2. Wizard

Form 13980

(Rev. September 2023)

VITA Grant Performance Measures Report

Catalog Number 51539E

Instructions

Purpose:

 

VITA grant recipients use this form to accompany the completed VITA Grant Program Year End Narrative due on or before 120 days after the Period of Performance ends. Data represents the recipient's program measures for the Period of Performance in the categories in this form.

All fields marked with an asterisk (*) are required.

Who is the tax analyst working with your organization. Please confirm the tax examiner that is assigned to your case.

Period of performance

Accepts year from 2021 to performance year. Ex: 2022.

Accepts year from 2022 to peformance year. Ex: 2023.

Enter a FAIN. Must be 2 digit peformance year followed by "VITA" and the last four should be digits. Ex. 23VITA1234.

Unique Entity Identifier should have 12 characters. Ex: 123456789abc.

All fields marked with an asterisk (*) are required.

Federal Return Preparation

Enter the number of low income federal returns filed electronically. Should be integer and greater than zero.

Enter the number of low income federal returns filed as a paper return. Should be integer and greater than zero.

Enter the number of low income federal returns filed as a paper return. Should be integer and greater than zero.

 This is the sum of lines 1 through 3.

Return Preparation Site Information (complete section 5 with site information)

Enter the number of sites operated as traditional site locations. Should be integer and greater than zero.

Enter the number of sites operated as virtual site locations. Should be integer and greater than zero.

Enter the number of sites operated as Facilitated Self-Assistance (FSA) locations. Should be integer and greater than zero.

This is the sum of lines 5 through 7.

Volunteers and Total Volunteer Hours (provide the number of volunteers and total hours worked by volunteers)

Enter the number of volunteers whose primary responsibility will be certified tax return preparers and record the total hours expected to work by all these volunteers.

Enter the number of volunteers whose primary responsibility will be support personnel such as a greeter and record the total hours expected to work by all these volunteers.

All fields marked with an asterisk (*) are required.

Estimate the number of federal tax returns expected to prepare for each underserved population. Choose only one population as your primary and one population as your secondary focus.

Select only one option.

Select only one option.

Enter the total number of federal returns prepared for the low income elderly population. Should be integer and greater than zero.

Enter the total number of federal returns prepared for the low income rural population. Should be integer and greater than zero.

Enter the total number of federal returns prepared for the low income persons with disabilities population. Should be integer and greater than zero.

Enter the total number of federal returns prepared for the low income limited English proficient population. Should be integer and greater than zero.

Enter the total number of federal returns prepared for the low income Native American population. Should be integer and greater than zero.

Enter the total number of federal returns prepared for the low income population not included in lines 11 through 15. Should be integer and greater than zero.

Dollars Generated

Enter the total EITC refund dollars generated. Allowed maximum 12 numeric digits.

Enter the total refund dollars generated. Allowed maximum 12 numeric digits.

Enter the number of federal returns prepared meeting the EITC Threshold.

All fields marked with an asterisk (*) are required.

Complete the following site information. Provide the EFIN (Electronic Filing Identification Number) and SIDN (Site Identification Number) for each site.

Site information for each site

Must be 6 digits. Ex: 123456.

SIDN must start with the letter 'S' followed by 8 digits. All eight numeric digits cannot be the same.

    (Maxmium 5 files can be attached. Each file can be up to 5 MB. You may attach pdf, excel, word, jpeg & png files)

    All fields marked with an asterisk (*) are required.

    Review

    General

    Tax analyst first name

    N/A

    EDIT

    Tax analyst last name

    N/A

    EDIT

    Recipient name

    N/A

    EDIT

    Start year (from October 1)

    N/A

    EDIT

    End year (to September 30)

    N/A

    EDIT

    Federal Award Identification Number (FAIN)

    N/A

    EDIT

    Unique Entity Identifier

    N/A

    EDIT
    Federal and Site Information

    1. Federal returns filed electronically

    N/A

    EDIT

    2. Federal returns filed as paper

    N/A

    EDIT

    3. Federal returns filed through MyFreeTaxes

    N/A

    EDIT

    4. Total federal returns prepared

    N/A

    EDIT

    5. Traditional sites

    N/A

    EDIT

    6. Virtual sites

    N/A

    EDIT

    7. Facilitated self-assistance (FSA) sites

    N/A

    EDIT

    8. Total sites operated

    N/A

    EDIT

    9. Number of volunteer tax preparers

    N/A

    EDIT

    10. Number of volunteer tax preparation hours

    N/A

    EDIT
    Underserved Population

    Primary Underserved Population

    N/A

    EDIT

    Secondary Underserved Population

    N/A

    EDIT

    17. Total EITC refund dollars generated by low income federal returns filed

    N/A

    EDIT

    18. Total refund dollars generated by low income federal returns filed

    N/A

    EDIT

    19. Number of federal returns prepared meeting EITC Threshold

    N/A

    EDIT
    Site Information

    Site information for each site

    EDIT

    Site name

    N/A

    EDIT

    Electronic Filing Identification Number (EFIN)

    N/A

    EDIT

    Site Identification Number (SIDN)

    S

    EDIT

    County

    N/A

    EDIT

    City

    N/A

    EDIT

    State

    N/A

    EDIT

    Open All Year

    N/A

    EDIT

    Your Form Has Been Submitted

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