VITA_Grant_Workbook rev 04172018.xlsx
XLSX spreadsheet 64 KB Posted
- Opportunity number
- VITA-2018-001
- Issued by
-
Department of the Treasury
About this file
VITA Grant Workbook
View the file
Other files
| File | Type | Posted |
|---|---|---|
| oppVITA-2018-001-cfda21.009-instructions.doc | DOC document | |
| VITA Notice of Funding Opportunity 2018.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contents of Workbook
| Application Submission Instructions | |
| Insert Applicant Name (This will populate to all templates used during application submission) | |
| DO NOT CONVERT THIS WORKBOOK TO PDF. SUBMIT AS AN EXCEL DOCUMENT. | |
| This workbook is provided as a convenience to applicants. Its use is preferred but not mandatory. If using a different format for submission of information, be sure to include all fields requested. Failure to include all requested information could result in non-consideration of the application and/or a lower technical ranking score. | |
| The following templates are included and can be viewed/edited by selecting on the tabs at the bottom of the workbook with the same name as indicated in these instructions. | |
| GENERAL INFORMATION ABOUT WORKBOOK | |
| Entry Required | Cells shaded in yellow require an entry when applicable. For example, you should insert your organization name above on row 2, in column B, and your organization name will populate to the other templates used during application submission (Tabs 1 - 6). |
| Auto-calculation | Cells shaded in green will automatically calculate based on information input in other cells. |
| Adding or deleting lines | Add or delete lines to fit your specific needs. If adding lines, insert lines before the last line to maintain pre-set print attributes and/or auto-calculation. |
| TEMPLATES FOR USE DURING APPLICATION SUBMISSION | |
| 1-Return Prep Performance | Complete this tab to record prior return performance information requested in the Program Plan narrative section at A.3. |
| 2-VITA Target Audience Instr. | Review this tab for instructions on completing the VITA Target Audience tab information requested in the Program Plan narrative section. |
| 3-VITA Target Audience | Complete this tab with information requested in the Program Plan narrative section. |
| 5-Matching Funds Summary Chart | Complete this tab with information requested in the Matching Funds Summary Chart section. Detailed instructions are included in the Publication 4671. Remember this is a dollar-for-dollar matching grant. You must have an equal amount of matching funds for the federal funds requested. Note: Completing the Matching Funds Summary Chart does not mean that you don't have to provide matching funds letters. |
| 6-Corporate Felony Convictions |
THIS TAB MUST BE COMPLETED BY ALL APPLICANTS. -If you are not a corporation, please enter NOT APPLICABLE to question 1.
-If you are a corporation and you or your officers or agents acting on your behalf:
- Were not convicted under any Federal law withing the preceding 24 months, enter NONE to question 1.
- Were convicted under any Federal law within the preceding 24 months, complete all questions.
| 8-Related Party Transactions | Completion of this template is required at time of application submission. It may be used to report related party transactions, when applicable, after a grant is awarded. Related party transactions are defined in the Terms and Conditions of the grant agreement. Update this section any time the need arises throughout the grant period of performance. |
| TEMPLATES FOR USE AFTER GRANT AWARD | |
| 4-Budget | Complete with information requested in the Budget section. Detailed instructions are included in the Publication 4671. Don't struggle with where to put a particular expense or matching fund. Just be consistent with like expenses. Make sure that the federal funds column matches the current award amount allocated. Additional columns have been added to the workbook to record a revised budget after award (if needed when approval is need for line item changes) and capture final program expenses and match. The final columns may be used to keep track of expenses incurred and match and must be completed and submitted with the final report. |
| 7-Subawards $1,000 or More | Completion of this template is not needed at time of application submission. It may be used to report cash sub-awards of $1,000 or more, when applicable, after a grant is awarded. Reporting of sub-awards are required under the Terms and Conditions of the grant agreement. Please note that a reimbursement of expenses incurred by other than your organization that you subsequently pay is a sub-award. |
&"Arial,Bold"&14CONTENTS OF WORKBOOK
1-Return Prep Performance
| Applicant Name | 0 | |||
| Program Plan Narrative: Return Preparation Performance (Item I.A.3.) | ||||
| Calendar Year | Total Federal Retuns Prepared | % E-filed | Number of Volunteers |
Note: This template can be copied and pasted into your narrative or submitted as a separate attachment.
| Instructions: | |
| Calendar Year | Record the calendar year of the filing seaosn your data represents with the most recent shown first to furthest in the last row. For example, record 2016 for returns prepared January 1, 2016 through April 15, 2016. This number should include all tax year returns prepared. |
| Total Federal Returns Prepared | This is the actual number of federal returns filed either electronically or through the mail. If your program is open after April, you may include all returns filed at time of application submission. You may also include any returns filed the previous year between July and December; however, you must provide a comment that "XXX returns filed between July and December, are included in this number reported." Returns reported under this filing season should not be included in the previous period. |
| % E-file | Provide the percent of returns filed electronically as identified in the previous column (electronic returns/total returns). |
| Number of Volunteers | Provide the number of volunteers that served in your program. |
| Note: If the information populated in the table shows a reduction in service from one year to the subsequent year, please explain in your narrative the reason for the reduction. |
2-VITA Target Audience Instr.
Instructions for Completing VITA TARGET AUDIENCE Template
| Program Plan Narrative: VITA TARGET AUDIENCE (Narrative Items I.C. 1-4 and 6) | |
| C. VITA Target Audience: 1. Focus | In Column E, Proposed, using the drop-down (it will appear when you are in the correct cell), select your primary focus for providing free return preparation service. Follow the same instructions for choosing the secondary focus. Choose only one focus for each category. In Column F, Returns Proposed by Focus, indicate the returns you propose to prepare for this focus. |
| C. VITA Target Audience: 2. Sites Proposed | In Columns E or F, Proposed, provide the number of existing sites (in operation in the current year) and the number of new sites you are proposing to support with this grant. Entries are split to represent the two service delivery models for VITA -- traditional and facilitated self-assistance. Please report numbers separately if you will be using both models at your sites. Site numbers should not include those supported through the Tax Counseling for the Elderly program. The total will automatically calculate unless the formula is erroneously removed. ONLY INCLUDE THOSE SITES THAT WILL BE COVERED BY THE VITA GRANT. In the comment field, answer the question, "If any of these sites share an EFIN, how many?" for existing and new. The total will automatically calculate unless the formula is erroneously removed. |
| C. VITA Target Audience: 3. Returns Prepared | In Column E, Proposed, provide the number of returns you project your program will electronically or file via paper submission. One of the goals of this grant is to increase electronic filing. It is an expectation that all returns that can be filed electronically will be filed electronically; however, we recognize that some returns will be filed via paper submission. |
ONLY INCLUDE PRODUCTION FROM SITES THAT WILL BE COVERED BY THE VITA GRANT.
C. VITA Target Audience: 4. Volunteers In Column E, Total Proposed, provide the number of volunteers you project will work in your program. ONLY INCLUDE VOLUNTEERS FROM SITES THAT WILL BE COVERED BY THE VITA GRANT.
| Program Plan Narrative: Geographic Coverage (Item C.2 Detailed Site Information and C.6 Service Delivery Methods) | |
| Existing or New | Select from the drop-down (it will appear when you are in the correct cell) either new or existing. An existing site is one that was operational during the current calendar year. |
| Name of Site | Self-explanatory |
| Site Address | Include the city, state, and county for existing sites. Include as much information as you have available on new sites. |
| Hours of Operation | Indicate hours/days the sites will operate; if unknown, estimate total hours per week. |
| EFIN | For existing sites, provide the EFIN (Electronic Filing Identification Number) for the site. If a new site, you may want to go ahead and secure an EFIN by filing Form 8633, Application to Participate in IRS e-file Program. Work with the local SPEC territory office to request new EFINs, if you determine that a separate software license is required. |
| SIDN | For existing sites, provide the SIDN (Site Identification Number) for the site. Site ID numbers begin with "S" followed by eight numbers. For new sites, you may leave this blank. The local SPEC territory office will provide you with the SIDN to include on every return filed at the site. All sites are required to have and use a unique SIDN. Work with the local SPEC territory office to request new SIDNs. |
| Special focus or needs | Provide information specific to the site's service and why you are targeting the location. Examples might include sign language interpreters or filing with ITINs. This may be left blank if there are no special characteristics beyond those chosen as your primary and secondary focus. |
| Adding or Deleting Lines | Add or delete lines to fit your specific needs. If adding lines, insert lines before the last line to maintain pre-set print attributes. |
3-VITA Target Audience
| Applicant Name | 0 | ||||
| Program Plan Narrative: VITA Target Audience (Narrative Items I.C. 1-4, and 6) | |||||
| Reference to Program Plan Narrative Section | |||||
| C. VITA Target Audience: 1. Focus | Options: | Category | Proposed Target (select only one for | ||
| each focus) | Returns Proposed by Target | Comments | |||
| Low income | Primary Focus | ||||
| Elderly | |||||
| Rural | |||||
| Persons with disabilities | Secondary Focus | ||||
| Limited English proficient | |||||
| Native American |
| C. VITA Target Audience: 2. Sites Proposed | Method | Traditional VITA Sites Proposed | Facilitated Self Assistance Sites Proposed | How many of these sites will share an EFIN? |
| Existing | ||||
| New | ||||
| Total | 0 | 0 | 0 | |
| Will all facilitated self assistance site activity be through MyFreeTaxes.com? |
| C. VITA Target Audience: 3. Returns Prepared | Method | Traditional VITA Returns Proposed | Facilitated Self Assistance Returns Proposed |
| Total |
| C. VITA Target Audience: 4. Volunteers | Total Volunteers Proposed | |
| Program Volunteers | ||
| Note: You may use your own template for providing this information as long as it includes all the fields requested. |
Program Plan Narrative: VITA Target Audience (Item C.2 Detailed Site Information)
Existing or New Name of Site Site Address (City, State, and County) EFIN SIDN Hours of Operations C.6. Special focus or needs (e.g., rural, deaf, disabled, facilitated self assistance, etc.)
&P
4-Budget
| Applicant Name: | 0 | |||||||||
| Budget Information: Budget Detail Explanation | ||||||||||
| A. Personnel (Salary) | ||||||||||
| List the person’s name for which salary is requested or that will be used as matching funds. If the position is not filled, record “To Hire.” If more than one position exists, record the number of positions as well. Provide information in the fields requested to demonstrate how costs are determined. Remember, only time spent on the VITA program is allowable. Examples are shown below. | Revised | Final | ||||||||
| Name and Title or Position | Number of positions | |||||||||
| (when applicable) | Weeks (when applicable) | Salary or Wage | Percent or Hours | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Example, Jane Doe, Program Coordinator annually | $60,000 | 0.1 | $3,000 | $3,000 | ||||||
| Example, To hire, site coordinators each year | 2 | 15 | $18 | 25 | $13,500 | |||||
| Example, Return preparers or quality reviewers annually | 5 | 15 | $15 | 10 | $11,250 | |||||
| Simplified method only | 1st year Returns | 2nd year Returns | 1st year value | 2nd year value | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Example, Screeners, preparers, and reviewers | 3,000 | 3,030 | $15 | $15 | $45,450 | |||||
| Other Description | Other Computation not Fitting Above Categories | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Personnel (Salary) Total | $0 | $0 | $0 | $0 | $0 | $0 | |||
| Additional Explanation Personnel: | |||||||||
| B. Fringe Benefits | |||||||||
| Only include fringe benefits for individuals paid. These should not be included in the salary calculations covered under category A. Under Item, list the person’s name for which fringe benefits are requested or that will be used as matching funds. If the position is not filled, record “To Hire.” If more than one position exists, record the number of positions as well. Provide information in the fields requested to demonstrate how costs are determined. | Revised | Final | |||||||
| Name and Title or Position | Other Explanation (if needed) | Base as Shown in Section A | Fringe Benefit Rate (%) | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Example, Jane Doe, Program Coordinator annually | Total base for two years | $12,000 | 15.5% | $930 | |||||
| Fringe Benefits Total | $0 | $0 | $0 | $0 | $0 | $0 | |||
| Additional Explanation Fringe Benefits: | |||||||||
| C. Travel | |||||||||
| Indicate the type of travel requested or that will be used as matching funds in the appropriate section. Include the number of individuals if known. Provide information in the fields requested to demonstrate how costs are determined. | Revised | Final | |||||||
| Proposed Mileage Reimbursement | # Miles | Cost per Mile | Federal Funds | Matching Funds | Proposed Mileage Reimbursement | Proposed Mileage Reimbursement | |||
| Name and Title or Position | Purpose | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Example, Volunteers | Travel to a mobile sites each year | 1,000 | $0.50 | $500 | ||||||
| Proposed Travel Involving Lodging and Per Diem | # People | # Days | Cost per Person per Day | Federal Funds | Matching Funds | Proposed Travel Involving Lodging and Per Diem | Proposed Travel Involving Lodging and Per Diem | |||
| Name and Title or Position | Purpose | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Example, Instructors | Conduct 3 day training each year with one day for setup | 2 | 4 | $150.00 | $1,200 | |||||
| Other Travel Costs | Other Computation not fitting above categories | Federal Funds | Matching Funds | Other Travel Costs | Other Travel Costs | |||||
| Other Description | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Travel Total | $0 | $0 | $0 | 0 | $0 | 0 | ||
| Additional Explanation Travel: | ||||||||
| D. Equipment | ||||||||
| Under item description indicate the type of equipment to be purchased or that will be used as matching funds. Include the quantity or number of items. Provide information in the fields requested to demonstrate how costs are determined. Computers are limited to a per unit cost of $1,000. | Revised | Final | ||||||
| Item Description | Quantity | Cost Per Unit | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Example, laptop purchase to replace obsolete and broken laptops used at sites | 10 | $540 | $5,400 | |||||
| Equipment Total | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Additional Explanation Equipment: | ||||||||
| E. Supplies | ||||||||
| Under item description indicate the supplies to be purchased or that will be used as matching funds. Include the quantity or number of items. Show under computation how determined. | Revised | Final | ||||||
| General Site Supplies | # Sites | Cost Per Site | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Item Description |
| Example, General site supplies based on historical average each year | 10 | $300 | $1,500 | $1,500 | ||||
| Other Supplies | Quantity | Cost per Unit | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Item Description |
| Example, Donated paper each year from Office Depot | 10 | $35 | $350 | |||||
| Supplies Total | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Additional Explanation Supplies: | ||||||||
| F. Contractual | ||||||||
| Under contractor name and purpose indicate the contracts planned or that will be used as matching funds. Include the quantity or number of items when applicable. | Revised | Final | ||||||
| Contractor Name and Purpose | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Example, ABC Mall, rental of site space for 5 months at $500 per month each year | $2,500 | ||||||
| Contractual Total | $0 | $0 | $0 | $0 | $0 | $0 | |
| Additional Explanation Contractual: | |||||||
| H. Other | |||||||
| Under item description indicate the expenses not covered in the categories above or resources that will be used as matching funds. Show under computation how determined. | Revised | Final | |||||
| Item Decription | Computation | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Example, Publicity services | Radio, TV and cable ads - $50 per spot x 25 spots, each year plus 6,000 flyers at cost of $5,000 each year | $5,000 | $1,250 | ||||||
| Other Total | $0 | $0 | $0 | $0 | $0 | $0 | |||
| Additional Explanation Other: | |||||||||
| I. Direct Charges | Federal Funds | Matching Funds | |||||||
| Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed | ||||||
| Total Direct Charges | $0 | $0 | $0 | $0 | $0 | $0 |
| J. Indirect Charges - If your organization has a negotiated indirect cost rate (ICR) agreement with a federal agency, please use that rate and submit a copy of the ICR with your application. If your organization does not have an ICR, an indirect cost rate of 10% of the base modified total direct costs (MTDC) is allowable. MTDC is all salaries and wages, fringe benefits, materials and supplies, services, travel, and subgrants and subcontracts up to the first $25,000 of each. Use the explanation section below to explain how you calcualted your indirect costs. | Item | |||
| Federal Funds | Matching Funds | |||
| Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed | |
| Show base amount for this grant | ||||
| ICR or MTDC rate proposed |
for this grant
| Total Indirect Charges | ||||||
| Additional Explanation Indirect Charges: | ||||||
| K. Total Charges | Federal Funds | Matching Funds | Federal Funds | Matching Funds | Actual Federal Funds Spent | Actual Matching Funds Contributed |
| Total Charges | $0 | $0 | $0 | $0 | $0 | $0 |
&P
5-Matching Funds Summary Chart
| Applicant Name: | 0 | ||||||
| Budget Information: Matching Funds Summary Chart | |||||||
| Matching Funds Summary Chart | |||||||
| # | Source Name | Type | Amount In-Hand or Committed* | Amount to be Raised | Date | Comments |
| Total | $0 | $0 |
| Instructions: |
| # | Number consecutively to assist in identifying the different sources. Record number on any attachments provided with the application. |
| Source Name | Name of organization or individual contributing the matching funds. Remember to include matching funds provided by you as the applicant. |
| Type | Description of the matching funds. Examples include cash, grant, donation or in-kind, etc. |
| *Amount In-Hand or Committed | This would include amounts set aside already to be used as matching funds or your anticipated volunteers. Other examples include a grant already received or cash from the applicant's operating budget to support the program. You must include matching funds supporting documentation for any items listed with amounts shown in the "Amount In-Hand or Committed" column when submitting your application. For volunteers, provide information on the number, hours, and value of volunteers. Also, make sure the documentation contains the necessary components (description of the contribution; dollar value and an explanation as to how the valuation was determined; current date; signature of authorized individual that can make the commitment; and an organization name on letterhead with contact information) to avoid delays in receiving funds if awarded. |
| Amount to be Raised | This would include amounts you need to secure for matching funds. Examples might be a grant you've applied for but not received confirmation as to whether it will be awarded; or you're in discussion with other organizations about supporting your program but haven't received a firm commitment. Although a grant can be awarded pending confirmation of matching funds, no funds are released until documentation is provided to the Grant Program Office confirming the commitment. It can also be used to record the amount to be raised for the second year of funding. Your organization is not expected to have all funds available at time of application for the two year program. |
| Date | A current date for matching funds already in-hand or committed; or for amounts to be raised, the date you anticipate having committed funds. |
| Comments | Include a brief description of the matching funds. |
&P
6-Corporate Felony Convictions
| Applicant Name: | 0 |
| This tab is for corporations.If you are not a corporation, indicate "Not Applicable" in question 1. No other entries are required. | |
| Corporations should continue. |
In connection with the Corporate Felony Convictions certification within the Assurances and Certifications section located on page 43 of Publication 4671, VITA Grant Program Overview and Application Instructions, answer questions 1-4 if you or your officer or agent acting on your behalf was convicted of a felony criminal violation under any Federal law within the preceding 24 months. Create additional tabs to report multiple convictions.
If you and your officers and agents acting on your behalf were not convicted under any Federal law within the preceding 24 months, enter "None" as the answer to question 1. No other entries are required.
1. Who or what was convicted?
2. Identify the date of conviction, the federal district court, and the case number (if known).
3. Describe the facts and criminal statutes for the conviction.
4. Who is the contact if additional information is needed?
&"Arial,Bold"&14Corporate Felony Convictions
7-Subawards $1,000 or More
| Grant Recipient Name: | 0 | ||
| Federal Award Identifier: | |||
| Indicate NA (not applicable) if your organization will not sub-award funds. Please recognize that reimbursement of expenses incurred by other than your organization is considered a sub-award. | |||
| Organization receiving Sub-Award | Address | DUNS Number | Sub-Award Amount |
&"Arial,Bold"&14Organizations Provided Cash Sub-Awards of $1,000 or More
8-Related Party Transactions
| Grant Recipient Name: | 0 | |
| Federal Award Identifier: | ||
| Indicate NA (not applicable) if you anticipate that you will not enter into any related party transactions. | ||
| Purpose: | Your grant agreement "Terms and Conditions" require your organization to notify the Grant Program Office of any related party transactions (as defined in the agreemen)using grant funds within 30 days of the transaction. | |
| 1. | What transaction is involved? Please describe. |
2. Does the transaction propose to use VITA grant federal funds or designated match? If the answer to this question is no, then this transaction is not reportable under the VITA Grant terms and conditions.
3. Who is involved? Provide organization and/or individual names.
4. What is the relationship? Provide information on how the organizations and/or individuals are related.
5. Where are the parties located?
6. When did the transaction occur or is planned to occur?
7. Who is the contact if additional information is needed?
&"Arial,Bold"&14Related Party Transactions
File details come from the government source that posted it.