Fillable U.S./Canadian Interview Sheet (H&R Block Canada)

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U.S./Canadian Interview Sheet (H&R Block Canada)

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The U.S./Canadian Interview Sheet (H&R Block Canada) form is 4 pages long and contains:

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  • 200 other fields

Country of origin: CANADA
File type: PDF

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U.S./Canadian Interview Sheet
Completing the U.S./Canadian Interview Sheet will help H&R Block match you with one of our 200+ dedicated U.S.
Tax Professionals. If you’re unsure how to answer any of the below, our U.S. Tax Professional will discuss with
you in more detail during your interview.
Taxpayer information
Date of birth:
SSN:
Name:
Phone number:
Address:
U.S. Determination
Are you an American Citizen? Yes No
Do you hold a Green Card?
Yes No
Were you on a U.S. Work Visa?
Yes No
Visa number:
Dates valid from: to:
Date entered the U.S.:
Date left the U.S.:
Have you led a U.S. return before? Yes No Last year led:
Do you have any RRSPs? Yes No
Do you have any Tax Free Savings Accounts?
Yes No
Do you have any RESPs or Mutual Funds?
Yes No
Do you have any non-US bank/investment accounts that at
any point in the year had an aggregate total of at least $10,000
(Even if the total may have only been achieved for one day)
Yes No
Is your spouse a US citizen?
Yes No ITIN#
Social Security#
Is your child a US citizen? Yes No ITIN#
Social Security#
92452Page 1 of 2© H&R Block Canada, Inc. 2019
ITIN#
Social Security#
ITIN#
Social Security#
ITIN#
Social Security#
Please provide the ITIN or Social Security number for each child.
ITIN#
Social Security#
92452Page 2 of 2© H&R Block Canada, Inc. 2019
Did you maintain bank accounts in Canada? Yes No
Did you completely sever your ties with Canada?
Yes No
Is this your rst time ling a Canadian return?
Yes No
Have you claimed worldwide income on your Canadian return?
Yes No
Will we complete a Canadian return?
Yes No
If yes, what location?
Date receivedName of receiver
Year Month Day
Canadian Determination
Are you working in Canada? Yes No
Canadian income since return to Canada:
Did you maintain a residence in Canada? Yes No
Do Not Email
Welcome to H&R Block! Please ll out the following form. Provide as much detail as possible.
If you have any quesons while compleng this form, please do not hesitate to ask.
Once your tax return is ready, the Tax Professional will contact you to set up an appointment to nalize your tax return.
Client Informaon:
First Name: Inial: Last Name :
Social Insurance Number (SIN): Date of birth:
dd
/
mm
/
yyyy
Address:
City: Province: Postal Code:
Preferred contact method: ■ Phone ■ Email Preferred method to review tax return: ■ In person ■ By phone
Phone : Alternate phone number:
Best me to call: Email:
Marital Status on December 31 last year:
■ Single ■ Married ■ Common-law ■ Widowed ■ Separated ■ Divorced
Spouse or Common-law partner informaon: (if applicable)
Last Name First Name Date of Birth Net Income Post-secondary Student Disabled
dd/mm/yyyy
■ yes ■ no ■ yes ■ no
Dependents*: (if applicable) Children, parents, grandparents, etc - living at the same address
Last Name First Name Date of Birth Net Income Relaonship Post-secondary
Student
Disabled
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
*Require Dependent's SIN during Tax Interview See reverse for addional space
1. a) Are you a U.S. Cizen by birth or bloodline? b) Do you meet the Green Card Test (Lawful Permanent Resident of U.S.)?
c) Were you PHYSICALLY PRESENT in U.S. at least 183 days during current year?
(checkYesifanyofthequesonsabovearetrue) YES ■ NO ■
2. Do you have an incorporated business? YES ■ NO ■
3. Do you need to complete an Estate Return or le for a deceased person? YES ■ NO ■
4. Are you self-employed, did you own your own business or did you work for a placement agency? YES ■ NO ■
5. Are you currently in Bankruptcy status? YES ■ NO ■
6. Did you work outside Canada or have foreign employment or foreign pension income? YES ■ NO ■
7. Excluding RRSPs, do you have any investments, own any rental properes or sell your principal residence last year? YES ■ NO ■
8. Are you claiming employment expenses (didyouremployerreimburseyouforoceorvehicleexpenses)? YES ■ NO ■
9. Did you move to Canada last year or switch provinces? YES ■ NO ■
10. Are we preparing more than one return for you today? YES ■ NO ■
Do you have a preferred Tax Professional? (Pleaseprovidename)
Any other informaon:
© H&R Block Canada, Inc. 2018
91104-4 02 -18
Easy Drop-Off
Start here - fillable form
dd
mm
yyyy
dd-mm-yyyy
Do Not Email
Easy Drop-Off continued
Dependents*: (if applicable) Children, parents, grandparents, etc - living at the same address
Last Name First Name Date of Birth Net Income Relaonship Post-secondary
Student
Disabled
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
*Require Dependent's SIN during Tax Interview
© H&R Block Canada, Inc. 2018
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U.S.Canadian Interview Sheet (H&R Block Canada)

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Completed 4 April 2021

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