Form 13614-C (Ar) - Intake/interview & Quality Review Sheet (Arabic Version) Page 4

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4 ‫ﺍﻟﺻﻔﺣﺔ‬

‫ﺍﻟﺟﺯء ﺍﻟﺛﺎﻣﻥ- ﻓﻘﺭﺓ ﺍﻟﻣﺗﻁﻭﻉ ﺍﻟﻣﻌﺗﻣﺩ ﺍﻟﻣﺩﻗﻕ ﻟﻠﺟﻭﺩﺓ‬

:‫ﺩﻗﻕ ﻓﻲ ﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ ﻣﻊ ﺩﺍﻓﻊ ﺍﻟﺿﺭﺍﺋﺏ ﻟﺿﻣﺎﻥ ﺃﻥ‬

.‫• ﺗﻡ ﺇﺛﺑﺎﺕ ﻫﻭﻳﺔ ﺩﺍﻓﻊ ﺍﻟﺿﺭﺍﺋﺏ )ﻭﺯﻭﺟﺗﻪ( ﺑﺑﻁﺎﻗﺔ ﻫﻭﻳﺔ ﺗﺣﻣﻝ ﺻﻭﺭﺓ‬

.‫• ﺍﻟﻣﺗﻁﻭﻉ ﺍﻟﻣﻌﺩ ﻟﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ/ﻣﺩﻗﻕ ﺟﻭﺩﺓ ﻣﻌﺗﻣﺩ ﻹﻋﺩﺍﺩ/ﺍﻟﺗﺩﻗﻳﻕ ﻓﻲ ﻫﺫﺍ ﺍﻟﻛﺷﻑ ﻭﺍﻟﻛﺷﻑ ﻫﻭ ﺿﻣﻥ ﻧﻁﺎﻕ ﺍﻟﺑﺭﻧﺎﻣﺞ‬

.‫• ﺗﻣﺕ ﺍﻹﺟﺎﺑﺔ ﻋﻠﻰ ﻛﺎﻓﺔ ﺍﻷﺳﺋﻠﺔ ﻓﻲ ﺍﻷﺟﺯﺍء ﺍﻷﻭﻟﻰ ﺣﺗﻰ ﺍﻟﺳﺎﺩﺳﺔ‬

.‫• ﺗﻣﺕ ﻣﻧﺎﻗﺷﺔ ﻛﺎﻓﺔ ﻣﺭﺑﻌﺎﺕ ﻏﻳﺭ ﻭﺍﺛﻕ ﻣﻊ ﺩﺍﻓﻊ ﺍﻟﺿﺭﺍﺋﺏ ﻭﺗﻡ ﺗﺳﺟﻳﻠﻬﺎ ﺑـ"ﻧﻌﻡ" ﺃﻭ "ﻻ" ﺑﺷﻛﻝ ﺻﺣﻳﺢ‬

.‫• ﺗﻡ ﻁﺭﺡ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻋﻠﻰ ﺍﻟﺻﻔﺣﺔ ﺍﻷﻭﻟﻰ ﺣﺗﻰ ﺍﻟﺛﺎﻟﺛﺔ ﺑﺷﻛﻝ ﺻﺣﻳﺢ ﻭﻧﻘﻠﻬﺎ ﺇﻟﻰ ﺍﻟﻛﺷﻑ‬

.‫• ﺗﻡ ﺇﺛﺑﺎﺕ ﺍﻷﺳﻣﺎء ﻭﺃﺭﻗﺎﻡ ﺍﻟﺿﻣﺎﻥ ﺍﻹﺟﺗﻣﺎﻋﻲ ﻭﺃﺭﻗﺎﻡ ﺍﻟﺿﺭﻳﺑﺔ ﺍﻟﻔﺭﺩﻳﺔ ﻭﺃﺭﻗﺎﻡ ﻫﻭﻳﺔ ﺭﺏ ﺍﻟﻌﻣﻝ ﻭﻧﻘﻠﻬﺎ ﺑﺷﻛﻝ ﺻﺣﻳﺢ ﺇﻟﻰ ﺍﻟﻛﺷﻑ‬

.‫• ﺗﻡ ﺇﺛﺑﺎﺕ ﺻﺣﺔ ﻭﺿﻊ ﺭﻓﻊ ﺍﻟﻛﺷﻑ‬

.‫• ﺗﻡ ﺑﺷﻛﻝ ﺻﺣﻳﺢ ﺗﺳﺟﻳﻝ ﺍﻹﻋﻔﺎءﺍﺕ ﺍﻟﺷﺧﺻﻳﺔ ﻭﺇﻋﻔﺎءﺍﺕ ﺍﻹﻋﺎﻟﺔ ﻋﻠﻰ ﺍﻟﻛﺷﻑ‬

.‫• ﺗﻡ ﺑﺷﻛﻝ ﺻﺣﻳﺢ ﻧﻘﻝ ﻛﺎﻣﻝ ﺍﻟﺩﺧﻝ )ﺑﻣﺎ ﻓﻲ ﺫﻟﻙ ﺍﻟﺩﺧﻝ ﺍﻟﻣﺭﻓﻕ ﻭﻏﻳﺭ ﺍﻟﻣﺭﻓﻕ ﺑﻪ ﺍﻟﻭﺛﺎﺋﻕ ﺍﻷﺻﻠﻳﺔ( ﺍﻟﻣﺧﺗﺎﺭ ﻟﻪ "ﻧﻌﻡ" ﻓﻲ ﺍﻟﺟﺯء ﺍﻟﺛﺎﻟﺙ ﺇﻟﻰ ﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ‬

.‫ ﻭﺿﺭﻳﺑﺔ ﺍﻟﻌﻣﻝ ﺍﻟﺣﺭ، ﻭﻫﻲ ﺻﺣﻳﺣﺔ‬IRA ‫• ﺗﻡ ﺍﻟﺗﺣﻘﻕ ﻣﻥ ﺻﺣﺔ ﺍﻟﺗﻌﺩﻳﻼﺕ ﻋﻠﻰ ﺍﻟﺩﺧﻝ، ﻣﺛﻝ ﻓﺎﺋﺩﺓ ﻗﺭﺽ ﺍﻟﻁﺎﻟﺏ، ﻭﻣﺳﺎﻫﻣﺎﺕ‬

.‫• ﺍﻟﻣﻘﺗﻁﻌﺎﺕ ﺍﻟﻌﺎﺩﻳﺔ ﺃﻭ ﺍﻟﻣﻔﺻﻠﺔ ﺻﺣﻳﺣﺔ‬

.‫• ﻛﺎﻓﺔ ﺍﻹﻋﺗﻣﺎﺩﺍﺕ ﻣﺑﻠﻎ ﻋﻧﻬﺎ ﺑﺷﻛﻝ ﺻﺣﻳﺢ‬

.‫[ ﻟﻛﻝ ﺷﺧﺹ ﻣﺫﻛﻭﺭ ﻋﻠﻰ ﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ ﻭﺗﻡ ﺗﺳﺟﻳﻠﻬﺎ ﺑﺷﻛﻝ ﺻﺣﻳﺢ‬ACA] "‫• ﺗﻡ ﺇﻋﺗﺑﺎﺭ ﻛﺎﻓﺔ ﺍﻟﺑﻧﻭﺩ ﺍﻟﺳﺎﺭﻳﺔ ﻣﻥ "ﻗﺎﻧﻭﻥ ﺍﻟﺭﻋﺎﻳﺔ ﺍﻟﻣﻳﺳﻭﺭﺓ‬

.‫• ﺃﻱ ﻣﺩﻓﻭﻋﺎﺕ ﻣﺳﺅﻭﻟﻳﺔ ﻣﺷﺗﺭﻛﺔ ﻫﻲ ﺻﺣﻳﺣﺔ‬

.‫، ﻭﻣﺩﻓﻭﻋﺎﺕ ﺍﻟﺿﺭﺍﺋﺏ ﺍﻟﻣﻘﺩﺭﺓ ﻣﺑﻠﻎ ﻋﻧﻬﺎ ﺑﺷﻛﻝ ﺻﺣﻳﺢ‬W-2، 1099 ‫• ﺍﻟﻣﻘﺗﻁﻊ ﺍﻟﻣﺑﻳﻥ ﻋﻠﻰ ﺍﻹﺳﺗﻣﺎﺭﺍﺕ‬

.‫• ﺃﺭﻗﺎﻡ ﺣﺳﺎﺑﺎﺕ ﺍﻹﻳﺩﺍﻉ ﺍﻟﻣﺑﺎﺷﺭ/ﺍﻟﻣﺩﻳﻥ ﻭﺍﻟﺷﻳﻛﺎﺕ/ﺍﻟﺗﻭﻓﻳﺭ ﺻﺣﻳﺣﺔ‬

.‫• ﺭﻗﻡ ﻫﻭﻳﺔ ﺍﻟﻣﻭﻗﻊ ﺻﺣﻳﺢ ﻋﻠﻰ ﺍﻟﻛﺷﻑ‬

.‫• ﺩﺍﻓﻊ )ﺩﺍﻓﻌﻭ( ﺍﻟﺿﺭﺍﺋﺏ ﺃﺣﻳﻁ ﻋﻠﻣ ﺎ ً ﺑﺄﻧﻬﻡ ﻣﺳﺅﻭﻟﻭﻥ ﻋﻥ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻋﻠﻰ ﻛﺷﻔﻬﻡ‬

(‫ﺍﻹﺳﻡ ﺍﻟﻛﺎﻣﻝ/ﺍﻟﻣﺧﺗﺻﺭ ﻟﻠﻣﺗﻁﻭﻉ ﺍﻟﻣﻌﺗﻣﺩ ﺍﻟﻣﺩﻗﻕ ﻟﻠﺟﻭﺩﺓ )ﺧﻴﺎري‬

(‫ﺍﻹﺳﻡ ﺍﻟﻛﺎﻣﻝ/ﺍﻟﻣﺧﺗﺻﺭ ﻟﻠﻣﺗﻁﻭﻉ ﺍﻟﻣﻌﺗﻣﺩ ﺍﻟﻣﻌﺩ ﻟﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ )ﺧﻴﺎري‬

‫ﻣﻼﺣﻅﺎﺕ ﺇﺿﺎﻓﻳﺔ ﻟﻣﻌﺩ ﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ‬

‫ﺇﺧﻁﺎﺭ ﻗﺎﻧﻭﻥ ﺍﻟﺧﺻﻭﺻﻳﺔ ﻭﻗﺎﻧﻭﻥ ﺗﺧﻔﻳﺽ ﺍﻟﻣﻌﺎﻣﻼﺕ ﺍﻟﻭﺭﻗﻳﺔ‬

.‫[ ﻟﻌﺎﻡ 4791 ﺑﺄﻥ ﻧﻘﻭﻡ، ﻋﻧﺩ ﻁﻠﺏ ﻣﻌﻠﻭﻣﺎﺕ، ﺑﺈﺧﺑﺎﺭﻙ ﺑﺣﻘﻧﺎ ﻗﺎﻧﻭﻧﻳ ﺎ ً ﻓﻲ ﻁﻠﺏ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ، ﻭﻟﻣﺎﺫﺍ ﻧﻁﻠﺑﻬﺎ، ﻭﻛﻳﻑ ﺳﻳﺗﻡ ﺇﺳﺗﺧﺩﺍﻣﻬﺎ. ﻛﻣﺎ ﻋﻠﻳﻧﺎ ﺃﻥ ﻧﺧﺑﺭﻙ ﺑﻣﺎ ﻗﺩ ﻳﺣﺩﺙ ﺇﻥ ﻟﻡ ﻧﺣﺻﻝ ﻋﻠﻳﻬﺎ، ﻭﺑﻣﺎ ﺇﺫﺍ ﻛﺎﻧﺕ ﺇﺟﺎﺑﺗﻙ ﻁﻭﻋﻳﺔ ﺃﻭ ﺇﻟﺯﺍﻣﻳﺔ ﻛﺷﺭﻁ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﻓﺎﺋﺩﺓ‬Privacy Act] "‫ﻳﻠﺯﻣﻧﺎ "ﻗﺎﻧﻭﻥ ﺍﻟﺧﺻﻭﺻﻳﺔ‬

.‫ ﻹﻋﺩﺍﺩ ﻛﺷﻭﻑ ﺿﺭﺍﺋﺏ ﺍﻟﺩﺧﻝ ﻭﺑﺭﺍﻣﺞ ﺍﻟﺗﻭﻋﻳﺔ ﻭﺍﻟﺗﻭﺍﺻﻝ‬IRS ‫[. ﻧﺣﻥ ﻧﻁﻠﺏ ﻫﺫﻩ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻟﻣﺳﺎﻋﺩﺗﻧﺎ ﻋﻠﻰ ﺍﻹﺗﺻﺎﻝ ﺑﻙ ﻓﻲ ﺷﺄﻥ ﻣﺻﻠﺣﺗﻙ ﻭ/ﺃﻭ ﻣﺷﺎﺭﻛﺗﻙ ﻓﻲ ﺑﺭﺍﻣﺞ ﻣﺗﻁﻭﻋﻲ ﻣﺻﻠﺣﺔ‬U.S.C. 301 5] ‫ﺣﻘﻧﺎ ﻗﺎﻧﻭﻧﻳ ﺎ ً ﻓﻲ ﻁﻠﺏ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﺧﺎﺿﻊ ﻟﻠﻔﻘﺭﺓ 103 ﻣﻥ ﺍﻟﻌﻧﻭﺍﻥ 5 ﻣﻥ ﻗﺎﻧﻭﻥ ﺍﻟﻭﻻﻳﺎﺕ ﺍﻟﻣﺗﺣﺩﺓ‬

‫ﻭﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﺗﻲ ﺗﻌﻁﻳﻬﺎ ﻗﺩ ﻳﺗﻡ ﺗﺯﻭﻳﺩﻫﺎ ﻵﺧﺭﻳﻥ ﻳﺗﻭﻟﻭﻥ ﺗﻧﺳﻳﻕ ﺍﻷﻧﺷﻁﺔ ﻭﺇﺟﺭﺍءﺍﺕ ﺍﻟﺗﻭﻅﻳﻑ ﻓﻲ ﻣﻭﺍﻗﻊ ﻟﻣﺗﻁﻭﻋﻲ ﺇﻋﺩﺍﺩ ﺍﻟﻛﺷﻭﻑ ﺃﻭ ﺃﻧﺷﻁﺔ ﺍﻟﺗﻭﺍﺻﻝ. ﻛﻣﺎ ﻗﺩ ﻳﺗﻡ ﺇﺳﺗﺧﺩﺍﻡ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻟﻭﺿﻊ ﺿﻭﺍﺑﻁ ﻓﻌﺎﻟﺔ ﻭﺇﺭﺳﺎﻝ ﻣﺭﺍﺳﻼﺕ ﻭﺍﻟﺗﻌﺭﻑ ﻋﻠﻰ ﺍﻟﻣﺗﻁﻭﻋﻳﻥ. ﺇﺟﺎﺑﺗﻙ ﻁﻭﻋﻳﺔ، ﻟﻛﻥ ﺇﻥ ﻟﻡ ﺗﺯﻭﺩ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﻣﻁﻠﻭﺑﺔ، ﻗﺩ ﻻ‬

.‫ ﻣﻥ ﺇﺳﺗﺧﺩﺍﻣﻙ ﻟﻠﻣﺳﺎﻋﺩﺓ ﻓﻲ ﻫﺫﻩ ﺍﻟﺑﺭﺍﻣﺞ‬IRS ‫ﺗﺗﻣﻛﻥ ﻣﺻﻠﺣﺔ‬

‫ ﻟﻬﺫﻩ ﺍﻟﺩﺭﺍﺳﺔ ﻫﻭ: 5451-4691. ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺫﻟﻙ، ﺇﺫﺍ ﻛﺎﻧﺕ ﻟﺩﻳﻙ ﺃﻱ ﺗﻌﻠﻳﻘﺎﺕ ﻋﻠﻰ ﺍﻟﺗﻘﺩﻳﺭﺍﺕ ﺍﻟﺯﻣﻧﻳﺔ ﺍﻟﻣﺭﺗﺑﻁﺔ‬OMB ‫ ﻋﻠﻰ ﻛﺎﻓﺔ ﻁﻠﺑﺎﺕ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﻌﺎﻣﺔ. ﻭﺭﻗﻡ ﻣﺭﺍﻗﺑﺔ ﻣﻛﺗﺏ‬OMB ‫ ﺑﻌﺭﺽ ﺭﻗﻡ ﻣﺭﺍﻗﺑﺔ ﻣﻛﺗﺏ‬IRS ‫[ ﻳﻠﺯﻡ ﻣﺻﻠﺣﺔ‬Paperwork Reduction Act] "‫"ﻗﺎﻧﻭﻥ ﺗﺧﻔﻳﺽ ﺍﻟﻣﻌﺎﻣﻼﺕ ﺍﻟﻭﺭﻗﻳﺔ‬

.Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224 :‫ﺑﻬﺫﻩ ﺍﻟﺩﺭﺍﺳﺔ ﺃﻭ ﺇﻗﺗﺭﺍﺣﺎﺕ ﺣﻭﻝ ﺗﺑﺳﻳﻁ ﻫﺫﻩ ﺍﻟﻌﻣﻠﻳﺔ، ﻳﺭﺟﻰ ﻣﺭﺍﺳﻠﺔ ﻣﺻﻠﺣﺔ ﺿﺭﻳﺑﺔ ﺍﻟﺩﺧﻝ ﻋﻠﻰ ﺍﻟﻌﻧﻭﺍﻥ‬

13614-C (AR)

58970P ‫ﺍﻟﻛﺗﺎﻟﻭﺝ ﺭﻗﻡ‬

(2017-10 ‫)ﺗﻌﺩﻳﻝ‬

‫ﺍﻹﺳﺗﻣﺎﺭﺓ‬