First Name *

Last Name *

Date of birth *

SSN *

Phone *

Email *

Occupation *

Preferred contact Method *

U.S CITIZEN *

Yes

No

If not a citizen, are you a resident alien? *

Yes

No

If yes, list states & dates lived.

Are you filing with a spouse?

Yes

No

Do you have dependents?

Yes

No

Do you have an IP PIN?

Yes

No

Please enter IP PIN

Did you Receive any w-2s?

Yes

No

Spouse legal Full Name *

Spouse SSN *

Spouse Date of Birth *

Phone Number

Spouse Occupation *

Dependent First & Last Name

Dependent SSN

Dependent Date of Birth

Dependent Relationship *

Did Dependent live with you?

Yes

No

Months Dependent lived with you

Did ths dependent provide more than half of their own support?

Yes

No

Full-Time Student

Yes

No

2nd Dependent Full Name

2nd Dependent SSN

2nd Date Birthdate

2nd Dependent Relationship

Did Dependent live with you? (2nd)

Yes

No

Months 2nd Dependent lived with you?

Did ths dependent provide more than half of their own support? (2nd)

Yes

No

Full-Time Student (2nd)

Yes

No

3rd Dependent Full Name

3rd Dependent SSN

3rd Date Birthdate

3rd Dependent Relationship

Did Dependent live with you? (3rd)

Yes

No

Months 3rd Dependent lived with you?

Did ths dependent provide more than half of their own support? (3rd)

Yes

No

Full-Time Student (3rd)

Yes

No

Filing Status *

CTS determines the proper filing status based on interview questions.

Claimed HOH last year? *

Yes

No

Did you receive any STATE benefits? *

Yes

No

If yes your filing status will be changed to Single.

What kind of STATE benefits do you receive

Do you pay over 50% of household cost? *

Yes

No

Dependent living with you? *

Yes

No

Any changes in marital status? *

How many jobs held this year? *

Did You have health coverage all year? *

Yes

No

Did you have Marketplace insurance (Obamacare)? *

Yes, (upload 1095- A)

No

Business Name: *

Type of business: *

EIN (if applicable) *

Home Office

Yes

No

Track Mileage

Yes

No

Purchased Equipment?

Yes

No

Mixed Funds? *

Yes

No

Did you keep bookkeeping records? *

Yes

No

Number of Properties

Property Address(es)

Rented All Year?

Yes

No

Income Amount

Property Manager *

Yes

No

Did you file Taxes last *

Yes

No

If yes, who prepared your taxes?

Have you received ANY IRS letters/ notices received *

Yes, (Upload all letters)

No

Choose One: *

Direct Deposit (input bank info)

Check by Mail ( update mailing Address if needed)

Cash Card

Name on Bank Account *

Bank Name

Routing/Account Number *

Drive Licenses information *

Date Issued *

Expiration Date *

Consent & Signature *

Clear

Date Signed