IRS Due Diligence Questionnaire (Form 8867 –Practitioner Checklist)
Tax Year
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Client Name
*
First Name
Last Name
SSN/ITIN
*
Preparer Name
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First Name
Last Name
Firm Name
*
Date
*
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Month
-
Day
Year
Date
Purpose
This form is used to document required IRS due diligence under Form 8867. All answers must be completed by the client and reviewed by the tax preparer. Incomplete forms may result in penalties.
Credits & Filing Status Covered (Check all that apply)
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Earned Income Credit (EIC)
Child Tax Credit (CTC)
Additional Child Tax Credit (ACTC)
Credit for Other Dependents (ODC)
Head of Household (HOH)
American Opportunity Tax Credit (AOTC)
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Section A – Identity & Filing Status
What was your marital status as of December 31?
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Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Widow(er)
If Head of Household, explain who lived with you and your relationship
Did you pay more than half the cost of keeping up your home?
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Yes
No
If yes, list expenses paid (rent, utilities, food, etc.):
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Section B – Dependents (Complete for each dependent)
Dependent #1
Name
First Name
Last Name
Relationship
SSN/ITIN
Lived with you more than half the year?
Yes
No
Provided more than half of their own support?
Yes
No
Dependent #2
Name
First Name
Last Name
Relationship
SSN/ITIN
Lived with you more than half the year?
Yes
No
Provided more than half of their own support?
Yes
No
Dependent #3
Name
First Name
Last Name
Relationship
SSN/ITIN
Lived with you more than half the year?
Yes
No
Provided more than half of their own support?
Yes
No
Dependent #4
Name
First Name
Last Name
Relationship
SSN/ITIN
Lived with you more than half the year?
Yes
No
Provided more than half of their own support?
Yes
No
Dependent #5
Name
First Name
Last Name
Relationship
SSN/ITIN
Lived with you more than half the year?
Yes
No
Provided more than half of their own support?
Yes
No
Does anyone else have the right to claim any dependent listed above?
Yes
No
If yes, explain:
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Section C – Income Information
List all income received during the year
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W-2 wages
Self-employment
1099 income
Cash income
Tips
Other income
Did you receive any income not reported on a tax form?
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Yes
No
If yes, explain
If self-employed, describe your business and how income/expenses were tracked:
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Section D – Earned Income Credit (EIC)
Did you live in the United States for more than half the year?
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Yes
No
Were you or your spouse a qualifying child of another taxpayer?
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Yes
No
Has the IRS ever disallowed your EIC in a prior year?
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Yes
No
If yes, what year(s)?
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Section E – Child Tax Credit / Additional Child Tax Credit
Is the child under age 17 at the end of the tax year?
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Yes
No
Did the child live with you more than half the year?
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Yes
No
Does the child have a valid SSN issued before the due date of the return?
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Yes
No
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Section F – American Opportunity Tax Credit (If Applicable)
Student Name
First Name
Last Name
Was the student enrolled at least half-time?
Yes
No
Is this within the first four years of post-secondary education?
Yes
No
Qualified education expenses paid: $
Scholarships or grants received: $
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Section G – IRS Consistency & Knowledge Checks (Preparer Review)
Are any answers incomplete or inconsistent?
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Yes
No
Were follow-up questions asked?
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Yes
No
Were explanations documented?
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Yes
No
Notes
Documents Provided (Check all that apply)
Government-issued photo ID
Social Security cards / ITIN letters
Birth certificates
School or medical records
Lease or mortgage statement
Utility bills
Income documents (W-2, 1099, receipts)
Other Documents
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Client Declaration
I declare under penalty of perjury that the information provided is true, correct, and complete.
Name
*
First Name
Last Name
Client Signature
*
Date
*
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Month
-
Day
Year
Date
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Should be Empty: