3170-0068 Tax Time Savings Application Form - OMB

CFPB SAVING TAX TIME DEMONSTRATION APPLICATION FOR

 Interested Volunteer Income Tax

OMB No. 3170-0068
Expiration Date: XX/XX/XXXX

Assistance Programs

The Consumer Financial Protection Bureau (CFPB) will provide educational
materials, training, and technical assistance to approximately 75 Volunteer Income
Tax Assistance (VITA) programs across the country that are committed to promoting
saving during the 2018 tax season. This is not an opportunity for a grant, contract,
sub-contract, or funding. This is an opportunity to receive consumer education
materials, training for staff and volunteers, and technical assistance to integrate
savings promotion into their tax campaigns.

If you are selected, the CFPB will
provide the following:
§ Promising practices on ways to encourage saving
at tax time;
§ Education materials for consumers about saving
at tax time including posters, brochures, flyers
on ways to save, and a video that can be used
for training and looped in waiting rooms (where
technology is available) that describes saving
options;
§ Webinar-based training and corresponding
manuals for trainers, volunteers, and staff of
participating tax programs on approaches to
implement promising practices at tax sites;
§ An additional training module to be used to train
volunteers specifically on how to help consumers
buy a bond or split their refund using IRS
provided tax preparation software;
§ Coordination calls for all pilot participants at key
points during tax season;

Consumer Financial
Protection Bureau

§ Individual technical assistance on-demand;
§ Convening at the end of tax season to share best
practices and lessons learned from 2018, and to
inform strategies for 2019 tax season; and
§ Final report on results of the project.

To participate
To be a good fit to participate in this project, your
organization must at a minimum be focused on
providing tax preparation assistance to a diverse
population of low-income and economically
vulnerable consumers and have sufficient tax
customer volume to support a savings integration
initiative. See below for more details about criteria
for interested organizations.
§ Knowledge about the benefits of saving.
Demonstrate an understanding of the benefits of
promoting saving at tax time and be interested in
how to integrate savings promotion into existing
VITA program.

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SAVING AT TA X TIME DEMONSTRATION APPLICATION FORM

§ Staff capacity. Demonstrate capacity to dedicate
at least a small amount of staff or volunteer time
directly to saving promotion.
§ Marketing saving. Have an interest in promoting
saving to clientele before tax season through
marketing and other consumer information
channels.

We are interested in engaging tax programs with a
variety of capacities and approaches including more
experienced programs and those with little prior
experience in saving integration.

§ Safe savings products as a saving option. Have
an interest in offering savings products to tax
customers.

Privacy Act Statement
The information you provide, including contact information, will only be used for managing participation in financial
empowerment initiatives sponsored by the Consumer Financial Protection Bureau (“CFPB”). The financial empowerment
initiatives are opportunities for public and private organizations or entities to receive tools, training, technical assistance,
and other services to help them reach low-income and economically vulnerable consumers. Identifying information
collected may be used by and disclosed to employees, contractors, agents, and others authorized by the CFPB to
receive this information to assist in related activities.
Information collected by the CFPB will be treated in accordance with the System of Records Notice (“SORN”), CFPB.021 –
CFPB Consumer Education and Engagement Records, 83 FR 23435.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022, codified at 12 U.S.C.
§§ 5493 and 5512.

Your participation is voluntary, and you may withdraw participation at any time. You are not required to submit or provide
any identifying information; however, not doing so may result in the CFPB being unable to fulfill your request.

Paperwork Reduction Act Notice
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and not withstanding any
other provision of law a person is not required to respond to a collection of information unless it displays a valid OMB
control number. The OMB control number for this collection is 3170-0068. It expires on XX/XX/XXXX. The time required
to complete this information collection is estimated to average approximately 3 hours per response. Comments
regarding this collection of information, including the estimated response time, suggestions for improving the usefulness
of the information, or suggestions for reducing the burden to respond to this collection should be submitted to Bureau at
the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by email
to [email protected]

Consumer Financial
Protection Bureau

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SAVING AT TA X TIME DEMONSTRATION APPLICATION FORM

Organization information

1

Please provide
your organization’s
contact information

ORGANIZATION NAME

ADDRESS

CITY

STATE

POINT OF CONTACT NAME

ZIP CODE

EMAIL

WORK PHONE

2

3

Describe your
organization’s
geographic service
territory and the
populations it
serves

Number of returns
prepared in the last
tax year

Consumer Financial
Protection Bureau

tax returns

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SAVING AT TA X TIME DEMONSTRATION APPLICATION FORM

Understanding of the project

4

5

6

Describe your
commitment to
begin to integrate
or to expand
saving promotion
in your tax
program

Describe your
organization’s
staff and volunteer
capacity to
undertake this
project

Describe the
communications
strategy your
organization will
use to promote this
saving opportunity
to consumers

Consumer Financial
Protection Bureau

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Information sharing

7

Can your organization commit to sharing aggregated, de-identified data
regarding returns and saving activity after the end of the tax season?

YES

NO

Submission instructions
Email this completed application along with the required documents listed below to
[email protected]. If your organization does not have any of these required documents,
provide an explanation in the body of your email.
§

Completed application

§

IRS Form 990

§

Accessibility Policy

§

Annual Report

§

Most recent financial audit

§

Nondiscrimination Policy



Email

[email protected]

Consumer Financial
Protection Bureau

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