Intake/Interview & Quality Review Sheet

Forms and Documents

Document Name	Status
Form 13614-C (SP) Intake/Interview and Quality Review Sheet Form	Modified
Justification_Emergency.doc Supplementary Document	2009-05-11
F13614-C_Sup Stmnt1.doc Supporting Statement A	2009-05-12

IC Document Collections

IC ID	Document Title	Status
19697	Intake/Interview and Quality Review Sheet Form	Modified

ICR Details

OMB Control No: 1545-1964	ICR Reference No: 200905-1545-005
Status: Historical Active	Previous ICR Reference No: 200604-1545-029
Agency/Subagency: TREAS/IRS	Agency Tracking No: CB-1964-005
Title: Intake/Interview & Quality Review Sheet
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 05/18/2009
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/21/2009
	Date Received in OIRA: 05/15/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2009	6 Months From Approved
Responses	2,700,000	0	0
Time Burden (Hours)	540,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The SPEC function developed the Form 13614-C, Intake/Interview & Quality Review Sheet that contains a standardized list of required intake and quality review questions to guide volunteers in asking taxpayers basic questions about themselves and conducting a quality review of the completed return. The intake/interview and quality review sheet is an effective tool for ensuring critical taxpayer information is obtained and applied during the interview and completion of the tax return process.

Emergency Justfication: Due to miscommunication, originator requested original Form 13614 to be obsolete and wanted to replace with Form 13614-C. The latter portion was not formally conveyed and OMB# was deleted. This new Form 13614-C (Intake/Interview and Quality Review Sheet)is an effective tool for ensuring critical taxpayer information is obtained and applied during the interview and completion of the tax return process.

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Authorizing Statute(s): US Code: 26 USC 6103 Name of Law: Confidentiality and disclosure of returns and return information
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Intake/Interview and Quality Review Sheet	13614-C, 13614-C (SP)	Entrevista y Hoja de Informaci�n ,   Intake/Interview and Quality Review Sheet

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,700,000	0	0	2,700,000	0	0
Annual Time Burden (Hours)	540,000	0	0	540,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Previous Form 13614 was replaced by Form 13614-C, resulting in an increase of burden hours to 540,000. Also the number of responses increased by 1,643,951 making the total responses 2,700,000. All of these changes were based on the updates of IRM 22.30.1.

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Annual Cost to Federal Government: $42,253

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/15/2009

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