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Tax Intake Form
Tax Intake Form
Home
Tax Intake Form
Filing Status*
Single
Head of Household
Married Filing Joint
Married Filing Separate
Is your home address the same as your business address?*
Yes
No
Total Business Income (If none please type "N/A")*
Yes
No
SELF-EMPLOYED COVID RELATED CREDITS* (Please check all that applies)
You were subject to a federal, state, or local quarantine or isolation order related to COVID-19.
You were advised by a health care provider to self-quarantine due to concerns related to COVID-19.
You were experiencing symptoms of COVID-19 and seeking a medical diagnosis.
You were caring for an individual who was subject to a federal, state, or local quarantine or isolation order related to COVID-19.
You were caring for an individual who was advised by a health care provider to self-quarantine due to concerns related to COVID-19.
You were caring for a son or daughter because the school or place of care for that child was closed or the childcare provider for that child was unavailable due to COVID-19 precautions.
ENTER YOUR NET EARNINGS FROM SELF-EMPLOYMENT. THIS IS THE GROSS INCOME DERIVED BY AN INDIVIDUAL FROM ANY TRADE OR BUSINESS YOU ENGAGE IN, LESS THE DEDUCTIONS YOU ARE ALLOWED RELATED TO THAT TRADE OR BUSINESS. *
DID YOU RECEIVE THE ECONOMIC STIMULUS PAYMENTS?*
Both First and Second Payments
First Economic Stimulus Payment
Second Economic Stimulus Payment
None
ENTER THE NUMBER OF DAYS IN THE PERIOD FROM APRIL 1, 2021, THROUGH DECEMBER 31, 2021, THAT YOU WERE UNABLE TO PERFORM SERVICES AS A SELF-EMPLOYED INDIVIDUAL BECAUSE OF ONE OR MORE OF THE FOLLOWING REASONS.*
ENTER THE NUMBER OF DAYS IN THE PERIOD FROM APRIL 1, 2021, THROUGH DECEMBER 31, 2021, THAT YOU WERE UNABLE TO PERFORM SERVICES AS A SELF-EMPLOYED INDIVIDUAL BECAUSE OF ONE OR MORE OF THE FOLLOWING REASONS:*
DID YOU RECEIVE QUALIFIED SICK LEAVE WAGES SUBJECT TO THE $200 PER-DAY LIMIT FROM AN EMPLOYER?*
Yes
No
DID YOU RECEIVE QUALIFIED SICK LEAVE WAGES SUBJECT TO THE $511 PER-DAY LIMIT FROM AN EMPLOYER?*
Yes
No
DID YOU RECEIVE QUALIFIED FAMILY LEAVE WAGES SUBJECT TO THE $200 PER-DAY LIMIT FROM AN EMPLOYER?*
Yes
No
Additional Information:* Please provide any additional information that is related to your current tax situation.
Copy of Valid ID (Drivers License, Passport, etc)
Send
