Form 14581 - Fslg Compliance Self-Assessment Page 13
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Flag Item Other Tax Issues – See
Publication 15
4.
Does the entity have written policies in place for the following?
Yes
No
A. Employer-provided passenger automobiles?
Note: Two types of written policy statements relating to a vehicle provided by the employer qualify as sufficient
evidence corroborating the employer’s own statement, and therefore will satisfy the substantiation requirements if
initiated and kept by an employer to implement a policy of either:
1) No personal use – see the requirements of Regulation §1.274-6T(a)(2).
2) No personal use except for commuting – see the requirements of Regulation §1.274-6T(a)(3).
A written policy statement adopted by a governmental unit as to employee use of its vehicles (for example, a city
council resolution or a state law) meets these substantiation rules if the conditions in the above cited Regulations
are met.
B. Other listed property or reimbursement of travel expenses?
Yes
No
Note: It is not required that the employer have a separate written policy to meet the substantiation requirements for
these items. Adequate accounting for these items by employees means the submission to the employer of an
account book, diary, log, statement of expense, trip sheet, or similar record maintained by the employer in which the
required information as to each element of expenditure or use is recorded at or near the time of the expenditure or
use in a manner that conforms to the listed property requirements.
Yes
No
C. Educational assistance program?
Note: For benefits to be excludable, an educational assistance plan must be in writing and meet certain other tests.
See
Publication
15-B.
5.
Is the entity required to file any of the following federal tax or information returns?
Note: All forms and instructions are available at
A. Form 720, Quarterly Excise Tax Return
Yes
No
B. Form 990, Return of Organization Exempt from Income Tax
Yes
No
Yes
No
C. Form 990-T, Exempt Organization Business Income Tax Return
D. Form CT-1, Employer's Annual Railroad Retirement Tax Return
Yes
No
E. Form 1096, Annual Summary and Transmittal of U.S. Information Returns
Yes
No
Yes
No
F. Form 1098-E, Student Loan Interest Statement
G. Form 1098-T, Tuition Statement
Yes
No
H. Form 1099-G, Certain Government Payments
Yes
No
Yes
No
I. Form 1099-INT, Interest Income
J. Form 1099-MISC, Miscellaneous Income
Yes
No
K. Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans,
Yes
No
IRAs, Insurance Contracts, etc.
L. Form 8300, Cash Payments over $10,000 Received in Trade or Business
Yes
No
M. Form W-2, Wage and Tax Statement
Yes
No
Yes
No
N. Form W-3, Transmittal of Wage and Tax Statements
Notes
14581
Catalog Number 66247V
Form
(Rev. 3-2015)
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