2024 BNH Extended Income Tax Clinic Screening Pre-Booking Form

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2024 BNH Extended Income Tax Clinic Screening Pre-Booking Form

Please answer the questions below to determine your eligibility for the income tax clinic. This year, it is in-person appointments only. If you qualify, a BNH representative will CALL or EMAIL to book your appointment time (The call might come from a blocked number so please pick up all calls.) Note: Due to the high volume of the applications, it will take 5-7 business days for us to get back to you.

**Please check your inboxes regularly (including junk folder)**

Questions/concerns? Contact taxassistant@burnabynh.ca or call 604-431-0400 (South) or 604-294-5444 (North) or 604-299-5778 (Brentwood)

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Do you have a social insurance number (SIN)? *

Yes

No (If you selected 'no', you are NOT eligible to receive our services. Please look for a paid tax service provider)

Do you live in Burnaby and does your ID show that you live in Burnaby? *

Yes

No (If you selected 'no', you are NOT eligible to receive our services. Please visit https://www.canada.ca/en/revenue-agency/services/tax/individuals/community-volunteer-income-tax-program.html to find a tax clinic in your area)

What was your income for the year(s) that you are filing for? (If your income was above the list below, please find a paid tax service). *

Single individual with an income of $40,000 or less from ALL tax slips per year

Single parent with an income of $45,000 or less from ALL tax slips per year

A couple with an income of $55,000 or less from ALL tax slips per year

Are you self-employed? *

Yes (If you selected 'yes', you are NOT eligible to receive our services. Please look for a paid tax service provider)

No (I have received All my T4(s) from my employer(s)

Have you claimed bankruptcy in the last 5 years? (of the year(s) you are filing for)? *

Yes (If you selected 'yes', you are NOT eligible to receive our services. Please look for a paid tax service provider)

No

Are you filing for a deceased person? *

Yes (If you selected 'yes', you are NOT eligible to receive our services. Please look for a paid tax service provider)

No

Do you have capital gains/losses or investments (mutual funds or stocks?) *

Yes (If you selected 'yes', you are NOT eligible to receive our services. Please look for a paid tax service provider)

No

Do you have business or rental income and expenses? *

Yes (If you selected 'yes', you are NOT eligible to receive our services. Please look for a paid tax service provider)

No

Are you claiming employment expenses? *

Yes (If you selected 'yes', you are NOT eligible to receive our services. Please look for a paid tax service provider)

No

Do you have foreign income or assets? (We can only do US Social Security income) *

Yes (If you selected 'yes', you are NOT eligible to receive our services. Please look for a paid tax service provider)

No

Do you have returns with any investment interest of $1000 or more? *

Yes (If you selected 'yes', you are NOT eligible to receive our services. Please look for a paid tax service provider)

No

For which year(s) are you filing your taxes? (We are only filing taxes for 2021-2023) *

2023

2022

2021

2020-earlier (If you are filing taxes for more than 3 years you can visit https://www.canada.ca/en/revenue-agency/services/tax/individuals/community-volunteer-income-tax-program/need-a-hand-complete-your-tax-return.html, to find another tax clinic that can provide the service.)

Required

Legal full name *

Email (If you do not have an email address, use noemail@gmail.com) *

Main phone (Please ensure that it is correct, or you will not be able to get your taxes done) *

Secondary phone

What is your time preference? (South House (4460 Beresford Street), Brentwood House (2055 Rosser Avenue)), please answer phone calls (block/unknown/private numbers) or check your emails frequently. *Please ONLY select ONE location.
*

Brentwood House - Tuesday 10am-1pm (In person Appointments)

South House - Saturday 1pm-4pm (In person Appointments)

Required

Who are you filing for? (If they are not your partner/spouse/dependent, they need to complete this form and file separately. If your child(ren) is over 18 years old, they need to complete this form and file separately) *

Myself

Partner/spouse/dependent

Required

Do you have a dependent or a child*? (*18 years old or under, or have a physical or mental impairment) *

1 child

2 children

3 children

4 children

5 children

Dependent

No

Do you need an interpreter? *

Yes

No

If 'yes', please indicate in which language

Dari

Farsi

French

Arabic

Spanish

Korean

Mandarin

Cantonese

Other

Clear selection

If 'Other', please specify which language

Have you renewed your BNH Membership since September 1, 2023? *

Yes

No (Please bring $5/person or $10/family cash to renew your membership in person or renew online at https://burnabynh.ca/about_membership/ in order to receive our tax service).

Thank you for completing the pre-screening form! You will receive a phone call or email confirming your eligibility and appointment time within 5 to 7 business days. Please remember to check your spam folders and pick up all blocked/private/no ID phone calls.
*

I understand!

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