Form 13614-C - Intake/interview & Quality Review Sheet - 2010 Page 3
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4TAXPAYER STOP HERE!
Thank you for completing this form.
Section C. To be completed by
Section B. To be Completed by Certified Volunteer Only
a Certified Quality Reviewer
Remember: You are the link between the taxpayer’s information and a
After reviewing the tax return and
correct tax return. Verify the taxpayer’s information on pages 1 & 2 is
verifying that it reflects correct tax law
complete. Any question marked “Unsure” must be discussed with the
application to the information provided
taxpayer and changed to “Yes” or “No”.
by the taxpayer, check the final item.
Must be completed ONLY if persons are listed in Part II, Question 2.
1. Sections A & B of this form are
complete.
1. Can anyone else claim any of the persons listed in
Yes
No
Part II, Question 2, as a dependent on their return?
2. Taxpayer’s Identity, Address
If yes, which ones:
and Phone Number were verified.
3. Names, SSN or ITINs, and dates of
birth of taxpayer, spouse and
dependents match the supporting
2. Were any of the persons listed in Part II, Question 2,
Yes
No
documents.
totally and permanently disabled? If yes, which ones:
4. Filing Status is correctly determined.
5. Personal and Dependency
Exemptions are entered correctly
on the return.
3. Did any of the persons listed in Part II, Question 2
Yes
No
provide more than half of their own support? If yes,
6. All Income shown on source
which ones:
documents and noted in Section A,
Part III is included on the tax return.
7. Any Adjustments to Income are
correctly reported.
4. Did the taxpayer provide more than half the support
Yes
No
for each of the persons in Part II, Question 2? If no,
8. Standard, Additional or Itemized
N/A
which ones:
Deductions are correct.
9. All Credits are correctly reported.
10. Withholding shown on Forms
W-2,1099 and Estimated Tax
Yes
No
5. Did the taxpayer pay over half the cost of main-
Payments are correctly reported.
taining a home for any of the persons in Part II,
Question 2? If yes, which ones:
11. If Direct Deposit or Debit was
elected, checking/saving account
and routing information match the
supporting documents.
12. Correct SIDN is shown on the return.
Reminder
Check if the items above have
Use Publication 17, Your Federal Income Tax For Individuals
been verified to validate accuracy
and Publication 4012, Volunteer Resource Guide in making tax
based on your interview with the
law determinations.
taxpayer and a second review of
their source documents.
13614-C
Catalog Number 52121E
Form
(Rev. 10-2010)
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