Free Form 8653 (Rev. 6-2009) - Federal

Department of the Treasury -- Internal Revenue Service

Form (June 2009) Reimbursement Expenses

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

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 Territory 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 for taxpayers 60+ 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 Date

Catalog Number 64328V

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

Form 8653 (Rev. 6-2009)

Instructions
Lines 1­3. 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. Line 5. Line 6. Total lines 1-3 in the Numbers Column and the Cost Column. Enter the number of clerical, administrative or technical staff you will pay in the Numbers Column and the dollar amount in the Cost Column. 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. Enter the rent, utilities and/or custodial services costs for the TCE Program. Enter the cost of audit services for the TCE Program. Enter travel of program sponsors or expenses incurred by program administrators or coordinators who are paid staff to monitor sites. Enter the estimated cost for the development of publicity (i.e., public service announcements, posters, brochures) and other publicity materials. Enter the estimated cost for Interpreter Services. Enter the estimated cost of installing temporary telephone lines at "telephone answering sites or Internet connectivity costs to provide e-file service." Enter the estimated cost for all postage, including postage needed for the fulfillment of orders for program materials. Total the administrative expenses (add lines 5-13 in the Cost Column (b)). This figure should not be more than 30% of 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. Enter the costs projected for attending a meeting at the IRS Territory Office or with IRS personnel. Include travel expenses for attendance at train-the-trainer tax law or Site Coordinator 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. 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. Enter the total estimated program costs (add lines 15, 16 and 17 in the Cost Column (b)).

Line 7. Line 8. Line 9. Line 10. Line 11. Line 12. Line 13. Line 14. Line 15. Line 16.

Line 17.

Line 18.

Lines 19 a­c. List the number of individual Federal returns you expect to prepare for taxpayers 60+ 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.

Lines 21 a­c. Project the number of tax preparation sites, the number of e-file sites, combination sites, and the total of lines 21a and 21b on line 21c.
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.

Catalog Number 64328V

Form 8653 (Rev. 6-2009)