Request for Proposals for Grants to Provide
Volunteer Taxpayer Assistance Services to
Low-Income and Disadvantaged Minnesota
Residents
Due Date for Proposals: August 26, 2015, 2:00 p.m., CDT
Contact Information
Location: Minnesota Department of Revenue
Contracts Unit
Mail Station 4220
St. Paul, MN 55146-4220
Email:
dor.rfp@state.mn.us
Phone:
651-556-4041
Website: www.revenue.state.mn.us
Search keyword “Grant”
Grant (Rev. 07/15)
Table of Contents
page
Important Information ....................................................................................................................................... 3
Part Two. Description of Project ..................................................................................................................... 3
Part Three. Proposal Content and Format .................................................................................................. 5
Part Four. Questions ............................................................................................................................................ 8
Part Five. Submitting Proposals ...................................................................................................................... 9
Part Six. Evaluation of Proposals .................................................................................................................... 9
Part Seven. Other Requirements and Information ............................................................................... 11
Grant Contract ..................................................................................................................................................... 13
Cover Sheet........................................................................................................................................................... 19
Progress Report .................................................................................................................................................. 22
Final Report.......................................................................................................................................................... 24
IRS Determination Letter ................................................................................................................................ 27
State of Minnesota Registration Certificate ............................................................................................. 30
IRS Form 990 (Page 1)..................................................................................................................................... 31
Grant (Rev. 07/15)
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Important Information
New for 2016 Grant Period
Please take note of important changes in the following areas of this Request for Proposals
(RFP):
Funding Distribution…………………………….....page 4
Reporting………………………………………........page 4
Content, item 6………………………………...........page 6
Advertising……………………………………..........page 8
Evaluation of Proposals…………………………….page 10
Other Requirements and Information……………..page 12
By submitting a proposal in response to this Request for Proposals (RFP), the applicant declares
that the organization is free of debt that could cause recapture or offset of grant funds. The
applicant is also agreeing to allow the department to verify this information prior to awarding
funds.
Part One. Purpose of this Request for Proposals
The Minnesota Department of Revenue (department) requests proposals from non-profit
organizations that qualify under §501(c)(3) of the Internal Revenue Code of 1986, to receive
grants to coordinate, facilitate, encourage, and provide volunteer taxpayer assistance services.
“Taxpayer assistance services” are accounting and tax-preparation services provided by
volunteers to low-income and disadvantaged Minnesota residents. This includes filing
federal, state income and property tax refund returns, and representing qualifying residents
before the Minnesota Department of Revenue and the Internal Revenue Service (IRS). For
purposes of this grant, organizations providing services must be part of the Volunteer Income
Tax Assistance (VITA) or Tax Counseling for the Elderly (TCE) program through the IRS.
For purposes of this grant application, “low-income” is less than $53,000. “Disadvantaged” is
defined as people with limited English-speaking ability, seniors 60 years and older, or
disabled people, as defined in Minnesota Statutes, §290A.03, subdivision 9.
The Commissioner of Revenue has authority to issue grants totaling $800,000 for the 2016-2017
biennium. This RFP is for $400,000 in grant funds available in the fiscal year ending June 30, 2016.
Any portion that is not awarded or returned will no longer be available.
Part Two. Description of Project
1. Funded Activities
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A. Recruiting volunteers to provide volunteer taxpayer assistance services.
B. Creating materials for and train volunteers to provide volunteer taxpayer assistance
services.
C. Creating materials to promote volunteer taxpayer assistance services, including
expenses to translate materials in languages other than English.
D. Materials and equipment that directly aid in volunteer taxpayer assistance services.
2. Funding Distribution
The department will distribute grant awards in the following ways:
A. Grant awards of $5,000 or less will be awarded in full after the grant contract is
executed.
B. Grant awards between $5,000 and $10,000 will be issued in two increments. After the
grant contract is executed, $5,000 will be issued. The remainder will be paid upon
approval of a satisfactory progress report.
C. Grant awards over $10,000 will have half of the funding issued upon execution of the
grant contract. The remainder will be paid upon approval of a satisfactory progress
report.
Note. The department generally disburses grant funds in advance. However,
organizations that are new to the grant program or have demonstrated noncompliance with grant policies in previous years will be reimbursed for
expenses after compliance with grant policies has been confirmed.
3. Reporting
The department requires reporting in the following ways:
A. Organizations awarded grants of $5,000 or less are not required to submit a progress
report but must submit a final report by September 1, 2016.
B. Organizations awarded more than $5,000 in total grant funds must submit a
satisfactory progress report by May 15, 2016. The progress report should be submitted
after the initial award payment has been expended. If the initial payment has not been
expended and the progress report becomes due, a satisfactory progress report must be
submitted by the due date. A final report must also be submitted by September 1, 2016.
Progress and final reports should be completed using the appropriate forms on pages
23-28. For electronic progress and final reports, go to our website
www.revenue.state.mn.us and type keyword Grant in the Search box.
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C. Organizations required to receive grant funds via reimbursement must submit a
satisfactory progress report by May 15, 2016. Included with the progress report must
be documentation showing how grant funds were spent. Grant funds will not be
disbursed until progress report and documentation have been received and accepted.
If any reports do not meet reporting standards, the organization will need to submit a
revised progress or final report. The department will provide a deadline for re-submitting
the report. Failure to meet the department’s deadline will be noted on the organization’s
record for future grant periods, and may result in the organization being denied grant
funds for future grant periods.
Reports may be submitted:
Electronically: kerrin.lee@state.mn.us
By fax: 651-297-7430, Attention: Kerrin Lee
By paper: Minnesota Department of Revenue, Attention: Kerrin Lee, Mail Station
7701, St. Paul, MN 55146-7701
Progress Reports
A grant recipient may submit a progress report at any time after it has spent the full
amount of the initial award payment; however, a progress report must be submitted no
later than May 15, 2016.
The progress report of an organization that has not yet spent the awarded funds must
demonstrate how the funds will be spent in a manner consistent with the grant
contract.
Important. Your organization will not receive the remainder of grant funds due if you
fail to submit a progress report by the due date.
Final Reports
All grant recipients must submit a final report to the department no later than
September 1, 2016. This report must show how the funds were used to carry out
activities for which the grant was awarded.
If grant funds remain after volunteer taxpayer assistance services end for the grant
period, the funds must be returned to the department. The check must be included
with the final report. If the grant funds are not returned to the department, your
organization will not be allowed to receive grant funding for the next grant period.
Important. Your organization will not be allowed to receive grant funding for the next
grant period if you fail to submit a final report by the due date.
Part Three. Proposal Content and Format
Proposals must include the following in the order listed below:
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1. The Grant Application Cover Sheet (page 21).
2. A copy of the determination letter issued by the Internal Revenue Service recognizing
the organization as qualifying under § 501(c)(3) of the Internal Revenue Code of 1986.
(See example on pages 29-30.) The organization or applicant name must be the same
on the Grant Application Cover Sheet and the IRS § 501(c)(3) determination letter.
3. A copy of your current Attorney General’s Registration Certification. (See example on
page 31)
4. The goals of the organization, including a mission statement.
5. If requesting over $25,000 in grant funds, you must include financial information
depending on your organization’s annual income:
If the annual income of the organization is:
 Under $50,000: Submit either your most recent board-reviewed financial
statement, or IRS Form 990. (See example on page 32.)
 $50,000 - $750,000: Submit your most recent IRS Form 990.
 Over $750,000: Submit your most recent certified financial audit.
6. For each site you provided volunteer taxpayer assistance services for the past three tax
filing seasons indicate the:



Volunteer taxpayer assistance services your organization provided, including
hours and days of operation. Provide detailed descriptions.
Types and numbers of low-income or disadvantaged people your organization
assisted.
Total number of federal and Minnesota income and property tax refund returns
prepared.
7. For each site you anticipate providing volunteer taxpayer assistance services indicate the:



Site Identification Number (SIDN). All volunteer taxpayer assistance sites must be
registered with the IRS.
Electronic Filing Identification Number (EFIN)
Days, hours, and locations of operation, including the opening and closing date.
Clearly indicate if the sites will be open during the summer.
8. Describe how funding will improve volunteer taxpayer assistance services to lowincome and disadvantaged Minnesota residents from prior years. Please include
specific goals that your organization has for improving volunteer taxpayer assistance
services.
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9. Describe how funding will improve recruiting and training volunteers to provide
volunteer taxpayer assistance services. Include the number of volunteers recruited and
number of hours spent training volunteers in each of the three most recent tax filing
seasons.
10. An indication of which of the following groups you intend to provide services to:
 Individuals living in greater Minnesota
 Individuals with limited English-speaking abilities
 Individuals with disabilities
 Seniors
 Individuals who are not required to file but benefit from filing a tax return
 Other low-income and disadvantaged individuals
If you intend to expand services to any group listed above, describe your plan and how
the grant will help you achieve it.
11. An itemized budget, by priority of funding, for your grant request (see page 22).
Provide details on how the grant funds, if awarded, will be spent.
All expenses must be reasonable and necessary for the activities listed below.
Expense requests must be separated into four categories in the proposed budget of
grant funds. Grant funds will be approved for total amounts within a particular
category rather than individual expenses. You may only spend the amount awarded in
each category. You cannot use funds granted for one category in another.
Example: If you were granted funding for 3 laptops, and after you
purchased them had grant funds remaining, you could spend that on
another laptop or other items that fall under the Equipment and
Accessories category. However, you cannot use the remaining dollars to
purchase items from a different category such as Salaries.
1. Equipment and Accessories includes the following: laptops, desktop computers,
printers, copiers, scanners, shredders, toner, ink cartridges, mice, flash drives,
calculators, 10-key pads, laptop cases, cables, software, routers, servers, hotspots, etc.
If your organization is awarded grant funds to purchase equipment and accessories,
the equipment and accessories must be used solely for volunteer taxpayer assistance
services. Any equipment no longer in approved use that is less than three years old
must be returned to the department. This requirement does not apply to equipment
being stored for the next tax filing season. Equipment may only be used after the tax
season ends if volunteer taxpayer assistance services are continued beyond that date.
2. Advertising Taxpayer Services includes the following: print advertisements, radio
advertisements, publicity, marketing, design, and printing, etc. The advertisements
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must nform the public about the volunteer taxpayer assistance services that are
provided by your organization.
This funding cannot be used to create advertisements to recruit volunteers. Volunteer
recruitment falls under the Other Expenses category.
Note. If your organization is requesting funds for advertising and is planning to
use print advertisements, a copy of the advertisement must be submitted, along
with the proposal, to the Department forreview. Advertisements must be
approved before funds are disbursed. The advertisements must be reviewed
and approved each grant period.
If your organization is requesting advertising funds but does not plan to use
print advertisements, please provide a detailed description of your marketing
plan in your proposal.
All approved advertisements must state, “Service made available through a grant
provided by the State of Minnesota.”
Advertisements may be submitted:
Electronically: kerrin.lee@state.mn.us
By paper: Minnesota Department of Revenue, Attention: Kerrin Lee, Mail Station
7701, St. Paul, MN 55146-7701
3. Salaries include monies paid to individuals specifically for services performed for the
volunteer taxpayer assistance program. This includes salaries for volunteer
coordinators, electronic filing coordinators, tax site coordinators, directors,
receptionists, office assistants, translators, trainers, etc. You must specify job duties
and percentage of time devoted to the volunteer taxpayer assistance program.
This funding cannot be used for volunteers preparing tax returns.
4. Other Expenses includes the following: volunteer training, paying for outside
trainers, volunteer recruitment, supplies, paper, training materials, mileage, parking,
printing, mailing, phone, volunteer recognition events, facilities, internet, contracted
technical support, etc.
Do not include phone, internet, electricity, or rent costs not associated with providing
volunteer taxpayer assistance services.
Part Four. Questions
Any questions about this RFP must be submitted by email, U. S. Mail, or fax.
Email: dor.rfp@state.mn.us
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U.S. Mail: Minnesota Department of Revenue
Contracts Unit
Mail Station 4220
St. Paul, MN 55146-4220
Fax: 651-556-3122
All questions must be received no later than 1:00 p.m., Central DaylightTime on August 19,
2015.
The department reserves the right to refrain from responding to late questions or those not
submitted in an approved manner.
All questions must have the requestor’s name, email address (if available), fax number (if
available), the title of the RFP, and “Grants – RFP Questions” written on the request.
The department will respond to questions regarding the RFP or grants by email or fax by
August 24, 2015.
Part Five. Submitting Proposals
Proposals must be delivered to:
Minnesota Department of Revenue
Contracts Unit
Mail Station 4220
600 North Robert Street
St. Paul, MN 55101
Proposals are due in the Contracts Unit by 2:00 p.m., Central Daylight Time in St. Paul,
Minnesota, August 26, 2015, as indicated by a time stamp at the location above.
Late proposals will not be considered. We suggest submitting proposals through a method
sure to arrive on time, for example, overnight delivery, local courier, or in person.
Fax, email, and standard delivery U. S. Mail proposals will not be considered.
Submit one original and five copies of the proposal. Proposals must be sealed in an envelope or
package with the proposer's name, address, and “Grant Proposal” written on the outside. The
original copy of the proposal should be marked and must be signed, in ink, by a person(s)
authorized to bind the organization to a grant contract.
Part Six. Evaluation of Proposals
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Proposals will be evaluated and grants awarded to maximize volunteer taxpayer assistance
services to low-income and disadvantaged Minnesota residents. In making this determination,
the following criteria will be used:
A. Number of individuals your organization expects to serve through volunteer taxpayer
assistance services. Specifically the number of individuals in the following groups your
organization expects to serve:
 Individuals living in greater Minnesota
 Individuals with limited English-speaking abilities
 Individuals with disabilities
 Seniors
 People who are not required to file but benefit from filing a tax return
 Other low-income and disadvantaged individuals
B. Number of hours that the organization expects to provide volunteer taxpayer
assistance services. (Additional consideration will be given to applications that expand
volunteer taxpayer assistance service hours.)
C. Span of time that volunteer taxpayer assistance services will be available. (Additional
consideration will be given to applications that indicate availability after April 15,
2016).
D. Amount of time your organization spends training volunteers to provide volunteer
taxpayer assistance services.
E. Organization’s efforts and experience training and recruiting volunteers and any
training plans for the upcoming tax year.
F. Clarity of operational plan to provide volunteer taxpayer assistance services, including
a detailed budget indicating how grant funds will be spent.
G. An organization that received a grant previously will also be evaluated on how well it
performed, met its goals, utilized funding, and met the requirements of the grant
contract.
H. Organization’s ability to meet payment obligations to government agencies thereby
preventing revenue recapture or offset of grant funds.
Successful proposers will be notified on or before September 23, 2015, of the amount of the
grant being awarded. Grant funds will be issued on or about October 1, 2015, providing the
grant contract has been fully executed.
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Part Seven. Other Requirements and Information
1. Any statement in this RFP that contains the word “must” means compliance is
mandatory and failure to satisfy that condition will cause the proposal to be rejected. If
grants have been awarded, failure to satisfy these conditions will be in violation of the
grant contract and funds may need to be returned.
2. Proposers may not restrict the rights of the State or qualify its proposal. If a proposer
does so, the department may not consider the proposal.
3. All proposals submitted in response to this RFP become property of the State. After the
grant awards have been announced, any proposal, in its entirety, may be reviewed by a
member of the public upon request.
4. The proposer will bear all costs incurred in responding to this RFP.
5. Grant requests typically far exceed available dollars. Therefore, your organization may
not receive its full request. This is at the department’s discretion.
6. A copy of the State’s grant contract is attached (pages 14-20). The grant contract
reflects language that is required by statute. If any section represents critical problems
for the proposer, the proposer must indicate those issues in their proposal.
7. Any resulting grant contract will begin on the date stated in the grant contract or upon
full execution of the grant contract, whichever is later.
8. The department will conduct at least one monitoring visit on any grant over $50,000
and may conduct monitoring visits on grants under $50,000. The monitoring visit may
be conducted in person or by telephone. The monitoring visit will occur near the
progress report deadline, and the progress report will not be approved until the
monitoring visit is completed.
9. The department must conduct a financial reconciliation at least once during the grant
period on grants of over $50,000. A financial reconciliation involves reconciling
expenses for a given period with supporting documentation, such as purchase orders,
invoices, itemized receipts, mileage logs, and payroll records. Expenses must be
reasonable, necessary, and documented.
10. The department will select several organizations at random for review. If selected, a
letter will be sent to notify your organization and request documentation to show how
grant funds have been spent. The review may also include a monitoring visit once the
requested documentation has been received and reviewed.
Documentation must be kept for all expenses, including itemized receipts, invoices,
mileage logs, payroll records, etc. Expenses must be fully supported. Documentation
Grant (Rev. 07/15)
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must be able to prove that the expenses are allowable within the guidelines of the
grant contract.
11. Any grant recipient may be subject to review by the department. Under Minnesota
Statute §16B.98, Subd.8, the Grantee’s books, records, documents, and accounting
procedures are subject to examination by the State for a minimum of six years from the
end of the grant contract.
12. The department will review organizations’ records to verify they are meeting payment
obligations to government agencies thereby preventing revenue recapture or offset of
grant funds. Department records will be checked at the time proposals are received
and prior to any grant disbursement.
13. If grant funds are returned or unused before June 30, 2016 the department will
reallocate the funds. Funds will be distributed following the re-evaluation of proposals,
progress reports, and site availability. Determinations will be made in an effort to
maximize volunteer taxpayer assistance services to low-income and disadvantaged
Minnesota residents.
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Sample
State of Minnesota
Grant Contract
This grant contract is between the State of Minnesota, acting through its Commissioner of
Revenue ("STATE") and (full name, address) ("GRANTEE").
Recitals
1. Under Minn. Stat. § 270C.03, subdivision 1, the State is authorized to enter into this grant
contract.
2. The State is in need of voluntary taxpayer assistance services to low income and
disadvantaged Minnesota residents.
3. The Grantee represents that it is duly qualified and agrees to perform all services
described in this grant contract to the satisfaction of the State. Pursuant to Minn. Stat.
§16B.98, subdivision 1, the Grantee agrees to minimize administrative costs as a condition
of this grant.
Grant Contract
1 Term of Grant Contract
1.1 Effective date: XXXX, or the date the State obtains all required signatures under Minn.
Stat. §16C.05, subdivision 2, whichever is later.
The Grantee must not begin work under this grant contract until this contract is fully
executed and the Grantee has been notified by the State’s Authorized Representative to
begin the work.
1.2 Expiration date: September 1, 2016 or until all obligations have been satisfactorily
fulfilled, whichever occurs first.
1.3 Survival of Terms. The following clauses survive the expiration or cancellation of this
grant contract: 8. Liability; 9. State Audits; 10. Government Data Practices and
Intellectual Property; 12. Publicity and Endorsement; 13. Governing Law, Jurisdiction,
and Venue; and 15 Data Disclosure.
2 Grantee’s Duties
2.1 The Grantee, who is not a state employee, will:
Coordinate, facilitate, encourage, and aid in the provision of volunteer taxpayer
assistance services to low- income or disadvantaged Minnesota residents. Volunteer
taxpayer assistance services will include filing federal, state income and property tax
refund returns, and to provide personal representation before the Minnesota
Department of Revenue and the Internal Revenue Service.
2.2 The grant may only be used for the purposes as specified above in item 2.1 and
below in item (1).
The Grantee will perform the duties as specified in item (2) and the two documents
listed below, items (3) and (4), which are referenced and incorporated into this
Grant (Rev. 07/15)
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contract and are therefore part of the contract. In the event of any conflict in language
provisions the order of precedent will be determined in the order listed below.
(1) The grant may only be used for the items and dollars amounts listed below;
this grant may not be used for any other purpose:
The grant may only be used as specified below:
Equipment
$
Advertising
$
Salaries
$
Other Expenses $
(2) Grantee reporting requirements as noted below:
(3) Attachment A: The Department of Revenue’s Request for Proposal is
incorporated by reference and therefore a part of this contract.
(4) Attachment B: The Grantee’s proposal as it is applicable to the usage of the
grant as stated above in item (1) of this section is incorporated by reference and
therefore a part of the contract.
2.3 The Grantee must submit a final report no later than September 1, 2016, as required in
the Reporting section of the Department’s Request for Proposals. The final report must
demonstrate how the money was used to carry out activities for which the grant was
awarded.
If the Grantee does not submit a final report by September 1, 2016, the organization will not
be eligible to receive grant monies under the volunteer taxpayer assistance grant program in
the next fiscal year.
3 Time
The Grantee must comply with all the time requirements described in this grant contract.
In the performance of this grant contract, time is of the essence.
4 Consideration and Payment
4.1 Consideration. The State will pay for all services performed by the Grantee under this
grant contract as follows:
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(a) Compensation. The Grantee will be paid a total amount not to exceed
$XXX, after the grant contract is fully executed.
(b) Travel Expenses. Reimbursement for travel and subsistence expenses
actually and necessarily incurred by the Grantee as a result of this grant
contract will not exceed $ 0.00.
(c) Total Obligation. The total obligation of the State for all compensation
and reimbursements to the Grantee under this grant contract will not exceed
$XXX.
4.2 Reports.
1) Organizations awarded grants of $5,000.00 or less are not required to
submit a progress report but must submit a final report by September 1,
2016.
2) Organizations awarded more than $5,000.00 in total grant funds must
submit a satisfactory progress report by May 15, 2016. The progress report
should be submitted after the initial award payment has been expended;
however, if the initial payment has not been expensed and the progress
report becomes due, a satisfactory progress report must be submitted by the
due date. A final report must also be submitted by September 1, 2016.
3) Organizations required to receive grant funds via reimbursement must
submit a satisfactory progress report by May 15, 2016. Included with the
progress report must be documentation showing how grant funds were
spent. Grant funds will not be disbursed until progress report and
documentation have been received and accepted.
The progress and final reports must demonstrate how the grant funds have been
used to carry out activities for which the grant was awarded. A grant recipient may
submit a progress report at any time after it has spent the full amount of the initial
award payment. The progress report for an organization that has not spent
previously awarded funds must demonstrate how the funds will be spent in a
manner consistent with how the grant was originally issued.
Failure to submit a timely progress report will result in your organization being
unable to receive the remainder of grant funds.
Failure to submit a timely final report will result in your organization being unable
to receive grant funding for the following grant period.
5
Conditions of Payment
All services provided by the Grantee under this grant contract must be performed to
the State’s satisfaction, as determined at the sole discretion of the State’s Authorized
Representative and in accordance with all applicable federal, state, and local laws,
ordinances, rules, and regulations. The Grantee will not receive payment for work
found by the State to be unsatisfactory or performed in violation of federal, state, or
local law.
15
6
Authorized Representative
The State's Authorized Representative is Carolyn Murphy, Contracts Manager (or
successor), phone 651-556-4041, Financial Management Division, Minnesota
Department of Revenue. She will be responsible for managing the compliance of this
contract and the authorized representative to consider, accept or reject any contract
modifications and has the authority for approval of acceptance of service and
invoice approval for payment.
Kerrin Lee, phone 651- 556-3052 or 1-800-818-6871, Income Tax & Withholding
Division, Minnesota Department of Revenue, will be the Technical/ Project Manager
for this project. She will be responsible for the technical aspect of the grant contract
and will serve as the liaison with the Grantee for operational issues, monitoring
visits, financial reconciliations, and progress and final reports.
The Grantee’s Authorized Representative is (Name/ Telephone Number). If the
Grantee’s Authorized Representative changes at any time during this grant contract,
the Grantee must immediately notify the State. The Grantee’s Authorized
Representative is the only individual allowed to request changes to this contract.
7
Assignment, Amendments, Waiver, and Grant Contract Complete
7.1 Assignment. The Grantee may neither assign nor transfer any rights or
obligations under this grant contract without the prior written consent of the
State, approved by the same parties who executed and approved this grant
contract, or their successors in office.
7.2 Amendments. Any amendments to this grant contract must be in writing and
will not be effective until it has been executed and approved by the same parties
who executed and approved the original grant contract, or their successors in
office.
7.3 Waiver. If the State fails to enforce any provision of this grant contract, that
failure does not waive the provision or the State’s right to enforce it.
7.4 Grant Contract Complete. This grant contract contains all negotiations and
agreements between the State and the Grantee. No other understanding
regarding this grant contract, whether written or oral, may be used to bind
either party.
8
Liability
The Grantee must indemnify, save, and hold the State, its agents, and employees
harmless from any claims or causes of action, including attorney’s fees incurred by
the State, arising from the performance of this grant contract by the Grantee or the
Grantee’s agents or employees. This clause will not be construed to bar any legal
remedies the Grantee may have for the State's failure to fulfill its obligations under
this grant contract.
9
State Audits
Under Minn. Stat. § 16B.98, subd.8, the Grantee’s books, records, documents, and
accounting procedures and practices of the Grantee or other party relevant to this
grant agreement or transaction are subject to examination by the State and/or the
State Auditor or Legislative Auditor, as appropriate, for a minimum of six years from
16
the end of this grant contract.
10
Government Data Practices
The Grantee and State must comply with the Minnesota Government Data Practices
Act, Minn. Stat. Ch. 13, as it applies to all data provided by the State under this grant
contract, and as it applies to all data created, collected, received, stored, used,
maintained, or disseminated by the Grantee under this grant contract. The civil
remedies of Minn. Stat. § 13.08, apply to the release of the data referred to in this
clause by either the Grantee or the State.
If the Grantee receives a request to release the data referred to in this Clause, the
Grantee must immediately notify the State. The State will give the Grantee
instructions concerning the release of the data to the requesting party before the
data is released. The Grantee’s response to the request shall comply with applicable
law.
11
Workers’ Compensation
The Grantee certifies that it is in compliance with Minn. Stat. § 176.181, subd. 2,
pertaining to workers’ compensation insurance coverage. The Grantee’s employees
and agents will not be considered State employees. Any claims that may arise under
the Minnesota Workers’ Compensation Act on behalf of these employees and any
claims made by any third party as a consequence of any act or omission on the part
of these employees are in no way the State’s obligation or responsibility.
12
Publicity and Endorsement
12.1 Publicity. Any publicity regarding the subject matter of this grant contract
must identify the State as the sponsoring agency and must not be released
without prior written approval from the State’s Authorized Representative.
For purposes of this provision, publicity includes notices, informational
pamphlets, press releases, research, reports, signs, and similar public notices
prepared by or for the Grantee individually or jointly with others, or any
subcontractors, with respect to the program, publications, or services provided
resulting from this grant contract.
12.2 Endorsement. The Grantee must not claim that the State endorses its products
or services.
13
Governing Law, Jurisdiction, and Venue
Minnesota law, without regard to its choice-of-law provisions, governs this grant
contract. Venue for all legal proceedings out of this grant contract, or its breach,
must be in the appropriate state or federal court with competent jurisdiction in
Ramsey County, Minnesota.
14
Termination
14.1 Termination by the State. The State may immediately terminate this grant
contract with or without cause, upon 30 days’ written notice to the Grantee. Upon
termination, the Grantee will be entitled to payment, determined on a pro rata basis,
for services satisfactorily performed.
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14.2 Termination for Cause. The State may immediately terminate this grant
contract if the State finds that there has been a failure to comply with the provisions
of this grant contract, that reasonable progress has not been made or that the
purposes for which the funds were granted have not been or will not be fulfilled.
The State may take action to protect the interests of the State of Minnesota,
including the refusal to disburse additional funds and requiring the return of all or
part of the funds already disbursed.
14.3 Termination for Insufficient Funding. The State may immediately terminate this
grant contract if:
a)
It does not obtain funding from the Minnesota Legislature.
b)
Or, if funding cannot be continued at a level sufficient to allow for the
payment of the services covered here. Termination must be by written or fax
notice to the Grantee. The State is not obligated to pay for any services that are
provided after notice and effective date of termination. However, the Grantee
will be entitled to payment, determined on a pro rata basis, for services
satisfactorily performed to the extent that funds are available. The State will
not be assessed any penalty if the contract is terminated because of the
decision of the Minnesota Legislature, or other funding source, not to
appropriate funds. The State must provide the Grantee notice of the lack of
funding within a reasonable time of the State’s receiving that notice.
15
Data Disclosure
Under Minn. Stat. § 270C.65, subd. 3, and other applicable law, the Grantee consents
to disclosure of its social security number, federal employer tax identification
number, and/or Minnesota tax identification number, already provided to the State,
to federal and state tax agencies and state personnel involved in the payment of
state obligations. These identification numbers may be used in the enforcement of
federal and state tax laws which could result in action requiring the Grantee to file
state tax returns and pay delinquent state tax liabilities, if any.
1. STATE ENCUMBRANCE VERIFICATION
3. STATE AGENCY
Individual certifies that funds have been encumbered
as required by Minn. Stat. §§ 16A.15 and 16C.05.
By: ____________________________________
(with delegated authority)
Signed: _______________________________
Title: Financial Management Director
Date: _________________________________
Date: _______________________________
Contract/PO No(s).______________________
2. GRANTEE
The Grantee certifies that the appropriate person(s)
have executed the grant contract on behalf of the Grantee as
required by applicable articles, bylaws, resolutions, or ordinances.
18
By: _____________________________________
Title: ____________________________________
Date: ___________________________________
Distribution:
Agency
Grantee
State’s Authorized Representative - Photo Copy
Cover
Sheet
Grant to Provide Volunteer Taxpayer Assistance Services
Grant Application Cover Sheet
Name of Organization
Date of Submission
$
Requested Amount
State ID #/Tax Exempt #
Federal Tax ID #
Website
Name of Contact Person
Phone (include extension)
Street Address
19
City
State
Email Address
Fax
Name of Person Authorized to Sign Contracts
Title
Signature of Person Authorized to Sign Contracts
Date
Zip Code
Comments
20
Grant to Provide Volunteer Taxpayer Assistance Services
Proposed Budget of Grant Funds
Organization:
Year:
Priority*
(1-4)
Quantity
Cost
A. Equipment and Accessories
Computers
Printers
Copiers
Accessories
Other:
Subtotal:
B. Advertising Tax Services
Advertising
Other:
Subtotal:
C. Salaries
Tax Site Coordinator
Electronic Filing Coordinator
Volunteer Coordinator
Administrative
Translator
Other:
Subtotal:
D. Other Expenses
Volunteer Training & Recruitment
Supplies
Mileage
Parking
Telephone
Volunteer Recognition
Other:
Subtotal:
TOTAL:
* Rate expense categories from 1 to 4 (1 being the highest priority and 4 being the lowest priority).
21
Grant to Provide Volunteer Taxpayer Assistance Services
Progress Report
Name of Organization
Report Period
(From MM/YY - To MM/YY)
Street Address
City
State
Zip Code
Volunteer Taxpayer Assistance Services Supported by your Organization
What were the goals of your organization for this tax season and what were the outcomes?
What groups (low-income, limited-English speaking, seniors, or other disadvantaged Minnesotans) has this grant
allowed your organization to provide volunteer taxpayer assistance services to?
How has this grant helped your organization develop or expand volunteer taxpayer assistance services to the
22
groups mentioned in the previous question?
Explain actions taken to enhance training of volunteers. Please provide any additional training information that was not
mentioned in your proposed plan.
If applicable, describe how your organization's quality of volunteer taxpayer assistance services has improved from prior
years.
Please share any other important information to better demonstrate how this grant has aided your organization’s
volunteer
taxpayer assistance services.
If more space is needed for responses, include additional pages.
Quantity
Cost
A. Equipment and Accessories
Computers
Printers
23
Copiers
Accessories
Other:
Subtotal:
$0.00
Subtotal:
$0.00
B. Advertising Taxpayer Services
Advertising
Other:
C. Salaries
Tax Site Coordinator
Electronic Filing Coordinator
Volunteer Coordinator
Administrative
Translator
Other:
Subtotal:
$0.00
Subtotal:
$0.00
TOTAL:
$0.00
D. Other Expenses
Volunteer Training & Recruitment
Supplies
Mileage
Parking
Telephone
Volunteer Recognition
Other:
Positions
Number of Volunteers
Previous Tax Year
Current Tax Year
Demographics
Number of Assistance Sites
Number of Federal Returns Prepared
Number of State Income Tax Returns Prepared
Number of Property Tax Refund Returns Prepared
Previous Tax Year
Current Tax Year
Signature of Authorized Representative
Date
For questions contact: Kerrin Lee, 651-556-3052 or 1-800-818-6871 (tollfree)
Send completed form to: Minnesota Revenue; Mail Station 7701; Attn: Kerrin Lee; St. Paul, MN 55146-7701, or
Fax completed form to: 651-297-7430, Attention: Kerrin Lee, or
Email completed form to: kerrin.lee@state.mn.us
Electronic version of this form is available at: www.revenue.state.mn.us (Search keyword: Grant)
Grant to Provide Volunteer Taxpayer Assistance Services
Final Report
24
Name of Organization
Report Period
(From MM/YY - To MM/YY)
Street Address
City
State
Zip Code
Identify any issues that hindered you from serving your target populations or reaching any goals outlined in your proposal.
What policies and procedures do you have in place to improve the quality of site operations and accuracy of returns
prepared?
Identify publicity methods used to reach your target audience. Provide a brief evalution of whether the publicity helped you
reach your goals.
How has this grant helped your organization develop or expand volunteer taxpayer assistance services to your target
audience?
Please describe how this grant has affected your organization's ability to recruit and train volunteers.
25
If applicable, describe how your organization's volunteer taxpayer assistance service level has changed from prior years.
Please share any other important information to better demonstrate how this grant has aided your organization’s
volunteer taxpayer assistance services.
If more space is needed for responses, include additional paper.
26
Quantity
Cost
A. Equipment and Accessories
Computers
Printers
Copiers
Accessories
Other:
Subtotal:
$0.00
Subtotal:
$0.00
B. Advertising Taxpayer Services
Advertising
Other:
C. Salaries
Tax Site Coordinator
Electronic Filing Coordinator
Volunteer Coordinator
Administrative
Translator
Other:
Subtotal:
$0.00
Subtotal:
$0.00
TOTAL:
$0.00
D. Other Expenses
Volunteer Training & Recruitment
Supplies
Mileage
Parking
Telephone
Volunteer Recognition
Other:
Positions
Number of Volunteers
Previous Tax Year
Current Tax Year
Demographics
Number of Assistance Sites
Number of Federal Returns Prepared
Number of State Income Tax Returns Prepared
Number of Property Tax Refund Returns Prepared
Previous Tax Year
Current Tax Year
Signature of Authorized Representative
Date
For questions contact: Kerrin Lee, 651-556-3052 or 1-800-818-6871 (tollfree)
Send completed form to: Minnesota Revenue; Mail Station 7701; Attn: Kerrin Lee; St. Paul, MN 55146-7701, or
Fax completed form to: 651-297-7430, Attention: Kerrin Lee, or
Email completed form to: kerrin.lee@state.mn.us
Electronic version of this form is available at: www.revenue.state.mn.us (Search keyword: Grant)
IRS Determination Letter
27
28
29
State of Minnesota Registration Certificate
30
IRS Form 990 (Page 1)
31