Free Form 8654 (Rev. 6-2009) - Federal

Department of the Treasury -- Internal Revenue Service

1. Report Type Quarterly 2. Fiscal Year 4. Report Period (Month, day, year) Final

Form (June 2009)
3. Recipient Organization Name Street Address Account/Identifying Number

Tax Counseling for the Elderly Program Quarterly / Final Program Report

City

State

Zip Code

From To

/ /

/ /

(a) Numbers

(b) Cost

5. To Volunteer tax assistors/quality reviewers
Reimbursement Expenses Administrative Expenses

6. To Volunteer instructors 7. To Volunteer coordinators/administrators 8. TOTAL (ADD lines 5-7) 9. Salaries/benefits (Clerical, Administrative or Technical Staff Only) 10. Supplies/Volunteer Recognition--For TCE Program 11. Rent/utilities/custodial services--When additional and necessary for TCE Program 12. Auditing 13. Daily Site Operations Travel (includes travel of paid staff to monitor sites) 14. Program publicity development 15. Interpreter Services 16. Telephone installation (No WATTS or 800 Lines) or Internet connectivity costs 17. Postage 18. Total administrative expenses (ADD lines 9 through 17, column (b)). This figure should not be more than 30% of line 19 19. Program cost (ADD lines 8 and 18 column (b)) 20. Cost of Travel to IRS Territory Office/IRS Training 21. Costs for Electronic Filing Supplies/Services 22. Total program cost (ADD lines 19, 20, and 21 column (b)) 23. Total amount of federal advance 24. Unexpended balance of federal advance (Subtract line 22 from 23) 25. Refund to IRS (Complete on final report ONLY) (Take amount from line 24)

Catalog Number 64330H

Form 8654 (Rev. 6-2009)

Account/Identifying Number

60+

Other

26. Number of individual Federal tax returns prepared (paper) 27. Number of individual Federal tax returns prepared (e-file) 28. Total number of individual Federal tax returns prepared (paper and e-file) 29. Number of taxpayers assisted--all other (excludes return preparation)
Other Information

30. Total number of taxpayers assisted (add lines 28 and 29) 31. Number of Tax Preparation sites a. e-file sites b. Combination of paper and e-file sites c. Total lines 31a and 31b 32. Please attach to this form, a listing of each site's Location ID, its EFIN Number, whether the site is a combination paper/e-file site, and the volunteer return preparation hours for each site. Numbers

Signature of responsible office

Date

Agency Use

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 64330H

Form 8654 (Rev. 6-2009)

Instructions
Line 1. Line 2. Line 3. Line 4. Lines 5-8. Enter the Report Type. If it is a quarterly report put an X or if it is the final report put an X in the box. Enter the Fiscal Year. Enter the recipient's organization name, street address, city, state, zip code, and the account/identifying number. The account/identifying number is the Employer Identification Number (EIN). Enter the report period (month, day and year) on the From and To lines. Enter the number of volunteer tax assistors/quality reviewers on line 5(a), the number of volunteer instructors on line 6(a), and the number of volunteer coordinators/administrators on line 7(a). Enter the total number of volunteer tax assistors/quality reviewers, volunteer instructors, and volunteer coordinators/administrators on line 8(a). DO NOT count any volunteer twice, even if he/she serves in two or more capacities. Enter the final amount of reimbursement for volunteer tax assistors/quality reviewers, volunteer instructors and volunteer 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 assistors/quality reviewers all of his/her expenses should be estimated on line 7, only). Include reimbursements made to volunteers 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. Enter the number of clerical, administrative or technical personnel you will pay in the Numbers Column and the dollar amount in the Cost Column. Supplies include pencils, pens, paper, etc. These are supplies for the TCE Program other than those directly attributable for e-file. Include purchase of recognition items not to exceed $10 purchased for volunteers on this line. Enter the rent, utilities and/or custodial services costs for the TCE Program. Enter the cost for 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 final cost for the development of publicity (i.e., public service announcements, posters, brochures) and other publicity materials. Enter the final cost for interpreter services. Enter the final cost of installing temporary telephone lines at "telephone answering sites", or internet connectivity costs to provide e-file services. Enter the final cost for all postage, including postage used for the fulfillment of orders for program materials. Total the administrative expenses (add lines 9-17 in the Cost Column (b)). This figure should not be more than 30% of line 19. Enter the program cost by adding lines 8 and 18 in the Cost Column (b). Enter the costs incurred for attending a meeting at the IRS territory office or with IRS personnel. Provide lodging receipts, taxi receipts, air fare, meals and incidental expenses, gas receipts, etc. Include travel expenses for attendance at train-the-trainer tax law or site coordinator training. Do not include expenses for daily site operations travel, this is now captured on line 13. 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 unit cost not to exceed $1,000) can be purchased to support e-file using grant funds. You should also include costs associated with computer repair of equipment used for tax preparation services. Enter the total program costs (add lines 19-21 in the Cost Column (b)). Enter the total amount of the federal advance. Enter the unexpended balance of the federal advance (subtract line 22 from line 23). Enter the remaining grant funds from the grant award. Only list this on the final report. This amount should be taken from line 24. List the number of individual paper Federal tax returns prepared for taxpayers 60+ and all other taxpayers. List the number of individual e-file Federal tax returns prepared for taxpayers 60+ and all other taxpayers. List the total number of individual paper and e-file Federal tax returns prepared for taxpayers 60+ and all other taxpayers. List the number of taxpayers assisted--All other (exclude return preparation) for taxpayers 60+ and all other taxpayers. Add figures from lines 28 and 29 and insert that total in line 30. Line 31. List the number of tax preparation sites for e-file sites, the combination of paper and e-file sites, and the total of lines 31a and 31b on line 31c. Provide the site name, Site Identification Number (SIDN), Electronic Filing Identification Number (EFIN), type of site i.e., e-file or combo, and the volunteer return preparation hours for each site. The volunteer return preparation hours are the actual hours the volunteers work and not the hours of operation.

Line 9. Line 10. Line 11. Line 12. Line 13. Line 14. Line 15. Line 16. Line 17. Line 18. Line 19. Line 20.

Line 21.

Line 22. Line 23. Line 24. Line 25. Line 26. Line 27. Line 28. Line 29. Line 30. Line 31. Line 32.

Form 8654 is due 30 days after the quarter ends. The quarter ending dates are December 31, March 31, June 30, and September 30. Form 8654 (Rev. 6-2009)