildFoster ChildNeice/NephewParentOther
- Did this person live with you for more than 6 months of the year?
  
  YesNoException applies
- Did this person provide more than half of their own support?
  
  YesNo
- Did this person have gross income?
  
  YesNo
- If yes, amount:
- Is this person a:
  
  U.S CitizenU.S NationalResident AlienResident of Canada/Mexico
- Does this person have a valid SSN issued before the return due date?
  
  YesNoITINATIN
- List Dependent: Full Name, DOB, SSN
- List Dependent: Full Name, DOB, SSN
- List Dependent: Full Name, DOB, SSN
- W-2 Income
- List all employers you worked for during the year:
- Did you receive any cash income, side income, or informal pay?
  
  YesNo
- If yes, explain source and amount:
- Self-Employment (Schedule C)
- Name
  
  First NameLast Name
- Describe your business activity:
- Describe your business activity.
- Did you operate with the intent to make a profit? ☐
  
  YesNo
- Total gross income received:
- List all business expenses (even small ones):
- Do you have records for income and expenses?
  
  YesNo
- (IRS flags “no expenses” as inconsistent — Pub 4687, pg. 9)
- Are you claiming EITC this year?
  
  YesNo
- For each qualifying child:
- Relationship test met?
  
  YesNo
- Age test met?
  
  YesNo
- Residency test met (6+ months)?
  
  YesNo
- Valid SSN before due date?
  
  YesNo
- Has anyone else attempted or plans to claim this child?
  
  YesNoUnsure
- Were you married at any time during the year?
  
  YesNoUnsure
- If yes and filing separately, explain how you qualify:
- For each child claimed:
- Child’s age on December 31:
- Relationship
- Did the child live with you more than half the year?
  
  YesNo
- Does the child have a valid SSN (CTC/ACTC) or ITIN (ODC)?
  
  YesNo
- Is the child claimed as a dependent on this return?
  
  YesNo
- Did the child live outside the U.S. at any point?
  
  YesNo
- If yes, list dates and country:
- (Residency & ID rules enforced — Pub 4687, pgs. 10, 13–14)
- Are you claiming Head of Household?
  
  YesNo
- Who is your qualifying person?
- Did this person live with you more than half the year?
  
  YesNo
- Did you pay more than 50% of the cost of keeping up the home?
  
  YesNo
- Did you pay more than 50% of the cost of keeping up the home?
  
  RentFoodUtilitiesInsurance
- Did anyone else contribute to household expenses?
  
  YesNo
- If yes, who and how much?
- If married: Date spouse last lived in the home:Are you considered unmarried under IRS rules?
- Student’s name and SSN:
- School attended (must be eligible institution):
- Was the student enrolled at least half-time?
  
  YesNo
- Is the student pursuing a degree or credential?
  
  YesNo
- How many years has AOTC been claimed for this student?
- Did you pay qualified education expenses?
  
  YesNo
- Due Diligence
  
  I certify that all information provided is true, correct, and complete to the best of my knowledge.I understand that false or incomplete information may result in denial of credits or IRS penalties.
- Signature
- Date
  
  MonthDayYear
  Date
- Bank Name
- Routing Number
- Account Number
- Photo Identification
  
  Cancelof
- Taxpayer Social Security Card
  
  Cancelof
- Dependent Social Security Card
  
  Cancelof
- Dependent Social Security Card
  
  Cancelof
- Dependent Social Security Card
  
  Cancelof
- Dependent Social Security Card
  
  Cancelof
- W2(s)
  
  Cancelof
- 1099(s)
  
  Cancelof
- - I confirmed that all information I entered here is accurate and true.
  - I allow THOMFLIP FINANCIAL SERVICES to capture my sensitive data like personal id, government id, and other information.
  - I have read the terms and conditions and privacy policy of ABC Financial.
  - By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
- Date Signed*
  
  MonthDayYear
  Date
- Taxpayer Signature*
- Date Signed
  
  MonthDayYear
  Date
- Spouse Signature
- Should be Empty:

Tax Client Intake Form

(Publication 4687 & IRC §6695(g) Compliant)

Outstanding Federal or Financial Obligations

Health Insurance Marketplace Coverage (Form 1095-A)

Identity Protection PIN (IP PIN)

Prior IRS Credit Disallowance (Due Diligence Requirement)

SECTION 1 — TAXPAYER IDENTIFICATION (ALL CLIENTS)

(Required under “Know the Facts” standard — Pub 4687, pgs. 4, 8–11)

W-2 Income

Self-Employment (Schedule C)

(IRS flags “no expenses” as inconsistent — Pub 4687, pg. 9)

For each child claimed:

(Residency & ID rules enforced — Pub 4687, pgs. 10, 13–14)