Form 13768 Form 13768 Electronic Tax Administration Advisory Committee Members

OMB #1545-XXXX

Electronic Tax Administration Advisory Committee Membership Application
Please complete this application and return it to one of the following addresses by Monday, March 28, 2011.
Please note: Members of the ETAAC may not be federally registered lobbyists.

Internal Revenue Service
ETA and Refundable Credits
ETAAC Analyst (C4-213)
SE:W:ETARC:D:RM
5000 Ellin Road (M/S C4-470)
Lanham, MD 20706

e-mail Address: [email protected]
-or-

You may also fax your application to: 202.283.2845

PART I
Maiden name or other name(s) used and date(s) (required for FBI check)

Name
Home Address

Home telephone number
Zip Code

City

State

Date of birth (required for FBI check)

City and State of Birth (required for FBI check)

Business name
Job title

Business address
City

State

ZIP Code

Business telephone number

Business FAX number

E-mail address

PART II – Desired Skills and Qualifications
Please submit a short (one or two page) statement, including recent examples, addressing your specific skills and
qualifications as they relate to the following:
1. Experience in public policy development.
2. Experience in formulating, developing, and presenting proposals for the ETAAC and Commissioner's
consideration.
E-file Security
1. Experience in developing security in tax software.
2. Experience in developing policies and programs related to the collection, processing, storage, and disposal
of taxpayer information by Authorized IRS e-file Providers.
Tax Software
1. Experience in developing policies that support tax software programs.
2. Experience in identifying risks to accuracy, confidentiality, integrity, and the availability of taxpayer data
attributable to tax software.
Accuracy refers to the correct computation of tax liability and, therefore, is inclusive of
1. Experience in tax software design, development, and testing practices as well as in mathematical
computations.
2. Experience in tax software developers' interpretation of applicable tax laws and regulations.

Form 13768 (Rev. 1-2011)

Catalog Number 47884W

www.irs.gov

Department of the Treasury – Internal Revenue Service

PART III
Please attach a copy of your resume, to include prior Treasury and/or IRS employment, please state position(s),
title(s), and dates of employment. In addition, please list professional credentials, membership in professional
organizations, and local liaison activities with IRS, if applicable.
PART IV
Have you ever been a member of the Electronic Tax Administration Advisory Committee (ETAAC), Internal Revenue
Service Advisory Council, (formerly known as CAG), Art Advisory Panel, Tax Exempt Advisory Committee, or
Information Reporting Program Advisory Committee. If so, please include dates of membership.

PART V
I certify that to the best of my knowledge and belief, all of my statements are true, correct, complete, and made in
good faith.
Date

Signature

PRIVACY ACT STATEMENT
The Privacy Act of 1974 requires that when we ask you for information about yourself, we state our legal right to do so, tell you why we are
asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is
voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for the information is Public Law 92-463 and Executive Order
(E.O.) 9397. We are asking for the information in order to perform Federal income tax, FBI, and practitioner checks as required of all
members and applicants to the Electronic Tax Administration Advisory Committee (ETAAC).
Supplying the information is voluntary and not directly required by law, but facilitates the processing of your application for membership
in the ETAAC. Requesting your social security number, which is solicited under authority of E.O. 9397, is also voluntary and no right,
benefit, or privilege provided by law will be denied as a result of refusal to disclose it. However, not providing all or any part of the
information may limit consideration of your application.

Form 13768 (Rev. 1-2011)

Catalog Number 47884W

www.irs.gov

Department of the Treasury – Internal Revenue Service