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Catalog Number 36126D www.irs.gov
Form
13424 (Rev. 4-2018)
Qualified Tax Expert (QTE)
Prefix Last name First name
Middle initial Suffix
Telephone number Email address
Licenses/Certifications (Check all that apply)
Attorney CPA Enrolled Agent Other
Qualified Business Administrator (QBA)
Prefix Last name First name
Middle initial Suffix
Telephone number Email address
Tax Compliance Officer
Prefix Last name First name
Middle initial Suffix
Title
Telephone number Email address
Instructions for Form 13424, Low Income Taxpayer Clinic (LITC) Application Information
Purpose
This form is used to report basic information about the applicant, including the amount and period of the grant requested, contact
information for the applicant’s sponsoring organization, the name and location of the clinic where services are provided, and key clinic
staff members. The Program Office uses the information reported on this form to correspond with clinics and to publicize the location of
service providers to taxpayers in IRS publications and online. Please follow the instructions carefully and report all information
completely and accurately. A complete response means an entry must be provided for each field.
Who Must Complete This Form
All organizations submitting a Full Grant Application or a Non-Competitive Continuation (NCC) Request must complete this form. See
Publication 3319, Section IV, Application and Submission Process.
Any forms submitted with a Full Grant Application or NCC Request may be released under the Freedom of Information Act (FOIA). In
response to a FOIA request, the LITC Program Office will release these forms after appropriate redactions to ensure confidentiality of
taxpayer information.
Specific Instructions
Grant Period Request
Check the appropriate box to indicate whether a single or multi-year grant is requested. Under IRC § 7526, the LITC Program Office is
authorized to issue grants for a period of up to three years. Applicants that have never been awarded an LITC grant are not eligible for
a multi-year grant and may only request a single year grant.
Current grantees requesting a NCC Request must check the box indicating whether the request is for the second or third year of a
multi-year grant.
Enter the total amount, rounded to whole dollars, of funding requested for the grant year. The maximum funding that may be awarded
for any grant year is $100,000.
Applicant Information
Enter the contact information for the organization applying for the grant. The name of the applicant must match exactly the name used
to register with the System for Award Management (SAM). If a grant is awarded, the award will be payable to the organization listed in
this section.
For Applicant’s Mailing Address, please provide a complete response, including zip plus-four code. Phone numbers should be
formatted as 123-456-7890 x.111.
Clinic Information
This section is used to report information about the clinic where services are provided to taxpayers. If a grant is awarded, the
information entered in this section will be used exactly as entered to prepare IRS Publication 4134, Low Income Taxpayer Clinic List.
Publication 4134 is the primary tool for many low income and ESL taxpayers to locate LITC services. Thus, the clinic name entered
should be the name used in materials publicizing the LITC’s services to taxpayers and the public.