HOOVER

Client Interview Form

Full Name *

Tax Preparer *

Address

Street Address

City

1. List All sources of income (including SSI benefits, W-2s, self-employment, Unemployment Income or others) and how are you supporting yourself and your dependent(s)? *

2. Do you receive state assistance? Yes No If yes, write down the type of assistance and the amount you receive each month. Example: Cash assistant, Food assistant, housing assistant? How much do you pay? *

3a. Indicate the total number of people living in your household: *

4. Have your EIC (Earned Income Credit) ever been reduced or disallowed? Yes No. If Yes, when\what was the reason? *

5. Did you or your dependent attend any educational institution that may qualify for the American Opportunity Credit or the Lifetime Learning Credit? *

6. Did you pay for student loans and did you receive form 1098 E (student loan interest paid) *

7.Do you have any garnishments such as IRS debt, child support, student loans, medical bills ETC. *

8. Did you receive a letter from unemployment stating that you owe or if your unemployment portal states that you owe for overpayment? *

9a. Do you own or rent? *

OWN

RENT

9b. Rent amount or taxed paid. *

9c. Landlord Name and Address or Mortgage Company *

10. Are you currently receiving Section 8 housing assistance?

11. ⁠Did you receive unemployment benefits this year?

12. Did you have any gambling winnings or win money from the lottery, including platforms like FanDuel, BetMGM, or similar?

13. Did you withdraw funds early from your retirement accounts?

14. Do you have an IRS Identity Protection (IP) PIN?

I agree to terms & conditions provided by the company. I confirm everything stated in the form is the truth to the best of my knowledge.

Signature *

Clear