Taxpayer Questionnaire Form – Fill Out and Use This PDF

Taxpayer Questionnaire Form – Fill Out and Use This PDF

Taxpayer Questionnaire Form PDF Details

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Taxpayer Questionnaire Form PDF Details

As a taxpayer, it's important to be familiar with the tax system and know how to properly fill out forms and submit them in a timely manner. To help taxpayers manage their taxes efficiently and accurately, the IRS has created various forms for different purposes such as deductions or refunds. One of those key documents is the Taxpayer Questionnaire Form which is designed to provide an overview of your financial records by collecting pertinent information from you regarding income, investments, liabilities, and other related data. It’s imperative that this form be filled out thoroughly so the tax agency can determine the correct amount due for each individual filing situation. As you prepare for tax season later this year we will review how to complete this valuable piece of paperwork and maximize its effectiveness in helping you save money on your taxes

Question	Answer
Form Name	Taxpayer Questionnaire Form
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	tax return questionnaire 2021, tax preparer client questionnaire template, tax questionnaire, tax preparer client questionnaire

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Taxpayer Questionnaire

PERSONAL INFORMATION

Primary Taxpayer

First Name:	Last Name:				M.I.:

S.S.N. :	Birthdate:			Taxpayer's PIN:

Home Phone:	Work Phone:			Cell Phone:

Occupation:	Dependant on	Yes	No	Legally Blind?	Disabled?
	another return?	Yes	No
	another return?

Email Address:		Text Message	Yes No	Cell Phone Carrier

Filing Status (Circle which Status number applies)

1 = Single	If: You were NOT married on or before December 31, 2011
	Your dependents lived with you less than 6 months during the year.
2 = Married Filing Joint	If: You were married as of December 31, 2011 or your spouse died during 2011.
3 = Married Filing Separate	If: You were married on or before December 31, 2011 and your spouse is
	filing a tax return using this filing status.
	* If MFS, did you live together at ANY time during the tax year?					Yes	No
	If yes, did you live together during the final 6 months?					Yes	No
	* If MFS, did your spouse itemize his/her deductions?					Yes	No
	NOTE: If spouse itemized deductions, taxpayer must also Itemize deductions.
4 = Head of Household	If: You were NOT married as of December 31, 2011
	Your child, foster child, or grandchild lived with your more than 6 months.
5 = Qualified Widow(er)	If: Your spouse died during either 2009 or 2010, and
	Your child, stepchild or foster child lived with you for 12 months in 2011.

	Spouse
First Name:	Last Name:					M.I.:

S.S.N. :	Birthdate:			Spouse's PIN:

Home Phone:	Work Phone:			Cell Phone:

Occupation:	Dependant on	Yes	No	Legally Blind?		Disabled?
	another return?	Yes	No
	another return?

	Address
Care-of (oradditional) Address Information

Street Address:						Apt. #:

City:		State:		Zip Code:

Military Address Info:(1=APO/FPO, 2=Stateside, 3=Foreign or Blank)		Combat Zone:

	Bank Information
(for Direct Deposit intoTaxpayers Personal Acct.)
Bank Name:		Account Type:	Savings		Checking
		Account Type:	Savings		Checking

Routing Number:		Account Number:

Will this refund go to an account outside of the US?		Yes	No

Page 1

Dependents

First Name

Last Name

Birthdate

SSN

Relationship

#of

Months

Dep.

Code

EIC

Children who lived with you and are being claimed on another return

Enter the dependents name, birthdate, SSN, Relationship, number of months lived with the taxpayer, starting with the youngest dependent. Refer to the information below for Dep. and EIC Codes.

Dependent Codes		EIC Codes
1	= Lived with Taxpayer	E = Eligible as of December 31, 2011, under the age of 19
2	= Lived Elsewhere	S = Student as of December 31, 2011, under the age of 24 and full-time student
3	= Taxpayer's parent	D = Disabled as of December 31, 2011, Permanently & totally disabled, at any age
4	= Other Dependent	K = Qualifing Child was Kidnapped
		N = Not eligible
		Child Tax and Earned Income Credit
		Number of Children under age 17 (CTC)
		Number of Children under age 19 (EIC)
		Number of Children under age 19 (EIC)
This Information is included in the		Number of Children between age 17 & 24, full time student (EIC)
This Information is included in the
	Dependents Table above
		Number of Children Totally Disabled (EIC)

		Include Form 8862 - Information to Claim EIC After Disallowance?	Yes	No

Total Amount Paid:		CHILD CARE CREDIT	Number Cared for:
		CHILD CARE CREDIT

A.	If married, did both, Taxpayer and Spouse work during the time of dependent care?		Yes	No
B.	If no to A, was Taxpayer or Spouse disabled or a full-time student for more than 5 months?		____ No
B.			____ Yes, Disabled
			____ Yes, Disabled

If no to A and B, this return is not eligible for dependent care credit	____ Yes, Student

Care Provider #1 Information

Name

Address

___SSN or

___EIN

Amount Paid

Care Provider #2 Information

Name			___SSN	or
			___EIN

Address					Amount Paid
					$

	DEPENDENT CARE EXPENSES
		List dependents cared for
First Name	Last Name	SSN			Expenses

Page 2

WAGES and SALARIES

(Use Actual Form W-2 for Data Entry)

Taxpayer	Employer's Name	Wages	Federal Withholding	St Withholding





Spouse	Employer's Name	Wages	Federal Withholding	St Withholding
		Wages	Federal Withholding	St Withholding

INTEREST AND DIVIDEND INCOME

(Use Actual Forms 1098, 1099B, 1099-INT, 1099-DIV for Data Entry)

Payer's Name	Interest	Dividends	Withholding
Payer's Name	Earned	Dividends	Withholding
	Earned

OTHER INCOME

Unemployment Income (Other Income wkst, Line 19)

Social Security, from Form 1099SSA (Other Income wkst, Line 20b)

Other Income:

Scholarship income not included onForm W-2

Prior Year's State and Local Income Tax Refund

Alimony Received

Gambling Income

Other Income Subject to Self-employment Tax

Schedule C - Business Income/(Loss)

IRA OR Pension Distribution from 1099R

Railroad Retirement from Form 1099RRB

		ADJUSTMENTS
	Student Loan Interest Deduction

	IRA Contributions (Limit of $5,000 per taxpayer, if over 50 limit is $6,000)

	Tuition and Fees Deduction

	Alimony Paid
	Recipient's SSN	Recipient's Name

CREDITS

Education Credits

American Opportunity Credit

Life Time Learning qualified expenses

First Time Home Buyer Credit

Other Federal Tax Payments

Page 3

ITEMIZED EXPENSES			Sch-A
Medical and Dental Expenses			Miles
Number of Miles driven to Doctor / Dental Visits during the year		(line 1)

Medical / Dental Expense Description			Amount

Medical / Dental Expense Description			Amount

Taxes Paid			Amount
State Taxes Paid on last year's state return		(line 5, wkst)

Real Estate Property Taxes Paid		(line 6)

Personal Property Taxes Paid (i.e. vehicle registration)		(line 7)

Other Taxes Paid (i.e. Non-resident State Taxes Paid)		(line 8)

Interest Paid			Amount
Home Mortgage Interest, from Form 1098		(line 10)

Points Paid (Principle Purchase of Residence OR Qualified Refinance)	(See Form Instructions)

Gifts to Charity			Miles
Number of Miles driven for Volunteer Work with Charitable Organization		(line 16)

Charitable Cash or Check Contributions			Amount
Description		(line 16)

Description

Description

Description

Non-Cash Charitable Contributions (if more than $500 must attach Form 8283)			Amount
Description		(line 17)

Description

Description

Job Expenses and Other Miscellaneous Expenses			Amount
Un-reimbursed employee expenses (i.e. union dues, uniforms, tools specific to work)		(line 21)
Prep Note: all other Un-reimbursed employee expenses must be filed on Form 2106
Tax Preparation Fees		(line 22)

Other Expenses (safe deposit box, attorney fees for production of income, etc.)
Description		(line 23)

Description

Other Miscellaneous Deductions			Amount
Other Miscellaneous Expenses (I.e. gambling losses-no more than reported winnings)		(line 28)

Other Expenses			Amount
Description		(line 28)

Description

Description

Page 4

EARNED INCOME CREDIT

Part I: Qualifications

Could you, or your spouse if filing jointly, be considered a "Qualifying Child" on another persons tax return during tax year 2011?

Yes

NOTE: If you answered "Yes" , you are not able to qualify for the earned income credit (skip Part II and Part III).

Part II: Qualifying Children			Child 1		Child 2
Is the Child:		(line 9)		Name		Name
Is the Child:		(line 9)
The Taxpayer's Son, Daughter, or adopted child	OR
The Taxpayer's Son, Daughter, or adopted child	OR
A child of the Taxpayer's son, daughter or adopted child OR
The Taxpayer's stepchild OR			Yes	No	Yes	No
The Taxpayer's stepchild OR
The Taxpayer's eligible foster child?

If the child is married, are you claiming this child as a dependent?			Yes	No	Yes	No
			Yes	No	Yes	No
(If child is not married, then simply mark yes)		(line 10)

Did the child live with you in the United States for over half of the year,		OR		No	Yes	No
			Yes	No	Yes	No
The full year if the child is an eligible foster child?	(line 11)

Was the child, at the end of the year:		(line 12)
Under age 19 OR			Yes	No	Yes	No
			Yes	No	Yes	No
Under age 24 and a full-time student OR
Any age and permanently and totally disabled?

Could any other person check "Yes" on lines 9 through 12 for the child?			Yes	No	Yes	No
			Yes	No	Yes	No

Prep Note: If yes, questions on line 13bb. through 13c must also be answered.(line 13a)

•If you checked "No" on any of the first four questions above, then:

The child is not the taxpayer's qualifying child. If the taxpayer does not have a qualifying child, go to "Part III" to see if the taxpayer can clain the EIC for people who do not have qualifying children

Part III: Earned Income Credit for Taxpayers without a Qualifying Child

	Was your main home, and your spouse if filing jointly, in the United States for more than half the year?								Yes	No
	(Military personnel on extended active duty outside the U.S. are considered to be living in the U.S. during that period.)								Yes	No

			NOTE: If you answered "No" , you are not able to qualify for the earned income credit (skip Part II and Part III).

					Form 8879 Information

( 1 )			= Check mailed from IRS	( 4 )	= Balance Due			Tax Payer's PIN	Spouse's PIN
(	2	)	= Direct Deposit to TP's Acct.	( 5 )	= RAC (14 Days) *
(	3	)	= RAL (2 Days) *
	* Please complete Pg. 6 - FINANCIAL PRODUCTS if selected.

Was the return prepared by the Taxpayer (self-prepared)?						Yes	No
Was the return prepared by an external Paid-Preparer?						Yes	No

TAXPAYER QUESTIONNAIRE REVIEW

The above information is true and correct, and I / we understand that the information given on this questionnaire will be used to complete my

/our 2011 tax return(s). I / We agree to hold this company harmless for any errors that they may make on my / our tax return. I / We also understand that error on my / our return will cause a delay in the processing of the return and the receipt of the refund, if any.

Customer Signature:		Date:
Spouse Signature:		Date:

Page 5

FINANCIAL PRODUCTS

Complete the following if refund type is a RAL or RAC

Identification Information: Bank Products require at least 1 of the following forms of ID
Drivers License	DMV/BMV State ID	Military ID	US Passport/Resident Alien ID
Matricular Consular
Taxpayer	ID NUMBER___________________ STATE___________________ EXP. DATE___________________
Spouse	ID NUMBER___________________ STATE___________________ EXP. DATE___________________

RAL Application Information:

If filing a joint return, who is borrower? T = Taxpayer Only; S = Spouse Only; B = Both Taxpayer & Spouse

RAL Application Military Personnel Questions:

Is the taxpayer a regular or reserve member of the Army, Navy, Marine Corps, Air Force or Coast Guard, serving on active

duty under a call or order that does not specify a period of 30 days or fewer?Yes

I am a dependent of a member of the Armed Forces on active duty as described above, because I am the member's spouse, the member's child under the age of eighteen years old or I am an individual for whom the member provided more than

one-half of my financial support for 180 days immediately preceding today's date.

Yes

With the IRS removing the Debit Indicator (DI), there is a chance that a RAL can be declined.

Some reasons for not getting a RAL are:

1.IRS says you owe back taxes

2.IRS says you have a current garnishment

3.Your tax return meets a certain profile that the bank finds unfavorable

4.IRS is auditing your Earned Income Credit

5.Earned Income Tax Credit (EITC) is claimed and an EITC qualifying child is a foster child

6.Dependent different from last year's return

7.Primary taxpayer is less than 18 years old

8.Refund amount minus EITC is less than $0

9.Refund amount is greater than $9999.99

10.You have an outstanding debt with any bank that provides RALs

PLEASE NOTE - WE DO NOT HAVE ANY CONTROL OVER THE ABOVE REASONS!

Taxpayer Initial _______________

Spouse Initial _______________

I understand that all information I have provided on this form is true. If any of this information is incorrect, I understand that a formal letter will be sent by the bank if I am denied for a RAL

In addtion, I understand that my refund may be provided to me in more than 1 check.

Make copies of form of ID and Social Security cards

Interview sheet filled out

One copy of tax return, W-2s and/or 1099 (Taxpayer & Spouse, if applicable)

Signature on 8879/Pin # and Bank application

Page 6

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As for the fields of this precise form, here is what you should consider:

1. Before anything else, once filling out the taxpayer questionnaire taxes, beging with the part that features the following blanks:

Stage # 1 for submitting taxpayer questionnaire forms form

2. Right after filling in this step, go to the subsequent step and enter the essential details in all these blanks - First Name, SSN, Home Phone, Occupation, Spouse, Last Name, Birthdate, Work Phone, Dependant on another return, Address, Spouses PIN, Cell Phone, Yes No, Legally Blind, and Disabled.

Step # 2 in submitting taxpayer questionnaire forms form

A lot of people generally get some points incorrect while filling in Occupation in this area. Don't forget to re-examine everything you type in here.

3. This next step is going to be hassle-free - complete all of the blanks in First Name, Last Name, Birthdate, SSN, Relationship, Months, Dep Code, EIC, Children who lived with you and, Enter the dependents name, E Eligible as of December under, EIC Codes, Child Tax and Earned Income Credit, Number of Children under age CTC, and Number of Children under age EIC to finish this process.

EIC Codes, Birthdate, and First Name of taxpayer questionnaire forms form

4. This next section requires some additional information. Ensure you complete all the necessary fields - Total Amount Paid, Number of Children Totally, Include Form Information to, A If married did both Taxpayer and, B If no to A was Taxpayer or, If no to A and B this return is, Care Provider Information, Yes No, Number Cared for, Yes No, No Yes Disabled Yes Student, Name, Address, Name, and Address - to proceed further in your process!

taxpayer questionnaire forms form conclusion process outlined (stage 4)

5. To finish your form, this particular part involves several additional blank fields. Filling in Page should conclude the process and you'll be done very fast!

A way to fill out taxpayer questionnaire forms form step 5

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Taxpayer Signature:

Spouse Signature:

FOR OFFICE USE ONLY

Process Checklist (to be included in customer file)