Tax Credits Due Diligence Questionnaire

** SKIP WHAT DOES NOT APPLY

Instructions

You are being supplied with this questionaire because you have claimed one of these credits in the past or you have indicated that you will be claiming one of them this year. The questionaire is designed to assist us in qualifying you for some valuable refundable tax credits.

While the questions may seem to be a little intrusive at times, they are questions that we are required to ask under the Due Diligence Requirements of the new Tax Laws.

Please complete them in as much detail as possible. Not all questions will apply to all taxpayers. If they do not apply to you please answer them as NA (not applicable) so that we will know that you read the question and didn't just miss it. Abbreviations used on the Questionaire:

CTC - Child Tax Credit

ACTC - Additional Child Tax Credit

EITC - Earned Income Tax Credit (Low Income Households)

AOTC - American Opportunity Tax Credit (College Credit)

FOR NEW CLIENTS with Dependents: Please remember to submit copies of social security cards, birth certificates and proof of residency (possibly school records or medical records showing the dependents name and YOUR address).

FOR TAXPAYERS CLAIMING COLLEGE TAX CREDITS: Please remember to submit copies of the Form 1098T that you received from the college AND a copy of the Bursar's statement from the college showing the Spring and/or Fall semester charges and payments. The Credit applies to all payments made in cash or via student loans to tuition, fees and related expenses. IT does NOT apply to Room and Board or travel expenses.

FOR TAXPAYERS CLAIMING HEAD OF HOUSEHOLD FILING STATUS: It is important to complete both the dependent questions and the Household Expense worksheet on page 3. If you are divorced or legally seperated please remember to include a copy of the divorce decree and/or seperation agreement. [NOTE: If the divorce is NOT final or you and your spouse lived together AT ANY TIME in the last 6 months of the tax year, you CANNOT claim Head of Household filing status]

IF you have any questions about the questionaire please do not hesitate to contact our office. We will be glad to assist you.

** SKIP WHAT DOES NOT APPLY

DUE DILIGENCE QUESTIONAIRE

To be Completed by All Taxpayers with Dependents:

25 Questions

Tax Payer 1 Name

Tax Payer 2 Name

Are you married?

YES

Have you ever been disallowed the EITC/AOTC/CTC? If so, when

Select Yes or No

If Yes, note when here.

Did you live in the United States and where?

If you are a single parent, where’s the other parent(s) of your child/children?

What is the name of the other parent(s)?

Why is the other parent of the child/children not claiming the child?

Explain why the dependent(s) have different last names than the taxpayer?

If you are separated/divorced, when did you last live in the same home?

Do you have joint custody of your child?

YES

How long did the child live in your home during this tax year?

How long did your child/children live in the other parent’s home during this tax year?

How much income did the other parent have during this tax year?

Do you have a signed Form 8332?

Did anyone else live in the home that provides financial support for your child/dependent?

If yes, who lives there and how much do they pay?

Not Your Biological Child:

8 Questions

If this is not your biological child, what is your relationship to the dependent?

Did the dependent live in your home for more than 6 months?

Do you have custody?

If so, through what court/agency?

Who are the biological parents?

Where do the biological parents live?

What were the circumstances leading to the dependent(s) being placed in your home?

Do you receive any financial aid for this child such as WIC, Medicaid, SNAP, listed on your health insurance policy, etc?

If yes, which ones?

Are you listed as the guardian for this dependent(s) on school records, medical records, daycare records, or place of worship records?

YES

College Credits

7 Questions

Which college did the student attend?

Did student attend at least half time?

Degree Seeking?

Did this student receive a tuition statement from the school?

Did this student work while attending school?

Amount Paid for r Books/Materials?

If so, how much did they earn?

How many tax years have you claimed the AOTC?

Any Drug Related Felonies?

YES

PLEASE UPLOAD BURSAR STATEMENT OF ACCOUNT HISTORY AND COPY OF 1098T FORM FROM THE COLLEGE.

Disabled At Any Age

9 Questions

If your dependent is over the age of 18 and Disabled, what is the nature of the disability?

Has this dependent been declared disabled by a physician?

Has this dependent been declared disabled by a physician? (2)

If so, can you provide documentation?

Does dependent receive social security/disability benefits?

Does dependent receive social security/disability benefits? (2)

If so, can you provide documentation?

Are you listed as the Social Security Representative Payee for this dependent?

YES

Is this the dependent(s) expected to recover in the next year?

YES

If this is not your biological child, why is this child living with you and not another family member?

Where are the biological parents of your disabled dependent(s)?

Who cares for the disabled dependent while the taxpayer works?

YES NO

YES

Filing Status

17 Questions

What is your filing status?

Married Filing Joint

Single

Married Filing Separate

Head of Household

Others that lived in your home that is not reported on this tax return?

Please also include their income.

Is this person biologically related to your dependent(s)?

If yes, to what relationship

Please note why the above named relative is not claiming the child on the above named relative’s tax return.

Please note Head of Household can ONLY be claimed by taxpayers with a Qualified Dependent AND who are:

Single and paying more than ½ cost of keeping up a home (complete worksheet below), OR

Married but did not live with your spouse AT ANY TIME in the last 6 months of the year OR

Divorced or LEGALLY seperated (Attach copy of Decree or Separation Agreement)

Monthly Income

Wages, Child Support, Other Income | Do not count money received under public assistance/welfare/foodstamps in the amount you paid. But include costs paid with public assistance in the total cost.

Monthly Income

Total Property Taxes

Total Rent

Mortgage interest expense

Utility Charges

Upkeep and Repairs

Property Insurance

Food Consumed on the premises

Other Household expenses

Here were your total expenses

Tax Payer Signature

Clear

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