Form 13614-C - Intake/interview & Quality Review Sheet
Download a blank fillable Form 13614-C - Intake/interview & Quality Review Sheet in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 13614-C - Intake/interview & Quality Review Sheet with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
413614-C
Department of the Treasury - Internal Revenue Service
OMB Number
Form
Intake/Interview & Quality Review Sheet
1545-1964
(October 2017)
• Please complete pages 1-3 of this form.
You will need:
• Tax Information such as Forms W-2, 1099, 1098, 1095.
• You are responsible for the information on your return. Please provide
• Social security cards or ITIN letters for all persons on your tax return.
complete and accurate information.
• Picture ID (such as valid driver's license) for you and your spouse.
• If you have questions, please ask the IRS-certified volunteer preparer.
Volunteers are trained to provide high quality service and uphold the highest ethical standards.
To report unethical behavior to the IRS, email us at wi.voltax@irs.gov
Part I – Your Personal Information (If you are filing a joint return, enter your names in the same order as last year’s return)
1. Your first name
M.I.
Last name
Telephone number
Are you a U.S. citizen?
Yes
No
2. Your spouse’s first name
M.I.
Last name
Telephone number
Is your spouse a U.S. citizen?
Yes
No
3. Mailing address
Apt #
City
State
ZIP code
4. Your Date of Birth
5. Your job title
6. Last year, were you:
a. Full-time student
Yes
No
b. Totally and permanently disabled
c. Legally blind
Yes
No
Yes
No
9. Last year, was your spouse:
a. Full-time student
Yes
No
7. Your spouse’s Date of Birth
8. Your spouse’s job title
b. Totally and permanently disabled
Yes
No
c. Legally blind
Yes
No
10. Can anyone claim you or your spouse as a dependent?
Yes
No
Unsure
11. Have you or your spouse:
a. Been a victim of identity theft?
Yes
No
b. Adopted a child?
Yes
No
Part II – Marital Status and Household Information
1. As of December 31, 2017, were
Never Married
(This includes registered domestic partnerships, civil unions, or other formal relationships under state law)
you:
Married
Yes
No
a. If Yes, Did you get married in 2017?
Yes
No
b. Did you live with your spouse during any part of the last six months of 2017?
Date of final decree
Divorced
Date of separate maintenance agreement
Legally Separated
Year of spouse’s death
Widowed
2. List the names below of:
If additional space is needed check here
and list on page 3
• everyone who lived with you last year (other than your spouse)
• anyone you supported but did not live with you last year
To be completed by a Certified Volunteer Preparer
Name (first, last) Do not enter your
Date of Birth
Relationship
Number of
US
Resident
Single or
Full-time
Totally and
Is this
Did this
Did this
Did the
Did the
name or spouse’s name below
(mm/dd/yy)
to you (for
months
Citizen
of US,
Married as
Student
Permanently
person a
person
person
taxpayer(s)
taxpayer(s)
example:
lived in
(yes/no)
Canada,
of 12/31/17
last year
Disabled
qualifying
provide
have less
provide more
pay more than
son,
your home
or Mexico
(S/M)
(yes/no)
(yes/no)
child/relative
more than
than $4,050
than 50% of
half the cost of
daughter,
last year
last year
of any other
50% of his/
of income?
support for
maintaining a
parent,
(yes/no)
person?
her own
(yes/no)
this person?
home for this
none, etc)
(yes/no)
support?
(yes/no/N/A)
person?
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(yes/no)
(yes/no)
13614-C
Catalog Number 52121E
Form
(Rev. 10-2017)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial