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Due Diligence Questionnaire for returns with Earned Income Tax Credit, Child Tax Credit, Other Dependent Credit or Head of Household filing status

  1. Client name

  2. Child or Adult Dependent’s Name(s):


  3. What is your relationship to the individual(s)?


  4. Where and with whom is the child’s or adult dependent’s main home?


  5. How long, if at all, did the child live with you last year (number of months)?


  6. Did the child live or spend a significant number of overnights with anyone else during the year? Yes No

    If yes, please list, the name, address and approximate number of nights spent with that individual and the dependent’s relationship to that individual


  7. If the child(ren) is/are not your biological child(ren), are/were you ever married to the child(ren)’s mother/father? Yes No

  8. If the child(ren) is/are adopted, is the adoption pending final? If pending, do you have a letter from an authorized adoption agency or social services organization? Yes No


  9. If the child(ren) is/are foster child, do you have a letter from the authorized foster care or social services agency or applicable court document? Yes No


  10. Is/are the child(ren) a citizen(s) or national(s) of the United States? Yes No

    If not, is the child or adult dependent a lawful, permanent resident (green card holder)? Yes No Please list the names of any child or adult dependent who is not a US citizen and their green card status:

  11. If requested by the IRS, can you provide a birth and/or marriage certificate that verifies your relationship to each child or adult dependent? Yes No


  12. What was each child or adult dependent’s marital status on December 31?


  13. Will or did any of the claimed children or adult dependents file a joint return for this year? Yes No If so, please list names


  14. Are you, and your spouse if married, a citizen of the United States? Yes No


  15. Did the child or adult dependent receive any income last year, including but not limited to scholarships or grants, student loans, wages, child support, alimony, public assistance, Social Security or disability benefits? Yes No If yes, please provide details

  16. Did any other person provide more than 1/2 of your or your spouse’s support last year? Yes No


  17. List the names and relationship of everyone who lived in your home last year:


  18. What was your marital status on December 31? Never Married

    Married and live with spouse

    Married but lived apart from spouse for the last six months of the year (July 1 – December 31) Divorced or separated

    Separated under a legal separation agreement


  19. If you are divorced or legally separated, can you provide the IRS with any of the following documents if requested?

    Divorce decree Separate maintenance agreement or separation agreement


  20. If you are legally married but did not reside with your spouse for the last six months of the tax year, if required to do so can you provide the IRS with any of these supporting documents verifying that your spouse did not live with you for the full six months:

    Not applicable Letter from Social Services

    Lease agreement Other (please describe) Utility bills

    Letter from clergy member


  21. What school(s) did the children/adult dependent attend last year?


    What address does the school(s) list for the children/adult dependent?


  22. Do you have daycare expenses for the child or adult dependent? Yes No If so, what address does the facility list for the children/adult dependent?


  23. Did anyone else contribute to the support of the child or adult dependent? Yes No If so, please provide details


  24. Is there an active Form 8332 – Release/Revocation of Exemption to Claim Child by Custodial Parent, or similar document, in place which states who can claim any of the children listed above? Yes No

    If yes, please provide a copy of the signed form/agreement.


  25. Is there a written custody, divorce or separation agreement or court order regarding the child(ren)? Yes No If yes, please provide a copy of the document

  26. If claiming a disabled adult, what is that disabled adult’s income?

    a. Has a licensed medical practitioner determined that this individual has a disability?

    1. What is the nature of the disability?

    2. How long will disability last?

    3. Can you provide documentation of the extent and nature of the disability? Yes No


  27. Did another resident in the home earn more than you or your spouse? Yes No


  28. If requested, can you provide the IRS with receipts and bills verifying you paid more than one-half of the cost of keeping up the home in which you and your qualifying child(ren) or your parent lived during the tax year? Examples of documentation that may be required by the IRS include:

    Utility bills Rent receipts or mortgage interest statement

    Property tax bills Maintenance and repair bills

    Grocery receipts Other household bills


  29. Did you receive any non-taxable support or income during the tax year? Family support Childcare assistance

    Child support Food stamps

    Housing assistance Other (please describe)


  30. Have you ever been notified by the IRS that the Earned Income Tax Credit or Child Tax Credit claimed on a return filed by you was denied or reduced? Yes No


  31. Any additional information you feel would be helpful:


The information provided on this form is true and correct to the best of my knowledge. I understand that providing incorrect information may result in denial of credit(s) both for the current tax year, and future tax years.


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Signature Date


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Printed Name