Form 14417 - Reimbursable Agreement - Non-Federal Entities Page 3
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10. CFO authorizing/approving official information
Seller (
organization name)
Internal Revenue Service
a. Official's name
b. Official's title
c. Telephone number
d. Email address
e. Signature/Date
11. Authorizing/Approving official information
Internal Revenue Service
Buyer (
Seller (
organization name)
organization name)
a. Official's name
a. Official's name
b. Official's title
b. Official's title
c. Telephone number
c. Telephone number
d. Email address
d. Email address
e. Signature/Date
e. Signature/Date
11a. Co-Signature for authorizing/approving official
(as appropriate)
Buyer (
Seller
organization name - optional)
(business unit name - optional)
a. Official's name
a. Official's name
b. Official's title
b. Official's title
c. Telephone number
c. Telephone number
d. Email address
d. Email address
e. Signature/Date
e. Signature/Date
For example, a Buyer may require more than one approving official to ratify
For example, co-signatures from approving officials in more than one
a reimbursable agreement.
business unit may be required under statutory authorities governing
reimbursable agreements with foreign entities.
Legal Terms and Conditions
1. IRS Reimbursable Authority: The authority to perform services on a cost reimbursable basis is contained in sections 6103(p)(2)
and 6108(b) of the Internal Revenue Code (IRC). Performance of services is authorized only when consistent with the basic public
obligations of the Internal Revenue Service (IRS). If necessary to fulfill its public obligations, the IRS may modify, reject, cancel, or
terminate any part of this agreement and return the unused balance of funds advanced.
1a. Section 6103(p)(4) of the IRC provides specific requirements for Federal, state, and local organizations to safeguard Federal tax
returns and return information as a condition of receiving the information. IRS Publication 1075, Tax Information Security Guidelines for
Federal, State, and Local Agencies (OMB No. 1545-0962) provides additional guidelines.
1b. Section 7213 of the IRC makes unauthorized disclosure of a return or return information a felony punishable by a fine not to exceed
$5,000 or imprisonment of not more than 5 years, or both, together with the costs of prosecution. Section 7213A makes unauthorized
inspection of a return or return information punishable by a fine up to $1,000, or imprisonment of not more than one year, or both,
together with the costs of prosecution. Section 7431 makes persons who knowingly or negligently make an unauthorized disclosure of a
return or return information liable for civil damages.
14417
Form
(Rev. 2-2013)
Catalog Number 59893X
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