SOI-339; SOI-340; SOI-341; SOI-342; SOI-343; and SOI-345

Evaluation of Taxpayer Decision Points for the Wage &
Investment Division of the Internal Revenue Service

Pre-Screening Questionnaire
January 23, 2009

Point of Contact: Karmen W. Carr
Contact Number: 202-223-8877
1220 19th Street, NW, Suite 502
Washington, D.C. 20036

Taxpayer Interviews
Pre-Screening Questionnaire

Opening Statement
Hello, may I speak with _________.
My name is _____, and I am calling you from Hebert Research on behalf of Concentrance
Consulting Group. Concentrance is a Washington, DC based management consulting firm
that is undertaking a study in the _____ area. We are offering a $100 ($150) cash honorarium
to study participants. The goal of this study is to improve the understanding of individuals’
experiences with regards to preparing and submitting their tax returns. We’re interested in
your opinions, the general process you go through and how you view and approach your
taxes.
This study is for research and information purposes only. Your privacy is guaranteed. All
information related to the project will be held in the strictest confidence by all members of
our staff. Our client, Concentrance, will not have access to your name or contact
information at any point during the study. We would like to invite you to participate in this
study, and as I mentioned, we will be offering a $100 ($150) cash honorarium for your time.
This interview will be held on ____ (dates) and at ___ (location).
We do have a few questions in order to determine if you qualify for the study, may I begin?
Qualifying Questions
[Note to interviewers: A negative answer to questions 1, 2, or 3 will disqualify the
potential participant from taking part in the study.]
Q1: Did you file a federal tax return in 2009?
Q2: Are you the individual who is most familiar with the details of your tax return?
Q3: Is your residence in the ____ area?
IF DISQUALIFIED: Mr./Ms.____, based on your answers, you do not qualify to
participate in this study. Thank you for your time.
IF QUALIFIED, continue with the next question.
Q4: Which age group do you belong to? [Note to interviewers: read and select from
following list:]
4a: 18-35
4b: 36-50
4c: 51-64
4d: 65-70
4e- 71 or older [IF SELECTED: Thank you and terminate]
[Note to interviewers: A positive answer to questions 5, 6, 7, or 8 will disqualify the
participant from taking part in the study.]

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Taxpayer Interviews
Pre-Screening Questionnaire

Q5: Do you work for the IRS?
Q6: Are you a Certified Public Accountant?
Q7: Were you self-employed or the sole proprietor of a business in 2008?
Q8: Did you have any income from farming or fishing in 2008?
Q9: Did you have any income or loss in 2008 from any of the following sources: rental real
estate, royalties, partnerships, S corporations, estates, trusts, or REMICs?)[“REE- micks” =
Real Estate Mortagage Investment Conduit]
IF DISQUALIFIED: Mr./Ms.____, based on your answers, you do not qualify to
participate in this study. Thank you for your time.
IF QUALIFIED: continue with the next question.
Placement Questions
Q10: I am going to read you a list of events. After I am done reading the list, please say YES
if you experienced any of these events in 2008, and NO if you did not. [Note to
interviewers: read the entire list at once]
10a: Change your marital status( married, divorced, widowed)
10b: Have your first child
10c: Move over 50 miles for a job
10d: Purchase or sell a home
10e: Retire
10f: Experience a disability or major illness
10g: Receive an inheritance
10h: Earn, for the first time, income over $100,000 (jointly or separately)
10i: Purchase or sell stock for the first time
10j: Receive dividends for the first time
10k: Receive a 401(k) distributions for the first time
10l: Hire household help for the first time
10m: Lose a job
10n: File for bankruptcy or have a credit charge-off or a settlement
Q11: Did you prepare your 2008 federal tax return yourself or did you use a preparer?
[IF PREPARER: move to question 11. IF SELF PREPARER, move to Q10a]
Q10a: Did you use computer software to prepare your return?
Q12: What was your filing status for 2008? [Note to interviewers: read and select from
following list:]

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Taxpayer Interviews
Pre-Screening Questionnaire

11a: single
11b: married filing jointly (or surviving spouse)
11c: married filing separately
11d: single head of household
Q13: For tax purposes, what was your combined gross income? [Note to interviewers: read
and select from following list:]
12a: less than $35,000
12b: $35,000-$49,999
12c: $50,000-$74,999
12d: $75,000-$99,999
12e: $100,000 or over
IF DISQUALIFIED: Mr./Ms.____, based on your answers, you do not qualify to
participate in this study. Thank you for your time.
IF QUALIFIED: continue with the next question.
Q14: Based on your responses to our questions, you qualify to participate in this study.
Would you like to participate and receive a cash honorarium of $100 ($150) for your time?
The interview will be recorded on audio and video to assist with subsequent analysis. Your
privacy is guaranteed. Researchers will not be aware of your identity or ask for any
identifying information. The interview will run about an hour.
IF NO: Mr./Ms.____, Thank you for your time.
IF YES: Mr./Ms.____, Thank you for agreeing to participate in this study. Here are the
details of your interview, and don’t worry about writing everything down, we will email or
mail the information to you.
Date:
Time:
Location name:
Location address:
Now, can I please get the following information from you so we can send the interview
information?
Confirm first and last name:
Confirm phone number:
Email address:
IF NO EMAIL ADDRESS, mailing addresses:
Street:
City:
State:
ZIP:
Thanks again Mr./Ms.____, you should hear from us soon! If you have any question in the
meantime you may reach us at _____.
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Taxpayer Interviews
Pre-Screening Questionnaire

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 1545-1349. Also, if
you have any comments regarding the time estimates associated with this study or
suggestions 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.

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