SOI-266 - Earned Income Credit Research Studies: Focus Groups with Third-Party, Paid Tax Preparers TIRNO-05-Z00003, Task Order 6

EIC FOCUS GROUPS WITH TAX PREPARERS

Consent for Participation and Session Recording

I, _______________________________________________________________,

(Print your name here)

consent to the audio recording of this focus group session, which is being conducted by Westat to support the IRS evaluation of third-party paid tax preparers’ EIC information needs and communication with the IRS.

I acknowledge that my participation in this session is voluntary, and that I will receive $100 for participating today. I understand that the recordings will be used only by the research staff to accurately capture the views expressed during the focus group, and that my name will not appear in the summary report.

I am aware that my participation in this focus group session will have no effect on my personal tax status or my status as a tax preparer, that identifying information about me will not be shared with the IRS, and that all of the information I share today is protected under the Privacy Act.

____________________________________________________

Participant’s Signature/Date

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.