Free Form 13977 (Rev. 6-2008) - Federal

Form 13977 (June 2008)

Department of the Treasury ­ Internal Revenue Service

VITA Grant Program Budget Plan

Purpose: This form is to be used by VITA Grant Program Applicants. It should accompany the completed VITA Grant Program Application Plan and only represent the categorical dollar expenses of estimated program expenditures, cash contributions and third party-in-kind contributions (donated cash, property or services) qualifying as matching funds. Attach a detailed breakdown listing individual items and their planned use in the Application Plan. If "In-kind" contributions are included as matching funds, also attach a brief explanation on a separate sheet. Name of Partner: Reimbursement Expenses 1. VITA Grant Orientation Conference 2. Training Travel Reimbursement (Site Coordinator, Instructors, Volunteers) 3. Volunteer Travel Reimbursement (Site operation) 4. Total Reimbursement Expenses (ADD Lines 1 - 3) Administrative Expense 5. Salary Costs (Clerical, Site Administration, Instructor) 6. General Office Supplies 7. Audit Services 8. Publicity for VITA Tax Preparation Program 9. Volunteer Services 10. Volunteer Recognition 11. Interpreter Services 12. Space Rental (Includes Utilities, Insurance and Custodial Services) 13. Total Administrative Expenses (ADD Lines 5 - 12) Technology Expenses 14. Hardware - Computers and Printers 15. Software 16. Network Cards and Internet Connectivity 17. IT Support 18. Installation of Phone Lines for E-File and Tax Preparation 19. Actual Cost of E-Filing Supplies 20. Total Technology Expenses (ADD Lines 14 - 19) Total Estimated Program Cost 21. Total Estimated Program Cost (ADD Lines 4, 13 and 20) Comments / Remarks VITA Grant Proposed Expenditures Cost (A) Matching Funds Proposed Expenditure Cost (B)

Cost (A)

Cost (B)

Cost (A)

Cost (B)

Cost (A)

Cost (B)

Signature Signature Of Responsible Official Date Form 13977 (Rev. 6-2008)

Catalog Number 51502R

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

Instructions ­ Column (A) ­ VITA Grant Proposed Expenditures

Instructions ­ Column (B) ­ Matching Funds Proposed Expenditures

Line 1

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Line 2

Enter the total estimated travel expenses (include airfare, actual fuel expense, meals, lodging, taxi fares, etc.) of program administrators (maximum 2) who met with the IRS SPEC Territory Coordinators, etc. and/or were required to travel to IRS SPEC Headquarters or the SPEC Territory Office to attend an orientation/training session. Cost of travel by commercial transportation must be economy fare, and discount rates (excursion and/or "super-saver" fares) should be used when applicable. Meals and lodging are limited to the applicable government per diem rate in effect at that time. Since location has not yet been determined, include $200 per day for meals and lodging and $700.00 for round trip airfare. Note: Orientation meeting may be conducted by a conference call with the SPEC Territory Manager. Enter the total estimated travel reimbursement for tax law training to volunteer Tax Assistors and Coordinators/Administrators who will attend IRS Site Coordinator sponsored training courses. DO NOT include expenses for any volunteer twice, even if he/she serves in two or more capacities. DO NOT include expenses for daily site operations travel; this is captured on Line 3 of this form. Enter the total estimated travel reimbursement for VITA site operations to volunteer Tax Assistors and Coordinators/Administrators. DO NOT include expenses for any volunteer twice, even if he/she serves in two or more capacities. DO NOT include expenses for training; this is captured on Line 2 of this form. Reimbursements may be made to volunteers for either actual expenses incurred or stipends provided to volunteers. Stipends must be designed to relieve the volunteer of expense documentation and should be based on expected out-of-pocket expenses not on the time engaged in volunteer service. Stipends may not be based on the time the volunteer is expected to be engaged in volunteer service. Total Reimbursement Expenses (ADD Lines 1 - 3). Enter estimated contract labor costs, salary costs and/or hourly wages and benefits for individuals performing services for the VITA program. Positions are limited to Clerical, Site Administrator/Site Coordinator, Information Technology (IT) Support and Instructor. In cases where an employee or contractor works on more than one program only include the portion of the contract labor, salaries, wages and benefits which are directly related to the VITA program and have been incurred due to the VITA program.

Line 1

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Line 2

Enter the total estimated travel expenses (include airfare, actual fuel expense, meals, lodging, taxi fares, etc.) of program administrators (maximum 2) who met with the IRS SPEC Territory Coordinators, etc. and/or were required to travel to IRS SPEC Headquarters or the SPEC Territory Office to attend an orientation/training session. Cost of travel by commercial transportation must be economy fare, and discount rates (excursion and/or "super-saver" fares) should be used when applicable. Meals and lodging are limited to the applicable government per diem rate in effect at that time. Since location has not yet been determined, include $200 per day for meals and lodging and $700.00 for round trip airfare. Enter the total estimated travel reimbursement for VITA site training for Tax Assistors and Coordinators/Administrators who will attend IRS sponsored training courses. DO NOT include expenses for any volunteer twice, even if he/she serves in two or more capacities. DO NOT include expenses for daily site operations travel; this is captured on Line 3 of this form. Enter the total estimated travel reimbursement for VITA site operations for Tax Assistors and Coordinators/Administrators on line 3. DO NOT include expenses for any volunteer twice, even if he/she serves in two or more capacities. DO NOT include expenses for training; this is captured on Line 2 of this form. Reimbursements may be made to volunteers for either actual expenses incurred or stipends provided to volunteers. Stipends must be designed to relieve the volunteer of expense documentation and should be based on expected out-of-pocket expenses not on the time engaged in volunteer service. Stipends may not be based on the time the volunteer is expected to be engaged in volunteer service. Total Reimbursement Expenses (ADD Lines 1 - 3) Enter estimated contract labor costs, salary costs and/or hourly wages and benefits for individuals performing direct services for the VITA program. DO NOT include indirect salaries for the grant recipient. When an employer other than the recipient furnishes the services of an employee to the VITA program, these services shall be valued at the employee's regular rate of pay (plus benefits but excluding overhead costs) provided these services are in the same skill for which the employee is normally paid. In cases where an employee or contractor works on more than one program only include the portion of the contract labor, salaries, wages and benefits which are directly related to the VITA program and have been incurred due to the VITA program. If in-kind contributions are included, provide a brief explanation on a separate sheet. Enter estimated expenses for general office supplies including pencils, pens, paper. Value assessed to donated supplies shall be reasonable and shall not exceed the fair market value of the property at the time of the donation. DO NOT include supplies directly attributable to delivery of e-file. The supplies attributable to e-file are captured on line 18. If in-kind contributions are included, provide a brief explanation on a separate sheet.

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Line 6

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Enter estimated expenses for general office supplies including pencils, pens, paper. Include postage for the fulfillment of orders for program materials. Only include office supplies and equipment purchased directly for use in supporting the VITA program. DO NOT include supplies directly attributable to delivery of e-file. The supplies attributable to e-file are captured on line 18.

Line 6

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Catalog Number 51502R

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Form 13977 (Rev. 6-2008)

Instructions ­ Column (A) ­ VITA Grant Proposed Expenditures

Instructions ­ Column (B) ­ Matching Funds Proposed Expenditures · ·

Line 7

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Enter estimated expenses incurred for Audit Services. Audit requirements applicable to grant recipients are described in OMB Circular A-133, 62 FIR 35278-35302 (June 30, 1997). If you expend less than $500,000 a year in total Federal awards, no audit requirements are applicable. If you expend $500,000 or more a year in Federal awards, you must provide IRS with a copy of your Single Audit Report. You must arrange for an audit by an independent auditor in accordance with the Government Auditing Standards developed by the comptroller General of the United States. Enter the estimated cost for the development and publication of publicity materials (i.e., public service announcements, posters, brochures, postage). Only include those costs directly associated with the publicity of the VITA program.

Line 7

Enter estimated expenses incurred for required Audit Services. Audit requirements applicable to grant recipients are described in OMB Circular A-133, 62 FIR 35278-35302 (June 30, 1997). If you expend less than $500,000 a year in total Federal awards, no audit requirements are applicable. If you expend $500,000 or more a year in Federal awards, you must provide IRS with a copy of your Single Audit Report. You must arrange for an audit by an independent auditor in accordance with the Government Auditing Standards developed by the comptroller General of the United States. Enter the estimated cost for the development and publication of publicity materials (i.e., public service announcements, posters, brochures, postage). Costs only include those directly associated with the publicity of the VITA program. If in-kind contributions are included, provide a brief explanation on a separate sheet. The value of volunteer service (not to exceed 25% of total in-kind value of volunteer services) furnished by professional and technical personnel, skilled and unskilled labor may be counted as matching funds if the services are an integral and necessary part of the program. The rate for volunteer services shall be determined consistent with the principals stated in the OMB Circular A-110, "Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations". Services provided by students to satisfy an academic requirement do not qualify as matching funds. Enter the estimated cost for Volunteer Recognition items. If in-kind contributions are included, provide a brief explanation on a separate sheet. Enter the estimated cost for Interpreter Services for hearing-impaired or non-English speaking taxpayers. If in-kind contributions are included, provide a brief explanation on a separate sheet. Enter estimated expenses for rent, utilities, insurance and custodial services associated with the operation of a VITA Program. You may include rental expenses directly related to conducting Training. Enter the estimated fair market rental value of office space (not to exceed 25% of total in-kind value of the donated space) provided for a volunteer site location. Provide a brief explanation on a separate sheet for this in-kind contribution. Total Administrative Expenses (ADD Lines 5 - 12). Enter the estimated expenses or cash value for computer hardware and printers for e-file return preparation at a VITA site. The value of donated equipment shall not exceed the fair market value of equipment of the same age and condition at the time of donation. The value of loaned equipment shall not exceed its fair market rental value. If in-kind contributions are included, provide a brief explanation on a separate sheet. Enter estimated expense for software including tax preparation, encryption and computer upgrades (memory and operating systems).

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Line 9

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N/A

Line 9

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Line 10

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Enter the estimated cost for Volunteer Recognition Items. You may use grant funds to purchase items to recognize volunteers for their contribution to the VITA Program. Recognition items should not exceed $5.00 per volunteer. Enter the estimated cost for Interpreter Services for hearingimpaired or non-English speaking taxpayers.

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Line 11

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Line 11

Line 12

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Enter estimated expenses for fair market rental value of space that is not routinely available for public use free of charge, utilities, insurance and custodial services associated with the operation of a VITA Program. You may include rental expenses directly related to conducting Training.

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Total Administrative Expenses (ADD Lines 5 - 12). This figure may not be more than 25% of the figure on Line 21. Enter estimated expenses for computer hardware and printers. This would include expenses associated with the purchase of computer and/or printer equipment in accordance with the cost principles outlined in OMB Circular A-122.

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Line 15

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Enter estimated expense for software including encryption and computer upgrades (memory and operating systems).

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Catalog Number 51502R

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Form 13977 (Rev. 6-2008)

Instructions ­ Column (A) ­ VITA Grant Proposed Expenditures · ·

Instructions ­ Column (B) ­ Matching Funds Proposed Expenditures · · ·

DO NOT include as a separate expense if this software was manufacturer installed prior to purchase. DO NOT include cost of purchasing tax preparation software.

DO NOT include as a separate expense if this software was manufacturer installed prior to purchase. The value of donated software should equal the current purchase price. If in-kind contributions are included, provide a brief explanation on a separate sheet. Enter estimated expenses for internet connectivity and for network cards. DO NOT include this as a separate expense if connectivity is included in space rental fees or if the network card was manufacturer installed software prior to purchase. If in-kind contributions are included, provide a brief explanation on a separate sheet. Enter estimated contract labor costs, salary costs and/or hourly wages and benefits for individuals performing Information Technology (IT) Support direct services for the VITA program. DO NOT include indirect salaries for the grant recipient. When an employer other than the recipient furnishes the services of an employee to the VITA program, these services shall be valued at the employee's regular rate of pay (plus benefits but excluding overhead costs) provided these services are in the same skill for which the employee is normally paid. In cases where an employee or contractor works on more than one program only include the portion of the contract labor, salaries, wages and benefits which are directly related to the VITA program and have been incurred due to the VITA program. If in-kind contributions are included, provide a brief explanation on a separate sheet. e-file and scheduling appointments.

Line 16

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Enter estimated expenses for internet connectivity and for network cards. DO NOT include this as a separate expense if connectivity is included in space rental fees or if the network card was manufacturer installed software prior to purchase.

Line 16

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Line 17

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Enter estimated contract labor costs, salary costs and/or hourly wages and benefits for individuals performing Information Technology (IT) Support services for the VITA program. In cases where an employee or contractor works on more than one program only include the portion of the contract labor, salaries, wages and benefits which are directly related to the VITA program and have been incurred due to the VITA program.

Line 17

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Line 18

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Enter the estimated cost of installing phone lines used for e-file and scheduling appointments. DO NOT include costs for installation of a "toll-free," "watts," or "800" number for providing tax assistance. Enter the estimated cost of e-file supplies including diskettes, paper, printer cartridges, toner, cable locks, CDs, jump drives, paper and any other supplies directly attributable to e-file expenses.

Line 18

· Enter the estimated cost of installing phone lines used for

Line 19

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Line 19

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Enter the estimated cost of e-file supplies including diskettes, paper, printer cartridges, toner, cable locks, CDs, jump drives, paper and any other supplies directly attributable to e-file expenses. Value assessed to donated supplies shall be reasonable and shall not exceed the fair market value of the property at the time of the donation. If in-kind contributions are included, provide a brief explanation on a separate sheet. Total Technology Expenses (ADD Lines 13 - 19) Total Estimated Program Cost (ADD Lines 4, 13 & 20)

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Total Technology Expenses (ADD Lines 13 - 19) Total estimated Program Cost (ADD Lines 4, 13 & 20)

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NOTE: For an explanation on what Federal funds may not be used for, see Publication 4671, VITA Grant Program Overview and Application Package.

NOTE: For an explanation on what Qualified Matching Funds may NOT include, see Publication 4671, VITA Grant Program Overview and Application Package.

Catalog Number 51502R

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Form 13977 (Rev. 6-2008)