Minnesota Intake Questionnaire

1

Name* This field is required.Please enter your name as it would appear on your Social Security card. This will allow us to match this questionnaire with your return.

First Name

Last Name

2

Minnesota Residence: How long did you live in Minnesota during 2022?* This field is required.

Resident of MN for all of 2022

Resident of MN part of the year (moved to or from Minnesota to another state)

Lived in MN > 183 days but considered the resident of another state

3

When did you live in Minnesota during 2022?* This field is required.NEXT

From (mm/dd)

To (mm/dd)

4

What other states did you live in?* This field is required.

5

Did you receive Frontline Worker's Pay of $487.45 in 2022?* This field is required.

YESNO

6

Did you spread federal income tax on a distribution from a retirement account over 3 years in 2022?* This field is required.

YESNO

7

Did you work in a different state while living in MN?* This field is required.

YESNO

8

Did you telecommute for a job in another state while working in MN?* This field is required.

YESNO

9

Did you use the itemized deduction on your 2022 MN tax return?* This field is required.

YESNO

10

Did you receive a MN property tax rebate (M1PR) in 2022?* This field is required.

YESNO

11

Did you work and live on an Indian Reservation where you are an enrolled member?* This field is required.

YESNO

12

Did you receive pay for training or active service as a member of the National Guard or Reserves?* This field is required.

YESNO

13

Did you receive military retirement or federal active duty pay?* This field is required.

YESNO

14

Did you receive a post-service education award for Americorps service?* This field is required.

YESNO

15

Did you use any of this award to repay a student loan?* This field is required.

YESNO

16

Did you make any contributions to a Qualified Education Savings Account (529 plan)?* This field is required. If yes, you will need to provide information about the account and contribution amount to the preparer.

YESNO

17

Did you experience a stillbirth in 2022? You must have a certificate from the Minnesota Department of Health (MDH).* This field is required.

YESNO

18

Do you have a First Time Home Buyer Savings Account?* This field is required.

YESNO

19

Did you (or your spouse) pay for Long Term Care Insurance?* This field is required.

YESNO

20

Did you (or your spouse) complete a Master's Degree in a Teacher's Licensure Field?* This field is required.

YESNO

21

Did you (or your spouse) make student loan payments?* This field is required.

YESNO

22

Did you make any estimated tax payments to MN or apply part of a previous year's refund to this tax year?* This field is required.

YESNO

23

Did you pay any education expenses for one or more qualifying children attending grades K-12?* This field is required.

YESNO

24

Which MN living situations applied to you?* This field is required.Please choose all situations that applied to you during 2022. This is for the MN Rent/Property tax rebate. Scroll down to see all 6 options.

Owned and occupied a home on 1/3/2023

Rented in MN 2022

Owned a mobile home and rented the lot

Rented a mobile home and rented the lot

Owned a mobile home and owned the lot

Did not pay rent to a landlord or property tax to the state

25

How many 2022 Certificates of Rent Paid (CRP) do you have?* This field is required.

26

How many 2023 Property Tax Statements do you have or are expecting to be sent from Minnesota?* This field is required.

27

Did you have any income from the following programs: Minnesota Family Investment Program (MFIP), Minnesota Supplemental Aid (MSA), General Assistance (GA) or Minnesota Housing Support (formerly GRH)?* This field is required.

YESNO

28

Did you have any income from Supplemental Security Income (SSI)?* This field is required.

YESNO

29

Did you receive any veteran's benefits or non-taxable military pay?* This field is required.

YESNO

30

Did you have any Workers compensation benefits?* This field is required.

YESNO

31

Did you have any nontaxable scholarships or educational grants?* This field is required.

YESNO

32

Did you make an employee contribution to a medical expense account like a Flexible Spending Account (FSA)? * This field is required. Note: This does not include a Health Spending Account (HSA) for a high deductible insurance plan.

YESNO

33

Did you have a nontaxable gain on the sale of a home?* This field is required.

YESNO

34

Did you have income from Diversionary Work Program (DWP)?* This field is required.

YESNO

35

Did you have income from Emergency Assistance?* This field is required.

YESNO

36

Did you have alimony income not included on the federal return?* This field is required.

YESNO

37

Did you have any cancelled, discharged, or forgiven debt not included on your federal return?* This field is required.

YESNO

38

Did you receive any foster care payments?* This field is required.

YESNO

39

Did you have any other nontaxable income?* This field is required.

YESNO

40

Does anyone live with you that is not a dependent, parent (unless the parent is a co-owner), or renter?* This field is required. If yes, we will need to know the amount of their taxable and nontaxable income to complete the property tax rebate.

YESNO

41

Any other information about your tax situation?* This field is required.