Download:
pdf |
pdfLITC
Low Income Taxpayer Clinic
> Access to Representation
Pa c k a g e a n d G u id e l i n e s
20 0 8 Grant Appl ication
> Outreach and Education for Taxpayers Who Speak
English as a Second Language
YOUR VOICE AT THE IRS
LITC
Low Income Taxpayer Clinic
> Access to Representation
YOUR VOICE AT THE IRS
P a c k a g e a n d G u i de lin e s
2 0 08 GRAN T APPL ICATION
> Outreach and Education for Taxpayers Who Speak
English as a Second Language
May 2007
Dear Prospective Low Income Taxpayer Clinic Grant Applicant:
I am pleased to announce the opening of the 2008 Low Income Taxpayer Clinic
(LITC) grant application period. All applications must be postmarked by July 6,
2007, in order to be considered timely. If filing electronically, applications must
be submitted on or before July 6, 2007.
The Taxpayer Advocate Service (TAS) is committed to enhancing the LITC
Program’s quality and coverage. With input from the clinics, the LITC Program
Office revised the 2008 LITC grant application to make it easier to understand
and complete. Some of the specific improvements include:
•
Clarifying the definition of an educational outreach program;
•
Clarifying the circumstances in which a clinic may engage in lobbying
activities;
•
Clarifying how a clinic should handle media requests to interview clients;
and
•
Providing guidance in the interim and annual reports allowing a clinic to
describe any additional activities through which it contributed to the
community or to improving services for low income and ESL taxpayers.
During the current 2007 grant cycle, we are pleased that we have at least one
clinic in 49 states, and we are seeking to cultivate interest for the state of
Colorado. We also have at least one clinic in the District of Columbia, Puerto
Rico, and Guam. We will be announcing a supplemental grant application period
for Colorado and hope to have at least one new clinic in Colorado for the second
half of 2007. The Taxpayer Advocate Service remains committed to achieving
maximum access to representation for low income taxpayers under the terms of
this grant program. Thus, in awarding 2008 LITC grants, we will continue to work
toward the following program goals:
•
Ensuring that each state (plus the District of Columbia, Puerto Rico,
and Guam) continues to be served by at least one clinic;
•
Expanding coverage in states that do not have both controversy
representation and ESL education and outreach; and
•
Ensuring grant recipients demonstrate that they are serving geographic
areas that have sizable populations eligible for and requiring LITC
services.
The LITC Program Office may award grants to qualifying organizations to fund
one-year, two-year or three-year project periods. Any clinic currently receiving
an LITC grant that does not expect to use all of its funds must contact the LITC
Program Office immediately so that other clinics may benefit from those funds.
Moreover, any clinic currently receiving a grant that does not intend to reapply in
the 2008 application cycle must notify the LITC Program Office immediately so
that we can encourage coverage of that service area by other applicants.
This package contains the current program guidelines, eligibility criteria,
application materials, and instructions to transmit an application to our office
electronically or by U.S. mail, private delivery service, or hand delivery. The cost
of preparing and submitting an application are the responsibility of each
applicant.
Your application must be postmarked by Friday, July 6. 2007. Applications
should be mailed to the Internal Revenue Service, Taxpayer Advocate
Service, LITC Program Office, Attention: LITC Applications, 1111
Constitution Ave. NW, TA:LITC, Room 1034, Washington, DC 20224.
Applicants may also file electronically at www.grants.gov. The LITC Program
Office will notify each applicant whether they were awarded a grant no later than
November 30, 2007.
If you have questions about the LITC Program or grant application process,
please contact the LITC Program Office at 202-622-7186 or by email at
[email protected].
I appreciate your interest in the LITC Program and look forward to working with
the 2008 Low Income Taxpayer Clinic grantees to improve the fairness and
quality of federal tax administration.
Sincerely,
Nina E. Olson
National Taxpayer Advocate
TABLE OF CONTENTS
I.
Introduction …………………………………………………………………………………….1
II.
Program Overview …………………………………………………………………………….1
III.
Definitions ……………………………………………………………………………………...1
IV.
LITC Program Grant Requirements ………………………………………………………..3
A.
1.
In General ……………………………………………………………………….3
2.
Controversy Clinic Requirements …………………………………………….4
3.
ESL Clinic Requirements ……………………………………………………...6
4.
Matching Funds Requirements ……………………………………………….7
B.
Office of Management and Budget (OMB) Requirements …………………………8
C.
Audit Requirements …………………………………………………………………….8
D.
Civil Rights Reporting Requirements ………………………………………………...9
E.
Lobbying Restrictions …………………………………………………………………11
F.
Other Applicable Laws and Regulations ……………………………………………12
G.
LITC Grant Agreement …………………………………………………………….…13
H.
Operational Requirements …………………………………………………………...13
I.
V.
Eligibility Criteria …………………………………………………………………..……3
1.
Standards of Operation ………………………………………………………13
2.
Managing Funds ………………………………………………………………18
3.
Grantee Responsibilities ……………………………………………………..20
Reporting Requirements ……………………………………………………………..22
1.
Interim Reports ………………………………………………………………..22
2.
Annual Reports ………………………………………………………………..24
LITC Program Office ………………………………………………………………………..28
A.
Responsibilities ………………………………………………………………………..28
B.
Site Assistance Visits …………………………………………………………………29
Paperwork Reduction Act Notice:
This application package is provided for awards under the Low Income Taxpayer Clinic Grant Program. The information is requested from the
applicants in order to determine their eligibility for an LITC grant and evaluate their grant proposals. Applicants are not required to respond to this
collection of information unless it displays a currently valid OMB number. The estimated average burden associated with this collection of information is
60 hours per respondent for program sponsors and 2 hours for student and program participants. Comments concerning the accuracy of this burden
estimate and suggestions for reducing this burden should be directed to the Tax Products Coordinating Committee, Western Area Distribution Center,
Rancho Cordova, CA 95743-0001. Do not send grant application forms to this address. Grant applications should be sent to: Internal Revenue Service,
Taxpayer Advocate Service, LITC Program Office, TA:LITC, Room 1034, 1111 Constitution Ave., NW, Washington, DC 20224.
Catalog of Federal Domestic Assistance Number: 21.008
-i-
OMB Approval No. 1545-1648
VI.
VII.
Completion and Submission of Grant Application ……………………………………29
A.
LITC Program Grant Application Contents …………………………………………29
B.
New or Single-Year Grant Applications …………………………………………….33
C.
Continuing Multi-Year Grant Applications ………………………………………….34
D.
Where and When to File ……………………………………………………………..35
Selection and Award of Grant Recipients ………………………………………………36
A.
Eligibility Screening …………………………………………………………………...36
B.
Evaluation Process ……………………………………………………………………36
C.
1.
Technical Evaluation ………………………………………………………….37
2.
Program Office Evaluation …………………………………………………...37
Notification of Award Decisions ……………………………………………………..39
Appendix A …………………………………………………………………………………………….A
LITC Program Grant Forms …………………………………………………………………...A
Appendix B …………………………………………………………………………………………….B
LITC Program Grant Application Checklists ………………………………………………...B
Appendix C …………………………………………………………………………………………….C
Report Forms and Supplemental Issue Form ………………………………………………C
Index …………………………………………………………………………………………………….D
-ii-
INTRODUCTION
This publication outlines requirements for the operation of a qualifying Internal Revenue Service (IRS)
Low Income Taxpayer Clinic (LITC) program and provides instructions on how to apply for a grant
under Internal Revenue Code (IRC) § 7526. All applications for this grant must be completed
thoroughly and accurately. Failure to do so may result in the application not being considered
for a grant.
This publication and copies of the required forms and certifications should be retained for future
reference. Interim and annual reporting requirements are included in this package and must be
followed when those reports are prepared.
NOTE: When questions arise regarding the program, they can be submitted by email to the
LITC Program Office at: [email protected].
II.
LITC PROGRAM OVERVIEW
IRC § 7526 authorizes the IRS to award matching grants of up to $100,000 per year to qualifying
organizations that represent low income taxpayers involved in controversies with the IRS and to
organizations that provide education and outreach on the taxpayer rights and responsibilities of U.S.
taxpayers to individuals who speak English as a second language (ESL) or who have limited English
proficiency (ESL taxpayers). IRC § 7526 requires clinics to provide services for free or for no more
than a nominal fee.
Low income status is determined by reference to the Federal Poverty Guidelines, which are updated
annually by the Department of Health and Human Services (HHS). Applications are accepted for
project periods of up to three years duration. Funding is provided for budget periods of one year,
subject to the availability of annually appropriated funds. With respect to applications for two or threeyear project periods, the second and third years will be funded subject to satisfactory performance,
compliance with grant terms, and availability of appropriated funds. All grant funds awarded to an LITC
must be used for the LITC project specifically authorized in the grant.
The LITC Program is administered by the Taxpayer Advocate Service (TAS). The Director of the TAS
LITC Program Office reports directly to the National Taxpayer Advocate and is responsible for providing
oversight, guidance, and assistance to LITC grantees and prospective applicants. The LITC Program
Office is comprised of a program administration manager, controversy and ESL program managers,
and other staff who work directly with the clinics.
III.
DEFINITIONS
The term “clinic” includes:
•
A clinical program at an accredited law, business, or accounting school in which students
represent low income taxpayers in controversies with the IRS; and
•
An organization described in IRC § 501(c) and exempt from tax under IRC § 501(a) that
either directly represents taxpayers or refers taxpayers to qualified representatives.
The term "controversy" includes:
•
An IRS account, collection, examination, or Appeals matter;
-1-
•
Representation on a federal tax matter in federal courts, including the United States Tax
Court;
•
Representation or referral of a low income taxpayer involved in a state or local tax
controversy, when the clinic is representing or referring that taxpayer in a federal tax
controversy;
•
Provision of assistance to a nonfiler in the preparation of prior year return(s);
•
Provision of assistance to a victim of identify theft on a federal or state tax matter; and
•
Preparation of an amended return, if such assistance is necessary to resolve a controversy
for which an LITC is representing a taxpayer.
The "referral” activity for which grant funds may be expended is the referral of low income taxpayers to
a pro bono panel – one that provides representation free of charge. A pro bono panel consists of
qualified representatives, nonprofit entities or other organizations that do not charge for representing
low income individuals.
What is a pro bono panel?
Examples of pro bono panels to which taxpayers may be referred include:
•
A panel of qualified representatives maintained by the clinic to whom the
clinic refers matters and who agree to provide pro bono representation to
low income taxpayers;
•
A panel maintained by a state bar association which makes referrals, for
free or for a nominal fee, to qualified representatives who have agreed to
provide pro bono representation in legal matters; and
•
A panel maintained by a state or local society of accountants which makes
referrals, for free or for a nominal fee, to qualified representatives who
have agreed to provide pro bono assistance to taxpayers.
Programs that inform ESL taxpayers about their federal taxpayer rights and
responsibilities must maintain a pro bono referral panel to which they may
refer federal, state, and local tax controversies. In addition to the examples
above, an ESL clinic can refer taxpayers to another LITC; however,
controversy funding will not be awarded to an organization that is solely
making referrals to another LITC.
A “qualified representative” is any individual who is authorized to practice before the IRS (e.g.,
attorney, certified public accountant, enrolled agent) or applicable court. Any controversy clinic that
does not have a staff member who is admitted to practice before the United States Tax Court must
have a pro bono panel member who is admitted to practice before the United State Tax Court and to
whom the clinic can refer litigation matters.
A “program to inform” is one in which the clinic educates ESL individuals about their rights and
responsibilities as U.S. taxpayers.
-2-
Examples of “qualifying ESL activities” are:
•
An educational outreach program about federal taxpayer rights and responsibilities
conducted by a clinic and attended by ESL taxpayers;
•
Direct consultation with ESL taxpayers regarding their rights and responsibilities as U.S.
taxpayers; and
•
Ancillary assistance to ESL taxpayers in the preparation of federal tax returns or other
required tax forms (see Treas. Reg. § 301.7701-15(a)(7)(vii)).
IV.
LITC PROGRAM GRANT REQUIREMENTS
A.
ELIGIBILITY CRITERIA
1.
In General
The organization must be a qualified clinic that represents or refers low income taxpayers in
controversies with the IRS or operates programs to inform ESL taxpayers about their taxpayer
rights and responsibilities. Qualified clinics are those that offer services for free or for no more
than a nominal fee and either represent low income taxpayers in controversies with the IRS or
provide information to ESL taxpayers about their rights and responsibilities as U.S. taxpayers.
The organization may be a clinic providing qualifying services that it conducts within a broader
spectrum of activity. A clinic may provide representation in nontax matters as well as
representation in tax matters. Such clinics must reasonably allocate their expenses and
matching funds for services shared with nonqualifying programs or other organizations in
determining allowable expenses for LITC funding and their compliance with the statutory
matching funds requirement.
•
Clinic Within a Clinic. Generally, the operation of a "clinic within a clinic" does not
disqualify an applicant from eligibility for an LITC program grant award. Nevertheless,
services a clinic provides to taxpayers cannot be separated and operated out of another
clinic within that clinic for purposes of meeting the 90/250 income requirement of IRC §
7526(b)(1)(B)(i) (described below).
•
Start-Up Expenses. Start-up operations qualify for grant funding. Thus, a clinic may be
awarded an LITC grant although it anticipates that it will not begin operating until after
the current grant cycle. Such applicants still must satisfy the statutory matching funds
requirement during the year covered by the grant and must meet all reporting
requirements to provide information on the status of the start-up. In addition, LITC
grants to these applicants will be conditioned on the conduct of qualifying activities
during the immediately succeeding grant year.
•
Nominal Fee. IRC § 7526 provides that a clinic must not charge more than a nominal
fee for clinic services, in addition to reimbursement of actual costs incurred (e.g.,
photocopying and court costs). A clinic may not charge any separate or additional
fee (even if it is nominal) for the preparation of a tax return (except for
reimbursement of actual costs incurred, e.g., photocopying). If a clinic is
charging a fee, the clinic must charge that same fee to everyone, regardless of the
services being sought. Remember: The goal of the LITC Program is to enhance
access to legal services for low income taxpayers. If the amount that a clinic is
-3-
trying to charge results in fewer taxpayers served, the goal of the Program is not
being achieved and that amount is not nominal.
2.
Controversy Clinic Requirements
•
90/250 Income Requirement. At least 90 percent of taxpayers represented or referred
must have incomes that do not exceed 250 percent of the Federal Poverty Guidelines
published annually by HHS.
A clinic must use the LITC Program’s poverty guidelines to determine whether a client
seeking representation is a low income client for purposes of LITC Program funding. A
clinic must base its determination of whether a taxpayer satisfies the income
requirement on current income information. The taxpayer must provide this information
on an intake form (or similar form) at the time the taxpayer seeks the clinic’s assistance.
Changes in financial status during representation do not disqualify clients from
continuing to receive clinic representation. A clinic may consider the taxpayer’s current
year return in determining the taxpayer’s income, as defined below.
Whether the 90/250 income requirement is met is determined based on taxpayers
actually represented. For this purpose, representation occurs when the arrangement is
memorialized through a letter of engagement, a pro bono representation agreement, or a
Form 2848, Power of Attorney and Declaration of Representative. If a clinic represents
and also refers taxpayers, the 90/250 income requirement is determined by aggregating
the representations and referrals.
For purposes of determining the total number of taxpayers represented or referred in
controversies with the IRS, include both those who do and do not meet the income
requirements. Preparation of a joint return counts as two taxpayers assisted. If only
one spouse on a joint return is represented or referred, the represented spouse counts
as one taxpayer assisted.
Satisfaction of the 90/250 income requirement is determined based on the income of
family units, not on the average income of the taxpayers represented or referred. For
example, suppose a clinic has the following clients: 97 unrelated individuals (i.e., 97
family units) and one family unit of three related taxpayers. For purposes of determining
whether the 90/250 income requirement is satisfied, at least 90 percent of the 98 family
units must have incomes which do not exceed 250 percent of the Federal Poverty
Guidelines.
A clinic must maintain records for the total number of taxpayers represented (or referred)
in controversies with the IRS and the number of taxpayers represented (or referred) in
controversies with the IRS who have incomes that do not exceed 250 percent of the
Federal Poverty Guidelines and whose cases meet the amount in controversy
requirement (described on page 6).
•
Current Poverty Guidelines. The LITC Program Office updates the poverty guidelines
for the LITC Program annually after HHS updates the Federal Poverty Guidelines each
year to account for inflation. Clinics must adopt the new income ceilings for determining
LITC low income representation eligibility within 30 days from the date of publication of
the HHS Federal Poverty Guidelines in the Federal Register.
Based on the Federal Poverty Guidelines published on January 24, 2007, the income
ceilings for low income representation for the 48 contiguous states, the District of
Columbia and Puerto Rico are as follows:
-4-
Size of Family
Unit
1
2
3
4
5
Income Ceiling (250% of
Federal Poverty Guidelines)
$25,525
$34,225
$42,925
$51,625
$60,325
For family units with more than five members add $8,700 for each additional member.
For Alaska, the income ceilings for low-income representation are as follows:
Size of Family
Unit
1
2
3
4
5
Income Ceiling (250% of
Federal Poverty Guidelines)
$31,925
$42,800
$53,675
$64,550
$75,425
For family units with more than five members add $10,875 for each additional member.
For Hawaii and Guam, the income ceilings for low-income representation are as follows:
Size of Family
Unit
1
2
3
4
5
Income Ceiling (250% of
Federal Poverty Guidelines)
$29,375
$39,375
$49,375
$59,375
$69,375
For family units with more than five members add $10,000 for each additional member.
•
Definition of Income for Purposes of the 90/250 Income Requirement
“Income” is defined in accordance with the definition used by the U.S. Bureau of the
Census. See http://www.census.gov/population/www/cps/cpsdef.html for the complete
list of items included in the definition of income.
Income includes total annual cash receipts before taxes with the exceptions provided
below. For example, income includes salaries before deductions, net receipts from selfemployment (receipts after deductions for business expenses), alimony, child support,
federally funded and other public assistance, social security, private pensions,
scholarships, dividends, interest, net gambling winnings, and survivor benefits or annuity
payments.
Income does not include capital gains, withdrawals from a bank account, money
received from the sale of property, a house, a car, tax refunds, gifts, loans, a lump sum
inheritance, one-time insurance payments, compensation for injury, or noncash benefits
(e.g., employer-paid or union-paid portion(s) of employee fringe benefits).
-5-
•
Definition of Family Unit
For purposes of this grant program, a family unit is defined as an unrelated individual or
a family. An unrelated individual is a person 15 years old or over who is not living with
persons related by birth, marriage, or adoption. A family is a group of two or more
persons related by birth, marriage, or adoption who live together. However, if related
individuals live together, but the person seeking assistance from the clinic is financially
independent, then that person may be treated as a family unit. If two unrelated
individuals live together, they constitute two family units.
•
Amount in Controversy
The amount in controversy for any taxable year generally must not exceed the amount
specified in IRC § 7463 (currently $50,000). The amount in controversy includes
penalties, but does not include interest. If a clinic takes on a case in which the amount
in controversy exceeds the amount specified in IRC § 7463, the clinic must provide an
explanation in its interim and annual reports of why the case was accepted.
3.
ESL Clinic Requirements
•
Outreach Activities. Clinics must identify their target audience and develop an outreach
strategy to reach that audience. An educational outreach program is a program
designed to educate ESL taxpayers about their federal taxpayer rights and
responsibilities. Educational outreach programs can take many forms, including:
•
•
•
•
•
One-on-one consultations;
Holding a workshop on collection alternatives or employee/independent contractor
status;
Making a presentation about federal taxpayer rights and responsibilities to an ESL
class at a local community college;
Staffing a table at a community event and handing out brochures for the clinic,
educational materials about various tax issues, and answering questions and
scheduling appointments for interested taxpayers; and
An outreach program at a local community center where the clinic holds weekly
discussions during the filing season to educate ESL taxpayers about choosing a tax
return preparer, family and education credits, refund anticipation loans, Individual
Taxpayer Identification Numbers (ITINs), and other related issues.
•
Publicity. In addition to conducting outreach activities, clinics are encouraged to reach
out to their target audience through publicity efforts. LITCs receiving funding for
qualifying ESL activities must advertise and promote themselves as providing
information and education to help ESL individuals understand the federal tax system.
For example, an LITC could advertise a community meeting to acquaint ESL individuals
with their rights and responsibilities under the federal tax system. Additionally, clinics
are encouraged to include substantive tax information (e.g., when to file, what forms to
file, who is eligible for the Earned Income Tax Credit (EITC), how to file an offer in
compromise (OIC)) in indirect outreach efforts.
•
Ancillary Tax Return Preparation. An ESL clinic can provide assistance with a return of
tax or a claim for refund under subtitle A and not be considered an income tax return
preparer if such assistance is an ancillary part of the clinic’s program. The term
“ancillary” means incidental. That is, the LITC’s program must focus on outreach and
education and not tax return preparation. If, for example, an ESL client requests help
-6-
with a tax return in the course of an LITC conducting outreach or education activities, the
LITC may not provide such assistance unless it arises from the LITC’s primary activity of
outreach and education. Clinics that engage in ancillary tax preparation cannot charge a
separate fee (even if it is a nominal fee) for this service. Tax return preparation
assistance that is directly related to a controversy is not considered “ancillary” and is
permitted under the definition of “controversy.”
•
Tax Preparation Referral. Generally, if ESL taxpayers require tax preparation
assistance, they should be referred to a Volunteer Income Tax Assistance (VITA)
program or a Tax Counseling for the Elderly (TCE) site (including a co-located
independently funded program), or an IRS Taxpayer Assistance Center, where
available. Grant funds awarded to an LITC must be used for the LITC activities
authorized in the grant agreement and cannot be used to fund VITA or TCE activities.
•
Fees. A clinic that engages in ancillary tax preparation cannot charge a separate fee
(even if it is a nominal fee) or vary a fee based on whether it provides assistance with a
return of tax or claim for refund. In addition, the clinic cannot charge more than a
nominal fee for its services.
4.
Matching Funds Requirements
All applicants must provide matching funds on a dollar-for-dollar basis for all LITC Program
grant funds received.
•
Qualified Matching Funds. Cash contributions and third party in-kind contributions
(donated property or services) qualify as matching funds. The salary, including fringe
benefits, paid for the individuals performing services for the clinic may count as matching
funds. The value of volunteer services furnished by professional and technical
personnel, consultants and other skilled and unskilled labor may be counted as matching
funds if the services are an integral and necessary part of an approved project or
program. Services provided by students to satisfy an academic requirement (e.g.,
representation of taxpayers by students enrolled in a clinic sponsored by a law or
business school) do not qualify as matching funds. The cost of equipment used in the
clinic may count as matching funds. The fair market rental value of office space
provided to the clinic may count as matching funds.
Indirect expenses, including general overhead of the institution sponsoring the clinic,
shall not be counted as matching funds, except for salaries and equipment as indicated
above. General overhead includes operation and maintenance expenses and
depreciation.
Note: OMB guidance restricts percentages of overhead that can be allocated as
matching funds.
•
Volunteer Services. The rates for volunteer services shall be determined consistent with
the principles stated in OMB Circular A-110, "Uniform Administrative Requirements for
Grants and Agreements with Institutions of Higher Education, Hospitals, and Other NonProfit Organizations", Subpart C, § .23.
•
Program Income. Program income (the clinic’s receipts from activities that are directly
related to the clinic’s objectives) counts as matching funds. For example, these types of
fees may count as matching funds: registration fees for training and technical
assistance programs for tax practitioners who serve the low income community,
-7-
registration fees for informational programs for ESL taxpayers, and nominal fees for
legal services.
B.
•
Documentation of Matching Funds Sources. While grant awards may be made based
on good faith estimates of matching funds, including verifiable pledge commitment(s) or
likely sources of funding, clinics must provide adequate documentation regarding the
committed sources of matching funds. For a clinic to obtain a grant payment in advance
of actual disbursement or receipt of the required nonfederal match, the clinic generally
must have firm commitments for the required matching funds. A firm commitment
consists of a binding written agreement between the grantee and the source of the
matching funds that is conditioned solely upon the availability of federal assistance (and
such other conditions as approved in advance by the IRS).
•
Funds from other federal grants cannot be counted as matching funds unless authorized
by statute. (See OMB Circular A-110, Subpart C, § .23). Legal Service Corporation
funds are ineligible as matching funds.
OFFICE OF MANAGEMENT AND BUDGET (OMB) REQUIREMENTS
Grant award administrative requirements are set forth in OMB Circulars. The basic
administrative requirements applicable to individual Grant Agreements are contained in:
•
OMB Circular No. A-110, "Uniform Administrative Requirements for Grants and
Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit
Organizations";
•
OMB Circular A-133, "Audits of States, Local Governments, and Non-Profit
Organizations”;
•
OMB Circular A-21, "Cost Principles for Educational Institutions"; and
•
OMB Circular A-122, "Cost Principles for Non-Profit Organizations."
All applicable provisions of these circulars, as revised, and any existing and further supplements
and revisions are incorporated into these program requirements and into all grant agreements
entered into between the IRS and clinics. These circulars were incorporated into Title 2 of the
Code of Federal Regulations.
C.
AUDIT REQUIREMENTS
OMB Circular A-133 describes the audit requirements applicable to grantees. If you expend
less than $500,000 a year in total federal awards, no audit requirements are applicable.
The IRS, however, has the right to audit expenditure of LITC funds regardless of the dollar
amount of federal funding received by the grantee.
If you expend $500,000 or more a year in federal awards, you must provide the IRS with a copy
of the results of an audit performed in compliance with OMB Circular A-133. You must arrange
for an audit by an independent auditor in accordance with the Government Auditing Standards
developed by the Comptroller General of the United States. The costs of audits performed in
compliance with OMB Circular A-133 are allowable.
An audit under OMB Circular A-133 is organization-wide. The auditor must determine whether:
-8-
•
Your financial statements present fairly your financial position and the results of your
operations in accordance with generally accepted accounting principles;
•
You have an internal control structure to provide reasonable assurance that you are
managing federal awards in compliance with applicable laws and regulations, and
controls that ensure compliance with the laws and regulations that could have a material
impact on the financial statements; and
•
You have complied with laws and regulations that may have a direct and material effect
on your financial statement amounts and on each major federal program.
Financial records, supporting documents, statistical records, and all other records pertinent to
an award shall be retained for a period of three years from the date of submission of the final
report for the grant cycle, subject to certain exceptions set forth in OMB Circular A-110.
D.
CIVIL RIGHTS REPORTING REQUIREMENTS
This information is being collected to enforce Title VI of the Civil Rights Act of 1964, as
amended, which prohibits discrimination on the basis of race, color, or national origin in any
program or activity receiving federal funds; Title IX of the Education Amendments of 1972, as
amended, which prohibits discrimination on the basis of sex in any education program or activity
receiving federal funds; § 504 of the Rehabilitation Act of 1973, as amended, which prohibits
discrimination on the basis of disability in any program or activity receiving federal funds; and
the Age Discrimination Act of 1975, as amended, which prohibits discrimination on the basis of
age in any program or activity receiving federal funds.
This section describes the data collection and reporting requirements required of LITC grant
applicants by the IRS to meet its responsibilities under these laws. This information is required
pursuant to the civil rights statutes and the regulations of the Department of Justice and the
Department of the Treasury.
This information is mandatory and required of every applicant on an annual basis. All applicants
must submit a response to the IRS containing information outlined below. All of the questions
must be answered and included with the submission of the Certification of Assurance
Concerning Civil Rights Compliance form. As a condition of eligibility under the LITC Program,
the applicant must provide the following information in its grant application package:
•
A list of active lawsuits or complaints naming the applicant which allege discrimination
on the basis of race, color, national origin, age, sex, or disability with respect to service
or benefits being provided. The list should include: the date the lawsuit or complaint
was filed; a summary of the allegation; and the status of the lawsuit or complaint,
including whether the parties to a lawsuit have entered into a consent decree.
•
A description of all pending applications for financial assistance and all financial
assistance currently provided by other federal agencies. For all applicants for IRS
financial assistance, this information should be relevant to the organizational entity
actually submitting the application, not necessarily the larger agency or department of
which the entity is a part.
•
A summary of all civil rights compliance review activities conducted in the last three
years. The summary shall include: the purpose or reason for the review; a summary of
the findings and recommendations of the review; and a report on the status or
disposition of such findings and recommendations. For all applicants for IRS financial
-9-
assistance, this information should be relevant to the organizational entity actually
submitting the application, not necessarily the larger agency or department of which the
entity is a part.
•
A signed and dated Statement of Assurance Concerning Civil Rights Compliance
agreeing that all of the records and other information required have been or will be
compiled, as appropriate, and maintained by the applicant, recipient, or sub-recipient.
•
Additional data may be requested only to the extent that it is readily available or can be
compiled with reasonable effort, and is found to be necessary to make a civil rights
compliance determination. Examples of data and information which, to the extent
necessary and appropriate for determining compliance with applicable civil rights
statutes and implementing regulations may be as follows, but not limited to:
The manner in which services are or will be provided by the program in question,
and related data necessary for determining whether any persons are or will be
denied such services on the basis of prohibited discrimination;
The population eligible to be served by race, color, national origin, age, sex, or
disability;
Data regarding covered employment, including use or planned use of bilingual
public contact employees serving beneficiaries of the program where necessary
to permit effective participation by beneficiaries unable to speak or understand
English;
The location of existing or proposed facilities connected with the program, and
related information adequate for determining whether the location has or will
have the effect of unnecessarily denying access to any persons on the basis of
prohibited discrimination;
The present or proposed membership, by race, color, national origin, sex, age, or
disability, in any planning or advisory body which is an integral part of the
program; and
Data, such as demographic maps, the racial composition of affected
neighborhoods or census data.
Each multi-year applicant shall update the civil rights reporting requirement information
annually. Each application for financial assistance shall be reviewed for its civil rights reporting
requirements by an external civil rights unit staff member. Upon completion, the reviewer shall
forward a letter of compliance to the applicant indicating the civil rights determination. Financial
assistance shall not be awarded to the applicant until the civil rights reviewer has issued a
finding of compliance or conditional compliance. Department of Justice regulations state that all
federal agency staff determinations of Title VI compliance shall be made by, or be subject to
review by the agency's civil rights office.
If you need additional information or have any questions, please contact William H. Williams,
Director, External Civil Rights Unit, at (202) 927-2743.
-10-
E.
LOBBYING RESTRICTIONS (18 U.S.C. § 1913; 31 U.S.C. § 1352; 31 CFR, PART 21)
PROHIBITION ON USING GRANT FUNDS FOR LOBBYING CONGRESS
Under 31 U.S.C. § 1352(a), recipients of Federal grants are prohibited from using appropriated
funds “to pay a person for influencing or attempting to influence” the executive or legislative
branches of the government with respect to any federal grant. Persons requesting or awarded a
single grant exceeding $100,000 must certify that they have not, and will not, use the grant
funds in a manner prohibited by 31 U.S.C. § 1352(a). See 31 C.F.R. § 21.110(a)-(b). In
addition, 18 U.S.C. § 1913 prohibits the use of appropriated funds for lobbying and provides that
violations of this restriction will constitute a violation of 31 U.S.C. § 1352(a).
Section 1352 of 31 U.S.C. also requires that any lobbying activities (e.g., those conducted with
non-federal funds) be disclosed by each organization that receives or accepts a federal grant of
more than $100,000 per year. The requirements to certify and disclose are based on the
award amount of a single grant rather than an aggregate of all federal grants awarded to
an organization during the year.
Because the maximum amount the IRS is allowed to award to any LITC pursuant to IRC §
7526(c)(2) is $100,000 per year, the requirements to certify and disclose lobbying activities with
respect to such a grant are not applicable. If, however, an LITC receives a federal grant of
more than $100,000 from another federal program, the requirements to certify and disclose
lobbying activities would then be applicable. The reporting period for disclosure of lobbying
activities, if applicable, is the same as the grant cycle.
LOBBYING FOR PURPOSES OF 31 U.S.C. § 1352
Influencing or attempting to influence for purposes of 31 U.S.C. § 1352 means making, with the
intent to influence, any communication to or appearance before an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the making or extending of a grant. Lobbying that is
prohibited by 18 U.S.C. § 1913 (and consequently prohibited by 31 U.S.C. § 1352) consists of
paying for any personal service, advertisement, telegram, telephone, letter, printed or written
matter or other device, intended or designed to influence a Member of Congress or other
government official with respect to legislation.
LOBBYING FOR PURPOSES OF IRC § 501(C)
While engaging in lobbying activities without spending grant funds does not violate 31 U.S.C. §
1352 or the terms of this Publication, there may be IRC § 501(c) implications. IRC § 501(c)(3)
organizations may conduct an insubstantial amount of lobbying and still maintain their taxexempt status. The term “insubstantial” is not defined and depends on all the facts and
circumstances (expenditures, volunteer time, time spent by officers and board, etc.). An IRC §
501(c)(3) organization may also voluntarily make a lobbying election under IRC § 501(h), where
the amount of lobbying is limited to a moderately complex percentage expenditure test detailed
in IRC § 4911 and the corresponding Treasury regulations.
IRC § 501(c) does not define the term “lobbying.” For purposes of the lobbying election under
IRC § 501(h), the concept of “influencing legislation” is defined by cross-reference to IRC §
4911(d). IRC § 4911(d) defines influencing legislation to mean the following:
(A) any attempt to influence any legislation through an attempt to affect the opinions of
the general public or any segment thereof, and
-11-
(B) any attempt to influence any legislation through communication with any member
or employee of a legislative body, or with any government official or employee who may
participate in the formulation of the legislation.
LITC ACTIVITIES WITH POSSIBLE LOBBYING IMPLICATIONS
For example, an LITC may send an email to the ABA-sponsored LITC listserve to gather
support (or opposition) for legislation without negative implications in the IRC § 501(c) context
and without violating 31 U.S.C. § 1352. Although such an e-mail is an attempt to influence
legislation, so long as grant funds are not used, the LITC has not violated Title 31 or Title 18. If
the LITC has a requirement under Title 31 to report lobbying activities, the e-mail activity would
need to be disclosed, including any research or background work performed in connection with
the e-mail to the listserve.
For purposes of IRC § 501(c), sending an email to the ABA listserve would likely constitute an
“insubstantial” amount of lobbying. Therefore, because the use of the ABA listserve is free, the
LITC should not have any expenditures for the purpose of influencing legislation and thus, an
IRC § 501(h) election should not be necessary. Keep in mind, though, that if an LITC is
devoting a large amount of time to the endeavor (e.g., researching the issue, drafting proposed
legislation, responding to comments on the ABA listserve about the proposal), the activity could
rise to the level of being more than insubstantial, in which case a lobbying election under IRC §
501(h) would be necessary. Similarly, depending on volume, sending multiple e-mails in a year
(even if on separate issues), combined with research or drafting proposed legislation could
require the LITC to make a lobbying election.
For more information about making a lobbying election, refer to:
•
•
•
•
F.
IRC § 501(h) and IRC § 4911
Treas. Reg. §§ 1.501(h)-1 thru 1.501(h)-3
Treas. Reg. §§ 56.4911-1 thru 56.4911-10
Publication 557, Tax-Exempt Status for Your Organization.
OTHER APPLICABLE LAWS AND REGULATIONS
Programs involving use of federal funds are governed by a wide variety of federal laws and
regulations. These include:
•
Restrictions on political activities at 18 U.S.C. §§ 595, 598, 600-603;
•
The preservation requirements in the National Historic Preservation Act (16 U.S.C. § 470
et seq.) and the Archeological and Historic Preservation Act of l966 (16 U.S.C. § 469a-1
et seq.);
•
Environmental requirements of the Clean Air Act (42 U.S.C. § 7401 et seq.); and
•
The non-pollution requirement of the Federal Water Pollution Control Provisions (33
U.S.C. § 1251 et seq.)
-12-
Certifications are required for LITC funding, according to the “common rule” on nonprocurement, debarment and suspension adopted by Department of Treasury at 31 CFR, Part
19, Subpart F. This means you must certify that your organization and Clinic Director are not
presently debarred or suspended from covered transactions by any federal agency. In addition,
you must certify that within the three-year period before applying for a grant, your organization
and Clinic Director have not been convicted of or had a civil judgment rendered against them for
fraud, theft or certain other offenses, and have not had one or more public transactions
terminated for cause or default. You must also certify that your organization and Clinic Director
are not presently criminally or civilly charged with certain offenses.
Additional certifications are required according to the Government-wide requirements for a drugfree workplace (Pub. L. 100-690, Title V, Subtitle D, 41 U.S.C. §§ 702-707), adopted by the
Department of the Treasury at 31 CFR, Part 19, Subpart F, and certification of civil rights
compliance, as required by the civil rights laws specified above.
Certification forms are included in Appendix A of this application package.
G.
LITC GRANT AGREEMENT
LITC organizations execute grant agreements with the IRS. The IRS, subject to the availability
of appropriated funds, is authorized to award grants to provide matching funds for the
development, expansion, or continuation of qualified LITCs. The LITC Grant Agreement
includes functions and duties to be performed by the LITC grantee, lists the maximum amount
of grant award, the type of services to be performed by the clinic, the period covered by the
grant, and any additional requirements specified in the application package and other pertinent
information.
An LITC Program grant may be awarded for up to a three-year grant cycle. Grants for an
approved program plan of two or three years will be funded for each subsequent year subject to
the availability of annually appropriated funds, satisfactory performance, and compliance with
grant terms. Although the LITC Program generally adheres to Circular A-110, the provision in
Subpart C, § .62(b) regarding hearings and appeals does not apply to LITC grant recipients;
Circular A-110 only requires an agency to provide a grant recipient with an opportunity for a
hearing, appeal, or other administrative proceeding if the statute or regulation authorizing the
particular grant program provides for one. IRC § 7526 does not require the IRS to provide grant
recipients an opportunity for hearing or appeal. Therefore, the necessity for renegotiation,
suspensions, or terminations of grant agreements will be determined solely by the IRS and will
not be subject to appeal. The grant agreement shall be terminated and enforced in accordance
with OMB Circular A-110.
H.
OPERATIONAL REQUIREMENTS
Each LITC will be held to certain operating and ethical standards during the duration of the grant
cycle.
1.
Standards of Operation. The LITC Program Office has developed baseline standards
of operation for LITC grant recipients. The standards ensure that all LITCs provide
consistent and quality service to low income and ESL taxpayers and ensure that all
LITCs are accountable for meeting the LITC Program requirements.
-13-
•
Qualified Tax Expert (QTE) – Availability of staff member with tax law expertise.
In general, the QTE must be an Attorney, CPA, or Enrolled Agent currently authorized to
practice before the IRS. However, consideration may be given to an applicant who can
demonstrate tax expertise because of a related academic degree, documented
experience or Continuing Professional Education credits.
The QTE will assume oversight of technical substantive tax matters.
•
Qualified Business Administrator (QBA) – Availability of staff member with business
administration expertise. If a department, as opposed to a single individual, fulfills this
requirement, please provide detail about the staff member who oversees the
department.
The QBA must demonstrate education or experience with business or program
administration, such as, but not limited to, internal controls, management of federal,
state or local grant funding, budget administration and procurement or the equivalent.
The QBA will have oversight of the clinic’s business operations.
•
Clinic Director – Availability of staff member with overall management responsibility for
the clinic.
The Clinic Director may be the QTE, QBA, or other clinic staff member. The Clinic
Director is responsible for managing the clinic, preparing or reviewing the required clinic
reports, and signing the reports as the clinic’s authorized representative. The Clinic
Director serves as the primary contact person for both the LITC Program Office and the
Local Taxpayer Advocate’s office.
•
Internal Controls – Assurance of compliance, safeguarding of assets, costs allowable,
authorized and allocable.
LITCs must create a written approval process to document the authorization of
expenditures from grant funds. The documentation should include, but is not limited to,
the expenditure’s amount, purpose, justification (if necessary), and the name of the
approving official. LITCs must have written procedures to track the clinic’s fixed assets
and inventory.
•
Publicity/Outreach – Effective publicity/outreach efforts to targeted audience.
LITCs must identify their target audience and develop and describe the outreach
strategy to reach that audience. LITCs should also implement a process that tracks how
participants hear about the program and the services offered. For example, an intake
form could be used to request needed information. For ESL outreach/education
seminars, the clinic could require that all attendees indicate on a sign-in sheet how they
learned about the seminar. The sign-in sheet also allows the clinic to keep track of the
number of attendees served, without requiring individual names or signatures.
Grantees are responsible for effectively publicizing the LITC Program to low income
taxpayers and ESL taxpayers. Publicity plans should be completed well in advance of
the period during which representation and other assistance will be offered.
-14-
Publicity materials and announcements to advertise the services provided by an LITC
may not mention tax return preparation or refund claim assistance.
Although the LITC Program recognizes the importance of using pamphlets,
brochures, and other advertisements to reach its target audience, clinics should
strive to include substantive tax information (e.g., when to file, what forms to file,
who is eligible for the Earned Income Tax Credit (EITC), how to file an offer in
compromise (OIC)) in indirect outreach efforts. Additionally, clinics should strive
for face-to-face contact (whether in one-on-one consultations or in a group
workshop), as the primary method for educating taxpayers.
•
Mentoring Programs – Availability of mentoring and other technical assistance for clinic
staff and volunteers.
Experienced LITCs may be asked to informally assist less experienced clinics with
operational inquiries and technical matters or issues. All clinics are encouraged to
identify best practices and submit them to the LITC Program Office for sharing with other
clinics to improve the overall quality of the LITC Program.
•
Networking – Development and maintenance of relationships with other communitybased organizations.
In the program plan, the LITC must identify networks within the community or
organizations with which it can work to reach its target audience.
•
Tax Library – Accessibility to and adequacy of tax library and research arrangements.
Each clinic must have a current version of the Internal Revenue Code and Treasury
Regulations in hard copy. Each LITC will establish and maintain current tax information
by documented subscription(s) or purchase agreement(s) demonstrating the purchase or
access to current tax information, updated Internet information, or through a written
agreement with another source. In the latter situation, the LITC may find research
sources through bar libraries, local law schools, or accounting and law firms.
•
Continuing Professional Education (CPE) – Quality of training of the clinic staff,
volunteers and other program participants to increase knowledge and skills necessary to
effectively deliver the services for which the clinic is funded. The QTE will be required to
ensure and document that the LITC staff, volunteers, and other program participants
receive appropriate training to enhance skills.
All clinics must attend the annual LITC conference. The cost of attending the LITC
Conference (e.g., transportation, hotel) should be included in an applicant’s request for
grant funding as a separate line item. If a clinic wishes to send more than two staff
members to the conference, the clinic must submit a written request to the Director of
the LITC Program Office no later than two weeks in advance of the conference.
For returning clinics: The Clinic Director must attend the annual LITC conference. If
the Clinic Director is not the QTE, we encourage both to attend the annual LITC
conference. The QTE is also encouraged to attend CPE programs run by the IRS and
professional organizations.
For new clinics: The QTE and QBA must attend the annual LITC conference and are
encouraged to attend CPE programs run by the IRS and professional organizations.
-15-
For all clinics: Any requests for an exception to the clinic attendance rules for the
annual LITC conference must be submitted in writing to the Director of the LITC Program
Office no later than two weeks in advance of the conference.
•
Qualified Volunteers – Qualifications, training, and background of volunteers used in the
clinics.
Each LITC will develop a written application process or volunteer position description to
determine qualifications of volunteers – that is, training, educational background and
other qualifications relevant to the services offered by the clinic.
•
Referral Services – If controversy clinics maintain a referral panel for representing
taxpayers in controversies, they must establish adequate referral systems controls.
Programs that inform ESL taxpayers about their rights and responsibilities must maintain
a pro bono panel and must establish adequate referral system controls. Clinics may
have their own referral panel, a relationship with an existing referral panel, or both. (See
definition of pro bono referral panel, page 2).
To expand clinic coverage, taxpayers with tax controversies may be referred to a panel
of qualified representatives who have agreed to provide free representation or other
assistance to taxpayers. Clinics are expected to have adequate procedures and a
monitoring system in place to ensure such referrals are handled expeditiously and that
the actual representation by individuals is, in fact, pro bono. Pro bono representatives
may not charge any fees for services (other than reimbursement of expenses such as
photocopying and court filing fees).
Controversy funding will not be awarded to an organization that is solely making
referrals to another LITC.
An LITC may only refer cases to other pro bono organizations, including a panel
maintained by a state bar association or a state or local society of accountants.
Generally, no one associated with the clinic should provide representation in a declined
case. Additionally, no one employed by the clinic, or who serves as a volunteer, should
continue providing representation in an accepted case or represent a clinic client in a
subsequent, separate matter on a fee-for-service basis. For example, an LITC holds an
ESL outreach program where an accountant who is the QTE for the clinic serves as a
speaker. An ESL taxpayer who attended the outreach session later seeks to engage the
accountant on a fee-for-service basis. Although the ESL taxpayer did not approach the
LITC for representation, the accountant must decline representation of the ESL taxpayer
unless the accountant is willing to represent the ESL taxpayer on a pro bono basis.
•
Confidentiality – Assurance that taxpayer information will be kept confidential.
Taxpayer information is confidential and should be shared on a limited basis. Grantees
are responsible for ensuring that taxpayer information is not compromised. Only those
who have a need to know in order to effect resolution of the controversy should be
allowed access to taxpayer information.
If a newspaper or other media reporter approaches clinic personnel to do a story about a
taxpayer helped by the clinic, clinic personnel cannot provide details about any particular
taxpayer’s case; a newspaper or other media reporter does not have a need to know of
taxpayer information.
If a client approaches clinic personnel and asks the clinic to participate in a news story,
the clinic must obtain a written waiver for the disclosure of the client’s taxpayer
-16-
information and clinic personnel must be confident that the client fully understands the
possible ramifications that could occur from disclosing taxpayer information.
In terms of a client discussing with the media the particulars of his or her case, there is
nothing in the LITC Program Guidelines that would prohibit such an interview. That
being said, however, this is an area where you should be very cautious. You may want
the interview to go forward as a way to advertise the services offered by your clinic, but
you cannot let this desire outweigh the best interests of your client.
By mentioning a potential interview to a client, the client may misunderstand and think
you are encouraging him or her to participate in the interview or that he or she is under
an obligation to participate as a way of thanking you for the services provided by your
clinic. You should communicate to the client that he or she is under no obligation to be
interviewed. Make sure the client fully understands the possible ramifications that could
occur from disclosing personal information to a reporter. You do not know what potential
issues other than tax issues could be lurking (e.g., custody or support battles, other
creditors, immigration) that could be brought to light as a result of the interview.
In summary, any time you receive a request from the media for a story about one of your
clients, you need to act, first and foremost, in the best interests of your client. If the
client chooses to participate in the interview, suggest to the client that he or she make it
a condition of the interview that the story be done without photos and names.
While generally a grantee, its employees, and volunteers, are not treated as income tax
return preparers for purposes of preparer penalties, the Treasury Regulations under IRC
§ 7216 define “tax return preparer” more broadly and generally prohibit a grantee, its
employees, and volunteers from disclosing taxpayer return information except when the
tax return preparer has obtained prior written consent from the taxpayer. The
regulations authorize disclosure without consent only in very limited situations. These
situations include disclosures made pursuant to an order of a court or a federal or state
agency. For unauthorized disclosure, IRC § 7216 imposes a sanction of up to one year
in prison or a $1,000 fine, or both. In addition, IRC § 6713 imposes a civil penalty of
$250 for each disclosure, up to $10,000 per calendar year.
Clinics must keep taxpayer information in a secure location. Before clinic employees or
volunteers leave the office each day, they must make sure that taxpayer information is
stored in a locked area. If it is necessary to take taxpayer information out of the office, it
should be safeguarded at all times.
Taxpayer information must be removed from materials before being used for teaching.
This includes deletion of names, addresses, taxpayer identification numbers and any
other information that could reasonably lead to identification of the taxpayer.
•
Workgroup Service – Participation in an LITC workgroup.
Each clinic is required to provide a representative to serve on at least one LITC
workgroup. These workgroups focus on substantive, administrative, and procedural tax
issues that impact low income or ESL taxpayers. Examples of workgroups are the
Earned Income Tax Credit (EITC), Individual Taxpayer Identification Numbers (ITINs),
Simplification of Notices Sent to Taxpayers, Financial Literacy, Multilingual Tax
Initiatives, and numerous federal tax compliance issues (e.g., Federal Payment Levy
Program, Offer In Compromise (OIC), Collection Due Process (CDP), and Refund
Litigation). The LITC Program Office provides guidelines to all clinics regarding the role
of workgroups and the expectations for workgroup service.
-17-
•
Tax Compliance – Compliance with federal tax responsibilities throughout the grant
cycle.
Clinics must be in full compliance with their federal tax responsibilities when applying for
an LITC grant and also throughout the grant cycle. To facilitate the resolution of any
potential tax compliance issues, we strongly encourage each clinic that is part of a larger
organization (e.g., a university) to submit with its application package a completed Tax
Information Authorization Form so that the LITC Program Office may contact your office
directly without violating IRC § 6103. For those clinics that are part of a larger
organization, the absence of a completed form may require additional time to resolve
any potential tax compliance issues and could result in a delay in the receipt of grant
funds.
•
Recordkeeping – Maintaining adequate records in case substantiation for an attorneys’
fee award is necessary.
In certain situations, attorneys’ fees (including fees for pro bono services) may be
awarded in a judgment or settlement of an administrative or judicial proceeding
concerning the determination, collection, or refund of tax, interest, or penalty. See IRC §
7430. Thus, a clinic doing controversy work must keep detailed contemporaneous
records so that if the situation arises, the clinic has adequate records to support an
award for attorneys’ fees. Records should include all time spent by employees,
volunteers, and students of the clinic. The records should describe what work was
performed by each individual, the status of the individual (e.g., paralegal, attorney,
volunteer, student, etc.), and the amount of time spent on each task.
2.
Managing Funds
ALLOWABLE EXPENSES
Allowable expenses, which must be in accordance with the grant award including OMB
Circulars A-122, “Cost Principles for Non-Profit Organizations” and A-21, “Cost
Principles for Educational Institutions”, as applicable, include (but are not limited to):
•
Salaries, wages, and personnel benefits;
•
Reasonable office supplies and equipment costs;
•
Rent, utilities, and custodial services;
•
Miscellaneous services, such as printing, postage, insurance, etc.;
•
Indirect costs as determined in accordance with principles set forth in OMB Circulars
A-21 and A-122;
•
Audit services;
•
Publicity and training costs directly and solely associated with the program;
•
Installation of telephone lines necessary to provide representation to low income
taxpayers or information to ESL taxpayers;
NOTE: To assist taxpayers in having the least cost in contacting a clinic for
assistance, it is highly recommended that the clinic have a toll-free number.
-18-
•
Travel performed by program administrator, coordinator, students or volunteers to
conduct clinic business. Other travel in support of clinic activities such as meetings
with the local Taxpayer Advocate and Low Income Taxpayer Clinic Program
sponsored LITC meetings;
•
Costs incurred in attending the mandatory annual LITC grant conference;
•
Costs incurred for interpreter services for hearing-impaired or non-English speaking
taxpayers; and
•
Cost of acquiring legal research and reference materials, including current copies of
the Internal Revenue Code and Treasury Regulations.
UNALLOWABLE EXPENSES
Examples of expenses for which LITC grant funds may NOT be used include (but are not
limited to):
•
Purchase, construction, repair, or rehabilitation of any building or any portion thereof;
•
Costs or expenses incurred which do not support or benefit the program, or which are
unnecessary in carrying out the program;
•
Certain advertising and public relations costs, as described in OMB Circular A-21, § J.1.f
and OMB Circular A-122, Attachment B, § 1;
•
Entertainment costs, as described in OMB Circular A-21, § J.17 and OMB Circular A122, Attachment B, § 14; and
•
Costs of goods or services for personal use of the clinic’s employees, as described in
OMB Circular A-21, § J.22 and OMB Circular A-122, Attachment B, § 19.
PAYMENTS TO LITC PROGRAM GRANTEES
Grantees must have a signed grant agreement on file with the LITC Program Office and
must provide written assurances of specific matching funds prior to the payment of any
funds. If expenses are incurred prior to approval, and the grant is later denied, all costs
incurred will be the responsibility of the applicant.
Electronic Funds Transfer (EFT) payments shall be limited to the minimum amounts needed
and be timed in accordance with the actual, immediate cash requirements of the recipient
organization in carrying out the purpose of the approved program or project. The timing and
amount of EFT payments shall be as close as is administratively feasible to the actual
disbursements by the recipient organization for direct program or project costs and the
proportionate share of any allowable indirect costs.
LITC Program grant payments will be disbursed through EFT. Information regarding the
EFT procedure is available on the Division of Payment Management segment of the HHS
website at www.dpm.psc.gov. Questions regarding disbursements should be directed to the
LITC Program Office at (202) 622-4711 or [email protected].
-19-
Advances of federal grant funds must be maintained in insured accounts. In addition,
grantees shall maintain advances of grant funds in interest bearing accounts, unless:
•
The grantee receives less than $120,000 in federal awards per year;
•
The best reasonably available interest-bearing account would not be expected to earn
interest in excess of $250 per year on federal cash balances; or
•
The depository would require an average or minimum balance so high that an interest
bearing account would not be feasible, given the grantee’s expected federal and
nonfederal cash resources.
You shall promptly, but at least annually, remit to the IRS interest earned on advances of
federal grant funds. However, you may keep interest up to $250 earned on all advances of
federal grant funds per calendar year.
When submitting the interim financial report, the clinic must indicate whether it will be
drawing down the remainder of its grant award during the second half of the year. The clinic
must also state whether it expects to be deobligating funds and if so, how much. Because
grant funds cannot generally be obligated after the end of the federal government’s fiscal
year (September 30), and because of the time involved to process a deobligation of funds
and any potential obligation to another clinic, it is important that a clinic notify the LITC
Program Office immediately if that clinic will not be using its entire award. The LITC
Program Office will then contact the clinic shortly thereafter to arrange for a formal release of
LITC grant funds so that any obligation to another clinic can be accomplished before
September 30. Unexpended grant amounts and advance payments must be returned to the
Internal Revenue Service.
The LITC Program Office will monitor clinics’ use of funds throughout the year. If you
determine that you will not use all of the funds awarded during the project period, the LITC
Program Office should be notified immediately in writing. This will give the LITC Program
Office time to reobligate those funds to other clinics prior to September 30 (the end of the
federal government’s fiscal year). The letter should include the amount being released, the
effective date of the release, and the reason that the amount awarded is being released.
The LITC Program Director must approve any changes to the above procedures in writing.
3.
Grantee Responsibilities
PROGRAM MANAGEMENT
Grantees are responsible for providing administrative support for the clinic by acting as
managers or program leaders for students, volunteers, and LITC employees. Grantees must:
•
State the amount of time managers or program leaders will devote to the LITC Program
as well as the amount of time that will be devoted to the management of students,
volunteers, and LITC employees;
•
Provide training for students, volunteers, and LITC employees;
•
Obtain a special order from the IRS Office of Professional Responsibility for students
who will be representing taxpayers before the IRS. If you need information about how to
request a special order, please contact Michael Hahn with the Office of Professional
Responsibility at (202) 622-6750. Only students who are enrolled in graduate business
-20-
and accounting classes or law school programs qualify for authorization by special order.
The Office of Professional Responsibility authorization is limited to IRS practice.
Permission must be obtained from the courts for student representation. LITCs that
receive student authorization from the Office of Professional Responsibility must have
their students revoke any existing Forms 2848 on file with the IRS before leaving the
program. If clinic students encounter difficulty with getting Forms 2848 processed or
with getting IRS personnel to recognize students as authorized representatives, please
contact the LITC Program Office at (202) 622-7186;
•
Monitor compliance of students, volunteers, and LITC employees with regard to program
requirements and guidelines outlined in grant agreement;
•
Maintain records of reimbursed expenses, if any, for students, volunteers, and LITC
employees; and
•
Submit timely reports, prepared in accordance with the guidelines established in this
Publication.
CHANGES IN LITC PROGRAM AWARD-SUPPORTED ACTIVITIES
Organizations should immediately notify the LITC Program Office of developments that have a
significant impact on the award-supported activities. Grantees must notify the LITC Program
Office in the case of problems, delays, or adverse conditions that materially impair the ability to
meet the objectives of this award. This notification shall include a statement of the action taken
or contemplated, and any assistance needed to resolve the situation. Failure to notify the LITC
Program Office may result in freezing of funds or termination of the grant.
LITC CONTACT INFORMATION
Clinics are required to update their contact information with the LITC Program Office twice a
year. This information includes the Clinic Director and contact person (and their phone numbers
and email addresses), the clinic address (both the physical address and the mailing address),
phone number, fax number, days and hours of operation, and the beginning and ending dates
clinic services will be provided. These requests ensure that the Program Office has the most
up-to-date information on each clinic. If there are any changes to this information throughout
the year, clinics should immediately notify the LITC Program Office and submit a revised Form
13424, IRS Low Income Taxpayer Clinic (LITC) Application Information Sheet.
LITC PROGRAM MATERIALS
Grantees that operate programs to inform ESL individuals of their taxpayer rights and
responsibilities are responsible for creating, printing, and distributing the educational program
materials used in conjunction with this activity.
WITHDRAWAL FROM LITC PROGRAM OR TERMINATION OF GRANT
A clinic must notify the LITC Program in writing if it withdraws from the Program or ceases to
exist before December 31; all unused funds must be returned to the IRS immediately.
If clinic activity is terminated prior to the expiration of the period of the grant agreement or if a
clinic withdraws from the LITC Program, a final program and financial report must be submitted
within 90 days of final clinic activity or withdrawal from the program. Similarly, if the LITC
Program Office terminates a grant because of a clinic’s failure to comply with the LITC Program
-21-
requirements, the clinic must submit a final program and financial report within 90 days of the
termination.
I.
REPORTING REQUIREMENTS
The LITC Program requires the submission of two reports during a grant cycle – an interim
report and an annual report. The LITC Program Office will measure the effectiveness of LITC
operations by the quality of service provided to low income taxpayers and ESL taxpayers.
Given the complexity of federal tax laws, it is important to monitor the accuracy and
thoroughness of representation and information provided to ESL taxpayers.
Failure to timely submit required reports to the LITC Program Office may result in
freezing of funds or termination of the grant. Under unusual circumstances, clinics may
request an extension of time to submit the interim or annual report. The request must be
submitted in writing to the LITC Program Office prior to the due date of the report.
Note: Interim and annual reports (including the report forms contained in Appendix C) are
subject to Freedom of Information Act (FOIA) requests. The LITC Program Office will release
these reports after appropriate redactions to ensure confidentiality of taxpayer information.
1.
INTERIM REPORTS
Interim reports must be submitted to the LITC Program Office by July 31, 2008. The
interim report covers the first half of the grant cycle (January 1 through June 30) and
consists of an interim financial report and an interim program narrative.
Interim Financial Report
The interim financial report must contain the following information:
1.
A completed Standard Form 269 (Long Form) for the period from January
1, 2008, through June 30, 2008; and
2.
A complete financial narrative, describing how grant funds were
expended for the period from January 1, 2008, through June 30, 2008.
If the clinic has not drawn down all of its awarded grant funds by the time the interim
financial report is due, the clinic must indicate whether it will be drawing down the
remainder of its grant award during the second half of the year. The clinic must also
state whether it expects to be deobligating funds and if so, how much. If a clinic does
not expect to use its entire grant award, it must contact the LITC Program Office as soon
as possible to arrange for a formal release of LITC grant funds.
If a clinic wants to request additional funding, it should submit a separate letter with its
interim report indicating the amount of additional funds being requested and how these
funds will be spent. The clinic’s grant award and amount of additional funding requested
for the grant cycle may not exceed $100,000 (see IRC § 7526(c)(2)).
Interim Program Narrative
The interim program narrative must contain the following information (numbered in
accordance with the information requested below):
1.
A detailed explanation of the strategy used for monitoring and evaluating
program results.
-22-
2.
A description of how you define and measure program success.
3.
A detailed explanation of the progress made in implementing the LITC
Program.
4.
The status of proposed goals and objectives.
5.
Describe any impediments to meeting established goals and objectives, and
efforts made to overcome them, if applicable.
6.
Describe the clinic’s efforts to publicize the program and the number of
individuals reached through the marketing activities. Include examples of
publicity such as flyers, brochures, posters, and newsletters distributed.
Other publicity efforts should also be discussed, including radio and television
ads, newspaper articles, workshops, outreach events, and visits to other
organizations. Appendix C contains a chart that can be used for tracking
publicity and outreach efforts. This form can be submitted as part of the
interim report.
7.
Describe the type of representation or other assistance provided to low
income taxpayers or ESL taxpayers, including a list of topics discussed
during educational presentations.
8.
If applicable, describe any additional activities, not described previously,
through which the clinic contributed to the community or to improving services
for low income and ESL taxpayers. Such activities include (but are not
limited to):
•
•
•
Training programs (both formal and informal) for other clinics,
community groups, service providers, or other organizations;
Educating students or employees who go on to provide pro bono
assistance to taxpayers, work for the IRS or other community groups;
and
Serving as a mentor or consultant to other clinics, attorneys, or other
organizations.
9.
A completed Supplemental Issue Form, contained in Appendix C of this
Publication. This form identifies some of the most common tax issues and
will help capture the type of assistance provided to taxpayers. If anything in
the form requires an additional explanation, please include this explanation in
the body of the report. You may describe cases that involve novel or
complex issues. In describing cases, please do not provide taxpayer
identifying information.
10.
A completed copy of the Report Form, contained in Appendix C of this
Publication. This form is designed to capture the work the clinic has
performed during the first six months of the grant cycle. This form should be
filled out completely. Enter N/A if a category does not apply to the clinic. The
numbers contained in the interim report form will be considered tentative. At
the end of the grant cycle, when you complete the annual report form, those
numbers will be considered the final numbers for the 2008 grant cycle. If
anything in the form requires an additional explanation, please include this
explanation in the body of the report. In addition, for any case opened during
-23-
the period where the amount in controversy exceeded $50,000, please
describe the reason(s) for accepting the case.
Interim reports should be submitted by July 31, 2008, to the following address:
Internal Revenue Service
Taxpayer Advocate Service
LITC Program Office
TA:LITC
Room 1034
Attention: Interim Reports
1111 Constitution Ave., NW
Washington, DC 20224
2.
ANNUAL REPORTS
Annual reports must be submitted to the LITC Program Office by March 31, 2009. The
annual report covers the entire grant cycle (January 1 through December 31) and
consists of a year-end financial report and a year-end program narrative. For grantees
that have been approved for the 2009 grant cycle, failure to submit the year-end report
for the 2008 grant cycle may result in freezing of grant funds or termination of the grant.
Year-End Financial Report
The year-end financial report must contain the following information:
1.
A completed Standard Form 269 (Long Form) for the period from January
1, 2008, through December 31, 2008;
2.
A complete financial narrative, describing how grant funds were
expended for the period from January 1, 2008, through December 31,
2008;
3.
A breakdown of the actual LITC expenses incurred during the calendar
year;
4.
The source, date, availability and amount of matching funds received for
the LITC Program; and
5.
An itemization and explanation of actual program costs for all expenses.
If space was rented for the clinic, provide a breakdown of costs incurred,
including rent and insurance.
Year-End Program Narrative
The year-end program narrative must contain the following information (numbered in
accordance with the information requested below):
1.
Implementation of the LITC Program. Describe the strategy for
monitoring and evaluating program results, including how success is
defined and measured. In addition, describe the overall approach taken
to implement the LITC Program and the steps taken to ensure
compliance with its rules and administrative guidelines. Include a
-24-
discussion of the clinic’s on-site quality review procedures. (For example,
explain internal procedures used to monitor and evaluate clinic activities
to ensure the program was administered in accordance with grant
agreement guidelines).
2.
3.
4.
5.
Information Provided to ESL Taxpayers. Identify how the topics were
determined and the type of analysis that was performed to determine how
to best meet the educational needs of the ESL community your
organization serves.
•
If written information was developed, identify the reviewer and his
or her qualifications. Identify the languages other than English in
which materials were prepared. If other languages were used,
identify the persons who reviewed the information and their
qualifications.
•
Identify the methods used to convey information to ESL taxpayers.
•
Identify the topics discussed during educational presentations.
Training Provided to Students, Volunteers, and LITC Employees. This
includes all training provided by the clinic, academic institution, or outside
sources. Identify the efforts undertaken to ensure students, volunteers,
and LITC employees were adequately prepared to assist taxpayers.
•
Describe how training materials were developed and prepared.
Identify who prepared the training materials, the qualifications of
the preparer and how the accuracy of the training materials was
verified.
•
Describe how the training was provided and the qualifications of
the instructor.
Case Tracking. Describe the process used to control assignment of
controversy cases to students, volunteers and LITC employees.
•
Describe how you determined to whom the case would be
assigned. Identify the skill levels of the students, volunteers, and
LITC employees in the clinic.
•
Describe clinic procedures when the controversy issue exceeds
students’, volunteers’, and LITC employees’ levels of training.
•
Describe the type of mentoring program in place to assist
students, volunteers, and LITC employees in resolving
controversies.
•
Describe the type of monitoring system used to insure that
controversies are resolved expeditiously and appropriately.
Publicity for the LITC. Describe the clinic’s efforts to publicize the
program and the number of individuals reached through the marketing
activities. Include examples of publicity such as flyers, brochures,
posters, and newsletters distributed. Identify who developed the publicity
-25-
radio and television ads, newspaper articles, workshops, outreach events,
and visits to other organizations. Appendix C contains a chart that can be
used for tracking publicity and outreach efforts. This form can be
submitted as part of the annual report.
6.
Referral Mechanism for Controversies. Describe the type of referral
system you used to refer taxpayers with a controversy. Indicate whether
follow-up action was performed to determine the outcome of the
controversy or to determine if the referral person/organization was able to
assist the taxpayer. Describe the procedures that you had in place to
resolve controversies for taxpayers who did not receive appropriate
assistance from the referral person/organization.
7.
Privacy and Confidentiality. Describe steps taken to ensure taxpayer
privacy and to maintain the confidentiality of tax information.
8.
Pro Bono Panel. Describe the qualified pro bono representatives to
whom taxpayers were referred. Include relevant education and
experience of panel members.
9.
Nominal Fee. Describe the nominal fee, if any, charged for representing
or providing tax information to taxpayers, including the basis for
determining the amount of the nominal fee to be charged.
10.
Delivery of Services. Describe the type of assistance given by telephone
and the procedures used to monitor its quality, if applicable.
11.
Miscellaneous. Describe the types of activity performed by the clinic that
facilitated accomplishment of the LITC Program mission and that are not
included elsewhere in your narrative.
12.
Program Goals. Explain whether established goals were met and if goals
were not met, the reasons why.
13.
Additional Activities. If applicable, describe any additional activities, not
described previously, through which the clinic contributed to the
community or to improving services for low income and ESL taxpayers.
Such activities include (but are not limited to):
•
•
•
14.
Training programs (both formal and informal) for other clinics,
community groups, service providers, or other organizations;
Educating students or employees who go on to provide pro bono
assistance to taxpayers, work for the IRS or other community groups;
and
Serving as a mentor or consultant to other clinics, attorneys, or other
organizations.
Last Year in LITC Program. If you are not continuing in the LITC Program
in the 2009 grant cycle, please detail the steps you have taken to resolve
any open cases or obtain new representation for current clients. For
employees and volunteers of the clinic that are lawyers, those individuals
need to adhere to their responsibilities as lawyers, not just the
-26-
responsibilities within the parameters of the LITC Program. The
American Bar Association (ABA) has model rules of professional conduct
that are applicable when a lawyer is terminating representation. In this
regard, ABA Model Rule 1.16 provides that upon terminating
representation of a client, a lawyer must take reasonable steps to protect
a client’s interests, which includes giving notice to the client, allowing the
client time to find other representation, and returning papers/property to
the client. Whichever state bar a lawyer is admitted to will likely have a
similar rule of professional responsibility that provides guidance for
terminating representation. In addition, the clinic must notify the United
States Tax Court that the clinic will not be continuing in the LITC Program
so that the Tax Court does not refer taxpayers to that clinic.
.
15.
Special Orders for Student Practice. Attach copies of the special orders
for student practice issued by the IRS Office of Professional
Responsibility, if applicable.
16.
Supplemental Issue Form. A completed copy of the Supplemental Issue
Form contained in Appendix C of this Publication. This form identifies
some of the most common tax issues and helps capture the type of
assistance provided to taxpayers. If anything in the form requires an
additional explanation, please include this explanation in the body of the
report. You may describe cases that involve novel or complex issues. In
describing cases, please do not provide taxpayer identifying information.
17.
Report Form. A completed copy of the Report Form, contained in
Appendix C of this Publication. This form is designed to capture the work
the clinic has performed during the entire grant cycle. This form should
be filled out completely. The numbers provided in the annual report form
will be considered the final numbers for the grant cycle. If anything in the
form requires an additional explanation, please include this explanation in
the body of the report.
Note: With respect to low income taxpayers whose controversies
exceeded $50,000, explain the circumstances surrounding the
representation or referral (e.g., the taxpayer had other taxable years in
controversy that did not exceed the statutory amount, the taxpayer’s
issues were of significance to the low income taxpayer population
generally, etc.).
Annual Reports should be submitted by March 31, 2009, to the following address:
Internal Revenue Service
Taxpayer Advocate Service
LITC Program Office
TA:LITC
Room 1034
Attention: Annual Report
1111 Constitution Ave., NW
Washington, DC 20224
-27-
NOTE: LITCs that terminate clinic activity prior to the expiration period of the grant
agreement or withdraw from the LITC Program must submit a final report to the IRS
within 90 days of final clinic activity or withdrawal from the program. Similarly, if the LITC
Program Office terminates a grant because of a clinic’s failure to comply with the LITC Program
requirements, the clinic must submit a final report within 90 days of the termination.
Subject to OMB approval, the LITC Program Office may require additional reporting information
from LITC grantees. Please refer to www.irs.gov/advocate prior to submitting your application
for updates to information reporting requirements.
V.
LITC PROGRAM OFFICE
A.
RESPONSIBILITIES
The LITC Program Office will assist LITCs in various ways at the national and local levels
including:
•
Furthering the clinics’ understanding of the LITC Program and their roles within the
Program;
•
Assisting with the placement of clinic materials in IRS offices;
•
Maintaining a publication listing all federally funded LITCs (Publication 4134) and
ensuring that the publication is included in appropriate IRS mailings and mentioned in
appropriate IRS publications;
•
Informing the public about the availability of LITCs, as appropriate, and to the extent
permitted by law, including references on the IRS Website at www.irs.gov;
•
Assisting with clinic marketing efforts to promote the LITC Program;
•
Answering questions from potential LITC applicants and current grantees;
•
Providing information on how to obtain a special order for student practice from the IRS
Office of Professional Responsibility;
•
Coordinating meetings between IRS officials and LITC Program grantees;
•
Coordinating and making periodic on-site assistance visits;
•
Providing technical assistance, suggestions, recommendations, and guidance to LITCs
regarding operation of their programs;
•
Coordinating the cross-functional LITC Program grant application review process;
•
Coordinating LITC workgroups;
•
Coordinating access to e-services products offered by the IRS; and
•
Providing information on how to obtain tax forms and instructions, IRS publications and
other pertinent IRS program materials.
-28-
B.
SITE ASSISTANCE VISITS
The LITC Program Office will periodically perform on-site assistance visits to selected clinics.
Site assistance visits are a means of providing reliable information to ensure grant funds are
being used appropriately and effectively and that the clinic is complying with the terms and
conditions of the LITC grant agreement and Program guidelines. These visits provide an
opportunity to share information about technical issues and identify areas where clinic services
can be improved. Site assistance visits also provide an opportunity for clinic personnel to ask
questions and share information about problems they may be encountering and to identify best
practices that can be shared with all LITCs.
During site assistance visits, the review process may include reviews of intake procedures,
systems for recording referrals of clients, communication and publicity plans,
demographics/population information, case statistics and analysis. Prior to the assistance visit,
the clinic will receive a list of items and topics to be reviewed. Additional items may be
requested during or after the assistance visit. This list may be derived from the standards for
clinic operation. As part of monitoring and evaluating clinic activities, however, the LITC
Program Office will be mindful of the clinic’s requirement to protect privileged information.
A site assistance visit generally begins with an opening conference at which the LITC Program
Office personnel and clinic staff will meet and discuss the purpose of the visit and the items to
be covered. A site assistance visit generally closes with a conference discussing the results of
the visit. The clinic will receive a written report of the visit, including any items requiring
corrective action, generally within 90 days of the visit.
•
New Clinics - All new clinics can expect to receive a site assistance visit from the LITC
Program Office staff within the first six months of the grant cycle. Clinics will be
contacted prior to the date of the visit to discuss specific items that may be reviewed.
This initial visit ensures that the clinic is operational and is not experiencing any major
difficulties. If the Program Office identifies problems during the initial visit, the Program
Office will schedule an in-depth follow-up visit.
•
Returning Clinics - The LITC Program Office strives to conduct a site assistance visit to
each clinic at least once every three years. Prior to a planned visit, the clinic will be
notified of the issues and items to be addressed during the visit.
All clinics should receive at least one visit from their Local Taxpayer Advocate (LTA) during the
year. This visit is designed to help foster the relationship between the clinic and its local
Taxpayer Advocate Office.
The LITC Program Office may make unscheduled visits during the year.
VI.
COMPLETION AND SUBMISSION OF GRANT APPLICATION
A.
LITC PROGRAM GRANT APPLICATION CONTENTS
•
Background Information (limited to 15 pages, double-spaced) - This section is designed
to solicit information concerning an organization’s qualifications. Provide specific responses
for each of the following requirements and keep comments concise and relevant. Begin
each response by annotating the letter that corresponds to the appropriate requirement.
-29-
a.
Describe nature of organization. Include a full explanation of existing affiliations
with other organizations, such as schools, governmental bodies, or other
charitable organizations.
b.
Describe experience in coordinating an LITC Program. Include type and duration
of service, target groups and geographic areas covered.
c.
Describe experience in delivering services to low income taxpayers and ESL
taxpayers. Include type of service provided, languages served, number of
individuals reached, and geographic area covered.
d.
Provide a detailed description of your matching funds. Identify committed
sources of funding to match the amount of funding requested. Provide copies of
any agreements, memoranda of understanding or similar documents pertaining
to matching funds. Any good faith estimates of matching funds must be
accompanied by letters of intent from third parties in an amount equal to the
estimated matching funds or a statement of when such letter of intent or award
letter will be granted.
e.
Describe the organization’s ability to properly utilize and account for program
funds. Include examples of experience in managing federal grants, if any, and a
description of the organization’s existing accounting system and accounting
support staff. Include copies of relevant internal procedures, and other pertinent
information. Specifically describe the following:
f.
•
i.
Accounting procedures;
ii.
The method for allocating allowable expenses and matching funds
between qualifying and nonqualifying activities or programs, if applicable;
iii.
The plans for audits and controls; and
iv.
The procedures that will be used for proper cost allocation for LITC
Program grant funds if the organization seeks to operate an LITC
Program in conjunction with a Volunteer Income Tax Assistance (VITA)
Program or a Tax Counseling for the Elderly (TCE) Program.
Certify that the applicant is in compliance with its own federal tax responsibilities.
Clinics must be in compliance with federal tax responsibilities when applying for
an LITC grant and also throughout the grant cycle. To facilitate the resolution of
any potential tax compliance issues, we strongly encourage each clinic that is
part of a larger organization (e.g., a university) to submit with its application
package a completed Tax Information Authorization Form. For those clinics that
are part of a larger organization, the absence of a completed form may require
additional time to resolve any potential tax compliance issues and could result in
a delay in the receipt of grant funds. A Tax Authorization Form is included in
Appendix A.
Determination of Program Performance (This section is not limited in length) - This
section of the application is designed to solicit information concerning the ability of a clinic to
represent taxpayers, refer taxpayers, or inform ESL taxpayers about their rights and
responsibilities as U.S. taxpayers. Provide specific responses for each of the following
requirements and keep comments concise and relevant. Begin each response by
annotating the letter that corresponds to the appropriate requirement.
-30-
1.
Describe your ability to meet the Standards of Operation. At a minimum, you
must answer the following questions when describing your ability to meet the
Standards of Operation:
a.
Who is the clinic’s Qualified Tax Expert (QTE)? What are the QTE’s
qualifications and relevant expertise?
b.
Who is the clinic’s Qualified Business Administrator (QBA)? What are the
QBA’s qualifications and relevant expertise?
c.
Who is the clinic’s Clinic Director? What are his or her qualifications and
relevant expertise?
d.
What is the clinic’s publicity and outreach plans, including potential
venues for outreach to low income taxpayers?
e.
What is the clinic’s experience in mentoring and providing technical
assistance to staff, students, and volunteers, as well as to other clinics?
f.
What is the clinic’s experience networking with other community-based
organizations with which it can work to reach its target audience?
g.
What is the clinic’s accessibility to, and adequacy of, a tax library?
h.
What are the qualifications, training, and background of students,
volunteers or staff of the clinic? This includes all training provided by the
clinic, academic institution, or outside sources. How will potential
students, volunteers or staff be identified, monitored, and evaluated to
ensure taxpayers receive accurate assistance?
i.
What are the continuing professional educational (CPE) activities of the
clinic staff and volunteers?
j.
What is the clinic’s pro bono network referral panel? How are panel
members recruited and what are the procedures for monitoring and
following up on referrals?
2.
Provide background information on quality of management staff. List the titles,
responsibilities and qualifications of the top five members of professional staff
who will be involved with the LITC Program.
3.
Describe your proposed program plan. The plan should not be limited to what
has been done in the past or to existing programs. Include a description of the
type of assistance (representation, referral, or ESL) that will be provided if an
award is granted. Provide a detailed description of your program goals. If the
program goals extend beyond one year, state goals by annual increments of up
to three years. If more than one type of assistance will be provided, provide
a separate program plan and goals for each.
4.
Explain internal procedures for monitoring and evaluating clinic activities to
ensure the program is administered in accordance with eligibility guidelines and
that grant funds are used for program purposes. The following procedures must
also be explained in this section, if applicable:
a.
Plans for ensuring the 90/250 income requirement is satisfied;
-31-
•
b.
Plans for ensuring the amount in controversy for any taxable year
generally does not exceed the amount specified in IRC § 7463 (currently
$50,000);
c.
Plans for ensuring that programs to inform ESL taxpayers about their
taxpayer rights and responsibilities reach the targeted audience;
d.
Plans for charging nominal fees, if any; and,
e.
Plans for determining number of ESL taxpayers served.
5.
Identify geographic area(s) the clinic will serve. This includes a breakdown of the
counties served by the clinic. Identify the number of ESL taxpayers in the
geographic area the clinic will serve. Also identify any languages in which the
clinic provides interpreter assistance. Clarify if interpreters are available.
6.
Include dates, days and hours of clinic operation. All clinics must indicate
whether the clinic will be open full-time and year round. Year-round, full-time
access is preferable to part-time or partial year access for clients. In making
grant awards, consideration will be given to whether clinics are open full-time and
year round. Describe plans for staffing the LITC during periods of student
absences if the LITC is part of an academic organization.
7.
Describe plans to ensure taxpayer privacy and to maintain confidentiality of
taxpayer information and any tax returns prepared.
8.
Describe the strategy for monitoring and evaluating program results (in short and
long-term), including how success will be defined and measured.
9.
Describe plans, if any, to make name or organizational changes. Requests to
approve name or organizational status changes must be submitted in
writing to the LITC Program Office in advance of the effective dates of
proposed changes with sufficient time to afford program evaluation and
legal review. Supplemental information may be required. Supplemental
information may include, but is not limited to, certifications by the clinic's legal
counsel that transfers were properly effected under applicable laws and evidence
that a successor-in-interest is eligible to perform the grant and will comply with all
the terms of the grant, including the program plan. IRS approval criteria will
include, but is not limited to, the statutory requirements of IRC § 7526. The
statutory requirements include, but are not limited to, the limitation that the
aggregate amount of grants which may be made to a clinic for a year shall not
exceed $100,000 (see IRC § 7526(c)(2)).
Budget/Financial Information – This section is designed to solicit information concerning
an organization’s budget request for the grant cycle. Provide the requested forms or
information listed below. Organizations conducting more than one qualifying activity
must provide a separate budget for each activity.
1.
Standard Form 424A, Budget Information – Non-Construction Programs
(one for each qualifying program, if applicable).
2.
Budget narrative (one for each qualifying program, if applicable). The budget
narrative should explain the expenses stated on Standard Form 424A.
-32-
B.
3.
Copy of most recent audited or unaudited financial statement. If an unaudited
financial statement is submitted, please explain why an audited financial
statement is not available.
4.
Copy of most recent A-133 Audit with findings, if applicable.
NEW OR SINGLE-YEAR GRANT APPLICATIONS - GENERAL INSTRUCTIONS FOR SUBMISSION OF LITC
PROGRAM GRANT APPLICATION PACKAGES
If applying by U.S.P.S. mail, private delivery service, or hand delivery, rather than electronically,
the Application Package must be assembled as described below and submitted in
quadruplicate (four sets). The LITC Program Office will provide a copy of your Application
Package to the IRS EEO Office, for a pre-award civil rights compliance review. All application
documents must be typed and numbered at the bottom of the page. All documents
(originals and copies) must have original signatures in blue ink.
NOTE: If your multi-year grant cycle has ended, you must submit a complete new application.
For applicants seeking continuing funding for current multi-year grants, see below for the
instructions for continuing multi-year grant applications.
LITC Program Grant Application Package Assembly
It is very important that the LITC Program grant application package be assembled
correctly. An improperly assembled or incomplete application will cause a delay in
processing and may result in rejection of the application. A copy of IRS Form
12183, Grant Agreement, included in Appendix A, is for information only and is not
required to be submitted with your package. Once a grant has been awarded, a clinic
will receive a completed Form 12183 to sign and denote acceptance of the award. A
checklist is provided in Appendix B to assist in assembling the package in the correct
order. The application package should be assembled in the following manner:
1.
Standard Form 424, Application for Federal Assistance: completed according to
instructions provided with form and signed and dated in blue ink (not a
photocopy) by an authorized representative of the organization. The LITC
Program Catalog of Federal Domestic Assistance Number, Block #10, is 21.008.
NOTE: In Box 5, the organization's legal name should be shown in the space
provided. The clinic's name (if different from the organization’s legal name)
should be placed in the space designated for the "Organizational Unit."
2.
Background Information prepared according to instructions (page 27).
3.
Copy of the determination letter issued by IRS recognizing organization as
exempt under IRC § 501(c), if applicable.
4.
Copy of letter of academic accreditation for affiliated college, university or other
institution of higher learning, if applicable.
5.
Determination of Program Performance prepared according to instructions (one
for each qualifying program, if applicable) (page 27).
6.
Budget/Financial Information prepared according to instructions (one for each
qualifying program, if applicable) (page 29).
-33-
C.
7.
Completed Form 13424, IRS Low Income Taxpayer Clinic (LITC) Application
Information Sheet. The form is included in Appendix A of this package.
8.
Assurances and Certifications signed and dated in blue ink by an authorized
representative of the organization. Assurances and Certifications should be
submitted in the following order:
a.
Standard Form 424B, Assurances – Non-Construction Programs;
b.
Certification Regarding Debarment, Suspension and Other
Responsibilities Matters Primary Covered Transactions;
c.
Certification Regarding Government-Wide Requirements for Drug-Free
Workplace (Grants);
d.
Certification of Assurance Concerning Civil Rights Compliance;
e.
Standard Form LLL, Disclosure of Lobbying Activities; and
f.
Tax Information Authorization Form, if applicable.
CONTINUING MULTI-YEAR GRANT APPLICATIONS - GENERAL INSTRUCTIONS FOR SUBMISSION OF
LITC PROGRAM GRANT APPLICATION PACKAGES
If applying by U.S.P.S. mail, private delivery service, or hand delivery rather than electronically,
the Application Package must be assembled as described below and submitted in
quadruplicate (four sets). The LITC Program Office will provide a copy of your Application
Package to the IRS EEO Office, for a pre-award civil rights compliance review. All application
documents must be typed, double-spaced and numbered at the bottom of the page. All
documents (originals and copies) must have original signatures in blue ink.
NOTE: If your multi-year grant cycle has ended, you must submit a complete new application.
LITC Program Grant Application Package Assembly
It is very important that the LITC Program grant application package be assembled
correctly. An improperly assembled or incomplete application will cause a delay in
processing and may result in rejection of the application. A copy of IRS Form
12183, Grant Agreement, included in Appendix A, is for information only and is not
required to be submitted with your package. Once a grant has been awarded, a clinic
will receive a completed Form 12183 to sign and denote acceptance of the award. A
checklist is provided in Appendix B to assist in assembling the package in the correct
order. The application package should be assembled in the following manner:
1.
Standard Form 424, Application for Federal Assistance, completed according to
instructions provided with form and with original signatures signed in blue ink (not
a photocopy) by an authorized representative of the organization. Check
“continuation” in Block 8, Type of Application. The LITC Catalog of Federal
Domestic Assistance Number, Block 10, is 21.008.
2.
A letter requesting continuation in the LITC Program for the 2008 grant cycle.
The letter must include the grant amount requested for the 2008 grant cycle and
any proposed program modifications to the original application.
-34-
3.
Standard Form 424A, Budget Information – Non-Construction Programs – check
the continuation box (one for each qualifying program, if applicable).
4.
Budget Narrative (one for each qualifying program, if applicable). The budget
should explain the expenses stated on Standard Form 424A and should include
the cost for up to two individuals from your organization to attend the annual IRS
LITC conference.
5.
Provide a detailed description of your matching funds. Identify committed
sources of funding to match the amount of funding requested. Provide copies of
any agreements, memoranda of understanding or similar documents pertaining
to matching funds. Any good faith estimates of matching funds must be
accompanied by letters of intent from third parties in an amount equal to the
estimated matching funds or a description of when such letter of intent or award
letter will be granted.
6.
An estimate of funds that will not be expended during the 2007 year and the
reason why the funds will not be used.
7.
Completed Form 13424, IRS Low Income Taxpayer Clinic (LITC) Application
Information Sheet. The form is included in Appendix A of this package.
8.
Assurances and Certifications signed and dated in blue ink by an authorized
representative of the organization. Assurances and Certifications should be
submitted in the following order:
a.
Standard Form 424B, Assurances – Non-Construction Programs;
b.
Certification Regarding Debarment, Suspension and Other
Responsibilities Matters Primary Covered Transactions;
c.
Certification Regarding Government-Wide Requirements for Drug-Free
Workplace (Grants);
d.
Certification of Assurance Concerning Civil Rights Compliance;
e.
Standard Form LLL, Disclosure of Lobbying Activities; and
f.
Tax Information Authorization Form, if applicable.
NOTE: Attachments must be assembled in the order listed above and all certifications
must be signed and dated in blue ink.
D.
WHERE AND WHEN TO FILE
Applications may be submitted either electronically or in hardcopy by U.S.P.S. mail, private
delivery service, or hand delivery. To submit an electronic application, go to www.grants.gov to
apply through the Federal Grants web site. For applicants applying through the Federal Grants
website, the Funding Number is TREAS-GRANTS-052008-001. All applications (whether
submitted electronically or in hardcopy) must be postmarked or submitted (if filed
electronically) by July 6, 2007, in order for them to be considered for 2008 LITC Program grant
funding. Applications submitted in hardcopy should be sent to the following address:
-35-
Internal Revenue Service
Taxpayer Advocate Service
LITC Program Office
TA:LITC
Room 1034
Attention: LITC Applications
1111 Constitution Ave., NW
Washington, DC 20224
An application may be withdrawn at any time during the application process or prior to the time
grant money is awarded. All withdrawals must be made in writing to the above address.
VII.
SELECTION AND AWARD OF GRANT RECIPIENTS
Through the selection and award decision-making process, the IRS will seek to implement
Congressional intent to provide grants to academic institutions and nonprofit organizations throughout
the United States for low income representation, and ESL tax educational services.
The IRS may award grants with one-year, two-year, and three-year project periods to clinics evaluated
under this application cycle’s selection and award process. Clinics awarded a two or three-year grant
based on acceptance of their program plans will not undergo formal evaluation under the second or
third year cycle selection and award process. However, two and three-year recipients will be reviewed
annually for satisfactory performance and progress in meeting goals and objectives as well as
compliance with grant terms. The funding level for subsequent years will be reviewed annually and
may be increased or decreased at the discretion of the LITC Program Office. All funding will be
based on the availability of annually appropriated funds. Awarding of multi-year grants is at the
discretion of the LITC Program Office.
All applications will undergo a preliminary eligibility screening. Applications that do not meet all
eligibility screening criteria will be eliminated from the award process. Applications that pass the
eligibility screening will then be evaluated based on their Technical Merit, Amount of Funding
Requested, and Other Considerations.
A.
ELIGIBILITY SCREENING
Applications will be reviewed to determine the following information:
•
Length of Grant Requested (one-year, two-year or three-year);
•
Type of Service Proposed (Controversy, ESL, or both); and
•
Status of Organization (previous recipient of an LITC grant, start-up or other).
Applications will be reviewed further to determine if all required items are included in the
application package. Please be sure to use the checklist in Appendix B to ensure all required
items are included.
B.
.
EVALUATION PROCESS
Applications that pass the eligibility screening process will undergo a two-tiered evaluation
process. Applications will be subject to both a technical evaluation and a secondary evaluation.
-36-
The IRS retains discretionary authority to award grant funds based on controversy, ESL or a
combination of program plans to achieve the goals of the LITC Program.
1.
Technical Evaluation
During the technical evaluation, each application will be awarded points in each of the
areas listed below based on the information contained in their proposed program plan(s).
Each criterion reflects the maximum number of points that may be assigned in that
category. In assigning numerical points, the IRS will evaluate the program plan based
on how it will assist in accomplishment of the LITC Program goals as stated elsewhere
in the application package. Organizations can receive a maximum of 100 points.
If you are applying for more than one qualifying activity (i.e., a combination of
controversy and, ESL), you must submit separate program plans and each program plan
will be evaluated separately. Points will be assigned as follows:
2.
•
Quality of programs offered to assist low income taxpayers or ESL taxpayers.
This item evaluates the qualifications of administrators and qualifications and tax
expertise of qualified representatives; comprehensiveness of the services to be
provided; amount of time devoted to the program by clinic staff; quality of training
and technical support to clinic volunteers, students, and LITC employees; plans
for supervising clinic volunteers, students, and LITC employees; procedures for
ensuring the confidentiality of taxpayer information; publicity of clinic operations;
and the dates and days and hours of clinic operation. (Maximum 75 points).
•
Experience in sponsoring a tax clinic where individuals with tax controversies
with the IRS were represented, or experience in sponsoring a tax clinic where
taxpayers with tax controversies with the IRS were referred to a pro bono panel
of qualified representatives, or experience in providing a program to inform ESL
taxpayers about their taxpayer rights and responsibilities. (Maximum 10
points).
•
Quality of grant administration and internal accounting procedures. (Maximum
10 points).
•
Number of low income or ESL taxpayers in geographic area and proposed efforts
to reach these taxpayers. (Maximum 5 points).
Program Office Evaluation
After the completion of the technical evaluation, applications will undergo a secondary
review by the LITC Program Office. This evaluation will be based on the information
contained in the program plan, as well as the clinic’s history in the LITC Program (if they
are a returning clinic). Specifically, the evaluation will look at:
•
New Applicants. The LITC Program Office will perform a general review of the
application and program plan to ensure that the clinic has sufficient funds, can
meet the program requirements, and that the technical review did not raise any
significant concerns.
-37-
•
Returning and Multiyear Applicants. The LITC Program Office will perform a
general review of the application and program plan, as well as a more detailed
review of the clinic’s history in the LITC Program. The Program Office will look
at:
1.
Timeliness and completeness of interim and annual reports;
2.
Any significant concerns raised by prior site assistance visits and
whether the clinic has addressed those concerns;
3.
Whether the clinic’s activities match its program plan;
4.
Clinic’s involvement with other clinics, community groups, Taxpayer
Advocate Service (TAS), and the LITC Program Office; and
5.
Whether the clinic has a history of not drawing down funds timely;
and
6.
Whether the clinic has failed to notify the LITC Program Office of
any unused funds in sufficient time for the Program Office to
reobligate them to another clinic.
All applicants will also undergo a review of the organization’s federal tax compliance
status. Grant funds may be withheld or denied based on an applicant’s failure to be in
full compliance with all current federal tax obligations.
The decision of whether or not to award grant funds will be based on the technical evaluation,
Program Office evaluation, and the following additional considerations:
•
To foster parity regarding clinic availability and accessibility for low income and ESL
taxpayers nationwide, the LITC Program Office will consider the geographic areas of
applicants and the languages in which the applicants will assist taxpayers.
•
If applications from more than one clinic sponsored by the same institution or
organization are received, the LITC Program will consider all factors surrounding the
operation of the clinics, including the geographic areas served by the clinics and the
comprehensiveness of the services to be provided, in determining whether and in
what amount grants will be made to one or more such clinics.
•
For academic clinics, which generally serve fewer taxpayers than nonacademic
clinics because of the time involved in teaching and mentoring students, the LITC
Program will consider additional ways in which academic clinics can accomplish
LITC Program goals (e.g., providing technical assistance, training, and mentoring to
other LITC programs, publishing articles about the LITC Program, commenting on
proposed Treasury regulations that affect low income or ESL taxpayers, and
monitoring graduates to determine whether they perform pro bono work on behalf of
or otherwise assist low income taxpayers).
•
The number of taxpayers who will be served by the clinic, including the ESL
taxpayers in the geographic area and the languages served by the clinic.
•
The existence of other LITC Programs serving the same population.
•
Appropriateness of funds sought for quantity and quality of services to be offered.
-38-
•
C.
Other sources of funding available to the clinic.
NOTIFICATION OF AWARD DECISIONS
The LITC Program Office will notify organizations of their acceptance or rejection of their grant
application. Accepted organizations will be provided the name, address and telephone number
of a local IRS contact person after their Form 12183, Grant Agreement, is signed. The LITC
Program Office may, at its discretion, conduct a site inspection visit to a prospective LITC
Program location prior to awarding grant funds.
-39-
Appendix A
LITC Program Grant Forms
-A-
Version 7/03
APPLICATION FOR
FEDERAL ASSISTANCE
1. TYPE OF SUBMISSION:
Application
2. DATE SUBMITTED
Applicant Identifier
3. DATE RECEIVED BY STATE
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY
Federal Identifier
Pre-application
Construction
Construction
Non-Construction
5. APPLICANT INFORMATION
Legal Name:
Non-Construction
Organizational Unit:
Department:
Organizational DUNS:
Division:
Address:
Street:
Name and telephone number of person to be contacted on matters
involving this application (give area code)
Prefix:
First Name:
City:
Middle Name
County:
Last Name
State:
Zip Code
Suffix:
Country:
Email:
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
Phone Number (give area code)
-
Fax Number (give area code)
7. TYPE OF APPLICANT: (See back of form for Application Types)
8. TYPE OF APPLICATION:
New
Continuation
If Revision, enter appropriate letter(s) in box(es)
(See back of form for description of letters.)
Revision
Other (specify)
Other (specify)
9. NAME OF FEDERAL AGENCY:
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
11. DESCRIPTIVE TITLE OF APPLICANT’S PROJECT:
-
TITLE (Name of Program):
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.):
13. PROPOSED PROJECT
Start Date:
14. CONGRESSIONAL DISTRICTS OF:
a. Applicant
b. Project
Ending Date:
15. ESTIMATED FUNDING:
00
a. Federal
$
.
b. Applicant
$
.
c. State
$
.
00
00
d. Local
$
.
00
e. Other
$
.
00
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
THIS PREAPPLICATION/APPLICATION WAS MADE
a. Yes.
AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
PROCESS FOR REVIEW ON
DATE:
b. No.
00
f. Program Income
$
.
g. TOTAL
$
.
PROGRAM IS NOT COVERED BY E. O. 12372
OR PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
00
Yes If “Yes” attach an explanation.
No
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Authorized Representative
Prefix
First Name
Middle Name
Last Name
Suffix
b. Title
c. Telephone Number (give area code)
d. Signature of Authorized Representative
e. Date Signed
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 424 (Rev.9-2003)
Prescribed by OMB Circular A-102
Reset Form
INSTRUCTIONS FOR THE SF-424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE
ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required face sheet for pre-applications and applications submitted for Federal
assistance. It will be used by Federal agencies to obtain applicant certification that States which have established a review and comment
procedure in response to Executive Order 12372 and have selected the program to be included in their process, have been given an
opportunity to review the applicant’s submission.
Item:
1.
Entry:
Select Type of Submission.
Item:
11.
2.
Date application submitted to Federal agency (or State if applicable)
and applicant’s control number (if applicable).
12.
3.
State use only (if applicable).
13
Enter the proposed start date and end date of the project.
4.
Enter Date Received by Federal Agency
Federal identifier number: If this application is a continuation or
revision to an existing award, enter the present Federal Identifier
number. If for a new project, leave blank.
Enter legal name of applicant, name of primary organizational unit
(including division, if applicable), which will undertake the
assistance activity, enter the organization’s DUNS number
(received from Dun and Bradstreet), enter the complete address of
the applicant (including country), and name, telephone number, email and fax of the person to contact on matters related to this
application.
14.
List the applicant’s Congressional District and any District(s)
affected by the program or project
15
Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in kind
contributions should be included on appropriate lines as
applicable. If the action will result in a dollar change to an
existing award, indicate only the amount of the change. For
decreases, enclose the amounts in parentheses. If both basic
and supplemental amounts are included, show breakdown on
an attached sheet. For multiple program funding, use totals
and show breakdown using same categories as item 15.
Applicants should contact the State Single Point of Contact
(SPOC) for Federal Executive Order 12372 to determine
whether the application is subject to the State
intergovernmental review process.
This question applies to the applicant organization, not the
person who signs as the authorized representative. Categories
of debt include delinquent audit disallowances, loans and
taxes.
5.
6.
Enter Employer Identification Number (EIN) as assigned by the
Internal Revenue Service.
16.
7.
Select the appropriate letter in
the space provided.
I.
State Controlled
A. State
Institution of Higher
B. County
Learning
C. Municipal
J. Private University
D. Township
K. Indian Tribe
E. Interstate
L. Individual
F. Intermunicipal
M. Profit Organization
G. Special District
N. Other (Specify)
H. Independent School
O. Not for Profit
District
Organization
Select the type from the following list:
•
"New" means a new assistance award.
•
“Continuation” means an extension for an additional
funding/budget period for a project with a projected completion
date.
•
“Revision” means any change in the Federal Government’s
financial obligation or contingent liability from an existing
obligation. If a revision enter the appropriate letter:
A. Increase Award
B. Decrease Award
C. Increase Duration
D. Decrease Duration
Name of Federal agency from which assistance is being requested
with this application.
17.
8.
9.
10.
18
Entry:
Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real
property projects), attach a map showing project location. For
preapplications, use a separate sheet to provide a summary
description of this project.
List only the largest political entities affected (e.g., State,
counties, cities).
To be signed by the authorized representative of the applicant.
A copy of the governing body’s authorization for you to sign
this application as official representative must be on file in the
applicant’s office. (Certain Federal agencies may require that
this authorization be submitted as part of the application.)
Use the Catalog of Federal Domestic Assistance number and title of
the program under which assistance is requested.
SF-424 (Rev. 7-97) Back
OMB Approval No. 0348-0044
BUDGET INFORMATION - Non-Construction Programs
SECTION A - BUDGET SUMMARY
Grant Program
Function
or Activity
(a)
Catalog of Federal
Domestic Assistance
Number
(b)
Estimated Unobligated Funds
Federal
(c)
Non-Federal
(d)
$
1.
New or Revised Budget
$
Federal
(e)
Non-Federal
(f)
$
Total
(g)
$
$
0.00
2.
0.00
3.
0.00
4.
0.00
5.
Totals
$
0.00
$
0.00
$
0.00
$
0.00
$
0.00
SECTION B - BUDGET CATEGORIES
GRANT PROGRAM, FUNCTION OR ACTIVITY
6. Object Class Categories
a. Personnel
Total
(1)
(2)
(3)
(4)
$
$
$
$
(5)
$
0.00
b. Fringe Benefits
0.00
c. Travel
0.00
d. Equipment
0.00
e. Supplies
0.00
f. Contractual
0.00
g. Construction
0.00
h. Other
0.00
i. Total Direct Charges (sum of 6a-6h)
0.00
0.00
0.00
0.00
0.00
j. Indirect Charges
k. TOTALS (sum of 6i and 6j)
7. Program Income
0.00
$
$
0.00
$
$
0.00
$
$
Authorized for Local Reproduction
Previous Edition Usable
0.00
$
$
0.00
$
$
0.00
0.00
Standard Form 424A (Rev. 7-97)
Prescribed by OMB Circular A-102
SECTION C - NON-FEDERAL RESOURCES
(b) Applicant
(c) State
(a) Grant Program
8.
$
$
(d) Other Sources
$
(e) TOTALS
0.00
$
9.
0.00
10.
0.00
11.
0.00
12. TOTAL (sum of lines 8-11)
$
0.00 $
0.00 $
0.00
$
0.00
SECTION D - FORECASTED CASH NEEDS
Total for 1st Year
13. Federal
$
14. Non-Federal
1st Quarter
0.00 $
2nd Quarter
3rd Quarter
$
$
0.00 $
0.00 $
4th Quarter
$
0.00
15. TOTAL (sum of lines 13 and 14)
$
0.00 $
0.00
0.00
$
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program
FUTURE FUNDING PERIODS (Years)
(c) Second
(d) Third
(b) First
16.
$
$
$
$
0.00 $
0.00 $
(e) Fourth
$
17.
18.
19.
20. TOTAL (sum of lines 16-19)
0.00
$
0.00
SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges:
22. Indirect Charges:
23. Remarks:
Authorized for Local Reproduction
Standard Form 424A (Rev. 7-97) Page 2
INSTRUCTIONS FOR THE SF-424A
Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0044), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
General Instructions
This form is designed so that application can be made for funds
from one or more grant programs. In preparing the budget,
adhere to any existing Federal grantor agency guidelines which
prescribe how and whether budgeted amounts should be
separately shown for different functions or activities within the
program. For some programs, grantor agencies may require
budgets to be separately shown by function or activity. For other
programs, grantor agencies may require a breakdown by function
or activity. Sections A, B, C, and D should include budget
estimates for the whole project except when applying for
assistance which requires Federal authorization in annual or
other funding period increments. In the latter case, Sections A, B,
C, and D should provide the budget for the first budget period
(usually a year) and Section E should present the need for
Federal assistance in the subsequent budget periods. All
applications should contain a breakdown by the object class
categories shown in Lines a-k of Section B.
For continuing grant program applications , submit these forms
before the end of each funding period as required by the grantor
agency. Enter in Columns (c) and (d) the estimated amounts of
funds which will remain unobligated at the end of the grant
funding period only if the Federal grantor agency instructions
provide for this. Otherwise, leave these columns blank. Enter in
columns (e) and (f) the amounts of funds needed for the
upcoming period. The amount(s) in Column (g) should be the
sum of amounts in Columns (e) and (f).
For supplemental grants and changes to existing grants, do not
use Columns (c) and (d). Enter in Column (e) the amount of the
increase or decrease of Federal funds and enter in Column (f) the
amount of the increase or decrease of non-Federal funds. In
Column (g) enter the new total budgeted amount (Federal and
non-Federal) which includes the total previous authorized
budgeted amounts plus or minus, as appropriate, the amounts
shown in Columns (e) and (f). The amount(s) in Column (g)
should not equal the sum of amounts in Columns (e) and (f).
Section A. Budget Summary Lines 1-4 Columns (a) and (b)
Line 5 - Show the totals for all columns used.
For applications pertaining to a single Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring
a functional or activity breakdown, enter on Line 1 under Column
(a) the Catalog program title and the Catalog number in Column
(b).
For applications pertaining to a single program requiring budget
amounts by multiple functions or activities, enter the name of
each activity or function on each line in Column (a), and enter the
Catalog number in Column (b). For applications pertaining to
multiple programs where none of the programs require a
breakdown by function or activity, enter the Catalog program title
on each line in Column (a) and the respective Catalog number on
each line in Column (b).
For applications pertaining to multiple programs where one or
more programs require a breakdown by function or activity,
prepare a separate sheet for each program requiring the
breakdown. Additional sheets should be used when one form
does not provide adequate space for all breakdown of data
required. However, when more than one sheet is used, the first
page should provide the summary totals by programs.
Lines 1-4, Columns (c) through (g)
For new applications , leave Column (c) and (d) blank. For each
line entry in Columns (a) and (b), enter in Columns (e), (f), and
(g) the appropriate amounts of funds needed to support the
project for the first funding period (usually a year).
Section B Budget Categories
In the column headings (1) through (4), enter the titles of the
same programs, functions, and activities shown on Lines 1-4,
Column (a), Section A. When additional sheets are prepared for
Section A, provide similar column headings on each sheet. For
each program, function or activity, fill in the total requirements for
funds (both Federal and non-Federal) by object class categories.
Line 6a-i - Show the totals of Lines 6a to 6h in each column.
Line 6j - Show the amount of indirect cost.
Line 6k - Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total
amount in column (5), Line 6k, should be the same as the total
amount shown in Section A, Column (g), Line 5. For
supplemental grants and changes to grants, the total amount of
the increase or decrease as shown in Columns (1)-(4), Line 6k
should be the same as the sum of the amounts in Section A,
Columns (e) and (f) on Line 5.
Line 7 - Enter the estimated amount of income, if any, expected
to be generated from this project. Do not add or subtract this
amount from the total project amount, Show under the program
SF-424A (Rev. 7-97) Page 3
INSTRUCTIONS FOR THE SF-424A (continued)
narrative statement the nature and source of income. The
estimated amount of program income may be considered by the
Federal grantor agency in determining the total amount of the
grant.
Line 15 - Enter the totals of amounts on Lines 13 and 14.
Section C. Non-Federal Resources
Lines 16-19 - Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or
activity is not necessary. For new applications and continuation
grant applications, enter in the proper columns amounts of Federal
funds which will be needed to complete the program or project over
the succeeding funding periods (usually in years). This section
need not be completed for revisions (amendments, changes, or
supplements) to funds for the current year of existing grants.
Lines 8-11 Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.
Column (a) - Enter the program titles identical to
Column (a), Section A. A breakdown by function or
activity is not necessary.
Column (b) - Enter the contribution to be made by the
applicant.
Column (c) - Enter the amount of the State’s cash and
in-kind contribution if the applicant is not a State or
State agency. Applicants which are a State or State
agencies should leave this column blank.
Column (d) - Enter the amount of cash and in-kind
contributions to be made from all other sources.
Column (e) - Enter totals of Columns (b), (c), and (d).
Line 12 - Enter the total for each of Columns (b)-(e). The amount
in Column (e) should be equal to the amount on Line 5, Column
(f), Section A.
Section D. Forecasted Cash Needs
Section E. Budget Estimates of Federal Funds Needed for
Balance of the Project
If more than four lines are needed to list the program titles, submit
additional schedules as necessary.
Line 20 - Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
accordingly and show the overall totals on this line.
Section F. Other Budget Information
Line 21 - Use this space to explain amounts for individual direct
object class cost categories that may appear to be out of the
ordinary or to explain the details as required by the Federal grantor
agency.
Line 22 - Enter the type of indirect rate (provisional, predetermined,
final or fixed) that will be in effect during the funding period, the
estimated amount of the base to which the rate is applied, and the
total indirect expense.
Line 23 - Provide any other explanations or comments deemed
necessary.
Line 13 - Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14 - Enter the amount of cash from all other sources needed
by quarter during the first year.
SF-424A (Rev. 7-97) Page 4
OMB Approval No. 0348-0044
BUDGET INFORMATION - Non-Construction Programs
SECTION A - BUDGET SUMMARY
Grant Program
Function
or Activity
(a)
Catalog of Federal
Domestic Assistance
Number
(b)
Estimated Unobligated Funds
Federal
(c)
Non-Federal
(d)
$
1.
New or Revised Budget
$
Federal
(e)
Non-Federal
(f)
$
Total
(g)
$
$
0.00
2.
0.00
3.
0.00
4.
0.00
5.
Totals
$
0.00
$
0.00
$
0.00
$
0.00
$
0.00
SECTION B - BUDGET CATEGORIES
GRANT PROGRAM, FUNCTION OR ACTIVITY
6. Object Class Categories
a. Personnel
Total
(1)
(2)
(3)
(4)
$
$
$
$
(5)
$
0.00
b. Fringe Benefits
0.00
c. Travel
0.00
d. Equipment
0.00
e. Supplies
0.00
f. Contractual
0.00
g. Construction
0.00
h. Other
0.00
i. Total Direct Charges (sum of 6a-6h)
0.00
0.00
0.00
0.00
0.00
j. Indirect Charges
k. TOTALS (sum of 6i and 6j)
7. Program Income
0.00
$
$
0.00
$
$
0.00
$
$
Authorized for Local Reproduction
Previous Edition Usable
0.00
$
$
0.00
$
$
0.00
0.00
Standard Form 424A (Rev. 7-97)
Prescribed by OMB Circular A-102
SECTION C - NON-FEDERAL RESOURCES
(b) Applicant
(c) State
(a) Grant Program
8.
$
$
(d) Other Sources
$
(e) TOTALS
0.00
$
9.
0.00
10.
0.00
11.
0.00
12. TOTAL (sum of lines 8-11)
$
0.00 $
0.00 $
0.00
$
0.00
SECTION D - FORECASTED CASH NEEDS
Total for 1st Year
13. Federal
$
14. Non-Federal
1st Quarter
0.00 $
2nd Quarter
3rd Quarter
$
$
0.00 $
0.00 $
4th Quarter
$
0.00
15. TOTAL (sum of lines 13 and 14)
$
0.00 $
0.00
0.00
$
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program
FUTURE FUNDING PERIODS (Years)
(c) Second
(d) Third
(b) First
16.
$
$
$
$
0.00 $
0.00 $
(e) Fourth
$
17.
18.
19.
20. TOTAL (sum of lines 16-19)
0.00
$
0.00
SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges:
22. Indirect Charges:
23. Remarks:
Authorized for Local Reproduction
Standard Form 424A (Rev. 7-97) Page 2
INSTRUCTIONS FOR THE SF-424A
Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0044), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
General Instructions
This form is designed so that application can be made for funds
from one or more grant programs. In preparing the budget,
adhere to any existing Federal grantor agency guidelines which
prescribe how and whether budgeted amounts should be
separately shown for different functions or activities within the
program. For some programs, grantor agencies may require
budgets to be separately shown by function or activity. For other
programs, grantor agencies may require a breakdown by function
or activity. Sections A, B, C, and D should include budget
estimates for the whole project except when applying for
assistance which requires Federal authorization in annual or
other funding period increments. In the latter case, Sections A, B,
C, and D should provide the budget for the first budget period
(usually a year) and Section E should present the need for
Federal assistance in the subsequent budget periods. All
applications should contain a breakdown by the object class
categories shown in Lines a-k of Section B.
For continuing grant program applications , submit these forms
before the end of each funding period as required by the grantor
agency. Enter in Columns (c) and (d) the estimated amounts of
funds which will remain unobligated at the end of the grant
funding period only if the Federal grantor agency instructions
provide for this. Otherwise, leave these columns blank. Enter in
columns (e) and (f) the amounts of funds needed for the
upcoming period. The amount(s) in Column (g) should be the
sum of amounts in Columns (e) and (f).
For supplemental grants and changes to existing grants, do not
use Columns (c) and (d). Enter in Column (e) the amount of the
increase or decrease of Federal funds and enter in Column (f) the
amount of the increase or decrease of non-Federal funds. In
Column (g) enter the new total budgeted amount (Federal and
non-Federal) which includes the total previous authorized
budgeted amounts plus or minus, as appropriate, the amounts
shown in Columns (e) and (f). The amount(s) in Column (g)
should not equal the sum of amounts in Columns (e) and (f).
Section A. Budget Summary Lines 1-4 Columns (a) and (b)
Line 5 - Show the totals for all columns used.
For applications pertaining to a single Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring
a functional or activity breakdown, enter on Line 1 under Column
(a) the Catalog program title and the Catalog number in Column
(b).
For applications pertaining to a single program requiring budget
amounts by multiple functions or activities, enter the name of
each activity or function on each line in Column (a), and enter the
Catalog number in Column (b). For applications pertaining to
multiple programs where none of the programs require a
breakdown by function or activity, enter the Catalog program title
on each line in Column (a) and the respective Catalog number on
each line in Column (b).
For applications pertaining to multiple programs where one or
more programs require a breakdown by function or activity,
prepare a separate sheet for each program requiring the
breakdown. Additional sheets should be used when one form
does not provide adequate space for all breakdown of data
required. However, when more than one sheet is used, the first
page should provide the summary totals by programs.
Lines 1-4, Columns (c) through (g)
For new applications , leave Column (c) and (d) blank. For each
line entry in Columns (a) and (b), enter in Columns (e), (f), and
(g) the appropriate amounts of funds needed to support the
project for the first funding period (usually a year).
Section B Budget Categories
In the column headings (1) through (4), enter the titles of the
same programs, functions, and activities shown on Lines 1-4,
Column (a), Section A. When additional sheets are prepared for
Section A, provide similar column headings on each sheet. For
each program, function or activity, fill in the total requirements for
funds (both Federal and non-Federal) by object class categories.
Line 6a-i - Show the totals of Lines 6a to 6h in each column.
Line 6j - Show the amount of indirect cost.
Line 6k - Enter the total of amounts on Lines 6i and 6j. For all
applications for new grants and continuation grants the total
amount in column (5), Line 6k, should be the same as the total
amount shown in Section A, Column (g), Line 5. For
supplemental grants and changes to grants, the total amount of
the increase or decrease as shown in Columns (1)-(4), Line 6k
should be the same as the sum of the amounts in Section A,
Columns (e) and (f) on Line 5.
Line 7 - Enter the estimated amount of income, if any, expected
to be generated from this project. Do not add or subtract this
amount from the total project amount, Show under the program
SF-424A (Rev. 7-97) Page 3
INSTRUCTIONS FOR THE SF-424A (continued)
narrative statement the nature and source of income. The
estimated amount of program income may be considered by the
Federal grantor agency in determining the total amount of the
grant.
Line 15 - Enter the totals of amounts on Lines 13 and 14.
Section C. Non-Federal Resources
Lines 16-19 - Enter in Column (a) the same grant program titles
shown in Column (a), Section A. A breakdown by function or
activity is not necessary. For new applications and continuation
grant applications, enter in the proper columns amounts of Federal
funds which will be needed to complete the program or project over
the succeeding funding periods (usually in years). This section
need not be completed for revisions (amendments, changes, or
supplements) to funds for the current year of existing grants.
Lines 8-11 Enter amounts of non-Federal resources that will be
used on the grant. If in-kind contributions are included, provide a
brief explanation on a separate sheet.
Column (a) - Enter the program titles identical to
Column (a), Section A. A breakdown by function or
activity is not necessary.
Column (b) - Enter the contribution to be made by the
applicant.
Column (c) - Enter the amount of the State’s cash and
in-kind contribution if the applicant is not a State or
State agency. Applicants which are a State or State
agencies should leave this column blank.
Column (d) - Enter the amount of cash and in-kind
contributions to be made from all other sources.
Column (e) - Enter totals of Columns (b), (c), and (d).
Line 12 - Enter the total for each of Columns (b)-(e). The amount
in Column (e) should be equal to the amount on Line 5, Column
(f), Section A.
Section D. Forecasted Cash Needs
Section E. Budget Estimates of Federal Funds Needed for
Balance of the Project
If more than four lines are needed to list the program titles, submit
additional schedules as necessary.
Line 20 - Enter the total for each of the Columns (b)-(e). When
additional schedules are prepared for this Section, annotate
accordingly and show the overall totals on this line.
Section F. Other Budget Information
Line 21 - Use this space to explain amounts for individual direct
object class cost categories that may appear to be out of the
ordinary or to explain the details as required by the Federal grantor
agency.
Line 22 - Enter the type of indirect rate (provisional, predetermined,
final or fixed) that will be in effect during the funding period, the
estimated amount of the base to which the rate is applied, and the
total indirect expense.
Line 23 - Provide any other explanations or comments deemed
necessary.
Line 13 - Enter the amount of cash needed by quarter from the
grantor agency during the first year.
Line 14 - Enter the amount of cash from all other sources needed
by quarter during the first year.
SF-424A (Rev. 7-97) Page 4
Applicant’s Name____________________________________________
CERTIFICATION REGARDING GOVERNMENT-WIDE REQUIREMENTS
FOR DRUG-FREE WORKPLACE (GRANTS)
This certification is required by the Treasury regulations implementing the Drug-Free Workplace Act of
1988, 31 CFR Part 19, Section 19.630, Certification Requirements and Procedures. The regulation was
published as Part 11 of the May 25, 1990 Federal Register (55 FR 21688-21691).
1.
The applicant certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the grantee’s workplace and specifying the action that will be taken against employees for violation of such
prohibition;
(b) Establishing a drug-free awareness program to inform other employees about
(1) the dangers of drug abuse in the workplace,
(2) the grantee’s policy of maintaining a drug-free workplace,
(3) any available drug counseling, rehabilitation, and employee assistance programs, and
(4) the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by
paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will –
(1) abide by the terms of the statement, and
(2) notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later
than five calendar days after such conviction;
(e) Notifying the agency in writing, within ten calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise
receiving actual notice of such convictions. Employers of convicted employees must provide notice, including position title, to every grant
officer or other designee on whose grant activity the convicted employee was working, unless the federal agency has designated a central
point for the receipt of such notices. Notices shall include the identification number(s) or each affected grant;
(f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee
who is so convicted –
(1) taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of
the Rehabilitation Act of 1973, as amended, or
(2) requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes
by a federal, state, or local health, law enforcement, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of Paragraphs (a), (b), (c), (d), (e), and (f).
2. The applicant may insert in the space provided below the site(s) for the performance of work done in connection with the
specific grant:
Check
if there are workplaces on file that are not identified here.
_________________________________________________________
Place of Performance
_________________________________________________________
Street Address
_________________________________________________________
City
County
_________________________________________________________
State
Zip Code
(Before signing certification, read the instructions which are an integral part of the certification.)
Print/Type:
_______________________________________________
NAME OF RESPONSIBLE OFFICIAL
_______________________________________________
TITLE
_______________________________________________
(Signature)
(Date)
DISCLOSURE OF LOBBYING ACTIVITIES
Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
0348-0046
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
a. contract
a. bid/offer/application
a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post-award
For Material Change Only:
d. loan
year _________ quarter _________
e. loan guarantee
date of last report ______________
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
Subawardee
and Address of Prime:
Prime
Tier ______, if known :
Congressional District, if known : 4c
6. Federal Department/Agency:
Congressional District, if known :
7. Federal Program Name/Description:
CFDA Number, if applicable : _____________
8. Federal Action Number, if known :
9. Award Amount, if known :
$
10. a. Name and Address of Lobbying Registrant
( if individual, last name, first name, MI ):
b. Individuals Performing Services (including address if
different from No. 10a )
( last name, first name, MI ):
requested through this form is authorized by title 31 U.S.C. section
11. Information
1352. This disclosure of lobbying activities is a material representation of fact
Signature:
upon which reliance was placed by the tier above when this transaction was made
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be available for public inspection. Any person who fails to file the
required disclosure shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
Print Name:
Title:
Telephone No.: _______________________ Date:
Federal Use Only:
PRINT
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make
payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employee of
Congress, or an employeeof a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material
change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter
the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal
action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriateclassification
of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,e.g., the first subawardee
of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington,
DC 20503.
OMB Approval No. 0348-0040
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such
is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1.
Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2.
Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3.
Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4.
Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
5.
Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6.
Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§16811683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42
U.S.C. §§6101-6107), which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
7.
Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally-assisted programs. These requirements apply
to all interests in real property acquired for project
purposes regardless of Federal participation in
purchases.
8.
Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole or
in part with Federal funds.
Previous Edition Usable
Standard Form 424B (Rev. 7-97)
Authorized for Local Reproduction
Prescribed by OMB Circular A-102
9.
10.
11.
Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327333), regarding labor standards for federally-assisted
construction subagreements.
Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93205).
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
APPLICANT ORGANIZATION
12.
Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
13.
Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).
14.
Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15.
Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16.
Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.
17.
Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations."
18.
Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
TITLE
DATE SUBMITTED
April 16, 2008
Standard Form 424B (Rev. 7-97) Back
FINANCIAL STATUS REPORT
(Long Form)
(Follow instructions on the back)
1. Federal Agency and Organizational Element
to Which Report is Submitted
2. Federal Grant or Other Identifying Number Assigned
By Federal Agency
OMB Approval Page of
No.
0348-0039
pages
3. Recipient Organization (Name and complete address, including ZIP code)
4. Employer Identification Number
5. Recipient Account Number or Identifying Number
6. Final Report
Yes
8. Funding/Grant Period (See instructions)
From: (Month, Day, Year)
To: (Month, Day, Year)
9. Period Covered by this Report
From: (Month, Day, Year)
10. Transactions:
a.
Total outlays
b.
Refunds, rebates, etc.
c.
Program income used in accordance with the deduction alternative
d.
Net outlays (Line a, less the sum of lines b and c)
7. Basis
Cash
No
Accrual
To: (Month, Day, Year)
I
I
III
Previously Reported
This Period
Cumulative
0.00
0.00
0.00
0.00
0.00
0.00
Recipient's share of net outlays, consisting of:
e. Third party (in-kind) contributions
f.
0.00
Other Federal awards authorized to be used to match this award
0.00
g.
Program income used in accordance with the matching or cost
sharing alternative
h. All other recipient outlays not shown on lines e, f or g
i.
Total recipient share of net outlays (Sum of lines e, f, g and h)
j.
Federal share of net outlays (line d less line i)
k.
Total unliquidated obligations
l.
Recipient's share of unliquidated obligations
m.
Federal share of unliquidated obligations
n.
Total Federal share (sum of lines j and m)
o.
Total Federal funds authorized for this funding period
p.
Unobligated balance of Federal funds (Line o minus line n)
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Program income, consisting of:
q. Disbursed program income shown on lines c and/or g above
r.
Disbursed program income using the addition alternative
s.
Undisbursed program income
t.
Total program income realized (Sum of lines q, r and s)
a.
11. Indirect
Expense
12.
b.
0.00
Type of Rate (Place "X" in appropriate box)
Provisional
Rate
c.
Predetermined
Base
d.
Total Amount
Final
Fixed
e.
Federal Share
Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with
governing legislation.
13. Certification:
I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and
unliquidated obligations are for the purposes set forth in the award documents.
Typed or Printed Name and Title
Telephone (Area code, number and extension)
Signature of Authorized Certifying Official
Date Report Submitted
April 16, 2008
Previous Edition Usable
269-104
NSN 7540-01-012-4285
Standard Form 269 (Rev. 7-97)
Prescribed by OMB Circulars A-102 and A-110
200-498 P.O. 139 (Face)
FINANCIAL STATUS REPORT
(Long Form)
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of
Management and Budget, Paperwork Reduction Project (0348-0039), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET.
Please type or print legibly. The following general instructions explain how to use the form itself. You may need additional
information to complete certain items correctly, or to decide whether a specific item is applicable to this award. Usually,
such information will be found in the Federal agency's grant regulations or in the terms and conditions of the award (e.g.,
how to calculate the Federal share, the permissible uses of program income, the value of in-kind contributions, etc.). You
may also contact the Federal agency directly.
Item
Entry
Item
Entry
4. Enter the Employer Identification Number (EIN)
assigned by the U.S. Internal Revenue Service.
10b. Enter any receipts related to outlays reported on the
form that are being treated as a reduction of expenditure
rather than income, and were not already netted out of
the amount shown as outlays on line 10a.
5. Space reserved for an account number or other
identifying number assigned by the recipient.
10c. Enter the amount of program income that was used in
accordance with the deduction alternative.
6. Check yes only if this is the last report for the
period shown in item 8.
Note: Program income used in accordance with other
alternatives is entered on lines q, r, and s. Recipients
reporting on a cash basis should enter the amount of
cash income received; on an accrual basis, enter the
program income earned. Program income may or may
not have been included in an application budget and/or
a budget on the award document. If actual income is
from a different source or is significantly different in
amount, attach an explanation or use the remarks
section.
1, 2 and 3. Self-explanatory.
7. Self-explanatory.
8. Unless you have received other instructions from
the awarding agency, enter the beginning and
ending dates of the current funding period. If this is
a multi-year program, the Federal agency might
require cumulative reporting through consecutive
funding periods. In that case, enter the beginning
and ending dates of the grant period, and in the rest
of these instructions, substitute the term "grant
period" for "funding period."
9. Self-explanatory.
10. The purpose of columns, I, II, and III is to show the
effect of this reporting period's transactions on
cumulative financial status. The amounts entered in
column I will normally be the same as those in
column III of the previous report in the same
funding period . If this is the first or only report of
the funding period, leave columns I and II blank. If
you need to adjust amounts entered on previous
reports, footnote the column I entry on this report
and attach an explanation.
10a. Enter total gross program outlays. Include
disbursements of cash realized as program income
if that income will also be shown on lines 10c or
10g. Do not include program income that will be
shown on lines 10r or 10s.
For reports prepared on a cash basis, outlays are
the sum of actual cash disbursements for direct
costs for goods and services, the amount of indirect
expense charged, the value of in-kind contributions
applied, and the amount of cash advances and
payments made to subrecipients. For reports
prepared on an accrual basis, outlays are the sum
of actual cash disbursements for direct charges for
goods and services, the amount of indirect expense
incurred, the value of in-kind contributions applied,
and the net increase or decrease in the amounts
owed by the recipient for goods and other property
received, for services performed by employees,
contractors, subgrantees and other payees, and
other amounts becoming owed under programs for
which no current services or performances are
required, such as annuities, insurance claims, and
other benefit payments.
10d,
e, f, g, h, i and j. Self-explanatory.
10k. Enter the total amount of unliquidated obligations,
including unliquidated obligations to subgrantees and
contractors.
Unliquidated obligations on a cash basis are obligations
incurred, but not yet paid. On an accrual basis, they are
obligations incurred, but for which an outlay has not yet
been recorded.
Do not include any amounts on line 10k that have been
included on lines 10a and 10j.
On the final report, line 10k must be zero.
10l. Self-explanatory.
10m. On the final report, line 10m must also be zero.
10n,
o, p, q, r, s and t. Self-explanatory.
11a. Self-explanatory.
11b. Enter the indirect cost rate in effect during the reporting
period.
11c. Enter the amount of the base against which the rate
was applied.
11d. Enter the total amount of indirect costs charged during
the report period.
11e. Enter the Federal share of the amount in 11d.
Note: If more than one rate was in effect during the period
shown in item 8, attach a schedule showing the bases
against which the different rates were applied, the
respective rates, the calendar periods they were in
effect, amounts of indirect expense charged to the
project, and the Federal share of indirect expense
charged to the project to date.
SF-269 Back (Rev. 7-97)
CERTIFICATION STATEMENT OF ASSURANCE
CONCERNING CIVIL RIGHTS COMPLIANCE
The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal
grants, loans, contracts, property, discounts or other Federal financial assistance from the Internal
Revenue Service. The Applicant agrees:
1. To conduct its activities so that no person is excluded from participation in, is denied the
benefits of, or is subject to discrimination, as prohibited by the laws identified in paragraph
2 and implementing regulations, in the distribution or services and/or benefits provided
under this financial assistance or grant program.
2. To compile, maintain and submit information to the Internal Revenue Service concerning
its compliance with Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended,
Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, Title IX of the
Education Amendments of 1972 (Pub. L. 92-318), as amended, and the Age Discrimination
Act of 1975 (Pub. L. 94-135), as amended, in accordance with those laws and the
implementing regulations.
3. To provide to the address shown on the Civil Rights Requirements statement, a copy of any
finding issued by a Federal or State court or by a Federal or State administrative agency that
the Applicant has discriminated on the basis of race, color, national origin, sex, age or
disability.
4. To inform the public that persons who believe they have been discriminated against on the
basis of race, color, national origin, sex, age or disability, in the distribution of services and
benefits resulting from this financial assistance or grant program may file a complaint with
the Department of the Treasury at the following address:
Director, Office of Equal Opportunity Program
Department of the Treasury
1500 Pennsylvania Avenue, NW
Metropolitan Square – Room 6068
Washington, DC 20220
The Applicant agrees that compliance with this assurance constitutes a condition for continued receipt
of Federal financial assistance and is binding on the Applicant, it successors, transferees and assignees.
The person whose signature appears below is authorized to sign this assurance and commit the
Applicant to the above provisions.
______________________________________________________________________________
(NAME AND TITLE OF AUTHORIZED OFFICIAL)
(SIGNATURE OF AUTHORIZED OFFICIAL)
(DATE)
IRS Low Income Taxpayer Clinic (LITC)
Application Information Sheet
Name of Sponsoring Organization
Contact Person
Title
Contact Person's Phone Number
Fax Number
Contact Person's E-Mail Address
Mailing Address
Street Address
(City)
(State)
(Zip Code)
(City)
(State)
(Zip Code)
Name of Clinic
Street Address
(City)
Mailing Address
(State)
(Zip Code)
(City)
(State)
(Zip Code)
Public Telephone Number
Clinic Director
Title
Clinic Director's Phone Number
Fax Number
Clinic Director's E-Mail Address
Grants Officer/Financial Administrator
Title
Street Address
(City)
Mailing Address
(State)
(Zip Code)
Grants Officer's/Financial Administrator's Phone Number
(City)
(State)
(Zip Code)
Fax Number
Grant Officer's/Financial Administrator's E-Mail Address
Funds will be forwarded to this address.
Form 13424 (Rev. 5-2003)
Catalog Number 36126D
Department of the Treasury—Internal Revenue Service
LITC Tax Information Authorization
As provided for in Publication 3319, all applicants for an LITC grant must be in
compliance with Federal tax responsibilities. The LITC Program Office will conduct
compliance checks on organizations applying for an LITC grant and will also conduct
periodic checks throughout the grant period. Therefore, any LITC that is part of a larger
organization (e.g., university) will need to have an authorized official from the larger
organization complete the following authorization:
Name of Academic Institution or other Parent Organization:
Name of Low Income Taxpayer Clinic:
I authorize the Internal Revenue Service to disclose the following return information, as
that term is defined in Internal Revenue Code section 6103(b), of the Academic
Institution or Parent Organization (listed above) to the Director of the Low Income
Taxpayer Clinic (listed above) in connection with the clinic’s application for a low income
taxpayer clinic matching grant and continued entitlement to such grant. Specifically, I
authorize the Internal Revenue Service to disclose that the Academic Institution or
Parent Organization has an outstanding federal tax liability (amount, type of tax, and
periods) that may affect the approval of the clinic’s grant application by the Internal
Revenue Service or the clinic’s continued entitlement to such grant.
I am aware that without this authorization the return information of the Academic
Institution or Parent Organization is confidential and is protected by law under the
Internal Revenue Code. I certify that I am authorized by law to bind the Academic
Institution or Parent Organization and that I have authority to execute this consent to
disclose return information.
Taxpayer Name: _____________________________
Taxpayer Address: ______________________________
______________________________
Employer Identification Number: ____________________
Name and Title of Authorized Person: ___________________________
Signature of Authorized Person: ________________________________
Telephone Number of Authorized Person: _________________________
Date: ____________________
GRANT AGREEMENT
The Grant Agreement is entered into by the Internal Revenue Service, Department of the Treasury, United States of
America, hereinafter referred to as IRS, and
_________________________________________________________________________________________________
(Name of Grantee)
Hereinafter referred to as recipient.
The recipient agrees to operate an LITC Program in conformity with the approved Grant Application and
1. Program Requirements (as stated in Publication 3319, "Low Income Taxpayer Clinics 2006 Application Package and
Guidelines");
2. Section 3601 of the Internal Revenue Service Restructuring and Reform Act of 1998, Public Law 105-206, adding 26
U.S.C. § 7526; and,
3. Office of Management and Budget Circulars No. A-110, A-133 and either A-21 or A-122, as applicable.
Grant Agreement Period:
The Grant Agreement covers the period ______________________ to________________________.
NOTE: If expenses are incurred prior to approval, and the grant is later denied, all costs incurred will be the
responsibility of the Recipient.
Maximum Amount of Funds Available from Internal Revenue Service for Expense Reimbursement:
The Maximum amount available from the Internal Revenue Service under this Grant Agreement is _______________.
This amount may be increased in writing only by the Internal Revenue Service, Taxpayer Advocate Service, LITC
Program Office, Mail Stop 211-D, 401 W. Peachtree St. NW, Atlanta, GA 30308. No additional expense reimbursements
or other payments shall be made by the Internal Revenue Service unless the maximum amount of funds set forth above
has been increased in writing by the National Taxpayer Advocate
Approved by an Authorized Representative of the Program Sponsor by:
Name (Please Print)
Title (Please Print)
Signature
Date
Approved for the Internal Revenue Service by:
Name (Please Print)
Title (Please Print)
Signature
Form 12183 (Rev. 5/2004)
Date
Catalog No. 26967K
Department of the Treasury - Internal Revenue Service
Appendix B
LITC Program Grant Application
Checklists
-B-
LITC PROGRAM GRANT APPLICATION PACKAGE SUBMISSION CHECKLIST
NEW OR SINGLE YEAR GRANT APPLICATIONS
New or single year applications for the LITC Program Grant Application must include the following information
Background Information (limited to 15 pages, double spaced)
Items described under section VI of this package.
Determination of Program Performance
Items described under section VI of this package.
Budget/Financial Information
Items described under section VI of this package.
Requisites for Package Submission
Submit application in quadruplicate (four sets). Double Space and sign all documents (application, certifications, etc) in blue ink.
Each set must have original signatures.
Package Assembly
It is very important that the LITC Program Grant Application Package be assembled correctly. A copy of the standard forms and
certifications are included Appendix A of this publication. The application package must be assembled in the following manner:
__1.
Standard Form 424, Application for Federal Assistance.
__2.
Background Information.
__3.
Copy of determination letter issued by IRS recognizing organization as exempt under IRC Section 501(c) (if applicable).
__4.
Copy of letter of academic accreditation for college, university or other institution of higher learning (if applicable).
__5.
Determination of Program Performance (one for each qualifying program, if applicable).
__6.
Budget/Financial Information (one for each qualifying program, if applicable).
__7.
Completed Form 13424, IRS Low Income Taxpayer Clinic (LITC) Program Grant Application Sheet.
__8.
Assurances and Certifications signed in blue ink by an authorized representative of the organization. Assurances and
Certifications should be submitted in the following order:
__A.
Standard Forms 424B, Assurances – Non-Construction Programs
__B.
Certification Regarding Debarment, Suspension and Other Responsibilities Matters Primary Covered Transactions
__C.
Certification Regarding Government-wide Requirements for Drug-Free Workplace (Grants)
__D.
Certification of Assurance Concerning Civil Rights Compliance
__E.
Standard Form LLL, Disclosure of Lobbying Activities
__F.
Tax Information Authorization (if applicable).
DELIVERY OF LITC GRANT APPLICATION PACKAGE
Applications may be submitted either electronically or in hardcopy by mail, private delivery service, or hand delivery. To submit an
electronic application, go to www.grants.gov to apply through the Federal Grants web site. For applicants applying through the Federal
Grants website, the Funding Number is TREAS-GRANTS-052008-001. All applications for both new or single year applications and
continuing multi-year grant applications (whether submitted electronically or in hardcopy) must be postmarked or submitted (if filed
electronically) by July 6, 2007, in order for them to be considered for 2008 LITC Program grant funding. Applications submitted in
hardcopy should be sent to the following address:
Internal Revenue Service
Taxpayer Advocate Service
LITC Program Office
TA:LITC
Attention: LITC Applications
1111 Constitution Ave., NW
Room 1034
Washington, DC 20224
Thank you for submitting an application to the Low Income Taxpayer Clinic (LITC) Grant Program.
-2-
LITC PROGRAM GRANT APPLICATION PACKAGE SUBMISSION CHECKLIST
CONTINUING MULTI-YEAR GRANT APPLICATIONS
Continuing multi-year applications for the LITC Program Grant Application must include the following information
Continuation Request
Letter described under Section VI of this package.
Budget/Financial Information
Items described under section VI of this package.
Requisites for Package Submission
Submit application in quadruplicate (four sets). Double Space and sign all documents (application, certifications, etc) in blue ink.
Each set must have original signatures.
Package Assembly
It is very important that the LITC Program Grant Application Package be assembled correctly. A copy of the standard forms and
certifications are included Appendix A of this publication. The application package must be assembled in the following manner:
__1.
Standard Form 424, Application for Federal Assistance.
__2.
Letter requesting continuation in the LITC Program for the 2007 grant cycle.
__3.
Standard Form 424A, Budget Information – Non-Construction Programs (one for each qualifying program, if applicable).
__4.
Budget Narrative (one for each qualifying program, if applicable).
__5.
Detailed description of matching funds.
__6.
Estimate of funds that will not be expended during the 2006 year.
__7.
Completed Form 13424, IRS Low Income Taxpayer Clinic (LITC) Program Grant Application Sheet.
__8.
Assurances and Certifications signed in blue ink by an authorized representative of the organization. Assurances and
Certifications should be submitted in the following order:
__A.
Standard Forms 424B, Assurances – Non-Construction Programs
__B.
Certification Regarding Debarment, Suspension and Other Responsibilities Matters Primary Covered Transactions
__C.
Certification Regarding Government-wide Requirements for Drug-Free Workplace (Grants)
__D.
Certification of Assurance Concerning Civil Rights Compliance
__E.
Standard Form LLL, Disclosure of Lobbying Activities
__F.
Tax Information Authorization (if applicable).
DELIVERY OF LITC GRANT APPLICATION PACKAGE
Applications may be submitted either electronically or in hardcopy by mail, private delivery service, or hand delivery. To submit an
electronic application, go to www.grants.gov to apply through the Federal Grants web site. For applicants applying through the Federal
Grants website, the Funding Number is TREAS-GRANTS-052008-001. All applications for both new or single year applications and
continuing multi-year grant applications (whether submitted electronically or in hardcopy) must be postmarked or submitted (if filed
electronically) by July 6, 2007, in order for them to be considered for 2008 LITC Program grant funding. Applications submitted in
hardcopy should be sent to the following address:
Internal Revenue Service
Taxpayer Advocate Service
LITC Program Office
TA:LITC
Attention: LITC Applications
1111 Constitution Ave., NW
Room 1034
Washington, DC 20224
Thank you for submitting an application to the Low Income Taxpayer Clinic (LITC) Grant Program.
-2-
Appendix C
Report Forms and Supplemental
Issue Forms
-C-
Low Income Taxpayer Clinic
Report Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
I. Controversy Activities
A
B
C
D
E
F
G
H
I
J
K
L
Number of cases1 open prior to start of period.
Number of cases opened during period.
Number of cases closed during period.
Number of cases opened during period for taxpayers
whose income exceeded 250% of the poverty level.
Number of cases opened during period for taxpayers
where the amount in controversy exceeded the
amount specified in IRC § 7463 (currently $50,000).
Number of consultations during period that did not
result in representation.2
Number of issues addressed during period3 (see the
Supplemental Issue Form).
Number of cases in U.S. Tax Court during period.4
Number of informal consultations in U.S Tax Court
during period.
Number of refund suits filed in U.S. District Court or
U.S. Court of Federal Claims during period.
Total number of cases referred to a qualified
representative during period.
Of the total cases reported in K (above), number where
Jan. 1 –
June 30
Total
1
A case includes all issues for one taxpayer with whom the clinic enters into a pro bono or clinic
representation agreement, or for whom the clinic obtains a Power of Attorney (POA) or other
official authorization.
2
Consultations include those instances where the clinic provided brief advice to the taxpayer but
did not enter into a pro bono or clinic representation agreement, engagement letter, or obtains a
Power of Attorney (POA) or other official authorization.
3
Clinics are encouraged to track the procedural status of cases. This information helps the LITC
Program Office better understand the level of service offered to taxpayers and the amount of
controversy work undertaken by the clinic. For a list of issues, see the Supplemental Issue Form
in this section. This form must be submitted as an attachment to the Annual Report and the total
number of issues listed on the form carried to the Annual Report Form.
4
Cases in U.S. Tax Court include petitions submitted to the court by the clinic, later entries of
appearance, and informal advice provided at a U.S. Tax Court calendar session.
1
Low Income Taxpayer Clinic
Report Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
M
N
O
P
Q
R
income exceeded 250% of the poverty level.
Of the total cases reported in K (above), number where
the amount in controversy exceeded the amount
specified in IRC § 7463 (currently $50,000).
Number of consultations that did not qualify for clinic
services but were referred to appropriate pro bono
alternatives such as state bars.
Number of taxpayers assisted during period5 including
those for whom cases were not opened.
Number of state tax matters handled during period.
Number of bankruptcy cases handled during period.
Number of case referred to TAS during the period.
5
For reporting purposes, preparation of a joint return counts as two taxpayers assisted. If
representation/referral is provided to only one spouse on a joint return, the number of taxpayers
assisted should be reported as one.
2
Low Income Taxpayer Clinic
Report Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
II. ESL, Publicity, and Outreach Activities
Jan. 1 –
June 30
Total
A
B
Number of outreaches conducted during period.
Number of workshops and education programs
conducted during period.
C Number of ESL taxpayers that attended outreach,
workshops, and education programs during period.
D Number of direct contacts or consultations with ESL
taxpayers during period.
E Number of radio or television
advertisements/appearances and newspaper articles
during period.6
F Number of ESL taxpayers referred for controversy
representation during period.
G Number of controversy cases opened for ESL
taxpayers during period
6
Please provide additional information in your report on the frequency of the advertisements,
programs, and articles, the potential listening, viewing, or reading audience and any other
information about your publicity efforts.
3
Low Income Taxpayer Clinic
Report Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
III. Return and Other Tax Form Preparation
Jan. 1 –
June 30
A
B
C
D
E
Total
Number of tax returns (including amended returns)
that were prepared during period.
Number of returns in A (above) that were directly
related to a controversy with the IRS for which the
clinic provided assistance.
Number of returns in A (above) prepared for ESL
taxpayers during period.
Number of returns in A (above) that were ancillary to
ESL outreach and education activities.
Number of Individual Taxpayer Identification Number
(ITIN) applications prepared during period.
4
Low Income Taxpayer Clinic
Supplemental Issue Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
Note: For each issue listed below, please provide the total number of cases worked during the
period containing that issue. Cases can involve more than one issue; each issue should be
reported separately.1
I.
Collection Issues
A
B
C
D
E
F
G
II.
Jan. 1 –
June 30
July 1 –
Dec. 31
Total
Jan. 1 –
June 30
July 1 –
Dec. 31
Total
Levy
Lien
Payment
Collection Due Process (CDP)
Offer In Compromise (OIC)
Installment Agreement
Currently Not Collectible (CNC)
Examination Issues
A
B
C
D
E
F
EITC Exam
EITC Certification
EITC Recertification
Other Correspondence Exam
Non-EITC Office or Field Exam2
Automated Substitute for Return
(ASFR)
G Automated Underreporter (AUR)
1
For example, if a case involving a lien later in the year morphs into a levy case, the same case should
be reported as involving both a lien and a levy.
2
Office exams are those examinations which are not conducted through correspondence from a service
center.
1
Low Income Taxpayer Clinic
Supplemental Issue Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
III.
Miscellaneous Issues
Jan. 1 –
June 30
July 1 –
Dec. 31
Total
Jan. 1 –
June 30
July 1 –
Dec. 31
Total
A
B
C
D
E
Appeal (not CDP)
Refund Claim
Tax Court
Refund Litigation
Relief from Joint and Several Liability
(Innocent Spouse)
F Employment Tax Liability
G IRC § 6672 Trust Fund Recovery
Penalty
H Other Civil Penalties
I Individual Taxpayer Identification
Numbers (ITINs)
J Nonfiler
IV. Other Issues3
A
B
C
D
E
F
G
H
I
J
K
3
For those issues not listed elsewhere on this form, please indicate the specific issue and the total
number of cases worked during the period containing that issue.
2
Low Income Taxpayer Clinic
Report Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
I. Controversy Activities
A
B
C
D
E
F
G
H
I
J
K
L
Number of cases1 open prior to start of period.
Number of cases opened during period.
Number of cases closed during period.
Number of cases opened during period for taxpayers
whose income exceeded 250% of the poverty level.
Number of cases opened during period for taxpayers
where the amount in controversy exceeded the
amount specified in IRC § 7463 (currently $50,000).
Number of consultations during period that did not
result in representation.2
Number of issues addressed during period3 (see the
Supplemental Issue Form).
Number of cases in U.S. Tax Court during period.4
Number of informal consultations in U.S Tax Court
during period.
Number of refund suits filed in U.S. District Court or
U.S. Court of Federal Claims during period.
Total number of cases referred to a qualified
representative during period.
Of the total cases reported in K (above), number where
Jan. 1 –
June 30
Total
1
A case includes all issues for one taxpayer with whom the clinic enters into a pro bono or clinic
representation agreement, or for whom the clinic obtains a Power of Attorney (POA) or other
official authorization.
2
Consultations include those instances where the clinic provided brief advice to the taxpayer but
did not enter into a pro bono or clinic representation agreement, engagement letter, or obtains a
Power of Attorney (POA) or other official authorization.
3
Clinics are encouraged to track the procedural status of cases. This information helps the LITC
Program Office better understand the level of service offered to taxpayers and the amount of
controversy work undertaken by the clinic. For a list of issues, see the Supplemental Issue Form
in this section. This form must be submitted as an attachment to the Annual Report and the total
number of issues listed on the form carried to the Annual Report Form.
4
Cases in U.S. Tax Court include petitions submitted to the court by the clinic, later entries of
appearance, and informal advice provided at a U.S. Tax Court calendar session.
1
Low Income Taxpayer Clinic
Report Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
M
N
O
P
Q
R
income exceeded 250% of the poverty level.
Of the total cases reported in K (above), number where
the amount in controversy exceeded the amount
specified in IRC § 7463 (currently $50,000).
Number of consultations that did not qualify for clinic
services but were referred to appropriate pro bono
alternatives such as state bars.
Number of taxpayers assisted during period5 including
those for whom cases were not opened.
Number of state tax matters handled during period.
Number of bankruptcy cases handled during period.
Number of case referred to TAS during the period.
5
For reporting purposes, preparation of a joint return counts as two taxpayers assisted. If
representation/referral is provided to only one spouse on a joint return, the number of taxpayers
assisted should be reported as one.
2
Low Income Taxpayer Clinic
Report Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
II. ESL, Publicity, and Outreach Activities
Jan. 1 –
June 30
Total
A
B
Number of outreaches conducted during period.
Number of workshops and education programs
conducted during period.
C Number of ESL taxpayers that attended outreach,
workshops, and education programs during period.
D Number of direct contacts or consultations with ESL
taxpayers during period.
E Number of radio or television
advertisements/appearances and newspaper articles
during period.6
F Number of ESL taxpayers referred for controversy
representation during period.
G Number of controversy cases opened for ESL
taxpayers during period
6
Please provide additional information in your report on the frequency of the advertisements,
programs, and articles, the potential listening, viewing, or reading audience and any other
information about your publicity efforts.
3
Low Income Taxpayer Clinic
Report Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
III. Return and Other Tax Form Preparation
Jan. 1 –
June 30
A
B
C
D
E
Total
Number of tax returns (including amended returns)
that were prepared during period.
Number of returns in A (above) that were directly
related to a controversy with the IRS for which the
clinic provided assistance.
Number of returns in A (above) prepared for ESL
taxpayers during period.
Number of returns in A (above) that were ancillary to
ESL outreach and education activities.
Number of Individual Taxpayer Identification Number
(ITIN) applications prepared during period.
4
Low Income Taxpayer Clinic
Supplemental Issue Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
Note: For each issue listed below, please provide the total number of cases worked during the
period containing that issue. Cases can involve more than one issue; each issue should be
reported separately.1
I.
Collection Issues
A
B
C
D
E
F
G
II.
Jan. 1 –
June 30
July 1 –
Dec. 31
Total
Jan. 1 –
June 30
July 1 –
Dec. 31
Total
Levy
Lien
Payment
Collection Due Process (CDP)
Offer In Compromise (OIC)
Installment Agreement
Currently Not Collectible (CNC)
Examination Issues
A
B
C
D
E
F
EITC Exam
EITC Certification
EITC Recertification
Other Correspondence Exam
Non-EITC Office or Field Exam2
Automated Substitute for Return
(ASFR)
G Automated Underreporter (AUR)
1
For example, if a case involving a lien later in the year morphs into a levy case, the same case should
be reported as involving both a lien and a levy.
2
Office exams are those examinations which are not conducted through correspondence from a service
center.
1
Low Income Taxpayer Clinic
Supplemental Issue Form
(clinic name)
For period beginning ___________________ and ending ________________
(date)
(date)
III.
Miscellaneous Issues
Jan. 1 –
June 30
July 1 –
Dec. 31
Total
Jan. 1 –
June 30
July 1 –
Dec. 31
Total
A
B
C
D
E
Appeal (not CDP)
Refund Claim
Tax Court
Refund Litigation
Relief from Joint and Several Liability
(Innocent Spouse)
F Employment Tax Liability
G IRC § 6672 Trust Fund Recovery
Penalty
H Other Civil Penalties
I Individual Taxpayer Identification
Numbers (ITINs)
J Nonfiler
IV. Other Issues3
A
B
C
D
E
F
G
H
I
J
K
3
For those issues not listed elsewhere on this form, please indicate the specific issue and the total
number of cases worked during the period containing that issue.
2
Index of LITC Terms
Term
Page Number
90/250 Requirement
3, 4, 5
Allowable Expenses
18
Amount in Controversy
6
Ancillary
3, 6, 7
Ancillary Tax Return Preparation
3, 6, 7
Annual Report
24
Report Form
27, Appendix C
Contents of
24
Application
29
Assembly of
33, 34, Appendix B
Background Information
29
Budget/Financial Information
32
Contents
29
Continuing Multi-Year Grant Applications
34
Determination of Program Performance
30
Electronic Application Website
35
New or Single-Year Grant Applications
33
Where and When to File
35
Audit
8
Cash Contributions
7
Civil Rights Reporting Requirements
9
Clinic
1
Clinic Director
14
Clinic within a Clinic
3
Confidentiality
16
Continuing Professional Education (CPE)
15
Controversies
1
Controversy Clinic Requirements
4
Deobligating Funds
20, 22
-D-
Determination of Program Performance
30
Documentation of Matching Funds Sources
8
Electronic Application Website
35
Electronic Funds Transfer
19
ESL Clinic Requirements
6
Expenses
18
Allowable Expenses
18
Indirect Expenses
7
Unallowable Expenses
19
Family Unit Defined
6
Fees
1, 3, 4, 7, 8, 16, 18, 32
Firm Commitment
8
Grant Agreement
13
Income Defined
5
Income Ceiling
4, 5
Indirect Expenses
7
In-kind Contributions
7
Interim Report
22
Contents of
22
Report Form
23, Appendix C
Internal Controls
14
Legal Service Organizations
8
LITC Conference
15, 19
LITC Contact Information
21
LITC Program Office
28
Email Address
1
Matching Funds
3, 7, 8, 13, 19, 24, 30, 35
Cash Contributions
7
Documentation of Matching Funds Sources
8
Firm Commitment
8
In-kind Contributions
7
Legal Service Organizations
8
-D-
Office Space
7
Program Income
7
Volunteer Services
7
Mentoring Programs
15
Name or Organization Change
32
Networking
15
Nominal Fee
1, 3, 4, 7, 8, 16, 18, 32
Office Space
7
OMB Circulars
7, 8, 9, 13, 18, 19, 28
OMB Requirements
8
Outreach Activities
3, 6, 14
Payments to LITC Grantees
17
Poverty Guidelines
4
Pro Bono Panel
2, 4, 16, 18, 23, 26, 31, 37, 38
Program Income
7
Program to Inform
2
Publicity
6, 14, 18
Qualified Business Administrator (QBA)
14
Qualified Matching Funds
7
Qualified Representative
2
Qualified Tax Expert (QTE)
14
Qualified Volunteers
16
Qualifying ESL Activities
3
Referral Activity
2, 16
Referral Services
2, 16
Reporting Requirements
22
Annual Report
24
Interim Report
22
Site Assistance Visits
29
Standards of Operation
13
Start-up Expenses
3
Student Authorization
21
-D-
Supplemental Issue Form
23, 27, Appendix C
Tax Compliance
18, 30, 38
Tax Information Authorization Form
18, 30, 34, 35, Appendix A
Tax Library
15
Tax Preparation
3, 6
Training Conference
15, 19
VITA
7, 30
Withdrawal from Program
21, 28,
Workgroup
17
Unallowable Expenses
19
Volunteer Services
7
-D-
IRS
Department of the Treasury
Internal Revenue Service
publish.no.irs.gov
Publication 3319 (5-2007)
Catalog Number 26939S
| File Type | application/pdf |
| File Title | Publication 3319 (Rev. 5-2007) |
| Subject | Low-Income Taxpayer Clinics Grant Application Package Book |
| File Modified | 2008-04-16 |
| File Created | 2007-05-09 |