Personal income tax questionnaire is used for determining the various aspects of paying income tax. The Personal income tax questionnaire contains questions that are related to the filing status, different types of income, contributions, interests received by you, different types of deductions and much more. This is a sample questionnaire and the actual questionnaire normally spreads over multiple pages.

Sample Personal Income Tax Questionnaire:

Name of the Tax Payer: _________________________ Name of Spouse: _____________

Social Security Number: _________________________ Occupation: _________________

Date of Birth: ____/_____/_____ (mm/dd/yy) |  Age: ___________

Social Security Number (Spouse): _____________________Occupation: _________________

Date of Birth: ____/_____/_____ (mm/dd/yy) |  Age: ___________

Address: ______________________________________  City:_______________

State: __________________  Zip: ________________

Email: _____________________________

Phone Number: ____________________________

  • Do you have any dependents? If yes, then please mention their name, relationship, and age.

a)      Yes

b)      No


a)      Name: ________________ Relationship: _______________ Age: _______

b)      Name: ________________ Relationship: _______________ Age: _______

c)      Name: ________________ Relationship: _______________ Age: _______

d)     Name: ________________ Relationship: _______________ Age: _______

  • Are you currently providing 50% financial support to your mother or father?

a)      Yes

b)      No

  • Do you currently have any childcare expense?

a)      Yes

b)      No

If yes, then please mention the following:

a)      Provider:________________________

b)      Dependent:______________________

c)      Amount ($):_____________________

  • Are you staying in a rented accommodation? If yes then provide the amount of rent being paid

a)      Yes

b)      No

c)      Rent Amount ($): _______________

d)     Number of months on Rent: _______

e)      Name and Address of Landlord:_________________________________________

  • Do you receive income from any of the following areas? If so then please provide the amount of income

a)      Social Services

b)      Unemployment Compensation

c)      Alimony

d)     Social Security

e)      Other Compensation

f)       Others: _________________

  • Have you made any recent contributions? (If yes, then please mention the specific contributions made and the amount)

a)      Yes

b)      No

c)      Contributions Made: _________________ Amount ($):______________________