Tax credit screening questionnaire helps in providing more clarity on the tax credits or earned tax credit of individuals filing for income tax. This is also applicable for those individuals who come under the category of low wage workers. The tax credit screening questionnaire is filled by the individual who wants to claim the credit and it offers an insight into their work, taxable income, and other related information. An individual who is claiming for tax credit has to satisfy certain rules and regulations.

Tax Credit Screening Questionnaire Sample

Name: ________________________________

Social Security Number: _________________________________

Address: ______________________________________

City: ________________ State: ___________________  Zip: _________________

Telephone: ____________________  Fax: ____________________________

Age:________________________ Occupation:_____________________________

Q1. What is the nature of your job?

a)   Sales and Marketing

b)   Unskilled labor

c)   Blue Collar job

d)   Others (pls specify): ____________________________________________

Q2. Is this the first time, you are filing income tax?

a)   Yes

b)   No

Q3. Is this the first time, you are making a claim for tax credit?

a)   Yes

b)   No

Q4. Which of the following criteria do you meet or can provide for claiming tax credit?

a)   Valid Social Security Number

b)   Earned income from low wage employment

c)   Earned income from self employment

d)   Filing status not married

e)   U.S. citizen or resident

f)    Filing is not for foreign income

g)   Qualify for earned income tax credit (EITC) income limits

h)   Qualify for EITC maximum credit amounts

Q5. Have you been denied income tax credit previously? If yes, please mention date and reason for denial.

a)   Yes

b)   No

Date: _____//_____//________                Reason:____________________________________

Q6. Which of the following does you taxable income also include?

a)   Salaries and wages

b)   Long-term disability benefits

c)   Union strike benefits

d)   Net earning from self employment

Q7. Which documents have you attached as proof to claim tax credit?

1. __________________________

2. __________________________

3. __________________________

4. __________________________

5. __________________________