HTS TAX SERVICE — PRE-SCREEN FORM

Full Name*

First NameLast Name

Welcome to Hometown Tax Service
Thank you for choosing Hometown Tax Service for your tax preparation needs.

This prescreen form is the first required step in beginning your tax filing process. The information you provide helps us determine eligibility, identify required documents, and ensure accurate and compliant tax preparation.

Before continuing, please review the following:

All information provided must be truthful and complete
We do not prepare tax returns using estimated or last pay stubs
Required documents must be submitted before any return is reviewed
Completion of this prescreen does not guarantee acceptance of service
By proceeding, you acknowledge that the information you provide is accurate to the best of your knowledge.

I have read and understand the information above and agree to proceed.

Are you a returning client?*

Yes(If Yes, Scroll down and Submit)No(If No,Contine Answering All Questions on this Form)

HTS New Client Pre-Qualification Form

Please answer these quick questions so we can confirm you qualify for tax preparation services with Hometown Tax Service. This helps us prepare you faster and ensure full IRS compliance.

Phone Number

Please enter a valid phone number.

Email

example@example.com

State of Residency

Preferred Preparer

What type of return do you need?

Current year (2025)Back Taxes (Prior Years)Amended Return

What filing status are you expecting to use?

Did you file your taxes last year?

YesNo

What type of income will you be reporting?

Do you have all documents?

YesStill waiting

⚠️ No Income Reported
If you do not have taxable income, you may not be required to file a tax return.
If you believe this is incorrect, please contact HTS before continuing.

⚠️ Missing Income Documents May Delay Processing
If you do not have all of your required income documents (W-2, 1099, SSA-1099, etc.), your tax return cannot be completed until those documents are provided.

Will you be claiming dependents?

YesNo

Do you have proof of residency for each dependent?).

YesNoNot sure

⚠️ Dependent Residency Requirement
IRS requires proof of residency for any dependent claimed on your tax return.
If you cannot provide proof, you may not qualify to claim this dependent.

❗ Examples of proof:

School letter
Medical letter
Daycare records
Lease listing the child
Government benefit letter
SNAP/Medicaid with child’s name

“Did each dependent live with you for more than 6 months?”

YesNo

Are you expecting to claim head of household?

YesNo

If YES, Did you pay more than 50% of household expenses for 2025?

YesNoI receive Section 8, SNAP, or other government assistance

If government assistance pays more of your household expenses than you do, you may NOT qualify for Head of Household.

Do you owe any federal or state debts that may offset your refund? (Select all that apply)

⚠️ Refund Offset Warning
The U.S. Treasury Offset Program (TOP) may reduce or take your federal refund if you owe certain debts—including child support, state taxes, unemployment overpayment, or federal tax debt.

This does not prevent you from filing, but your refund amount may be reduced.

Do you have a valid government issued ID or driver's license?

YesNo

Will you be filing virtually or in-person?

VirtualIn-person

Are you ready to upload all of your tax documents within 24 hours?

YesNo

Are you interested in applying for Refund Advance?

YesNoNot sure

Did you receive a refund last year?

Yes.NoI didn't file last year

Do you understand that approval is NOT guaranteed and is based on bank partner underwriting?

YesNo

Do you understand that you must meet bank identity and fraud-prevention requirements?

YesNo

Do you understand that your estimated refund must be large enough to cover fees AND the advance amount?

YesNo

Do you understand that if your refund is lower than expected or adjusted by the IRS, you may still be responsible for fees associated with bank products?

YesNo

“Do you understand that HTS fees must still be paid whether or not the advance is approved

YesNo

⚠️ Refund Advance Not Available
Based on your responses, you do not qualify for the Refund Advance program.
You may still continue with standard tax preparation services through HTS.

“I agree to the terms and conditions of the Refund Advance product and understand that approval is not guaranteed.”

I agree

Do you agree to follow all HTS document and communication requirements?

YesNo

⚠️Thank your for your interest. Based on your answers, we cannot continue with your tax preparation at this time. Please contact us if you have questions.

I confirm that all information provided in this pre-screen form is true and accurate to the best of my knowledge. I understand this is not an engagement letter and does not create a tax preparer–client relationship.
I understand that no refund amount, eligibility, or tax outcome can be guaranteed until all required documents are submitted and a full review is completed.
By submitting this form, I give permission for Hometown Tax Service to contact me regarding my tax needs.

By submitting this form, I acknowledge that I have reviewed and agree to the
Hometown Tax Service Privacy Policy
.

I understand and agree to the Hometown Tax Service Privacy Policy.