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Department of the Treasury - Internal Revenue Service
OMB Number 1545-1964

Form 13614-C
(November 2024)
Intake/Interview and
Quality Review Sheet

You will need:
• Tax Information such as Forms W-2, 1099, 1098, 1095.
• Social Security cards or ITIN letters for all persons on your tax return
• Picture ID (such as valid driver's license) for you and your spouse
• Complete pages 1-6 of this form.
• You are responsible for the information on your return. Provide complete and accurate information.
• If you have questions, 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 
ts.voltax@irs.gov

Your first name (pronouns, optional) ----
M.I. ----
Last name ----
Your date of birth ----
Your job title ----
Spouse's first name (pronouns, optional) ----
M.I. ----
Last name ----
Spouse's date of birth ----
Spouse's job title ----
Mailing address ----
Apt # ----
City ----
State ----
ZIP code ----
Your telephone number ----
Spouse's telephone number ----
Email address (optional) ----
Did you live or work in two or more states in 2024
-- Yes
-- No

Check if you or your spouse were in 2024:

A U.S. citizen
-- You
-- Spouse
-- No
In the U.S. on a visa
-- You
-- Spouse
-- No
A full-time student
-- You
-- Spouse
-- No
Legally blind
-- You
-- Spouse
-- No
Totally and permanently disabled
-- You
-- Spouse
-- No
Issued an identity protection PIN (IPPIN)
-- You
-- Spouse
-- No
Owners or holders of any digital assets
-- You
-- Spouse
-- No
If due a refund, how would you like your refund
-- Direct deposit
-- Split refund between accounts
-- Check by mail
-- Other ----
If you have a balance due, how would you like to make your payment
-- Bank account
-- Set up installment agreement
-- IRS.gov Direct Pay
-- Mail payment to IRS
Would you like to receive written communications from the IRS in a language other than English
-- You
-- Spouse
-- No
What language ----
Would you like information on how to vote and/or how to register to vote
-- Yes
-- No
Would you, or your spouse if married filing jointly, like $3 to go to the Presidential Election Campaign Fund
-- You
-- Spouse
-- No
As of December 31, 2024, what was your marital status
-- Never Married
-- Divorced
Date of final decree ----
-- Married
If married, were you married for all of 2024
-- Yes
-- No
Did you live with your spouse during any part of the last six months of 2024
-- Yes
-- No
-- Legally Separated but not Divorced
Date of separate maintenance decree ----
-- Widowed
Year of spouse's death ----

To be completed by certified volunteer: Can anyone else claim the taxpayer or spouse on their tax return
-- Yes
-- No

List the names below of everyone who lived with you last year (except your spouse) AND anyone you supported but did not live with you last year. 3 blank lines shown in print.
Name (first, last) ----
Date of birth (mm/dd/yy) ----
Relationship to you (child, parent, none, etc.) ----
Number of months lived in your home in 2024 ----
Single or Married as of 12/31/2024 (S/M) ----
Answer Yes or No (Y/N) 3 blank lines shown in print.
U.S. Citizen ----
Resident of U.S., Canada or Mexico ----
Full-time student ----
Totally and permanently disabled ----
Issued IPPIN ----
To be completed by certified volunteer (Yes, No, or N/A) 3 blank, partially shaded lines in print.
Qualifying child or relative of any other person ----
This person provided more than 50% of their own support ----
This person had less than $5,050 of income ----
Taxpayer(s) provided more than 50% of support for this person ----
Taxpayer(s) paid more than half the cost of maintaining a home for this person ----

Catalog Number 52121E
www.irs.gov
Form 13614-C (Rev. 11-2024)

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Income: Answer the following questions on the left side of this page. Check only the boxes that apply to you and/or your spouse.
The following list repeats the bold column headings for each row item, starting with the left side and followed by the shaded right side. This continues through print page 3.
Received money from any of the following in 2024:

-- (B) Wages as a part-time or full-time employee
How many jobs ----
(To be completed by certified volunteer) Income to be included

-- (B) W-2s # ----
Notes/Comments ----

Received money from any of the following in 2024:

-- (B/A) Tips
(To be completed by certified volunteer) Income to be included

-- (B/A) Tips (Basic when reported on W2)
Notes/Comments ----

Received money from any of the following in 2024:

-- (B/A) Retirement account, pension or annuity proceeds
(To be completed by certified volunteer) Income to be included

-- (B/A) 1099-R (Basic when taxable amount is reported) # ----
-- (A) Qualified Charitable Distribution From 1099-R $ ----
Notes/Comments ----

Received money from any of the following in 2024:

-- (B) Disability benefits (such as payments from insurance and worker's compensation)
(To be completed by certified volunteer) Income to be included

-- (B) Disability benefits on 1099-R or W-2 # ----
Notes/Comments ----

Received money from any of the following in 2024:

-- (B) Social Security or Railroad Retirement Benefits
(To be completed by certified volunteer) Income to be included

-- (B) SSA-1099, RRB-1099 # ----
Notes/Comments ----

Received money from any of the following in 2024:

-- (B) Unemployment benefits
(To be completed by certified volunteer) Income to be included

-- (B) 1099-G # ----
Notes/Comments ----

Received money from any of the following in 2024:

-- (B) Refund of state or local income tax
(To be completed by certified volunteer) Income to be included

-- (B) Refund $ ----
-- (B) Itemized last year
-- Yes
-- No
Notes/Comments ----

Received money from any of the following in 2024:

-- (B) Interest or dividends (bank account, bonds, etc.)
(To be completed by certified volunteer) Income to be included

-- (B) 1099-INT # ----
-- (B) 1099-DIV # ----
Notes/Comments ----

Received money from any of the following in 2024:

-- (A) Sale of stocks, bonds or real estate
Did you report a loss on last year's return
-- Yes
-- No
(To be completed by certified volunteer) Income to be included

-- (A) 1099-B (include brokerage statement) # ----
-- Capital loss carryover
-- Yes
-- No
Notes/Comments ----

Received money from any of the following in 2024:

-- (B) Alimony
(To be completed by certified volunteer) Income to be included

-- (B) Alimony $ ----
Excluded from income
-- Yes
-- No
Notes/Comments ----

Received money from any of the following in 2024:

-- (A/M) Income from renting out your house or a room in your house
If yes, did you use the dwelling unit as a personal residence and rent it for fewer than 15 days
-- Yes
-- No
-- Income from renting personal property such as a vehicle
(To be completed by certified volunteer) Income to be included

-- (A/M) Rental income (Advanced when the dwelling is a personal residence and rented for fewer than 15 days)
-- Rental expense $ ----
Notes/Comments ----

Received money from any of the following in 2024:

-- (B) Gambling winnings, including lottery
(To be completed by certified volunteer) Income to be included

-- (B) W-2G or other gambling winnings (list losses below if taxpayer can itemize deductions) # ----
Notes/Comments ----

Received money from any of the following in 2024:

-- (A) Payments for contract or self-employment work
Did you report a loss on last year's return
-- Yes
-- No
(To be completed by certified volunteer) Income to be included

-- (A) Schedule C
-- 1099-MISC # ----
-- 1099-NEC # ----
-- 1099-K # ----
-- Other income reported elsewhere
-- Schedule C expenses $ ----
Notes/Comments ----

Received money from any of the following in 2024:

-- Any other money received during the year? (example: cash payments, jury duty, awards, digital assets, royalties, union strike benefits)
(To be completed by certified volunteer) Income to be included

-- Other income (see Pub 4012 for guidance on other income, i.e., scope of service chart)
Notes/Comments ----

Catalog Number 52121E
www.irs.gov
Form 13614-C (Rev. 11-2024)

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Expenses and Tax Related Events: Answer the questions on the left side of this page. Check only the boxes that apply to you and/or your spouse.

Paid any of the following expenses to itemize in 2024?

-- (A) Mortgage Interest
-- (A) Taxes: state, local, real estate, sales, etc.
-- (A) Medical, dental, prescription expenses
-- (A) Charitable contributions
(To be completed by certified volunteer) Standard or Itemized Deductions

-- (A) 1098 # ----
-- (B) Standard deduction
-- (A) Itemized deduction
Notes/Comments ----

Paid any of these expenses in 2024?

-- (B) Student loan interest
(To be completed by certified volunteer) Expenses to report

-- (B) 1098-E
Notes/Comments ----

Paid any of these expenses in 2024?

-- (B) Child and dependent care
(To be completed by certified volunteer) Expenses to report

-- (B) Child and dependent care credit
Notes/Comments ----

Paid any of these expenses in 2024?

-- (B/A) Contributions to a retirement account
(To be completed by certified volunteer) Expenses to report

-- (B/A) IRA (Basic if a Roth IRA or 401K)
Notes/Comments ----

Paid any of these expenses in 2024?

-- (B) School supplies by a teacher, teacher's aide or other educator
(To be completed by certified volunteer) Expenses to report

-- (B) Educator expenses deduction $ ----
Notes/Comments ----

Paid any of these expenses in 2024?

-- (B) Alimony payments (do not include child support)
(To be completed by certified volunteer) Expenses to report

-- (B) Alimony payments with spouse's SSN $ ----
Adjustment to income
-- Yes
-- No
Notes/Comments ----

Did any of the following happen during 2024?

-- (B) You or someone in your family took educational classes (technical school, college, job related, etc.)
(To be completed by certified volunteer) Information to report

-- (B) Taxable scholarship income
-- (B) 1098-T (itemized statement from school, invoice, etc.)
-- (B) Education credit or tuition and fees deduction
Notes/Comments ----

Did any of the following happen during 2024?

-- (A) Sell a home
(To be completed by certified volunteer) Information to report

-- (A) Sale of home (1099-S)
Notes/Comments ----

Did any of the following happen during 2024?

-- (A) Have a health savings account (HSA)
(To be completed by certified volunteer) Information to report

-- HSA contributions
-- HSA distributions
Notes/Comments ----

Did any of the following happen during 2024?

-- (A) Purchase health insurance through the Marketplace (Exchange)
(To be completed by certified volunteer) Information to report

-- (A) 1095-A
Notes/Comments ----

Did any of the following happen during 2024?

-- (A) Purchase and install energy-efficient home items (example: windows, furnace, insulation, etc.)
(To be completed by certified volunteer) Information to report

-- (B) Energy efficient home improvement credit
Notes/Comments ----

Did any of the following happen during 2024?

-- (A) Have credit card, mortgage, or other debt cancelled/forgiven by a lender
(To be completed by certified volunteer) Information to report

-- (A) 1099-C
Notes/Comments ----

Did any of the following happen during 2024?

-- (A) Have a loss related to a declared Federal disaster area
(To be completed by certified volunteer) Information to report

-- (A) 1099-A
-- Disaster relief impacts return
Notes/Comments ----

Did any of the following happen during 2024?

-- (B) Have a tax credit disallowed (example: earned income credit, child tax credit, or American opportunity credit)
(To be completed by certified volunteer) Information to report

-- (B) EITC, CTC, AOTC or HOH disallowed in a previous year
Year disallowed ----
Reason ----
Notes/Comments ----

Did any of the following happen during 2024?

-- Receive any letter or bill from the IRS
(To be completed by certified volunteer) Information to report

-- Eligible for Low Income Taxpayer Clinic referral
Notes/Comments ----

Did any of the following happen during 2024?

-- (B) Make estimated tax payments or apply last year's refund to 2024 taxes
(To be completed by certified volunteer) Information to report

-- Estimated tax payments ----
-- Last year's refund applied to this year ----
-- Last year's return available
Notes/Comments ----

Catalog Number 52121E
www.irs.gov
Form 13614-C (Rev. 11-2024)

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Optional Information

The following information is for statistical purposes only. Your responses to these questions are not a part of your tax return and are not transmitted to the IRS with your tax return. You are not required to answer these questions.

1. Would you say you can carry on a conversation in English
-- Very well
-- Well
-- Not well
-- Not at all
-- Prefer not to answer
2. Would you say you can read a newspaper in English
-- Very well
-- Well
-- Not well
-- Not at all
-- Prefer not to answer
3. Do you or any member of your household have a disability
-- Yes
-- No
-- Prefer not to answer
4. Are you or your spouse a Veteran of the U.S. Armed Forces
-- Yes
-- No
-- Prefer not to answer
5. What is your race and/or ethnicity? Select all that apply
-- American Indian or Alaska Native (for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.)
-- Asian (for example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.)
-- Black or African American (for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.)
-- Hispanic or Latino (for example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.)
-- Middle Eastern or North African (for example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.)
-- Native Hawaiian or Pacific Islander (for example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.)
-- White (for example, English, German, Irish, Italian, Polish, Scottish, etc.)
6. What is your spouse's race and/or ethnicity? Select all that apply
-- American Indian or Alaska Native (for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.)
-- Asian (for example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.)
-- Black or African American (for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.)
-- Hispanic or Latino (for example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.)
-- Middle Eastern or North African (for example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.)
-- Native Hawaiian or Pacific Islander (for example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.)
-- White (for example, English, German, Irish, Italian, Polish, Scottish, etc.)

Privacy Act and Paperwork Reduction Act Notice

We are asking for this information so you may participate in the IRS Volunteer Income Tax Assistance (VITA) and Tax Counseling for the Elderly (TCE) program which provides IRS-certified volunteer income tax preparers to assist with basic income tax return preparation for qualified individuals. The IRS authority to collect this information is 5 U.S.C. section 301 and 26 U.S.C. section 7801. The information you provide may be disclosed to others who coordinate VITA/TCE staffing, outreach, and other VITA/TCE related activities. The IRS may only disclose your return and return information as provided by 26 U.S.C. section 6103. All other records may be disclosed only for purposes the IRS deems are compatible with the purpose for which IRS collected the records, and consistent with any routine use disclosures described in the System of Record Notice (SORN) Treasury/IRS 24.030, Customer Account Data Engine (CADE) Individual Master File (IMF). You may view Treasury/IRS SORNs on the Treasury SORN website at Treasury.gov/System of Records Notices (SORNs). Providing this information is voluntary however, if you do not provide the requested information the IRS volunteers may not be able to assist you with preparing and filing your tax return.

The Paperwork Reduction Act requires that the IRS display an OMB control number on all public information requests. The OMB Control Number for this study is 1545-1964. Also, if you have any comments regarding the time estimates associated with this study or suggestion on making this process simpler, please write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:TS:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224.

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Additional Notes/Comments ---- entire page

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Department of the Treasury - Internal Revenue Service

Form 15080
(October 2024)
Consent to Disclose Tax Return Information to VITA/TCE Tax Preparation Sites

Federal Disclosure:

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.

Terms:

Global Carry Forward of data allows TaxSlayer LLC, the provider of the VITA/TCE tax software, to make your tax return information available to ANY volunteer site participating in the IRS's VITA/TCE program that you select to prepare a tax return in the next filing season. This means you will be able to visit any volunteer site using TaxSlayer next year and have your tax return populate with your current year data, regardless of where you filed your tax return this year. This consent is valid through November 30, 2026.

The tax return information that will be disclosed includes, but is not limited to, demographic, financial and other personally identifiable information, about you, your tax return and your sources of income, which was input into the tax preparation software for the purpose of preparing your tax return. This information includes your name, address, date of birth, phone number, SSN, filing status, occupation, employer's name and address, and the amounts and sources of income, deductions and credits that were claimed on, or contained within, your tax return. The tax return information that will be disclosed also includes the name, SSN, date of birth, and relationship of any dependents that were claimed on your tax return.

You do not need to provide consent for the VITA/TCE partner preparing your tax return this year. Global Carry Forward will assist you only if you visit a different VITA or TCE partner next year that uses TaxSlayer. You have the right to receive a signed copy of this form.

Limitation on the Duration of Consent: I/we, the taxpayer, do not wish to limit the duration of the consent of the disclosure of tax return information to a date earlier than presented above (November 30, 2026). If I/ we wish to limit the duration of the consent of the disclosure to an earlier date, I/we will deny consent.

Limitation on the Scope of Disclosure: I/we, the taxpayer, do not wish to limit the scope of the disclosure of tax return information further than presented above. If I/we wish to limit the scope of the disclosure of tax return information further than presented above, I/we will deny consent.

Consent:

I/we, the taxpayer, have read the above information.

I/we hereby consent to the disclosure of tax return information described in the Global Carry Forward terms above and allow the tax return preparer to enter a PIN in the tax preparation software on my behalf to verify that I/we consent to the terms of this disclosure.

Primary taxpayer printed name and signature ----
Date ----
Secondary taxpayer printed name and signature ----
Date ----

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484. Report a Crime or IRS Employee Misconduct - U.S. Treasury Inspector General for Tax Administration (TIGTA) (https://www.tigta.gov/reportcrime-misconduct).

Catalog Number 39573K
www.irs.gov
Form 15080 (Rev. 10-2024)
       