Tax-Aid Questionnaire

Part 1 - Your information

Please Check Your Answers To Yes/No Questions



Personal Information Taxpayer Spouse
Social Security Information
If you have an Individual Taxpayer Identification Number(ITIN), please fill it in
Mobile Phone Number
Birth Date
Are you a U.S. citizen?
Are you a full-time student?
Are you claimed as a dependent on another person’s tax return such as your parent?
Are you legally blind?
Last year were you permanently disabled?
Home Phone
Employer, Job Title, What is your job?
Email Address
Home Address
City, State, Zip Code, Apt./Unit

Part 2 - How Are You Filing?






E-Filing PIN You Your spouse
IP PIN #
Type of ID
ID #
State ID issued
Issue date
Expiration date

Bank name
Routing number
Account number
Type of Account

Part 3 - Dependents

Dependent's Full Name (First, Middle Initial, Last) Date of Birth (MM/DD/YY) Social Security Number or ITIN # Months Lived with Taxpayer Full-time Student? Relation (son, daughter, etc.) Totally and Permanently Disabled?

Part 4 - Last year, did you, your spouse, or all your dependents...





Part 4A - Did You or Your Spouse Receive...?



Part 4B - Did You or Your Spouse Pay...



Part 4C - Did you have...


Taxpayer Agreement to Disclose

  • Tax-Aid 2020 Results
  • 3,096 tax returns
  • $2,186,013 million in total refunds
  • Free tax preparation program donors and volunteers
  • Various media partners
  • Elected officials and other program supporters
  • General public

Consent to Disclose


Name(s) Date
Signature Spouse's Signature

TAX-AID CLIENT PRIVACY NOTICE

FACTS WHAT DOES TAX-AID DO WITH YOUR PERSONAL INFORMATION?
WHY? U.S. federal law provides clients with the right to limit some but not all of a company’s decisions with respect to the sharing of the client’s personal information. U.S. federal law also requires us to tell you how we collect, share and protect your personal information. Please read this notice carefully to understand what we do.
WHAT? We collect nonpublic personal information about you that is either provided by you or obtained by us with your authorization. The types of personal information we collect and share depend on the particular service that we provide to you. This information can include your:
  • name;
  • Social Security number;
  • Individual Taxpayer Identification Number;
  • address;
  • date of birth;
  • bank account information;
  • employment details;
  • earnings and expenses;
  • family members’ names, dates of birth, Social Security numbers and earnings (if any);
  • contact information (phone number and email address);
HOW? Accounting service companies need to share their clients’ personal information to run their everyday business. In the section below, we list the reasons accounting service companies can share their clients’ personal information, the reasons Tax-Aid chooses to share some of this information and whether you can limit this sharing. Once you are no longer our client, we can continue to share your information as described in this notice.
Reasons we can share your personal information Does Tax-Aid share? Can you limit this sharing?
For our everyday business purposes - such as to process your tax filings, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus Yes No
For our marketing purposes - to offer our services to you No We don’t share
For joint marketing with other companies No We don’t share
For Nonaffiliates (defined below) to market to you No We don’t share
QUESTIONS? Call us at 415-229-9240 or email us at admin@tax-aid.org
Who we are
Who is providing this notice? Tax-Aid
What we do
How does Tax-Aid protect my personal information? To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include physical, electronic and procedural safeguards.
How does Tax-Aid collect my personal information? We collect your personal information, for example, when you
  • submit your tax documents to us;
  • contact us with questions; and
  • work with one of our tax professionals to prepare your taxes.
Why can’t I limit all sharing? U.S. federal law gives you the right to limit only our sharing to Nonaffiliates to market to you. State laws and individual companies may give you additional rights to limit sharing.
Definitions
Nonaffiliates Companies not related by common ownership or control. Such companies can be financial and nonfinancial companies.
Joint marketing A formal agreement between nonaffiliated companies that together market products or services to you. Tax-Aid does not jointly market.
Other important information
N/A