Client Intake Form Part 2

First name

Last name

Refund Selection

Account Number

Routing #

How would you like your refund?

Paper Check Printed in Office

Prepaid Debit Card

Direct Deposit

Earned Income Credit

Areas of Emphasis

Around 60% of all mistakes in EITC are the results of 3 main areas:

1. The child might not meet the age, residency, or relationship requirement.

2. The case might be that someone is filing as single or HOH when he/she is actually married.

3. A mistake might arise when reporting income or expenses. Special attention has to be paid when the client is answering these questions.

The people who are eligible for EITC:

1. Have earned income

2. Have a valid Social Security Number

3. Are filing separately and not as married

4. Are not a nonresident alien

5. Are not a qualifying child of another person

6. Are not filing Form 2555 or Form 2555-EZ

7. Have limited investment income

Due Diligence Questionnaire

If you will be claiming an Earned Income Credit, Child Tax Credit, Additional Child Tax Credit, HOH, and/ or an American Opportunity Credit on your 2023 tax return, you must complete this questionnaire.

The United States Congress has, as a reaction to the substantial tax fraud resulting from their original error of choosing to distribute federal social welfare program benefits via the tax return, placed new excessive inappropriate "due diligence" requirements on paid tax return preparers whose clients are claiming certain tax credits. This added to the excessive and inappropriate requirements previously implemented by the Internal Revenue Service, the IRS has forced tax preparers to question and verify that their clients qualify to receive certain credits i.e. EIC, CTC, ACTC, and now HOH.

I am the custodial parent for the dependent(s) for whom the tax credit(s) will be requested, and I released the dependency deduction to my former spouse for 2023 by signing Form 8332( release / Revocation of claim to exemption for Child by Custodial Paren

Yes

No

I certify that the child(ren) for whom the tax credit(s) will be requested can be claimed as my dependent(s), as per the information provided at the end of this questionnaire.

Yes

No

I or my child(ren) , have documentation to substantiate the credit(s) being claimed, such as form 1098-T , bills, statements, and receipts for college tuition, fees, books, and material cost (you are responsible for keeping this documentation and providin

Yes

No

The child(ren) for whom the tax credit(s) will be requested has lived with me for the entire year of 2023

Yes

No

Was a child Tax Credit, Additional Child Tax Credit, or American Opportunity Credit claimed by you disallowed or reduced by the IRS on a past tax return?

Yes

No

I am unmarried or separated, support a qualifying person as your dependent, and pay more than half the cost of maintaining your household.

Yes

No

Attestation and Disclaimer

I AGREE, The information contained in this office or on this website is of a general nature. It should not be construed as legal advice nor should it be acted upon in your specific situation without further details and/or professional assistance. Any use of information contained in this office or on our website is done so at the risk of the user, and Jackson & Co Financial. is not responsible for the result or outcome of its use. Jackson & Co Financial does not guarantee and is not liable for the truthfulness, accuracy, effectiveness, or any resulting effects of the use of any information contained in this office or on the website. It is advised and it is the responsibility of the visitor of this office or website to seek proper instruction and/or seek professional assistance in all matters regarding taxes and the IRS. Jackson & Co Financial. is thus held harmless, the release of, and users of information contained in this office or on this website assume full responsibility for, any violation of Tax laws and/or IRS procedure, and any other legal liability resulting from the use of any information contained in this office or on this web site. I attest that all information contained in this income tax return was obtained from the taxpayer or spouse and is true and correct to the best of his/her knowledge. *

Yes

I, "Tax Client", give and express full written and verbal permission over to "Tax Company's Name" and it's employees/agents/representatives to contact the American Offset Debt Line/Treasury Offset Program on behalf of myself to determine if I have any non-tax debt that could potentially offset my current tax return. The Offset Debt Line contact number is 1-800-304-3107. *

Yes

I agree by signing my name that I have answered the above due diligence questionnaire to the best of my knowledge. Jackson & Co Financial is not responsible if the taxpayer provides us with incorrect information(i.e. social security numbers, names, or date of births)and I understand this will delay my refund. Jackson & Co Financial is not responsible for IRS Tax Audits and all information obtained must presentable if the IRS audits your tax return. You must pay for $75 Audit assistance separately if you need to utilize this service. Jackson & Co Financial provides each customer with one complimentary copy of their return . Should you need additional copies , there is a $15 fee per copy. We are not responsible for any changes by the IRS or Bank on disbursement dates, filing status, or any other required information from the IRS. We Do Not Reimburse any bank fees in the event of delays out of our control.

Signature

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