Your Name *

First Name

Last Name

Phone *

(###)

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1. Did your marital status change during the year? *

Yes

No

N/A

2. Did you live separately from your spouse during the last six months of the year? *

Yes

No

N/A

3. Do you have a separate decree, instrument, or agreement and are not living in the same household by the end of the year? *

Yes

No

N/A

4. Did your address change from last year? *

Yes

No

N/A

If yes, please provide your new address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

5. Can you be claimed as a dependent by another taxpayer? *

Yes

No

N/A

6. Did you change any bank accounts, or did routing transit numbers (RTN) and/or bank account number change for existing bank accounts that have been used to direct deposit (or direct debit) funds from (or to) the IRS or other taxing authority during the tax year?

Yes

No

N/A

7. Do you, your spouse (if applicable), and any dependents have a taxpayer identification number (SSN, ITIN, or ATIN)? *

Yes

No

N/A

8. Did you receive an Identity Protection PIN (IP PIN) from the IRS or have you been a victim of identity theft? If yes, attach the IRS letter. *

Yes

No

N/A

9. Did you reside in or operate a business in a Federally declared disaster area? The Federally declared disaster areas include victims of hurricanes, tropical storms, floods, as well as wildfires. *

Yes

No

N/A

10. Did you receive an Economic Impact Payment (EIP3) as reported on Notice 1444-C? *

Yes

No

N/A

11. Did you receive an adjustment to your refund or balance due for the exclusion of unemployment compensation and/or Advance Premium Tax Credit as a result of the American Rescue Plan Act (ARPA)? *

Yes

No

N/A

12. Did you receive advanced Child Tax Credit (CTC) payments in July, August, September, October, November, and December? *

Yes

No

N/A

13. Did you receive a Paycheck Protection Program (PPP) loan? *

Yes

No

N/A

If yes, did you apply for Paycheck Protection Program (PPP) loan forgiveness?

Yes

No

14. Are you a telecommuting employee that was required to "shelter in place" due to local COVID-19 protocols while working in a state that was not your home state? *

Yes

No

N/A

15. Did you receive emergency leave sick pay? *

Yes

No

N/A

16. Did you receive emergency family leave wages? *

Yes

No

N/A

17. Did you receive any special unemployment benefits or compensation under the Coronavirus Relief Act during the year? *

Yes

No

N/A

18. If you are self-employed, were you unable to perform your self-employed activities due to coronavirus related care you needed? *

Yes

No

N/A

19. If you are self-employed, were you unable to perform your self-employed activities due to coronavirus related care you provided to your son or daughter under the age of 18? *

Yes

No

N/A

20. If you are self-employed, were you unable to perform your self-employed activities due to coronavirus related care you provided to another? *

Yes

No

N/A

21. Were there any changes in dependents from the prior year? *

Yes

No

N/A

22. Do you have any children under age 19 or a full-time student under age 24 with unearned income in excess of $2,200? *

Yes

No

N/A

23. Do you have dependents who must file a tax return? *

Yes

No

N/A

24. Did you provide over half the support for any other person(s) other than your dependent children during the year? *

Yes

No

N/A

25. Did you pay for child care while you worked, looked for work, or while a full-time student? *

Yes

No

N/A

26. Is there any other person(s) who lived with you more than half the year but not claimed by you last year? *

Yes

No

N/A

27. Did you pay any expenses related to the adoption of a child during the year? *

Yes

No

N/A

28. If you are divorced or separated with child(ren), do you have a divorce decree or other form of separation agreement which establishes custodial responsibilities? *

Yes

No

N/A

29. Did any dependents receive an Identity Protection PIN (IP PIN) from the IRS or have they been a victim of identity theft? If yes, attach the IRS letter. *

Yes

No

N/A

30. Did you start a new business or purchase rental property during the year? *

Yes

No

N/A

31. Did you sell, exchange, or purchase any assets used in your trade or business? *

Yes

No

N/A

32. Did you acquire a new or additional interest in a partnership or S corporation? *

Yes

No

N/A

33. Did you sell, exchange, or purchase any real estate during the year? *

Yes

No

N/A

34. Did you purchase or sell a principal residence during the year? *

Yes

No

N/A

35. Did you foreclose or abandon a principal residence or real property during the year? *

Yes

No

N/A

36. Did you acquire or dispose of any stock during the year? *

Yes

No

N/A

37. Did you take out a home equity loan this year? *

Yes

No

N/A

38. Did you refinance a principal residence or second home this year? *

Yes

No

N/A

39. Did you sell an existing business, rental, or other property this year? *

Yes

No

N/A

40. Did you lend money with the understanding of repayment and this year it became totally uncollectable? *

Yes

No

N/A

41. Did you have any debts canceled or forgiven this year, such as a home mortgage or student loan(s)? *

Yes

No

N/A

42. Did you purchase a qualified plug-in electric drive vehicle or qualified fuel cell vehicle this year? *

Yes

No

N/A

43. Did you have any foreign income or pay any foreign taxes during the year, directly or indirectly, such as from investment accounts, partnerships or a foreign employer? *

Yes

No

N/A

44. Did you receive any income from property sold prior to this year? *

Yes

No

N/A

45. Did you receive any unemployment benefits during the year? *

Yes

No

N/A

46. Did you receive any disability income during the year? *

Yes

No

N/A

47. Did you receive any Medicaid waiver payments as difficulty of care during the year? *

Yes

No

N/A

48. Did you receive tip income not reported to your employer this year? *

Yes

No

N/A

49. Did any of your life insurance policies mature, or did you surrender any policies? *

Yes

No

N/A

50. Did you receive any awards, prizes, hobby income, gambling or lottery winnings? *

Yes

No

N/A

51. Did you receive any income considered to be non-employee compensation? *

Yes

No

N/A

52. Do you expect a large fluctuation in income, deductions, or withholding next year? *

Yes

No

N/A

53. Did you have any sales or other exchanges of virtual currencies (including from an airdrop or a hard fork) or used virtual currencies (Bitcoin, etc.) to pay for goods or services? *

Yes

No

N/A

54. Are you an active participant in a pension or retirement plan? *

Yes

No

N/A

55. Did you receive any Social Security benefits during the year? *

Yes

No

N/A

56. Did you make any withdrawals from an IRA, Roth, myRA, Keogh, SIMPLE, SEP, 401(k), or other qualified retirement plan? *

Yes

No

N/A

If yes, were any withdrawals due to a Federally declared disaster or COVID-19?

Yes

No

57. If you received any qualified disaster retirement plan distributions, did you repay any of the distributions in 2020? *

Yes

No

N/A

58. Did you receive any lump-sum payments from a pension, profit sharing or 401(k) plan? *

Yes

No

N/A

59. Did you make any contributions to an IRA, Roth, myRA, Keogh, SIMPLE, SEP, 401(k), or other qualified retirement plan? *

Yes

No

N/A

60. Did you, your spouse, or your dependents attend a post-secondary school during the year, or plan to attend one in the coming year? *

Yes

No

N/A

61. Did you have any educational expenses during the year on behalf of yourself, your spouse, or a dependent? If yes, send your tax preparer Form(s) 1098-T and receipts for qualified tuition and related expenses. *

Yes

No

N/A

62. Did anyone in your family receive a scholarship of any kind during the year? *

Yes

No

N/A

63. Did you make any withdrawals from an education savings or 529 Plan account? *

Yes

No

64. Did you make any contributions to an education savings or 529 Plan account? *

Yes

No

N/A

65. Did you pay any student loan interest this year? *

Yes

No

N/A

66. Did you cash any Series EE or I U.S. Savings bonds issued after 1989? *

Yes

No

N/A

67. Would you like a worksheet to aid in the completion of a Free Application for Federal Student Aid (FAFSA) with the U.S. Department of Education? *

Yes

No

N/A

68. Did you have qualifying health care coverage, such as employer-sponsored coverage or government-sponsored coverage (i.e. Medicare/Medicaid) for your family? Your family for health care coverage refers to you, your spouse if filing jointly, and anyone you can claim as a dependent. If yes, attach any Form(s) 1095-B and/or 1095-C you received. *

Yes

No

N/A

69. Did you enroll for lower cost Marketplace Coverage through healthcare.gov under the Affordable Care Act? *

Yes

No

N/A

70. Did you enroll for lower cost Marketplace Coverage through healthcare.gov under the Affordable Care Act and share a policy with anyone who is not included in your family? *

Yes

No

N/A

71. Did you make any contributions to a Health savings account (HSA) or Archer MSA? *

Yes

No

N/A

72. Did you receive any distributions from a Health savings account (HSA), Archer MSA, or Medicare Advantage MSA this year? *

Yes

No

N/A

73. Did you pay long-term care premiums for yourself or your family? *

Yes

No

N/A

74. Did you make any contributions to an ABLE (Achieving a Better Life Experience) account? If yes, attach any Form(s) 5498-QA you received. *

Yes

No

N/A

75. Did you receive any withdrawals from an ABLE (Achieving a Better Life Experience) account? If yes, attach any Form(s) 1099-QA you received. *

Yes

No

N/A

76. If you are a business owner, did you pay health insurance premiums for your employees this year? *

Yes

No

N/A

77. Did you receive any Health Coverage Tax Credit (HCTC) advance payments? If yes, attach any Form(s) 1099-H you received. *

Yes

No

N/A

78. Did you incur a casualty or theft loss or any condemnation awards during the year? *

Yes

No

N/A

If yes, did the loss occur in a Federally declared disaster area?

Yes

No

79. Did you pay out-of-pocket medical expenses (Co-pays, prescription drugs, etc.)? *

Yes

No

N/A

80. Did you make any cash or noncash charitable contributions (clothes, furniture, etc.)? If yes, please provide evidence such as a receipt from the donee organization, a canceled check, or record of payment, to substantiate all contributions made. *

Yes

No

N/A

81. Did you donate a vehicle or boat during the year? If yes, attach Form 1098-C or other written acknowledgment from the donee organization. *

Yes

No

N/A

82. Did you pay real estate taxes for your primary home and/or second home? *

Yes

No

N/A

83. Did you pay any mortgage interest on an existing home loan? If yes, attach any Form(s) 1098 you received. *

Yes

No

N/A

84. Did you incur interest expenses associated with any investment accounts you held? *

Yes

No

N/A

85. Did you make any major purchases during the year (cars, boats, etc.)? *

Yes

No

N/A

86. Did you make any out-of-state purchases (by telephone, internet, mail, or in person) for which the seller did not collect state sales or use tax? *

Yes

No

N/A

87. Did you make gifts of more than $15,000 to any individual? *

Yes

No

N/A

88. Did you utilize an area of your home for business purposes? *

Yes

No

N/A

89. Did you engage in any bartering transactions? *

Yes

No

N/A

90. Did you retire or change jobs this year? *

Yes

No

N/A

91. Did you incur moving costs because of a permanent change of station as a member of the Armed Forces on active duty? *

Yes

No

N/A

92. Did you pay any individual as a household employee during the year? *

Yes

No

N/A

93. Did you make energy efficient improvements to your main home this year? *

Yes

No

N/A

94. Did you receive a distribution from, or were you a grantor or transferor for a foreign trust? *

Yes

No

N/A

95. Did you have a financial interest in or signature authority over a financial account such as a bank account, securities account, or brokerage account, located in a foreign country? *

Yes

No

N/A

96. Do you have any foreign financial accounts, foreign financial assets, or hold interest in a foreign entity? *

Yes

No

N/A

97. Did you receive correspondence from the State or the IRS? *

Yes

No

N/A

98. Do you have previous years of tax returns that are either unfiled or filed with unpaid balances due? *

Yes

No

N/A

99. Do you want to designate $3 to the Presidential Election Campaign Fund? If you check yes, it will not change your tax or reduce your refund. *

Yes

No