Form 13715 Volunteer Site Information Sheet

OMB No.: 1545-2222

Department of the Treasury — Internal Revenue Service

Form 13715
(Rev. September 2012)

Volunteer Site Information Sheet

Purpose: Information provided on this form is used by our IRS toll-free assistance line to help taxpayers locate the nearest
volunteer tax preparation site and to list sites on irs.gov. Review the information below carefully. Update and/or correct missing or
existing information. Return the completed form to your local IRS contact. If the site information changes after submitting this
form, please provide your local IRS contact with the updated information immediately.

Site Information
Yes

No

Yes

No

Yes

✖ No

Federal e-file

Yes

No

State e-file

Yes

No

Does the site offer Certifying Acceptance Agent (CAA) service?

Yes

No

Is the site open to public?

Yes

No

Does the site offer Financial Education and Asset Building Services?

Yes

No

Is the site an appointment only site?

Site Name:

If yes to the above question, please provide the phone number for site.

Site Address:

If yes to the above question, please provide the contact name for site.
Does the site use the Virtual Delivery Method for return preparation?

City, State:

If "Yes"

Intake Site

Preparation Site

Zip Code:

Both

Is the site a mobile only site?
Program Type: FSA, VITA, VITA Grant, Military, AARP, TCE

Site Identification
Number (SIDN)

If VITA or TCE Grant, enter name of Grant Organization

First day open/
Last day open

/

What languages are
offered at the site?

Does site prepare prior year returns?

Yes

No

Site Operating Hours
Day

Time
Open

Comments (e.g. holiday closures, alternative opening times)
Close

MON
TUE
WED
THUR
FRI
SAT
SUN
Your response is voluntary. However,
if you do not provide the requested

Site Coordinator or Contact
information, the IRS may not be able
Name:
Mailing Address:
City, State, Zip:
Phone Number:

and Paperwork Reduction

to promote your assistance in these

Best Time to Call:programsAM

PM

Email Address:
Is this a revision of information you
previously provided for this year?

Yes

No

The time estimated for participation is
Date of this revision:
XX minutes.

IRS Use Only

Date Form 13715 Received in Territory Office:
Territory Manager Approval (Signature & Date):
Date SPECTRM Updated:
SEID of employee who updated SPECTRM:
Privacy Act Notice – Our legal right to ask for information is 5 U.S.C. 301 and 26 USC 7801.
The primary purpose of asking for this information is to assist us in providing services to taxpayers at sites supporting IRS volunteer income tax preparation and outreach
programs. We may provide information to volunteers who coordinate activities and staffing at taxpayer assistance sites.
For more information about uses, see the Privacy Act notice for SPEC Total Relationship Management (SPECTRM) in the Federal Register: July 19, 2004 (Volume 69,
Number 137) [Notices] [Pages 43055-43056]
Your response is voluntary. However, if you do not provide all or part of the requested information, the IRS may not be able to provide accurate information regarding the
locations and services at volunteer tax preparation sites.

Catalog Number 43863F

Form 13715 (Rev. 9-2012)