Intake/Interview & Quality Review Sheet

Forms and Documents

Document Name	Status
Form 13614-C Intake/Interview and Quality Review Sheet Form	Modified
Form 13614-C (SP) Form 13614-C (SP) - Hoja de Admisión/Entrevista y Verificación de Calidad Form and Instruction	New
ombat2.doc Supplementary Document	2009-11-06
Supporting Statement.doc Supporting Statement A	2009-11-06

IC Document Collections

IC ID	Document Title	Status
19697	Intake/Interview and Quality Review Sheet Form	Modified
191233	Form 13614-C (SP) - Hoja de Admisión/Entrevista y Verificación de Calidad Form and Instruction	New

ICR Details

OMB Control No: 1545-1964	ICR Reference No: 200911-1545-015
Status: Historical Active	Previous ICR Reference No: 200905-1545-005
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Intake/Interview & Quality Review Sheet
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/19/2010
	Date Received in OIRA: 11/17/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	36 Months From Approved	01/31/2010
Responses	3,375,000	0	2,700,000
Time Burden (Hours)	562,583	0	540,000
Cost Burden (Dollars)	0	0	0

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Abstract: The SPEC function developed the Form 13614-C, Intake/Interview & Quality Review Sheet that contains a standardized list of required intake and quality review questions to guide volunteers in asking taxpayers basic questions about themselves and conducting a quality review of the completed return. The intake/interview and quality review sheet is an effective tool for ensuring critical taxpayer information is obtained and applied during the interview and completion of the tax return process.

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Authorizing Statute(s): US Code: 26 USC 6103 Name of Law: Confidentiality and disclosure of returns and return information
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 40646	08/12/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 59030	11/16/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Intake/Interview and Quality Review Sheet	13614-C	Intake/Interview and Quality Review Sheet
Form 13614-C (SP) - Hoja de Admisión/Entrevista y Verificación de Calidad	13614-C (SP)	Hoja de Admisi�n/Entrevista y Verificaci�n de Calidad

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,375,000	2,700,000	0	0	675,000	0
Annual Time Burden (Hours)	562,583	540,000	0	0	22,583	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The SPEC function developed the Form 13614-C and 13614-C (SP)to guide volunteers in asking taxpayers basic questions about themselves and conducting a quality review of the completed return. The number of taxpayers assisted through the volunteer return preparation program has significantly increased. The time needed by each respondent to complete the form decreased by two minutes. The net result is an increase in estimated responses by 675,500 and a total estimated burden increase of 22,583 hours.

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Annual Cost to Federal Government: $80,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/17/2009

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