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Federal Free Printable Form 13424 (Rev. 4-2018) for 2019 Federal Low Income Taxpayer Clinic (LITC) Application Information

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Low Income Taxpayer Clinic (LITC) Application Information
Form 13424 (Rev. 4-2018)

Form Department of the Treasury - Internal Revenue Service 13424 OMB Number 1545-1648 Low Income Taxpayer Clinic (LITC) Application Information (April 2018) Grant Period Request (Check one) New application Single year Multi-year Non-Competitive continuation Second year Third year Grant amount requested (maximum $100,000) Applicant Information Legal name of sponsoring organization Prefix Last name First name Middle initial Suffix State ZIP + 4 code Title Phone number FAX number Email address Applicant's Mailing Address Street Street address line 2 City Clinic Information Name of clinic Public telephone number Toll-Free telephone number (if applicable) FAX number Website address (if applicable) Languages served in addition to English Clinic Street Address Clinic Mailing Address Street Street City State ZIP + 4 code City State ZIP + 4 code Middle initial Suffix Clinic Director Information Prefix Last name First name Telephone number Email address Licenses/Certifications (Check all that apply) Attorney CPA Catalog Number 36126D Enrolled Agent Other www.irs.gov Form 13424 (Rev. 4-2018) Page 2 Qualified Tax Expert (QTE) Prefix Last name First name Telephone number Middle initial Suffix Middle initial Suffix Middle initial Suffix Email address Licenses/Certifications (Check all that apply) Attorney CPA Enrolled Agent Other Qualified Business Administrator (QBA) Prefix Last name Telephone number First name Email address Tax Compliance Officer Prefix Last name First name Title Telephone number Email address Instructions for Form 13424, Low Income Taxpayer Clinic (LITC) Application Information Purpose This form is used to report basic information about the applicant, including the amount and period of the grant requested, contact information for the applicant’s sponsoring organization, the name and location of the clinic where services are provided, and key clinic staff members. The Program Office uses the information reported on this form to correspond with clinics and to publicize the location of service providers to taxpayers in IRS publications and online. Please follow the instructions carefully and report all information completely and accurately. A complete response means an entry must be provided for each field. Who Must Complete This Form All organizations submitting a Full Grant Application or a Non-Competitive Continuation (NCC) Request must complete this form. See Publication 3319, Section IV, Application and Submission Process. Any forms submitted with a Full Grant Application or NCC Request may be released under the Freedom of Information Act (FOIA). In response to a FOIA request, the LITC Program Office will release these forms after appropriate redactions to ensure confidentiality of taxpayer information. Specific Instructions Grant Period Request Check the appropriate box to indicate whether a single or multi-year grant is requested. Under IRC § 7526, the LITC Program Office is authorized to issue grants for a period of up to three years. Applicants that have never been awarded an LITC grant are not eligible for a multi-year grant and may only request a single year grant. Current grantees requesting a NCC Request must check the box indicating whether the request is for the second or third year of a multi-year grant. Enter the total amount, rounded to whole dollars, of funding requested for the grant year. The maximum funding that may be awarded for any grant year is $100,000. Applicant Information Enter the contact information for the organization applying for the grant. The name of the applicant must match exactly the name used to register with the System for Award Management (SAM). If a grant is awarded, the award will be payable to the organization listed in this section. For Applicant’s Mailing Address, please provide a complete response, including zip plus-four code. Phone numbers should be formatted as 123-456-7890 x.111. Clinic Information This section is used to report information about the clinic where services are provided to taxpayers. If a grant is awarded, the information entered in this section will be used exactly as entered to prepare 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. Thus, the clinic name entered should be the name used in materials publicizing the LITC’s services to taxpayers and the public. Catalog Number 36126D www.irs.gov Form 13424 (Rev. 4-2018) Page 3 Instructions for Form 13424, Low Income Taxpayer Clinic (LITC) Application Information (cont'd) Please provide a complete response, including zip plus-four code, for the 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 must identify a Clinic Director, Qualified Expert (QTE), and Qualified Business Administrator (QBA) responsible for clinic operations and management of funds. For more information on these positions, see Publication 3319, Section VI.C.i, Standards for Operating an LITC. For the clinic director and QTE, list any applicable licenses and certifications. Tax Compliance Officer All applicants must identify a Tax Compliance Officer. See Section III.C.iii, Compliance with Federal Tax and Nontax Requirements and Glossary for a discussion of who may be designated. An applicant must be in full compliance with its federal tax responsibilities when applying for an LITC grant and throughout the grant year. Catalog Number 36126D www.irs.gov Form 13424 (Rev. 4-2018)
Extracted from PDF file 2018-federal-form-13424.pdf, last modified April 2018

More about the Federal Form 13424 Other TY 2018

We last updated the Low Income Taxpayer Clinic (LITC) Application Information in December 2018, so this is the latest version of Form 13424, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 13424 directly from TaxFormFinder. You can print other Federal tax forms here.

Related Federal Other Forms:

TaxFormFinder has an additional 774 Federal income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Federal Form 13424.

Form Code Form Name
Form 13424-B Low Income Taxpayer Clinic (LITC) Interim and Year-End Report Controversy Issues
Form 13424-C Low Income Taxpayer Clinic (LITC) Advocacy Information
Form 13424-F Volunteer / Pro Bono Time Reporting
Form 13424-I Low Income Taxpayer Clinic (LITC) LITC Tax Information Authorization

Download all  tax forms View all 775 Federal Income Tax Forms


Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 13424 from the Internal Revenue Service in December 2018.

Show Sources >

Historical Past-Year Versions of Federal Form 13424

We have a total of six past-year versions of Form 13424 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 13424

Form 13424 (Rev. 4-2018)

2017 Form 13424

Form 13424 (Rev. 4-2016)

2016 Form 13424

Form 13424 (Rev. 4-2016)

Low Income Taxpayer Clinic (LITC) Application Information 2015 Form 13424

Form 13424 (Rev. 8-2014)

Low Income Taxpayer Clinic (LITC) Application Information 2012 Form 13424

Form 13424 (Rev. 9-2012)

Low Income Taxpayer Clinics (LITCs) Application 2011 Form 13424

Form 13424 (Rev. 5-2011)


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