Form 14024 Tax Counseling for the Elderly (TCE) Program Application

OMB No. 1545-2222

Tax Counseling for the Elderly (TCE) Program
Application Checklist and Transmittal

Form 14204
(May 2011)

CONTACT INFORMATION
Name of Organization:

Address of Organization:

Telephone:

Fax:

Point of Contact (POC) and title:
Email Address for POC:
ADMINISTRATIVE INFORMATION
Does your organization have a valid DUNS number?

Yes

No

Has your organization registered or renewed your registration this year with the Central Contractor Registry?
(Note: Organizations must renew their registration once a year in order to maintain active status)
Yes

No

Is your organization interested in applying for a multi-year grant?

Yes

No

If so, have you checked the criteria under the Multi-Year Grant Opportunities section of Publication 1101 to
determine if your organization is eligible to apply?
Yes

No
APPLICATION CHECKLIST AND ASSEMBLY

Completed Application Packets MUST include 3 Copies of ALL documents. Sign all documents in blue ink. The
application must be assembled in the order as indicated in the “Application Assembly” section within Publication 1101
and listed below on this checklist. Make sure you double check that you have all documents and information required.
An improperly assembled or incomplete application may result in rejection of the application.
Checklist and Assembly Order:
1. Form 14204, TCE Application Checklist & Transmittal (this sheet)
2. Background Narrative
3. Nonprofit Status Determination letter issued by the Internal Revenue Service
4. Organizational letter if your organization is not required to file a Federal tax return

IRS Volunteer Income Tax Preparation and Outreach
Programs Privacy and Paperwork Reduction Act Notice

5. Proposed Program/Budget Plan
6. Form 8653 - TCE Application Plan
7. Standard Form 424
8. Civil Rights Narrative
9. Standard Form 424B, Assurances and Certifications
10. Standard Form LLL, Disclosure of Lobbying Activities (if required)
11. If applicable, a copy of your Single Audit
12. CD containing your entire application package

Privacy and Paperwork Reduction 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. The Paperwork Reduction Act requires that the IRS
display an OMB control number on all public information requests. The OMB Control
Number for this study is 1545-2222. The time estimated for participation is 10
minutes. 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

2012 Application Due Date: June 30, 2011
Form 14204 (5-2011)

Catalog Number 57258Q

Department of the Treasury – Internal Revenue Service