Form Dr-370061 - Refund Sampling Results
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1DR-370061
Refund Sampling Results
R. 05/09
This form is a checklist to provide guidance on specific sampling plan results the Department of Revenue needs
to evaluate your sample. You must first complete and submit a Refund Sampling Methodology Application (Form
DR-370060) to the Department and receive approval of your sampling plan before submitting this form. You must also
complete and submit an Application for Refund (Form DR-26S) with this form.
The final evaluation of the sample and a summary of all the overall conclusions related to your sampling methodology
must be provided with this form to the Department. Please include any printouts of population parameters, copies of
WinSample reports, sample point invoices, spreadsheets, formulas/calculations, and any other necessary supporting
documentation as required by Rule 12-26.003, Florida Administrative Code (F.A.C.).
Your results must show that the sample was completed in accordance with Rule 12-26.004, F.A.C., and your approved
sampling plan. We may require that the sample be expanded to reach an acceptable final accuracy for the projection
of the refund amount. Please include your approval number in the appropriate box. You must provide an explanation if
you are unable to supply any of the requested information.
Check the items below that are attached
Statistical Sampling Results
Non-statistical Sampling Results
Approval #
Approval #
Provide the results of your sampling plan in detail
Provide the results of your sampling plan in detail
including all formulas and calculations.
including all formulas and calculations.
❏
Population size
❏
Type of sample (imaging, journals, time periods,
microfiche, etc)
❏
Sample size
❏
Beginning range number for each range
❏
Method used to determine sample size
❏
Ending range number for each range
❏
Sample points
❏
Number of ranges
❏
Copy of WinSample report
❏
Population size
❏
Method of selecting and using spares
❏
Sample size
If stratification is used:
❏
Method used to determine sample size
❏
Stratum boundaries
❏
Sample points
❏
Method of determining stratum boundaries
❏
Copy of WinSample report
❏
Number of strata
❏
Method of establishing correspondence
❏
Detail threshold amount
❏
Method of selecting and using spares
For sample analysis:
❏
The estimator used (difference or mean)
❏
Precision amount
❏
Projected refund amount
❏
Confidence level
❏
Other pertinent sampling plan results
❏
Method used to calculate precision
❏
The estimator used (difference or mean)
❏
Projected refund amount
❏
Other pertinent sampling plan results
Mail completed form, attachments, and documentation to:
Florida Department of Revenue
Refunds Subprocess
PO Box 6470
Tallahassee, FL 32314-6470
For more information on completing this application call: 850-488-8937
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