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1. Your Contact Information

Name
Address

2. Date(s) Verification

First, let's talk about "caring for yourself" and how Covid-19 affected your ability to perform your business related services:

  • Did you miss work due to:

  • Quarantine
    • Federal, state, or local lockdown orders related to COVID-19
    • Quarantining or isolation order related to COVID-19
  • Illness
    • Symptoms of COVID-19 or seeking a medical diagnosis
    • Sickness due to vaccination side effects
    • Caring for someone with COVID symptoms
  • Vaccination
    • A COVID-19 vaccination appointment
    • Side effects due to vaccination


Please enter a number from 0 to 10.
IMPORTANT NOTE: You have selected a number that is less than 10 days for the time period of January 1, 2021 through March 31, 2021 that you were unable to work in this section. As a reminder, the FFCRA allows up to 10 total days in this date range that you can claim because you were unable to work due to:

  • Quarantine
  • Illness
  • Vaccination

Please enter the dates below that you were unable to work during this time period:

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3. Date(s) Verification (Part 2)

  • Did you miss work due to:

  • Quarantine
    • Federal, state, or local lockdown orders related to COVID-19
    • Quarantining or isolation order related to COVID-19
  • Illness
    • Symptoms of COVID-19 or seeking a medical diagnosis
    • Sickness due to vaccination side effects
    • Caring for someone with COVID symptoms
  • Vaccination
    • A COVID-19 vaccination appointment
    • Side effects due to vaccination


Please enter a number from 0 to 10.
IMPORTANT NOTE: You have selected a number that is less than 10 days for the time period of April 1, 2021 through September 30, 2021 that you were unable to work in this section. As a reminder, the FFCRA allows up to 10 total days in this date range that you can claim because you were unable to work due to:

  • Quarantine
  • Illness
  • Vaccination

Please enter the dates you were unable to work during this time period below:

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4. Caring for Your Dependents

Let's talk about "caring for your dependents" and how Covid-19 affected your ability to perform your business related services:
IMPORTANT NOTE: You have selected "no" indicating that you were NOT unable to work more than 50 days for the time period of January 1, 2021 through March 31, 2021. As a reminder, the FFCRA allows up to 50 total days in this date range that you can claim because you were unable to work due to:

  • Taking care of a child who’s school or childcare provider was closed or switched to virtual/remote learning
  • Taking care of your child who had COVID-19 or COVID-like symptoms, etc.

IMPORTANT NOTE: You have selected "no" indicating that you were NOT unable to work more than 60 days for the time period of April 1, 2021 through September 30, 2021. As a reminder, the FFCRA allows up to 60 total days in this date range that you can claim because you were unable to work due to:

  • Taking care of a child who’s school or childcare provider was closed or switched to virtual/remote learning
  • Taking care of your child who had COVID-19 or COVID-like symptoms, etc.

ALSO NOTE: The IRS does not require you to have PROOF that you cared for a minor child under the age of 18 (or dependent). You simply need to affirm with the IRS that you did in fact lose time from work or business because you cared for the dependent (in good faith).

Please upload a copy of your 1040X tax amendment package for the year 2020 or 2021 that you stated was filed by you or your CPA.
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    5. Acceptance of Terms

    Consent*
    I acknowledge that Direct Funder, LLC. (DBA Tax Credit Funder) cannot guarantee the accuracy or completeness of any information provided by me, and that I assume all risks associated with any inaccuracies or omissions in the information provided. I understand that Direct Funder, LLC is not responsible for any losses, damages, or expenses arising from the use of inaccurate or misleading information provided by me, or from any errors or omissions made by Direct Funder, LLC in preparing my tax credit. I further acknowledge that Direct Funder, LLC makes no guarantees or representations regarding the outcome of any tax credit prepared by the company, and that the results may vary depending on a variety of factors outside the control of Direct Funder, LLC. I understand that any information I provide to Direct Funder, LLC is presumed to be true and accurate, and that I am solely responsible for ensuring the accuracy and completeness of such information. I hereby waive and release Direct Funder, LLC, its officers, directors, employees, agents, and affiliates, from any and all claims, liabilities, damages, or expenses arising from or related to the preparation of my tax credit or any services provided by Direct Funder, LLC. This waiver and release shall be binding upon me, my heirs, executors, administrators, and assigns.
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    This field is for validation purposes and should be left unchanged.