Form 8653 Tax Counseling for the Elderly Program Application Plan

Department of the Treasury — Internal Revenue Service

Form
(May 2011)

OMB No. 1545-2222

Tax Counseling for the Elderly Program
Application Plan
(a)
Numbers

(b)
Cost

60 + Taxpayers

Other Taxpayers

Reimbursement Expenses
1. To Volunteer tax assistors/quality reviewers
2. To Volunteer tax instructors
3. To Volunteer coordinators/administrators
4. TOTAL (ADD 1-3)

Administrative Expenses
5. Salaries/benefits (Clerical, Administrative or Technical staff only)
6. Supplies/Volunteer Recognition—For TCE Program
7. Rent/utilities/custodial services—When additional and necessary for
TCE Program
8. Auditing
9. Daily site operations travel (travel to monitor TCE sites)
10. Program publicity development
11. Interpreter Services
12. Telephone installation (No 800 or WATTS Lines) or Internet connectivity
costs
13. Postage
14. Total administrative expenses (ADD lines 5 through 13, column (b)).
This figure should not be more than 30% of line 15
15. Estimated program cost (ADD lines 4 and 14, column (b))
16. Estimated cost of travel to IRS Office/IRS Training
17. Estimated cost of Electronic Filing Supplies/Services
18. Total estimated program cost (ADD lines 15, 16, and 17 column (b))

Other Information
19. Number of individual Federal tax returns you expect to prepare
a. Paper Federal returns
b. Electronically filed Federal returns
c. Total of 19a and 19b
20. Number of other taxpayers 60+ you plan to assist not included in Lines
19a through 19c above.
21. Number of tax preparation sites planned
a. e-file sites
b. Combination sites
c. Total of 21a and 21b
Signature of responsible office

Catalog Number 64328V

Date

NOTE: To be completed when applying for entry into the program.

Form 8653 (Rev. 5-2011)

Instructions
Lines 1–3.

Enter the number of volunteer tax assistors/quality reviewers on line 1(a), the number of volunteer tax
instructors on line 2(a), the number of volunteer coordinators/administrators on line 3(a). DO NOT
count any volunteer twice, even if he/she serves in two or more capacities.
Enter the estimated amount of reimbursement for tax assistors/quality reviewers, instructors and
coordinators/administrators on the appropriate line in column (b). DO NOT include expenses for any
volunteer twice (i.e., if an individual serves as a volunteer coordinator as well as a tax assistor all of
his/her expenses should be estimated on line 3, only). Include reimbursements made to volunteers for
EITHER actual expenses incurred or stipends provided to volunteers. Stipends must be designated on
expected out-of-pocket expenses not on time engaged in volunteer service.

Line 4.

Total lines 1-3 in the Numbers Column and the Cost Column.

Line 5.

Enter the number of clerical, administrative or technical staff you will pay in the Numbers
Column and the dollar amount in the Cost Column.

Line 6.

Supplies include pencils, pens, paper, postage, etc. These are supplies for the TCE Program other
than those directly attributable for e-file. Also recognition items not to exceed $10 may be purchased to
recognize your volunteers.

Line 7.

Enter the rent, utilities and/or custodial services costs for the TCE Program.

Line 8.

Enter the cost of audit services for the TCE Program.

Line 9.

Enter travel of program sponsors or expenses incurred by program administrators or coordinators
who are paid staff to monitor sites.

Line 10.

Enter the estimated cost for the development of publicity (i.e., public service announcements,
posters, brochures) and other publicity materials.

Line 11.

Enter the estimated cost for Interpreter Services.

Line 12.

Enter the estimated cost of installing temporary telephone lines at “telephone answering sites or
Internet connectivity costs to provide e-file service.”

Line 13.

Enter the estimated cost for all postage, including postage needed for the fulfillment of orders for
program materials.

Line 14.

Total the administrative expenses (add lines 5-13 in the Cost Column (b)). This figure should not be
more than 30% of line 15.

Line 15.

Enter the program cost by adding lines 4 and 14 in the Cost Column (b). Do not include the
orientation meeting in the program cost.

Line 16.

Enter the costs projected for attending a meeting at the IRS Office or with IRS personnel. Include
travel expenses for attendance at train-the-trainer tax law, Site Coordinator, or an Orientation type
training. Do not include expenses for daily site operation travel, this is captured on line 9. Provide
lodging receipts, taxi receipts, air fare, meals and incidental expenses, gas receipts, etc.

Line 17.

Cost for diskettes, paper, printer cartridges, toner, cable locks, memory, network cards, external
media, and anything else directly attributable to e-file expenses. Computers and printers (with a
unit cost not to exceed $1,000) can be purchased to support e-file using grant funds. You may
also include costs associated with computer repair of equipment used for tax preparation services.

Line 18.

Enter the total estimated program costs (add lines 15, 16 and 17 in the Cost Column (b)).

Lines 19 a–c. List the number of individual Federal returns you expect to prepare for taxpayers 60+ and all other
taxpayers in appropriate columns for paper Federal returns, electronically filed Federal returns, and
the total of paper Federal returns and electronically filed Federal returns.
Line 20.

This will include any tax counseling that does not result in a return being prepared, and it will also
include telephone assistance provided.

Project the number of tax preparation sites, the number of e-file sites, combination sites, and the
Lines 21 a–c.
and Paperwork
Reduction
total of lines 21a and 21b on line 21c.
and Paperwork Reduction
IRS Volunteer Income Tax Preparation and Outreach Programs Privacy Act Notice
Privacy Act Notice– The Privacy Act of 1974 requires that when we ask for information we tell you our legal right to ask for the information, 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 information is 5 U.S.C. 301. We are asking
for this information to assist us in contacting you relative to your interest and/or participation in the IRS volunteer income tax preparation and outreach programs. The information you provide may be
furnished to others who coordinate activities and staffing at volunteer return preparation sites or outreach activities. The information may also be used to establish effective controls, send correspondence
and recognize volunteers. Your response is voluntary. However, if you do not provide the requested information, the IRS may not be able to use your assistance in these programs.

Form
(Rev.
5-2011)
Catalog Number 64328V The Paperwork Reduction Act requires that the IRS display an OMB control number
on 8653
all public
information

requests. The OMB Control Number for this study is 1545-2222. The time estimated for participation is 15 minutes.