VITA Appointment Intake Form

Welcome! We're so glad you have chosen our VITA site to help you with your tax return requirement this year!

The following Intake Form has been redesigned for the 2024 tax season. After completing this form, you will not need to manually complete Form 13614-C or -NR, as has been necessary in the past.

However, you must complete this form as accurately as possible, as we will rely on the information you provide to complete your tax return. It is also critical that you complete this form well in advance of your appointment, to ensure we can complete your return both effectively and efficiently.

The questions you will be asked are the equivalent of those on Form 13614-C and -NR, with a few extra questions for our clients with citizenship outside of the United States. Thus, please review these forms, as applicable to your circumstances, before you begin. While our online form is in English, Form 13614-C is available in 23 languages.

If you are a U.S. Citizen or Resident Alien, please click here to select Form 13614-C, in the appropriate language for you.
For Nonresident Aliens, unfortunately, Form 13614-NR is only published in English. This form can be found here.

How do I know if I am a Resident Alien or Nonresident Alien for tax purposes?

A general idea of your total income for 2023, including wages, scholarships/fellowships, investment, retirement, and unemployment income.
All 2023 fee bills and/or Forms 1098-T for all post-secondary students included in your tax return, in pdf, jpg, gif, or png form. Pdf is strongly preferred.
- If you or someone in your household is a UConn student, please see this guidance for accessing and downloading your fee bills.
For divorced taxpayers, the date of your divorce decree.
For legally separated taxpayers, the date of your separate maintenance decree.
The amount of any estimated tax payments made by you (and/or your spouse) toward this year's tax. This does not include any withholdings by your employer(s).
The amount of any prior year tax refund applied by you (and/or your spouse) toward this year's tax.

A general idea of your total income for 2023, including wages, scholarships/fellowships, investment, retirement, and unemployment income. In making this calculation, do not exclude any income that may be exempt due to a treaty with your country of citizenship.
Your passport number
Determine whether or not you will be receiving a 1042-S form for your wages. If you are unsure, please see the first section at this website.
If you are a student, all 2023 fee bills and/or Forms 1098-T from the institution you attended in 2023 in pdf, jpg, gif, or png form. Pdf is strongly preferred.
- If you are a UConn student, please see this guidance for accessing and downloading your fee bills.
The number of days you were present in the U.S. for the years 2021, 2022, and 2023.
Dates of U.S. travel for all years in pdf, jpg, gif, or png form. Pdf is strongly preferred.
- You can access your Travel History here. Please do not provide your "Official I-94" document, unless you were in the U.S. for all of 2023.
- This is a required document, so if you did not enter or depart the U.S. in 2023, please provide a statement to that effect in the same format.
The name, phone number, and address of your academic program director at the educational institution you attended in 2023.

This form is a prerequisite to attending a VITA appointment, intended to improve accuracy and efficiency during the in-person appointment. Please be sure to complete this form accurately, as we will be relying on the information provided here to complete your tax return. Chrome is the recommended browser. Use of any other browser may cause problems in the display of information and/or ability to upload the necessary forms.

"*" indicates required fields

Name*

First Last or Family Name

Please indicate the date of your appointment with UConn VITA.*

Please indicate the time of your appointment with UConn VITA.*

Your seven-digit UConn Peoplesoft number is (if you are not affiliated with UConn please enter "1" seven times):*

Email address (please use UConn address if applicable):*

Please be sure to use the same email address as the address you entered when scheduling your appointment. This is critical to ensure we are able to match your data with your appointment.

Enter Email Confirm Email

In 2023, did you earn taxable income in any U.S. state other than the State of Connecticut?*

Yes

Is the other state, in which you earned income, a state without an income tax? Those are Alaska, Florida, New Hampshire, Nevada, South Dakota, Tennessee, Texas, Washington, and Wyoming.*

Yes

PLEASE NOTE: Unfortunately, because you have income from an income-taxing state other than the state of Connecticut, your tax return is "out of scope" for UConn's VITA program. In other words, by law, we cannot complete your return, either federal or state. We will regretfully cancel your appointment upon receipt of this entry to free up space for other clients. If you have answered the previous question in error, please fix your entry and continue. Otherwise, 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 20223 tax return and that any appointment I make with UConn VITA will be invalid and canceled to make room for taxpayers with circumstances within our scope of operations.

Residency Determination Data

PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE The Privacy Act of 1974 requires that when we ask for information we tell you our legal right to ask for the information, why we are asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for information is 5 U.S.C. 301. We are asking for this information to assist us in contacting you relative to your interest and/or participation in the IRS volunteer income tax preparation and outreach programs. The information you provide may be furnished to others who coordinate activities and staffing at volunteer return preparation sites or outreach activities. The information may also be used to establish effective controls, send correspondence and recognize volunteers. Your response is voluntary. However, if you do not provide the requested information, the IRS may not be able to use your assistance in these programs. 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 1545-2075. 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:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224.

Were you a U.S. Citizen, Resident Alien, or Green Card Holder the entire 2023 year?*

Yes

Part 1 - Your Personal Information

Address*

For state, please enter only the two letter state abbreviation. For example, instead of "Connecticut," please enter "CT".

Street Address City State / Province / Region ZIP / Postal Code

Best contact number*

Your Date of Birth*

Last year, were you:*

Please select all that apply.

a full-time student

totally and permanently blind

legally blind

none of the above

You have indicated you are a full-time student. Please upload form(s) 1098-T from the institution(s) you attended in 2023. If you were not issued a 1098-T, please upload all 2023 fee bills produced for you by the Bursar's Office..*

Please note: You may a fee bill for terms in which you did not attend classes. For example, if you did not attend classes in the summer, but did receive a scholarship or fellowship during that term, you will have a fee bill for the summer session. In order to serve you efficiently and complete your tax return accurately, we must have all fee bills applicable to you well in advance of your appointment.

Drop files here or

Accepted file types: pdf, jpg, gif, png, Max. file size: 250 MB.

Can anyone claim you as a dependent?*

Yes

Unsure

Your job title*

Part II - Marital Status and Household Information

As of December 31, 2023, what was your marital status?*

Never married

Married

Divorced

Legally Separated

Widowed / Widower

Did you get married in 2023?*

Yes

Did you live with your spouse during any part of the last six months of 2023?*

Yes

Date of final divorce decree*

Date of separate maintenance decree*

Year of spouse's death*

As a married taxpayer, please indicate your choice of filing status for the 2023 tax year.*

PLEASE NOTE: if you intend to file jointly with your spouse, your spouse must be present, in-person, for the entire length of your appointment. Children are welcome, if you need to bring them along!

Married filing jointly

Married filing separately

Spouse's Name*

First Last

Spouse's best contact number*

Your Spouse's Date of Birth*

Your spouse's job title*

Is your spouse a U.S. citizen?*

Yes

Can anyone claim your spouse as a dependent?*

Yes

Unsure

Last year, was your spouse:*

Please select all that apply.

a full-time student

totally and permanently blind

legally blind

none of the above

You have indicated your spouse is a full-time student. Please upload form(s) 1098-T from the institution(s) your spouse attended in 2023. If your spouse was not issued a 1098-T, please upload all 2023 fee bills produced for your spouse by the Bursar's Office.*

Please note: Students may be issued a fee bill for terms in which they did not attend classes. For example, if they did not attend classes in the summer, but did receive a scholarship or fellowship during that term, they will have a fee bill for the summer session. In order to serve you efficiently and complete your tax return accurately, we must have all fee bills applicable to any students on your tax return well in advance of your appointment.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 250 MB.

Did you have one or more qualified dependent(s)?*

Simply put, the IRS defines a dependent as a qualifying child (under age 19 or under 24 if a full-time student, or any age if permanently and totally disabled) or a qualifying relative. In general, A qualifying dependent can have income but cannot provide more than half of their own annual support. There are many other qualifications that we will discuss further, if necessary, during your appointment.

Yes

Have you, your spouse, or dependents been a victim of tax related identity theft or been issued an Identity Protection PIN?*

Yes (If yes, please be sure to bring your Identity Protection PIN to your appointment. Your tax return cannot be efiled without it)

Part III - Income

Last year, did you or your spouse receive wages or salary (Form W-2)?*

Yes

How many jobs did you (and your spouse) have last year?*

Last year, did you or your spouse receive any of the following basic income items?*

Please select all that apply.

Last year, did you or your spouse receive any of the following more advanced income items?*

Please select all that apply.

Unreported tip income

Self-Employment income on Form 1099-NEC, 1099-K, cash, digital assets, or other property or services)

Cash/Check/Digital assets, or other property or services for any work performed, not reported on Forms W-2 or 1099

Income (or loss) from the sale or exchange or stocks, bonds, digital assets or real estate (including your home) (Forms 1099-S, 1099-B)

Income (or loss) from rental property

Other income (digital assets, Sch K-1, royalties, foreign income, etc.)

None of the above

Part IV - Expenses

Last year, did you (or your spouse) pay alimony or separate maintenance payments?*

Yes

Do you have the recipient's Social Security Number?*

Yes

Last year, did you (or your spouse) make contributions or repayments to any of the following types of retirement accounts?*

Please select all that apply.

IRA

Roth IRA

401K

Other

None of the above

Last year, did you (or your spouse) pay any of the following?

Please select all that apply.

College or post-secondary educational expenses for yourself, spouse or dependents (form 1098-T)

Medical and/or dental expenses (including insurance premiums), in total, greater than 7.5% of your income

Taxes not including federal income taxes (state, real estate, personal property, sales)

Mortgage interest (form 1098)

Charitable contributions

Child or dependent care expenses such as daycare

For supplies used as an eligible educator (K-12th grade) such as a teacher, teacher's aide, counselor, etc.

Expenses related to self-employment income or any other income you received

Student loan interest (Form 1098-E)

Part V - Life Events

Last year, did you (or your spouse)*

Please select all that apply.

Have a Health Savings Account?

Have credit card, student loan or mortgage debt cancelled/forgiven by a lender or have a home foreclosure? (Forms 1099-C, 1099-A)

Adopt a child?

Have Earned Income Credit, Child Tax Credit or American Opportunity Credit disallowed in a prior year?

Purchase and install energy-efficient home items? (such as windows, furnace, insulation, etc.)

Receive the First Time Homebuyers Credit in 2008?

File a federal return last year containing a “capital loss carryover” on Form 1040 Schedule D?

Have health coverage through the Marketplace (Exchange)? [Provide Form 1095-A]

None of the above.

Last year, did you (or your spouse) make estimated tax payments or apply last year's refund to this year's tax?*

Yes

If so, how much?*

Resident / Non-resident Alien Section

Your Passport Number*

Phone*

Date of Birth*

Were you ever a U.S. Citizen?*

Yes

Are you a student-athlete attending UConn on scholarship?*

Yes

Have you been a victim of tax related identity theft and/or been issued an Identity Protection PIN?*

Yes (If yes, please be sure to bring your Identity Protection PIN to your appointment. Your tax return cannot be efiled without it)

U.S. Local Address

For state, please enter only the two letter state abbreviation. For example, instead of "Connecticut," please enter "CT".

Street Address City State / Province / Region ZIP / Postal Code

Please select your Country of Citizenship*

PLEASE NOTE: this field automatically populates "Afghanistan." Please be sure to change this if it does not apply to you!

Please consider the following and answer accordingly.*

You have indicated you are from a country whose income tax treaty with the U.S. contains provisions that retroactively eliminates benefits if the allowable period in the U.S. or income amounts are exceeded as defined in the treaty. This means that if you 1) use the treaty to exempt your income from tax and 2) stay in the U.S. for more than four years (Germany), or two years (Luxembourg), you will owe any taxes which were excluded during those prior years.

Yes, I am aware of the provisions and nonetheless choose to use the treaty to reduce my tax liability for the 2023 tax year.

Yes, I am aware of the provisions and choose NOT to use the treaty to reduce my tax liability for the 2023 tax year.

What is the country that issued your Passport?*

PLEASE NOTE: this field automatically populates "Afghanistan." Please be sure to change this if it does not apply to you!

Immediately prior to entering the U.S. as a student, teacher or trainee, were you residing in a country other than your country of citizenship?*

Yes

You 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.*

Are you married?*

Yes

If "Married" is your spouse in the U.S.?*

Yes

Is your marriage recognized by the state where you will be filing?*

Yes

Are you a U.S. National?*

Yes

What is the first date you entered the U.S., NOT including trips on temporary visitor visas.*

Entry Immigration Status - Check one*

U.S. Immigrant/Permanent Resident

F-1 Student

F-1 Spouse or child of Student

H-1 Temporary Employee

J-1 Exchange Visitor

J-2 Spouse or child of Exchange Visitor

Other

Current Immigration Status - Check one*

U.S. Immigrant/Permanent Resident

F-1 Student

F-2 Spouse or child of Student

H-1 Temporary Employee

J-1 Exchange Visitor

J-2 Spouse or child of Exchange Visitor

Other

You have indicated your current immigration status is J-1. What is the subtype? Check one.

01 Student

02 Short Term Scholar

05 Professor

12 Research Scholar

Other

Please consider the following and answer accordingly.*

You have indicated you are from a country whose income tax treaty with the U.S. contains provisions that retroactively eliminates benefits if the allowable period in the U.S. or income amounts are exceeded as defined in the treaty. This means that if you 1) use the treaty to exempt your income from tax and 2) stay in the U.S. for more than two years you will owe any taxes which were excluded during those prior years.

Yes, I am aware of the provisions and nonetheless choose to use the treaty to reduce my tax liability for the 2023 tax year.

Yes, I am aware of the provisions and choose NOT to use the treaty to reduce my tax liability for the 2023 tax year.

Please consider the following and answer accordingly.*

You have indicated you are from a country whose income tax treaty with the U.S. contains provisions that retroactively eliminates benefits if the allowable period in the U.S. or income amounts are exceeded as defined in the treaty. This means that if you 1) use the treaty to exempt your income from tax and 2) stay in the U.S. for more than two years, you will owe any taxes which were excluded during those prior years.

Yes, I am aware of the provisions and nonetheless choose to use the treaty to reduce my tax liability for the 2023 tax year.

Yes, I am aware of the provisions and choose NOT to use the treaty to reduce my tax liability for the 2023 tax year.

Please consider the following and answer accordingly.*

You have indicated you are from a country whose income tax treaty with the U.S. contains provisions that retroactively eliminates benefits if the allowable period in the U.S. or income amounts are exceeded as defined in the treaty. This means that if you 1) use the treaty to exempt your income from tax and 2) stay in the U.S. for more than two years, you will owe any taxes which were excluded during those prior years.

Yes, I am aware of the provisions and nonetheless choose to use the treaty to reduce my tax liability for the 2023 tax year.

Yes, I am aware of the provisions and choose NOT to use the treaty to reduce my tax liability for the 2023 tax year.

What is the actual primary activity of the visit? Check one.*

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 250 MB.

Have you ever changed your visa type or U.S. immigration status?*

Please do not include changes from or to a visitor visa.

Yes

You have indicated you have changed your visa type or U.S. immigration status. Please indicate the date of the change.*

You have indicated you have changed your visa type or U.S. immigration status. Please indicate the nature and purpose of the change.*

Please do not include changes from or to temporary visitor visas.

Enter the type of U.S. visa you held during 2017.*

U.S. Immigrant/Permanent Resident

F-1 Student

F-1 Spouse or child of Student

H-1 Temporary Employee

J-1 Exchange Visitor

J-2 Spouse or child of Exchange Visitor

None

Other

Enter the type of U.S. visa you held during 2018.*

U.S. Immigrant/Permanent Resident

F-1 Student

F-1 Spouse or child of Student

H-1 Temporary Employee

J-1 Exchange Visitor

J-2 Spouse or child of Exchange Visitor

None

Other

Enter the type of U.S. visa you held during 2019.*

U.S. Immigrant/Permanent Resident

F-1 Student

F-1 Spouse or child of Student

H-1 Temporary Employee

J-1 Exchange Visitor

J-2 Spouse or child of Exchange Visitor

None

Other

Enter the type of U.S. visa you held during 2020.*

U.S. Immigrant/Permanent Resident

F-1 Student

F-1 Spouse or child of Student

H-1 Temporary Employee

J-1 Exchange Visitor

J-2 Spouse or child of Exchange Visitor

None

Other

Enter the type of U.S. visa you held during 2021.*

U.S. Immigrant/Permanent Resident

F-1 Student

F-1 Spouse or child of Student

H-1 Temporary Employee

J-1 Exchange Visitor

J-2 Spouse or child of Exchange Visitor

None

Other

Enter the type of U.S. visa you held during 2022.*

U.S. Immigrant/Permanent Resident

F-1 Student

F-1 Spouse or child of Student

H-1 Temporary Employee

J-1 Exchange Visitor

J-2 Spouse or child of Exchange Visitor

None

Other

Select the years you were present in the United States as a teacher, trainee, student or as an accompanying spouse or dependent of a person in such status for any part of the year.*

2017

2018

2019

2020

2021

2022

I was not in the U.S. during any of the above years.

Have you ever been present in the U.S. PRIOR to 2017 on a teacher, trainee, student visa, or as their accompanying spouse or dependent?*

Yes

If so, what years and what visa type?*

How many days (including vacations, nonworkdays and partial days) were you present in the U.S. during 2021?*

Please enter a number from 0 to 365.

How many days (including vacations, nonworkdays and partial days) were you present in the U.S. during 2022?*

Please enter a number from 0 to 365.

How many days (including vacations, nonworkdays and partial days) were you present in the U.S. during 2023?*

Please enter a number from 0 to 365.

Please upload a photo or pdf file of your TRAVEL HISTORY. The "Official I-94" document is NOT sufficient, unless you were in the U.S. for all of 2023. We need your TRAVEL HISTORY. Thank you!*

If you did not leave the U.S. during 2023, please upload a statement to that effect.

Accepted file types: jpg, gif, png, pdf, Max. file size: 250 MB.

Did you file a U.S. Income tax return for any year before 2023?*

For example, 2022, 2021, etc.

Yes

What was the latest year that you filed a tax return?*

What tax form did you file?*

If you filed a nonresident return, select "1040-NR," if you filed a resident alien or U.S. return with TurboTax, select "1040."

During 2023, did you apply to be a green card holder (lawful permanent resident) of the United States?*

Yes

Do you have an application pending to change your status to lawful permanent resident?*

Yes

Name of the academic institution you attended in 2023*

Phone number of the academic institution you attended in 2023*

Name of your academic/specialized program director*

Phone number of your academic/specialized program director*

Address of your academic/specialized program director*

Street Address City State / Province / Region ZIP / Postal Code

During 2023, did you receive:*

Scholarships or fellowship grants

Wages, salaries or tips (this includes payments for working as a Graduate Assistant)

Interest

Distributions from IRA, pension or annuity

State or local tax refunds

Unemployment compensation

Any other income (gambling, lottery, prizes, awards, self-employment, rents, royalties, virtual currency, etc.)

None of the above

Please select all that apply.

Will you be (or have you) received a Form 1042-S for your wage treaty exemption?*

If "yes," please be sure you bring this form to your VITA appointment.

Yes

During 2023, did you have:*

Casualty losses in a declared disaster area

Student loan interest paid

State or local income taxes (select this if you earned wages during 2023)

U.S. Charitable contributions

Child/Dependent care expenses

IRA contributions

None of the above

Please select all that apply.

Did you or any dependent have health insurance coverage through Healthcare.gov (the Marketplace)?*

Answer "no" if your health insurance is provided through your academic institution.

Yes

Was any Advanced Premium Tax Credit received? (Provide Form 1095-A)*

Answer "no" if your health insurance is provided through your academic institution.

Yes

Additional Information and Questions Related to the Preparation of Your Return

Would you like to receive written communications from the IRS in a language other than English?*

Yes

What language?*

If you are due a refund, would you like Direct Deposit?*

Yes

If you have a balance due, would you like to make a payment directly from your bank account?*

Yes

Did you live in an area that was declared a Federal disaster area?*

Yes

If yes, where?

Did you, or your spouse if filing jointly, receive a letter from the IRS?*

Yes

Additional Comments

Please let us know if there is any information pertinent to the accurate completion of your tax return that has not already been addressed by this form.

State of Residency

Please 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 ("CT" is the abbreviation for Connecticut).

NOTE: "183 days" represents approximately 6 months. If you began living in CT on or prior to Jun 30, 2023, you lived here for more than 183 days.

My permanent residence is outside of the U.S., however I lived in CT for more than 183 days in 2023.

I moved to CT from another state or country on or subsequent to July 2, 2023.

My permanent residence was in CT for all of 2023, either on/near campus or in my family home.

My permanent residence is outside of CT, however I lived a total of more than 183 days in CT during the tax year.

My permanent residence is outside of CT, and I did not live in CT for 183 days or more.

The following question will determine whether you are required to file a CT tax return. Please select all that apply to you.*

I had CT income tax withheld from my wages (this is true if there is a number in box 17 of your Form W-2).

I meet the Gross Income Test (see below) and had income earned in CT.

I did not have CT income tax withheld from my wages, nor do I meet the Gross Income Test.

You meet the Gross Income Test if your gross income* for the 2023 taxable year is greater than: $15,000 as a single taxpayer; $12,000 as taxpayer married filing separately; $19,000 as a head of household filer; or $24,000 as a couple married filing jointly or a taxpayer filing as a qualifying surviving spouse. *Gross income includes but is not limited to: Wages Interest, dividends or capital gains; Alimony; Retirement income; Scholarship/Fellowship income, prizes, and awards; Unemployment compensation; Social Security benefits; and Disability benefits. PLEASE NOTE: income of nonresident aliens, excluded by treaty, should NOT be subtracted from this calculation.

This field is for validation purposes and should be left unchanged.

UConn Volunteer Income Tax Assistance (VITA) Program

Welcome! We're so glad you have chosen our VITA site to help you with your tax return requirement this year!

This survey must be completed in one sitting, and all information is required. Most of the information should be known to you or easily obtained. There are a few items you will need to prepare beforehand, as follows.

U.S. Citizens and Resident Aliens

Nonresident Aliens (Foreign Students and Scholars)

2024 Appointment Intake Form

Residency Determination Data

Part 1 - Your Personal Information

Part II - Marital Status and Household Information

Part III - Income

Part IV - Expenses

Part V - Life Events

Resident / Non-resident Alien Section

Additional Information and Questions Related to the Preparation of Your Return

State of Residency