Residency Determination Form VITA Residency Determination Form My name is:* First Last or Family Name My email address Is (please use UConn address if applicable):* In 2019, did you earn taxable income in any U.S. state other than the State of Connecticut?*YesNoPLEASE NOTE: unfortunately, because you have income from outside the state of Connecticut, your tax return is "out of scope" for UConn's VITA program. In other words, we cannot complete your return, either federal or state. You are welcome to continue using this form to determine your filing status, however any appointment you make with VITA will be cancelled without notice. Please visit our "What are my options if I cannot attend a VITA session?" webpage for more information.*I understand that UConn VITA cannot prepare my 2019 tax return. I agree to continue using this form for my information only and with the understanding that any appointment I make with UConn VITA this year will be invalid and will be cancelled.I understand that UConn VITA cannot prepare my 2019 tax return and that any appointment I make with UConn VITA will be invalid and cancelled. I choose not to continue with this form and ask that my entry be deleted.Please indicate the date of your appointment with UConn VITA.* Date Format: MM slash DD slash YYYY The last four digits of my social security number or ITIN are:*My seven-digit UConn Peoplesoft number is (if you are not affiliated with UConn please enter "1" seven times):*Have you, your spouse or dependents been issued an Identity Protection PIN by the IRS as a result of having been a victim of tax related identity theft?*YesNoPlease indicate the language in which you are most comfortable speaking. If possible, we will match you with a preparer fluent in your preferred language.*Were you a U.S. Citizen or Green Card Holder the entire 2019 year?*YesNoWhat is your marital status?*Single / DivorcedMarried (even if spouse does not reside in the U.S.)Widowed / Widower (spouse passed prior to 2019)What is your marital status?*Single / DivorcedMarried (even if spouse does not reside in the U.S.)As a married U.S. Citizen, please indicate your choice of filing status for the 2019 tax year.*Married filing jointlyMarried filing separatelyIf you are unmarried, paid more than half the cost of keeping up a home and have a qualified dependent who lived with you for more than half the year (or a parent who qualifies as a dependent but did not live with you), you may qualify for Head of Household status. Do you believe this applies to you?*YesNoDid your spouse pass during either 2017 or 2018 and were you entitled to file a joint return for the tax year in which your spouse passed?*YesNoDo you have a child, stepchild, or adopted child who qualifies as your dependent for the 2019 tax year, AND, did this person live with you for the entire year, AND did you pay more than have the cost of keeping up your home for the year?*YesNoResidency DeterminationAs you have indicated you are not a U.S. Citizen, In this section we will be determining your residency status for federal tax filing purposes. This will help us to establish the tax law which applies to you, and any income tax treaties for which you might be eligible.I am a full-time student on an F, J, M or Q visa*YesNoI am a teacher, trainee or researcher on a J-1 visa*YesNoI am not in the U.S. as a student, teacher, trainee or researcher on F, J, M or Q visa status. My visa status and primary visit activity is:*Have you been in the U.S. (other than as a tourist) for any part of more than 5 calendar years, NOT including 2020?*YesNoHave you been in the U.S. (other than as a tourist) for any part of 2 of the preceding 6 calendar years (2013-2018)?*YesNoDuring which of the following years were you present in the U.S. (other than as a tourist), for one day or more? Be sure to include years you were present as a spouse or child of an F, H, J, M, or Q visa holder)* 2012 2013 2014 2015 2016 2017 2018 2019 Additional years prior to 2011 (please indicate in the next question) Indicate any years other than 2012 - 2019 that you were present in the U.S. (other than as a tourist) for one day or more. Be sure to include years you were present as a spouse or child of an F, H, J, M or Q visa holder).Please select your Country of CitizenshipAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweImmediately prior to entering the U.S. as a student, teacher or trainee, were you residing in a country other than your country of citizenship?*YesNoYou have indicated that you were residing in a country other than your country of citizenship immediately prior to entering the U.S. as a student, teacher or trainee. Please provide the name of the country, and explain the purpose and duration of your time in that country, immediately prior to entering the U.S.*State of ResidencyPlease note that the "State Residency" is different from residency for federal filing purposes. In this section, we are simply trying to determine the state in which you live while in the U.S., regardless of your country of citizenship.Indicate which of the following applies to you.*NOTE: "183 days" represents approximately 6 months. If you began living in CT on or prior to July 2, 2019, you lived here for more than 183 days. If you maintained an apartment in CT for all except the summer months, you lived here for more than 183 days.I am NOT a U.S. Citizen. My permanent residence is outside of the U.S., however I lived in a home that I own, a rented apartment or the dorms while attending school, teaching or performing research in the U.S. for more than 183 days (see NOTE, below).I am NOT a U.S. Citizen. I moved to CT from another country subsequent to July 2, 2019.I am a U.S. Citizen and I lived with my family in their owned or rented home in CT for all of 2019, unless I was living in a dorm.I am a U.S. Citizen and my family lives in a state other than CT, however I rented and lived in an apartment in CT for more than 183 days of 2019 (see NOTE, below).I am a U.S. Citizen and I changed my permanent residence by moving into or out of CT during the year 2019.I am a U.S. Citizen and my family lives in a U.S. state other than CT and I lived in the dorms while attending school in CT.By clicking this button and scheduling an appointment with VITA, I consent to the disclosure of any tax information reportable to me on Form 1042-S to the VITA Program Administrator by the UConn Tax & Compliance and Payroll Departments for the exclusive purpose of preparing my income tax return(s).* I agree.I certify that that information provided in this form is true to the best of my knowledge. I understand that the information provided will be used in the determination of my filing status for the purpose of completing my tax return. I further acknowledge that I am responsible for the accuracy of this information and any errors made in the preparation of my tax return, based on erroneous or incorrect information I have provided, is my responsibility.* I agree.