Form 8654 - Tax Counseling For The Elderly Semi-Annual/annual Program Report Form Page 2

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Page 2

Account/Identifying Number

Other Information

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)

Add lines 26 and 27.

29. Number of taxpayers assisted—all other (excludes return preparation)

30. Total number of taxpayers assisted (add lines 28 and 29)

31. Number of tax preparation sites

Numbers

a. e-file sites

b. combination of paper and e-file sites

c. Total lines 31a and 31b

32. Attach to this form, a listing of each site’s SIDN (Site Identification Number) that was provided

by the IRS Territory Office, its EFIN (Electronic Filing Identification Number), whether the site

is a combination paper/e-file site, and the volunteer return preparation hours for each site.

Signature of responsible officer

Date

Agency use

IRS Volunteer Income Tax Preparation and Outreach Programs Privacy and Paperwork Reduction Act Notice

Privacy and Paperwork Reduction 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. The Paperwork Reduction Act

requires that the IRS display an OMB control number on all public information requests. The OMB Control Number for this study is 1545-2222. The time

estimated for participation is 15 minutes. 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.

8654

Catalog Number 64330H

Form

(Rev. 4-2016)