27-LITCApplication.docx
DOCX document 61 KB Posted
- Attached to
- Low Income Taxpayer Clinic Grants
- Solicitation number
- BD-27-1028-DR999-DR999-132038
- Issued by
- Massachusetts
About this file
This is a Low Income Taxpayer Clinic (LITC) Grant Application form administered by the Massachusetts Department of Revenue (DOR). The application requests funding to support legal clinics that provide tax advice and representation to low-income taxpayers. Applicants must submit comprehensive documentation including a program plan detailing the clinic's history, capacity, and service expansion plans, along with a detailed program budget and narrative justifying the requested grant amount. The application requires submission either through COMMBUYS or directly to the DOR at taxadvocate@dor.state.ma.us for organizations already under contract, depending on the applicant's current status.
Applicants must meet specific eligibility and compliance requirements, including registration with the Massachusetts Department of Revenue and Secretary of the Commonwealth, demonstrated stable financial condition without bankruptcy or receivership within the past three years, and compliance with all Massachusetts tax and child support laws. Supporting documentation required for COMMBUYS submission includes an IRS Award Letter for the current program period if applicable, the Commonwealth Standard Contract Form, a Massachusetts Substitute W-9 Form, a Contractor Authorized Signatory Listing, and an Electronic Funds Transfer Sign Up Form. The application requires certification under penalties of perjury that all information is accurate and that the applicant will disclose any civil litigation, criminal investigations, or potential conflicts of interest. Questions regarding the application should be directed to Mireille Eastman at eastmanm@dor.state.ma.us.
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Other files
| File | Type | Posted |
|---|---|---|
| 27-LITCGrantBudgetTemplate.xlsx | XLSX spreadsheet | |
| 27-LITCGrantAgreement~1.docx | DOCX document | |
| 27-LITCGrantApplication~2.docx | DOCX document | |
| StandardContractFEB2026.docx | DOCX document |
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Text version
Application Fiscal Year: ______________ Grant Amount Requested (This amount is from the proposed budget) Clinic/Applicant Information
Legal Name of LITC Organization (Applicant) Telephone Number Email Address
Filing Tax Identification number (EFIN/TIN) Website Address
| Clinic Location address |
| City/Town |
| State |
| Zip |
Name of contact person/contract manager Direct Telephone Number: Contact email address:
Contract Number (if applicable)
Under the pains and penalties of perjury, by signing this application I certify all the following:
· The information contained in this application is true.
· I have the authority to execute this application on behalf of the Applicant.
· The Applicant is registered with DOR and the Secretary of the Commonwealth of Massachusetts.
· The Applicant accepts the terms of the LITC Grant Application and Grant Agreement without substantive changes.
· The Applicant is in stable financial condition and has not been in bankruptcy and/or receivership within the last three calendar years.
· The Applicant is compliant with all Massachusetts tax and child support laws, and requirements of wage withholding and reporting.
· The Applicant will disclose any civil litigation, criminal investigation, indictment, prosecution, or other proceeding that has been brought against Applicant in the last three years.
· The Applicant will disclose any potential conflicts of interest, including any possible conflicts of interest the applicant’s employees may have, in connection with the performance of services required under the Grant Agreement resulting from this Grant Agreement.
Signature
Signature of applicant or Director
Date
Print applicant’s or Director’s name
Title
Required documents for COMMBUYS*:
· Copy of IRS Award Letter for current program period if applicable
· Commonwealth Standard Contract Form (Includes the Commonwealth Terms and Conditions)
· Request for Taxpayer Identification Number and Certification (Massachusetts Substitute W-9 Form)**
· Contractor Authorized Signatory Listing**
· Electronic Funds Transfer Sign Up Form**
· Program Plan includes (history/capacity of clinic, how funds will be used to expend services, etc.)
· Program Budget with Narrative for requested Amount*
*If the LITC is already under contract, it must submit this application and the Program budget for the Fiscal Year to DOR directly to taxadvocate@dor.state.ma.us. It does not need to submit a bid on COMMBUYS.
**Please contact the Grant Application Contact for the form. These forms may not be required if previously submitted.
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