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*Ph:
*Ph:
Yes No
Routing#: Acct#:
Yes No
*DOB: *SSN:Add Delete
(mm/dd/yyyy) (xxx-xx-xxxx)
*DOB: *SSN: Add Delete
(mm/dd/yyyy) (xxx-xx-xxxx)
Amount: $Amount: $
If YES , please provide full name, date of birth, and social security number:
*Full Name:
*Full Name:
Personal Information (*Information required to complete tax return)
Did your marital status change during the year?
Dependent Information (*Information required to complete tax return)
Were there any changes in dependents from the prior year?
*Full Name:
*Email:
*Spouse's Full Name:
*Spouse's Email:
Date:
If YES , please provide the bank account you would like to use. If the banking information is the same as the prior year, please confirm the last 4 digits of the account number. Either fill in below or call our office with the information.
Bank Name:
If YES , explain:
Did your address change from last year?
If YES , what is your current address?
Will you be claimed as a dependent by another taxpayer?
Would you like to use Electronic Funds Transfer (EFT) for direct deposit?
Date:Date:Date:
Amount: $Amount: $
Did you receive an Identity Protection PIN (IP PIN) from the IRS or have you been a victim of identity theft? >>> If YES , please provide the IRS letter! <<<
Did you make any estimated tax payments in 2020? If YES, list the date & amount of each payment made below.
2020 Current Client Questionnaire
Please upload the completed Questionnaire to your Secure Client Portal.For all answers marked YES, upload applicable support documents to your Portal.
Please Note: Incomplete information may delay the completion of your return.
Page 1
2020 Current Client Questionnaire
Yes No
*DOB: *SSN:(mm/dd/yyyy) (xxx-xx-xxxx)
Address:
Phone#:
Child 2
Yes No
Relationship:
Full Name:
Other than your spouse and dependent children, did you provide over half the support for any other person(s) that you can claim as a dependent? If YES , please provide their information below:
Did any dependents receive an Identity Protection PIN (IP PIN) from the IRS or have they been a victim of identity theft? If YES , please provide the IRS letter.
Purchases, Sales, and Debt Information
Always primary residence? YES NO
Did you have any debts canceled or forgiven this year (credit card, student loan, auto loan, etc)? If YES , provide 1099-C(s).
*Provider EIN:
*Amt Paid: Child 1
Dependent Information (cont.)
*Provider Name:
Did you pay for child care while you worked or looked for work? If YES, furnish provider information :
Did you pay any expenses related to the adoption of a child during the year?
Original purchase date: Original purchase price: $
If YES, complete a Mileage Worksheet. Mileage Worksheet
Did you sell any real estate during the year? If YES, provide closing statement(s).
Did you purchase rental property during the year? If YES, provide closing statement(s), complete a Rental Property Worksheet, and if the property has a mortage provide Form 1098.
Rental Property Worksheet
Do you have a home office (does not apply to W-2 jobs)? If YES, complete a Home Office Worksheet.
Home Office Worksheet
Did you use your car on the job, for other than commuting (does not apply to W-2 jobs)?
Did you start a new business during the year? If YES , describe briefly:
Did you acquire or dispose of any stock during the year? If YES, provide a 1099 from each brokerage.
Did you take out a home equity loan this year? If YES, provide closing statement.
Did you refinance a principal residence or second home this year? If YES, provide closing statement.
Did you purchase any real estate during the year? If YES, provide closing statement(s) and the following:
Page 2
2020 Current Client Questionnaire
Yes No
Yes No
1)
2)
3)
4)
5)
1st Stimulus Check (Apr 2020 - May 2020):2nd Stimulus Check (Dec 2020 - Jan 2021):
* This is not taxable income. We need this information to determine whether you are entitled to additional funds.
Income Information
Date Received:Amt. Received: $ Amt. Received: $
If YES , provide the total amount received in 2020: $
Program name: Total received $
Did you have any sales or other exchanges of virtual currencies, use virtual currencies to pay for goods or services, or are you holding virtual currencies as an investment?
COVID-19 / Stimulus Program / Small Business Loans (SBA)
Program name: Total received $
Did you receive any local grants (or additional grants) in 2020? If YES , provide information below.
Did you or anyone included on your tax return, receive stimulus checks* (EIC/Economic Impact Check payments)?
INDIVIDUALS:
Did you receive tip income not reported to your employer this year?
Did you receive any gambling or lottery winnings? If YES, provide W2-G(s) and Win/Loss statement(s).
BUSINESSES:
Date Received:
Were you a sole-proprietor who was unable to work or telework for a period of time in 2020 due to any of the following reasons:
You were subject to a Federal, State, or local quarantine or isolation order related to COVID-19.
You had been 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 is subject to a Federal, State, or local quarantine or isolation order related to COVID-19, or has been advised by a health care provider to self-quarantine due to concerns related to COVID-19
You were caring for a child if the child’s school or place of care has been closed, or child care provider is unavailable due to COVID-19 precautions.
If you own a business, did you receive a PPP (Paycheck Protection Program) loan?
If YES , provide the total amount received : $
Have you applied for Loan Forgiveness?
Has the Forgiveness request been approved?
If YES, amount forgiven: $
Did you receive any EIDL (Economic Injury Disaster Loan) advances?
Did you receive any unemployment benefits during the year? If YES, provide Form 1099-G.
If YES , provide the total amount received :
Date Received:
Page 3
2020 Current Client Questionnaire
Yes No
Yes No
Yes No
Yes No
$
Were you enrolled in a High Deductible Health Plan (HDHP) which has a deductible of $1,300 for Self-Only or $2,600 for family coverage or more?
Did anyone in your family receive a scholarship of any kind during the year?
Health Care Information
Itemized Deduction Information
Retirement Information
Did you receive any Social Security benefits during the year? If YES, provide Form SSA-1099.
Did you have qualifying health care coverage for your family, and was everyone in your family covered for every month of 2020? ("Your family " for health care coverage refers to you, your spouse if filing jointly, and anyone you can claim as a dependent.)
If YES , upload any Form(s) 1095-B and/or 1095-C you received.
Did you enroll for Marketplace Coverage through healthcare.gov under the Affordable Care Act? If YES , upload any Form(s) 1095-A you received.
If NO, explain:
Did you cash any Series EE or I U.S. Savings bonds issued after 1989? If YES, provide 1099INT
Did you make any withdrawals from an IRA, Roth, Keogh, SIMPLE, SEP, 401(k), or other qualified retirement plan?
Did you make any contributions to a traditional, Roth, or SEP IRA?
Education Information
Did you have any post-secondary educational expenses during the year on behalf of yourself, your spouse, or a dependent? (If YES, upload Form(s) 1098-T, receipts for qualified tuition and related expenses.)
Did you make any contributions to an education savings or 529 Plan account?
Did you make any withdrawals from an education savings or 529 Plan account? If YES, provide 1099-Q.
Did you pay any student loan interest this year? If YES, provide 1098-E
Did you pay significant out-of-pocket medical expenses (Co-pays, prescription drugs, etc.)?
Did you make any cash contributions? If YES , please provide evidence such as a receipt from the donee organization, a canceled check, or record of payment, to substantiate all contributions made.
If YES, provide an estimated total:
Did you make any contributions to a Health savings account (HSA) or Archer MSA? If YES, provide 5498-SA.
Did you receive any distributions from a Health savings account (HSA), Archer MSA, or Medicare Advantage MSAthis year? If YES, provide 1099-SA.
Page 4
2020 Current Client Questionnaire
Yes No
Yes No
Did you make energy efficient improvements to your main home in 2019 (solar, exterior windows/doors, heating and A/C systems, water heaters, etc? If YES, please provide detail.
Did you or your spouse change jobs in 2020?
Payment 2 $Payment 1 $
Did you make any non-cash charitable contributions (clothes, furniture, etc.)? If YES, complete a Non-Cash Charitable Donation/Contributions worksheet.
Did you receive correspondence from the State or the IRS? If YES, explain and upload the document to your portal.
Do you want to designate $3 to the Presidential Election Campaign Fund? If you check yes, it will not change your tax or reduce your refund.
Do you have previous years of tax returns that are either unfiled or filed with unpaid balances due?
Did you pay real estate taxes for your primary home and/or second home? If YES, please provide amounts paid:
Did you retire in 2020?
Did you make any major non-real estate purchases during the year (cars, boats, etc.)? If YES, upload sales tax paid.
Old Employer Name (spouse) New Employer Name (spouse)
Miscellaneous Information
Did you make gifts of more than $15,000 to any individual?
Did you donate a vehicle or boat during the year? If YES, upload Form 1098-C or other written acknowledgement from the donee organization.
Non-Cash Charitable Donation Contributions Worksheet
Itemized Deduction Information (cont.)
Old Employer Name New Employer Name
Payment 3 $
Did you incur moving costs because of a permanent change of station as a member of the Armed Forces on active duty?
Did you pay any mortgage interest on an existing home loan? If Yes, upload any Form(s) 1098 you received.
Do you have any foreign financial accounts, foreign financial assets, or hold interest in a foreign entity?
Did you pay any individual as a household employee during the year? If YES, provide copy of W-2 filed with SSA.
Did you make energy efficient improvements to your main home in 2020 (solar, exterior windows/doors, heating and A/C systems, water heaters, etc? If YES, please provide detail.
*If the worksheet links do not work, you can find the required worksheets on our website at www.larryphillipscpa.com.Navigate to the "Tax Worksheets" page. Scroll down to locate the worksheet you need.
Page 5
2020 Current Client Questionnaire
660 S Bagdad Road, Suite 610 Leander, TX 78641 Tel: (512) 337-6485 Fax: (800) 575-1401 www.LarryPhillipsCPA.com
Notes:
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