Form 13424 - Low Income Taxpayer Clinic (Litc) Application Information Page 2
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Qualified Tax Expert (QTE)
Prefix
Last name
First name
Middle initial
Suffix
Telephone number
Email address
Licenses/Certifications (Check all that apply)
Attorney
CPA
Enrolled Agent
Other
Qualified Business Administrator (QBA)
Prefix
Last name
First name
Middle initial
Suffix
Telephone number
Email address
Tax Compliance Officer
Prefix
Last name
First name
Middle initial
Suffix
Telephone number
Email address
Instructions for Form 13424, Low Income Taxpayer Clinic (LITC) Application Information
Each grant application and non-competitive continuation application must include Form 13424, Application Information.
LITC Grant Applications may be released under the Freedom of Information Act (FOIA). In response to a FOIA request, the LITC Program Office
will release this application after appropriate redactions to ensure confidentiality of taxpayer information.
Purpose
This form is used to report basic information about the grant, including the amount and period of the grant requested, basic contact information
for 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.
Specific Instructions
Grant Period Request
Under IRC § 7526, the LITC Program Office is authorized to issue grants for a period of one, two, or three years. Check the appropriate box for a
new application or a non-competitive continuation. For a new application, indicate whether it is a single or multi-year request. Applicants that
have never been awarded an LITC grant may only apply for a single year grant. For a non-competitive continuation, indicate whether the request
is for the second or third year of funding.
Grant Amount Requested
Input the amount, rounded to whole dollars, that is requested for funding. You must input zero if you do not wish funding for a certain program.
The maximum total funding that may be requested by an applicant 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 an LITC grant, the information entered in this section is used exactly as entered to populate 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. Please provide
a complete response, including zip plus-four code, for Applicant’s Mailing Address, Clinic Street Address, and Clinic Mailing Address. Do not
write “same.” Phone numbers should be formatted as 123-456-7890 x.111. When providing the clinic’s website address, please provide the direct
link to the LITC page if one is available. If no website exists, write “none.”
Please individually list all languages in addition to English in which services can be provided on site. If the clinic uses a telephone or internet
based translation service, state “other languages through interpreter services.”
All applicants are required to identify a Clinic Director, Qualified Expert (QE), and Qualified Business Administrator (QBA) at the time of
application. For more information on these positions, see Publication 3319, LITC Grant Application and Guidelines. For the clinic director and
QTE, list any applicable licenses and certifications. Also list the Tax Compliance Officer. The Tax Compliance Officer is the responsible individual
authorized to speak with the LITC Program Office about the tax compliance issues involving the clinic and the sponsoring organization.
13424
Form
(Rev. 8-2014)
Catalog Number 36126D
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