tax intake

VIP TAX INTAKE QUESTION FORM
Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address
Email
example@example.com
Telephone
Format: (000) 000-0000.
Dependent 1 Name
Dependent 1 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dependent 2 Name
Dependent 2 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dependent 3 Name
Dependent 3 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
TREASURY OFFSET PROGRAM VERIFICATION (REQUIRED BEFORE STARTING) CALL 1800-304-3107
Did client owe any offsets
Notes
Did you have health insurance during the tax year? If yes - was it through the Marketplace?

provide Form 1095-A If yes 24-hour Marketplace Hotline: 1-800-318-2596

If not Marketplace: Employer I Medicaid I Medicare I Private
Any gaps in coverage
Did you attend college part-time or full-time this tax year? Did you receive Form 1098-T?
Did you purchase bookssupplies
Did you have grants or scholarships
Did you pay childcare expenses
Provider name
Provider address
Provider phone
Format: (000) 000-0000.
Provider EINSSN
Did child live with you 6 months AT LEAST
Is anyone else eligible to claim this child? IF SO MAKE US AWARE
Did you own a home? IF SO Did you receive:1098 Mortgage Interest? Property tax statement?Homeowners insurance? HOA fees?
BUSINESS OR SIDE HUSTLE? SELF EMPLOYED ?
Did you receive IRS letters
Do you owe back taxes
Are you in a payment plan WITH THE IRS?
Are you interested in credit repair
Are you interested in life insurance
DO YOU WANT ADVANCES?
TREASURY OFFSET PROGRAM (TOP) REQUIRED TO CHECK BEFORE PREPARATION PLEASE CALL BEFORE WE BEGIN YOUR RETURN Offset Line: 1-800-304-3107
INCOME INFORMATIOM

W-2 Employment information
Type a question

TREASURY OFFSET PROGRAM (TOP) REQUIRED TO CHECK BEFORE PREPARATION PLEASE CALL BEFORE WE BEGIN YOUR RETURN Offset Line: 1-800-304-3107

INCOME INFORMATIOM