Fillable Form 13715 - Volunteer Site Information Sheet printable pdf download

13715

OMB Number

Form

Volunteer Site Information Sheet

1545-2222

(September 2017)

Purpose: Information provided on this form is used by our IRS toll-free assistance line and is posted to the VITA Site Locator Tool on irs.gov to

help taxpayers locate the nearest volunteer tax preparation site. Review the information below carefully. Update and/or correct missing or existing

information. Return the completed form to your local IRS contact. If the site information changes after submitting this form, please provide

your local IRS contact with the updated information immediately.

Site Information

Is the site open to public?

Yes

Site Name:

Is the site an appointment only site?

Yes

Site Address:

If yes to the above question, please provide the phone number for site.

City, State:

If yes to the above question, please provide the contact name for site.

Zip Code:

Federal e-file

Yes

State e-file

Yes

Site Identification

Does the site use the Virtual Delivery Method for return preparation?

Yes

Number (SIDN)

If “Yes”

Is the site a mobile only site?

Yes

First day open/

Does the site Prepare Non-Resident Alien/Foreign Student/Scholar

Yes

Last day open

Returns?

Does the site offer Certifying Acceptance Agent (CAA) service?

Yes

What languages

are offered at

Does the site offer Financial Education and Asset Building Services?

Yes

the site?

If Yes, Relationship Manager is required to complete Form 14099 - SPEC

Financial Education & Asset Building Partner Assessment Tool

Does site prepare prior year returns?

Yes

Program Type: FSA, VITA, VITA Grant, Military, AARP, TCE

Site Operating Hours

Day

Time

Comments (e.g. holiday closures, alternative opening times)

Open

MON

TUE

WED

THUR

FRI

SAT

SUN

Site Coordinator or Contact

Best Time to Call:

Name:

Email Address:

Mailing Address:

Is this a revision of information you

City, State, Zip:

Yes

previously provided for this year?

Phone Number:

Date of this revision:

IRS Use Only

Date Form 13715 Received in Territory Office:

Date SPECTRM Updated:

SEID of employee who updated SPECTRM:

I certify the information provided on this form match the data in SPECTRM.

Territory Manager Approval (Signature & Date):

Privacy Act and Paperwork Reduction Notice – Our legal right to ask for information is 5 U.S.C. 301 and 26 USC 7801.

The primary purpose of asking for this information is to assist us in providing services to taxpayers at sites supporting IRS volunteer income tax preparation and outreach

programs. The time estimated for participation is 30 minutes. We may provide information to volunteers who coordinate activities and staffing at taxpayer assistance sites.

Your response is voluntary. However, if you do not provide the requested information, the IRS may not be able to promote your assistance in these programs.

For more information about uses, see the Privacy Act notice for SPEC Total Relationship Management (SPECTRM) in the Federal Register: July 19, 2004 (Volume 69, Number

137) [Notices] [Pages 43055-43056]

13715

Form

(Rev. 9-2017)

Catalog Number 43863F

Department of the Treasury - Internal Revenue Service