Form 14204 - Tax Counseling For The Elderly (Tce) Program Application Checklist And Contact Sheet

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Tax Counseling for the Elderly (TCE) Program
14204
Form
OMB Number
(Rev. May 2012)
Application Checklist and Contact Sheet
1545-2222
CONTACT INFORMATION
Name of Organization:
Address of Organization:
Telephone:
Fax:
Point of Contact (POC) and title:
Email Address for POC:
ADMINISTRATIVE INFORMATION
Does your organization have a valid DUNS number?
Yes
No
Has your organization registered or renewed your registration this year with the Central Contractor Registry?
(Note: Organizations must renew their registration once a year in order to maintain active status)
Yes
No
Yes
No
Is your organization interested in applying for a multi-year grant?
If so, have you checked the criteria under the Multi-Year Grant Opportunities section of Publication 1101 to
determine if your organization is eligible to apply?
Yes
No
APPLICATION CHECKLIST AND ASSEMBLY
All documents requiring a signature must contain either an electronic signature or scanned copy of the original
signature. Make sure you double check that you have all documents and information required. Technical ranking
occurs simultaneously with Grant Program Office (GPO) evaluation. Any missing information identified by the GPO
during its evaluation may or may not be considered by technical evaluators depending on when the review is
completed. It is the responsibility of the applicant to ensure all information is submitted. Incomplete applications
meeting basic eligibility will be scored based on the information available at time of review. Therefore, it is extremely
important that the submission is complete.
Checklist:
1. Form 14204, TCE Application Checklist & Contact Sheet (this sheet)
2. Background Narrative
3. Nonprofit Status Determination letter issued by the Internal Revenue Service
4. Organizational letter if your organization is not required to file a Federal tax return
5. Proposed Program/Budget Plan
6. Form 8653 - TCE Application Plan
7. Standard Form 424, Application for Federal Assistance
8. Civil Rights Narrative
9. Standard Form LLL, Disclosure of Lobbying Activities (if required)
10. If applicable, a copy of your Single Audit
st
Application Due Date: May 31
st
(Note: If May 31
falls on a weekend, the Monday following the 5/31 date will be the deadline for application submission)
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 10 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.
14204
Form
(Rev. 5-2012)
Catalog Number 57258Q
Department of the Treasury – Internal Revenue Service

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