Catalog Number 66299X
13533-A (2-2014)
Form 13533-A
(February 2014)
Department of the Treasury - Internal Revenue Service
FSA Remote Sponsor Agreement
We appreciate your willingness and commitment to serve as a sponsor of a Facilitated Self Assistance (FSA) Remote site,
by promoting web link(s) to a third-party provider offering free online tax preparation services to taxpayers.
To maintain program integrity and provide for reasonable protection of information provided by the taxpayers serviced
through the FSA Program, it is essential that partners adhere to the following key principles:
• Partner agrees not to connect the promotion of the above referenced web link(s) with any request for compensation or
donation from the user.
• Partner agrees to refer any taxpayer questions about the FSA Program back to the third-party provider website for
• Partner agrees not to engage in criminal, infamous, dishonest, notoriously disgraceful conduct, or other conduct
deemed to have a negative effect on the FSA Program.
1. Sponsor name
2. Street address 3. City 4. State 5. ZIP code
6. Telephone number 7. Email address
By signing and dating this form, you are agreeing to the key principles outlined above.
Website where FSA link will be located
The IRS may terminate this agreement and add you to a volunteer registry, effective immediately for disreputable conduct
that could impact taxpayers’ confidence in the FSA Program operated by you or your coalition members
Sponsor signature Date
Name (print) Title
Privacy Act Notice
The Privacy Act of 1974 requires that when we ask for information we tell you our legal right to ask for the information, why we are asking for it, and how
it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or
mandatory. Our legal right to ask for information is 5 U.S.C. 301. We are asking for this information to assist us in contacting you relative to your interest
and/or participation in the IRS volunteer income tax preparation and outreach programs. The information you provide may be furnished to others who
coordinate activities and staffing at volunteer return preparation sites or outreach activities. The information may also be used to establish effective
controls, send correspondence and recognize volunteers. Your response is voluntary. However, if you do not provide the requested information, the IRS
may not be able to use your assistance in these programs.
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