Free Form 13980 (Rev. 6-2008) - Federal

Form 13980 (June 2008)

Department of the Treasury­ Internal Revenue Service

Business Results VITA Grant Program Year End Report

Purpose: This form is to be used by VITA Grant Program grantees. It should accompany the completed VITA Grant Program Year End Narrative due September 30 and should represent the grantees performance for the below grant period in the categories listed. Name of Partner: Grant Period: October 1, through June 30,
Number of Returns

Federal Return Preparation 1. Total low income federal returns filed electronically 2. Total low income federal returns filed as paper returns 3. Total low income federal returns prepared (Add lines 1 & 2) Return Preparation Site Information 4. Total established sites - fixed location 5. Total established sites - ad hoc location 6. Total new sites - fixed location 7. Total new sites - ad hoc location 8. Total sites operated (Add lines 4 through 7) 9. Total sites offering paper only return preparation 10. Total sites offering electronic filing 11. Total tax preparation software packages provided by the IRS Quality Review Method Used at Sites 12. Total sites using peer review 13. Total sites using designated review Volunteers and Total Volunteer Hours 14. Total number of all volunteers 15. Total number of all volunteer hours Volunteer Certification - Record the number of volunteers certified at each training level shown in items 17-23. Volunteers with multiple certification levels should be shown in each level they are certified. Volunteers not certified should be recorded on line 16. 16. Volunteers not certified 17. Volunteer certified in VITA/TCE Basic 18. Volunteer certified in VITA/TCE Intermediate 19. Volunteer certified in VITA/TCE Advanced 20. Volunteer certified in VITA/TCE International 21. Volunteer certified in VITA Military 22. Volunteer certified in VITA Foreign Student 23 Volunteer certified in VITA Puerto Rico Underserved Population - Indicate the number of federal tax returns prepared for each underserved population. 24. Low income elderly 25. Low income rural 26. Low income disabled 27. Low income limited English proficient 28. Low income Native American 29. Low income (not included in Lines 24-28) Dollars Generated 30. Total EITC refund dollars generated by low income federal returns filed 31. Total refund dollars generated by low income federal returns filed Signature Signature Of Responsible Official Date

Number of Sites

Number of Sites

Volunteers

Number of Volunteers

Number of Returns

Dollars

Catalog Number 51539E

Form 13980 (Rev. 6-2008)

Instructions ­ VITA Grant Program Plan ­ Program Effectiveness
Line 1 Line 2 Line 3 Line 4 Line 5 Line 6 Line 7 Line 8 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 Record the number of low income federal returns filed electronically. Record the number of low income federal returns filed as a paper return. Record the total low income federal returns filed. This is the sum of lines 1 and 2. Record the number of sites that were already established that operated during this filing season in fixed site locations. Record the number of sites that were already established that operated during this filing season in ad hoc site locations. More explanation on fixed and ad hoc sites can be found in the glossary section of Publication 4671. Record the number of new sites that operated during this filing season in fixed site locations. Record the number of new sites that operated during this filing season in ad hoc site locations. More explanation on fixed and ad hoc sites can be found in the glossary section of Publication 4671. Record the number of sites operated. This is the sum of lines 4 through 7. Record the total number of sites that offered paper only return preparation. Record the total number of sites that offered electronic filing. Record the number of tax preparation software packages provided by the IRS for the sites covered by this grant. Record the number of sites that used peer review. Record the number of sites that used designated review. Record the total number of volunteers. Record the total number of volunteer hours. Record the total number of volunteers that served in a support role and did not successfully complete certification in one of the tax law courses. Record the total number of volunteers that successfully certified on the VITA/TCE Basic tax law training. Record the total number of volunteers that successfully certified on the VITA/TCE Intermediate tax law training. Record the total number of volunteers that successfully certified on the VITA/TCE Advanced tax law training. Record the total number of volunteers that successfully certified on the VITA/TCE International tax law training. Record the total number of volunteers that successfully certified on the VITA Military tax law training. Record the total number of volunteers that successfully certified on the VITA Foreign Student tax law training. Record the total number of volunteers that successfully certified on the VITA Puerto Rico tax law training. Record the total number of federal returns prepared for the low income elderly population. Record the total number of federal returns prepared for the low income rural population. Record the total number of federal returns prepared for the low income disabled population. Record the total number of federal returns prepared for the low income limited English proficient population. Record the total number of federal returns prepared for the low income Native American population. Record the total number of federal returns prepared for the low income population not included in Lines 24 - 28. Record the total EITC dollars generated by all low income federal returns filed. Record the total refund dollars generated by all low income federal returns filed.

Catalog Number 51539E

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Form 13980 (Rev. 6-2008)