Free Form 13981 (Rev. 6-2008) - Federal

Form 13981 (June 2008)

Department of the Treasury­ Internal Revenue Service

GRANT AGREEMENT

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.

The Grant Agreement is entered into by the Internal Revenue Service, Department of the Treasury, United States of America, hereinafter referred to as IRS, and . Name of Grantee hereinafter referred to as recipient. This agreement is conditioned upon the appropriation of funds by Congress for the VITA (Volunteer Income Tax Assistance) Program. The recipient agrees to operate a Volunteer Tax Assistance Program in conformity with the following: Proposed Program Plan; Program Requirements (As outlined in Publication 4671, VITA Grant Program Overview and Application Package); Standard Forms 424 and 269; Assurances and Certifications; Office of Management and Budget (OMB) Circulars A-21, A-87, A-102, A-110, A-122, and A-133, and Federal regulations, as applicable; 6. All additional applicable statutory requirements, and all additional applicable requirements in OMB Circulars, Department of the Treasury Circulars and Federal Management Circulars; 7. The common rule on nonprocurement debarment and suspension, adopted by the Department of the Treasury (31 C.F.R. Part 19); 8. The common rule on government-wide requirements for Drug-Free Workplace (Grants), as published in the Federal Register (54 F.R. 4946, January 31, 1989) and adopted by the Department of the Treasury (31 C.F.R. Part 19, Sections 19,600 et seq.). 1. 2. 3. 4. 5.

Grant Agreement Period: The Grant Agreement covers the period from October 1, 2008, to June 30, 2009, pending approval of the above named sponsor's proposal. NOTE: If expenses are incurred prior to approval, and the grant is later denied, all costs incurred will be the responsibility of the Sponsor. Maximum Amount of Funds Available from Internal Revenue Service for Expense Reimbursement: The maximum amount of funds available from the Internal Revenue Service under the Grant Agreement is

.

The availability of funds is conditional upon the appropriation of funds by Congress for the VITA Grant Program. This amount may be increased only by writing the Internal Revenue Service Grant Program Office, 401 West Peachtree Street NW, Stop 420-D, Atlanta, GA 30308. No additional expense reimbursements or other payments shall be made by the Internal Revenue Service unless the maximum amount of funds set forth above has been increased in writing by the Director, Field Operations, Stakeholder Partnerships, Education and Communication, Wage and Investment Division.

Approved by an Authorized Representative of the Program Sponsor by:
Name (Please Print)

Approved for the Internal Revenue Service by:
Leslye Baronich Name (Please Print) Director, Field Operations Stakeholder Partnerships, Education and Communication Title (Please Print)

Title (Please Print)

Signature

Date

Signature

Date

Catalog Number 51540F

Form 13981 (Rev. 6-2008)