Preparer Resource

Client Due Diligence Intake Questionnaire

A structured intake form to support accurate due diligence documentation before and during the client interview.

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Important Notice: This questionnaire is provided as a general reference tool for tax preparers. It is not intended to constitute, and should not be relied upon as, tax, legal, or financial advice. You are solely responsible for confirming all client-provided information, applying all applicable laws and regulations, and exercising independent professional judgment on every return. Use of this form does not guarantee compliance with IRS due diligence requirements. Consult applicable regulations, including IRC Section 6695(g) and Treasury Regulation 1.6695-2, to ensure your practices meet current standards.

Session Information

Tax Year

Preparer Name / Office ID

Date of Interview

Taxpayer Identity & Contact Information

Taxpayer Full Legal Name

SSN / ITIN

Date of Birth

Primary Phone

Email Address

Physical Address

City / State / ZIP

Years at This Address

Residency & Living Situation

U.S. resident all year Lived part-year More than one household this year

Household Members

List everyone who lived in the home during the year.

Full Name	SSN / ITIN	DOB	Relationship	Months w/ Taxpayer	Student?	Disabled?	Provided >50% Support?

Explain your living situation for the year

Income Verification & Work Activity

Employment Income (W-2) Employer Names

W-2s Received? Yes No

Self-Employment / Gig Work Nature of Business How is income tracked? Other Income Sources Describe how you earned income this year

Dependents & Relationship Tests

Dependent lived with me more than half the year No one else provided more than half of their support I am eligible to claim this dependent Custody documentation available (if applicable)

Documentation Reviewed

Birth certificate School / medical records Lease or mortgage listing dependent Court or custody orders Other

Earned Income Tax Credit (EITC)

Did anyone else provide financial support? Yes No

Does another parent or person live in the home? Yes No

If someone else could claim the dependent, explain

Child Tax Credit / ODC

Dependent is a U.S. citizen or resident Dependent has valid SSN / ITIN Dependent lived with taxpayer more than 6 months Support and relationship tests met

Head of Household Filing Status

Legally married this year? Yes No

Spouse live with you after June 30? Yes No

Paid more than half the cost of home? Yes No

Home Costs (Amount You Paid)

Rent / Mortgage
Utilities
Food
Insurance
Repairs
Property Taxes
Other
Total

American Opportunity Tax Credit (AOTC)

Institution	Enrolled at Least Half-Time?	Pursuing Degree?	First 4 Years?	1098-T Received?

Red Flag & Accuracy Declaration

I affirm my answers are truthful and complete to the best of my knowledge. I understand that providing false information is illegal and may result in penalties. I have provided documentation where applicable.

Taxpayer Signatures

Taxpayer Signature

Date

Spouse Signature

Date

Preparer Notes Internal

Documents reviewed & inquiries made Eligibility determination & notes Preparer Signature

Preparer Name / PTIN

Preparer Signature

Date

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