13797 -Electronic Tribal Evaluation of Filing and Accuracy Compliance (TEF

Compliance Check Report
Use this template to fully document the activity and findings from your Compliance
Check. This template is designed to report on data for one entity within the tribe (each
Employer Identification Number (EIN) is considered to be one Entity for this purpose). If
you decide to expand to additional tribal entities, pages 2-10 should be completed for
each entity and attached to the final report. Only one summary sheet should be
completed.

This page to be completed by the IRS ITG Specialist.

If you have any questions regarding a federal tax administration issue during the course
of your Compliance Check, or any questions regarding the completion of this form,
please check our web resources, or contact:

Once the Compliance Check is completed, this document should be saved and returned
on a 3 ½” diskette or CD-Rom to:

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In order to assist you in completing the Compliance Check, our records currently
indicate the following information in regard to this entity:
EIN:
Entity Name:
Address:
Required to file the following federal tax returns:
Form 940
Form 941
Form 943
Form 945
Form 990
Form 1065
Form 1120
Form 720
Form 730
Form 11-C
Form 1042
Form 2290
Form 1041

Employer's Annual Federal Unemployment (FUTA) Tax Return
Employer’s Quarterly Federal Tax Return
Employer’s Annual Return – Agricultural Employees
Annual Return of Withheld Federal Income Tax
Return of Exempt Organization
Partnership Tax Return
Corporation Income Tax Return
Quarterly Federal Excise Tax Return
Monthly Tax on Wagering
Occupational Tax and Registration Return for Wagering
Ann. Withholding Return for U.S. Source Income of Foreign Persons
Highway Use Tax Return
Fiduciary Tax Return
Other

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Use the TAB key to move through the form.
Tribal Entity Reviewed
Employer Identification Number (EIN):
Name of Entity:
Address:

City:

State:

Activity of Entity:

Zip:

Year Entity Started:

Performs Services for the Tribe in the Area of:

Which of the following tax issues are applicable to the entity:
YES NO Tax Issues Present
Employment Tax (Withholding and FICA)
Information Reporting (Forms 1099)
Tip Income (do employees of the entity receive tip income)
Title 31 (Bank Secrecy Act compliance)
Natural Resources (Fishing and Land based income exclusions)
Excise Tax (Wagering)
Excise Tax (Other)
Employee Plans (pension and 401k plans) (are employees of the entity covered by an employee
retirement or income deferral plan)
Exempt Organizations (is the entity structured as a not-for-profit organization under Section 501 of
the Internal Revenue Code)
Tax Exempt Bonds (does the entity have any outstanding obligations for tax exempt bonds issued)
Is the Entity presently required to file:
YES NO Form
Form 940
Form 941
Form 943
Form 945
Form 990
Form 1065
Form 1120
Form 720
Form 730
Form 11-C
Form 1042
Form 2290
Form 1041
Form W-2
Form W-2G
Form 8027
Form 1098-T
Form 1099-MISC
Form 1099-R
Form 8300
FinCEN Form 102
FinCEN Form 103

Form Description
Employer's Annual Federal Unemployment (FUTA) Tax Return
Employer’s Quarterly Federal Tax Return
Employer’s Annual Return – Agricultural Employees
Annual Return of Withheld Federal Income Tax
Return of Exempt Organization
Partnership Tax Return
Corporation Income Tax Return
Quarterly Federal Excise Tax Return
Monthly Tax on Wagering
Occupational Tax and Registration Return for Wagering
Annual Withholding Return for U.S. Source Income of Foreign Persons
Highway Use Tax Return
Fiduciary Tax Return
Wage and Tax Statement
Certain Gambling Winnings
Employer's Annual Return of Tip Income and Allocated Tips
Tuition Statement
Statement for Recipients of Miscellaneous Income
Distributions from Retirement, Insurance, or Profit Sharing Plans
Cash Transactions Over $10,000 Received in a Trade or Business
Suspicious Activity Report by Casinos and Card Clubs
Currency Transaction Report by Casinos

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Review of Forms
Comment from your review of copies of the most recently filed tax forms. Include comments on
whether the returns were accurately prepared; whether there were any returns processing
problems, whether there was a balance due, whether there were any penalties imposed, etc.

If problems were encountered, how could they have been mitigated?

Forms W-4
Does the entity have employees?

Yes

No

Are Forms W-4 on file for every employee?

Yes

Are all forms W-4 secured prior to initial payment?

No
Yes

No

If No, what percentage was received after initial payment? 0%
Are all forms W-4 properly completed?

Yes

No

If No, what percentage was incomplete? 0%
Are new forms W-4 secured each year on all individuals claiming to be exempt from
income tax withholding?
Yes
No
List any other comments from inspection of Forms W-4.

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Forms W-9
Does the entity make payments to vendors or independent contractors?

Yes

No

Are Forms W-9 on file for every vendor or independent contractor? Yes
Are all forms W-9 secured prior to initial payment?

Yes

No
No

If No, what percentage was received after initial payment? 0%
Are all forms W-9 properly completed?

Yes

No

If No, what percentage was incomplete? 0%
List any other comments from inspection of Forms W-9.

Forms 1099
Are Forms 1099 filed for payments to all vendors and independent contractors for payments in
excess of $600 per year?
Yes
No
Not Applicable
Is federal income tax withheld when required, due to invalid or missing Forms W-9?
Yes
No
Employment Taxes
Do Forms W-3, W-2and 941 reconcile for the most recent calendar year?
Yes
No
Not Applicable
If No, comment on the discrepancy and any actions need or taken to resolve it.

Were there Federal Tax Deposit penalties assessed that could have been avoided?
Yes
No
Does the Entity provide any fringe benefits (i.e. medical insurance, life insurance, tribal/employerYes
No
provided vehicle, tribal/employer-provided housing, etc.)?
If Yes, list the type and whether they are deemed taxable in whole or part by the Entity.

Were taxable fringe benefits included on Forms W-2 for the applicable employee?
Yes
No

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Does the entity pay Tribal Council members for their services on the Council (i.e. salary,
meetings fees, stipends, etc.)?
Yes
No
Are the payments reported on Form W-2 or Form 1099?

Yes

No

If reported on Form W-2, are there withholding for FICA, Medicare, and Federal Income
Tax?
Yes
No
Is the entity aware of Revenue Ruling 59-354?
Yes
No
Are internal controls present to ensure that a Form 1099 is not issued to an employee for an
item that should be reported on Form W-2 (i.e. bonuses, excess reimbursement of expenses,
personal use of a tribal asset, etc.)
Yes
No
Is the level of tax filings consistent with the activity of the entity (i.e. Do the wages paid and
withholding remittances appear accurate based on the size of the entity and the number of
employees)?
Yes
No
If No, comment on the discrepancy and any actions taken to resolve it.

Does the Entity utilize a payroll service or Employee Leasing entity to file any required
employment tax forms?
Yes
No
If Yes, list the name, address and EIN of the service provider as well as the specific
forms filed on behalf of the entity.
EIN:

Name:

Address:
City:

State:

Zip:

Forms filed by payroll service on behalf of THIS entity:

Is the entity required to file Form 940 (Employer's Annual Federal Unemployment (FUTA) Tax
Return)?
Yes
No
If Yes, does the entity participate in the State Unemployment Tax Act (SUTA) program?
Yes
No
If yes, are you aware of the relief from Federal Unemployment Tax that is
available if you are in compliance with SUTA?
Yes
No

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Comment on tax compliance in the following areas, including if the area is “not
applicable” since the Entity has no involvement with the listed issue.
1. General Welfare Programs
Is the Entity involved in the development and/or implementation of any programs that are
designed to promote the general welfare of tribal members?
Yes
No
If Yes, describe the nature of the programs and how the potential tax consequence of
such program was determined.

2. Employee Leasing
Is the Entity involved in leasing employees TO or FROM another entity?
Yes
No
Lease TO another entity

Lease FROM another entity

Is the other entity controlled by the the tribe or another tribe?
Have all federal tax filings and payments been properly made?

Yes

No

Yes

No

List any other comments on employee leasing.

3. Excise Taxes– comment on the excise taxes that are applicable to the Entity as reflected on
Forms 720, 730, 2290, and 11-C (include a comment on whether the essential government
services exclusion was appropriately defined and applied to any communication or fuel taxes)

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4. Non-Gaming Distributions to Members
Are there any distributions of non-gaming revenue made by the entity to any individuals (i.e
royalty income, business profits, land claim proceeds, etc.)?
Yes
No
If Yes, are Forms 1099 issued?

Yes

No

If No (Forms 1099 are NOT issued) comment on the reason.

List any other comments on Non-Gaming Distributions.

5. Housing Assistance for Law Enforcement Personnel Living in High Crime Tribal Areas
Does the Entity provide any tax-free housing for law enforcement officials to reside in areas
deemed to be a “high crime zone” by the Tribe?
Yes
No
If Yes, has the tribal governing body duly designated the zone and payments?
Yes
No

List any other comments on law enforcement housing.

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6. Tip Income
Does the Entity have employees who receive tip income? Yes

No

If Yes, is there a voluntary Tip Agreement in place (Tip Rate Determination Agreement or a
Gaming Industry Tip Compliance Agreement)? Yes
No
What is the percentage of tipped employees who are participating in such an
agreement? 0%
If there are non-participating employees, do all of them report their tip income to the
entity as required each month? Yes
No
Are all employee tips properly reported on line 6c of Form 941?
Yes
No
Comment on whether the tip income being reported by employees appears accurate.

7. Bank Secrecy Act (BSA) Issues
Is the Entity subject to Title 31 (gross gaming revenues of $1 million or more per year, or the
entity provides services such as check cashing, wire transfers, etc.)?
Yes
No
Does the entity have a designated BSA Compliance Officer?
Is that position solely dedicated to that task?

Yes

Yes

Does the entity have formal written BSA compliance program?

No
No

Yes

No

Is ongoing bank Secrecy Act training held for all employees who interact with customers on
the gaming floor, or work in security?
Yes
No
Comment on the level of filings of FinCEN Forms 102 and 103, specifically whether the
number being filed is changing in proportion to any changes in the size of the gaming
operation.

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8. Per Capita Distributions of Gaming Revenues to Members
Does the Tribe distribute any gaming revenues directly to tribal members?
Yes
No
Does the Tribe have a Revenue Allocation Plan (RAP)?

Yes

No

If Yes, is the tribe in compliance with it’s RAP?

Yes

No

Is Form 1099 issued to each receipient?

Yes

No

Is proper withholding made from the distributions?

Yes

No

List any other comments on Per Capita Gaming Distributions

9. Use of Trusts or Other Programs to Defer Distributions, or the Tax Consequence of
Distributions
Are any programs utilizied by the tribe or tribal members to defer the tax consequence of a
distribution, or to defer the actual distribution to a later date (i.e.through the use of a trust or
other legal structure)?
Yes
No
Are they operated by the tribe? Yes

No

Are they under contract or facilitated by a third party?

Yes

Were the guidelines in Revenue Procedure 2003-14 used?

No
Yes

If not, was
a Private
Letter
Rulingsecurred
secured on
Ifnot,was
a Private
Letter
Ruling
on the
thedeferral
deferralprogram?
program?

No
Yes

No

List any other comments on use of Trusts.

10.Aggregation Agreement on Gaming
Does the Entity have an agreement with the IRS to aggregate slot machine wins for a patron in
a gaming day?
Yes
No
If Yes, is the entity in compliance with that agreement?

Yes

No

List any other comments on aggregation agreements.

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11. Acceptance Agent Agreement on ITINs for Gaming Patrons
Does the Entity have an agreement with the IRS to secure Tax Identification Numbers for
gaming patrons from foreign countries who lack a social security number?
Yes
No
If Yes, is the entity in compliance with that agreement?

Yes

No

List any other comments on ITIN agreements.

Actions / Corrections / Improvements
List any actions that the Tribe has taken on its own, or plans to implement, to effect
improvements in compliance as a result of conducting this Compliance Check

List any actions where the IRS office of Indian Tribal Governments could assist the Tribe in
effecting improvements to compliance (i.e. Outreach/Education, improved access to information,
need for a Private Letter Ruling, implementation of a Tip Agreement, etc.)
Note: Specific identified compliance concerns that may result in additional tax or penalties can be listed at
the conclusion of this template if you are seeking IRS assistance and potential penalty relief.

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Summary of Compliance Check
Name of Tribe
Address of Tribe
City

State

Zip

Date Compliance Check Completed
Tribal Entity Contact Name

Tribal Entity Contact Title

Tribal Entity Contact Telephone Number

Tribal Entity Contact E-Mail Address

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The following information summarizes the results of the Compliance Check that was conducted
(complete all applicable sections):
Employer Identification Number (EIN) Changes Required
(List the affected EINs, check the column for the change(s) required
and list an explanation for each change in the last column).

EIN

New
EIN

Change
of
Address

Filing
Requirement
Change

Other

Explanation of Change

Required Corrective Actions Uncovered by Compliance Check
Based on the results of this Compliance Check, we request assistance in effecting the following corrective
actions with the understanding that penalties will be waived wherever permissible:

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