Form 13424 - Low Income Taxpayer Clinic (Litc) Application Information Page 2

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Qualified Tax Expert (QTE)
Last name
First name
Middle initial
Telephone number
Email address
Licenses/Certifications (Check all that apply)
Enrolled Agent
Qualified Business Administrator (QBA)
Last name
First name
Middle initial
Telephone number
Email address
Tax Compliance Officer
Last name
First name
Middle initial
Telephone number
Email address
Instructions for Form 13424, Low Income Taxpayer Clinic (LITC) Application Information
NOTE: Application forms, including this form (Form 13424), may be released under the Freedom of Information Act (FOIA). In response
to a FOIA request, the LITC Program Office will release these forms after appropriate redactions to ensure confidentiality of taxpayer
This form is used to report basic information about the applicant, including the amount and period of the grant requested, basic contact
information about the clinic, and key staff members. The Program Office uses the information reported on this form to send
correspondence to the clinics and also to share with taxpayers through various IRS publications. Please be careful to follow the
instructions for this form and to report all information completely and accurately. A complete response means an entry must be provided
for each field.
Who Must Complete This Form
All organizations submitting an Application for an LITC grant or a Non-Competitive Continuation (NCC) request must complete this
form. See Publication 3319 for additional information.
Specific Instructions
Grant Period Request
Complete this section by checking the appropriate box. Organizations submitting a New Application must indicate whether a single or
multi-year grant is requested. Under IRC § 7526, the LITC Program Office is authorized to issue grants for a period of up to three years.
Applicants that have never been awarded an LITC grant may only apply for a single year grant.
Current grantees submitting a Non-Competitive Continuation request must check the box indicating whether the request is for the
second or third year of a multi-year grant.
Grant Amount Requested
Enter the total amount, rounded to whole dollars, of funding requested for the grant year. The maximum funding that may be requested
for any grant year is $100,000.
Applicant Information
Enter the contact information for the organization applying for the grant. If a grant is awarded, the award will be payable to the
organization listed in this section. Please provide a complete response, including zip plus-four code, for Applicant’s Mailing Address.
Phone numbers should be formatted as 123-456-7890 x.111.
Clinic Information
Enter information in this section relating to the clinic that will be providing services to taxpayers. For clinics awarded a grant, the
information entered in this section will be used exactly as entered to prepare IRS Publication 4134, Low Income Taxpayer Clinic List.
Publication 4134 is the primary tool for many low income and ESL taxpayers to locate LITC services. Thus, the clinic name entered
should be the same name you will use to publicize LITC services to taxpayers and the public.
(Rev. 4-2016)
Catalog Number 36126D


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