Draft 12/13/04
2005 Self-Assessment Survey
This survey is an important data collection mechanism for the National Community Tax Coalition. By accurately completing this survey, you are helping the Coalition better serve its affiliates by gaining a clear understanding of the size and impact of the free tax preparation field. This is critical for designing our capacity building services and advocacy approaches. We ask you to provide complete and accurate data on your outcomes for us to effectively promote your program and the free tax preparation field. Completing this survey is a requirement for all National Community Tax Coalition affiliates who carry out free tax preparation and/or EITC Outreach to retain affiliation status and access to affiliate benefits, including a number of valuable tools and resources for free tax preparation. This year's survey asks for specific programmatic data from the Tax Year 2004 (Jan - April 2005) tax preparation season. Free Tax Preparation Programs: Before you complete this survey, please read the data requirements listed below and make sure you have accurate programmatic data to answer the questions. If you do not have accurate programmatic data and you used TaxWise preparation software this tax season you can utilize our Data Collection Tool to obtain accurate data and then revisit this survey. Your cooperation in gathering accurate data is appreciated. Data required to complete this survey, in order of appearance: (Those marked with an * can be answered using our Data Collection Tool) Total # of 2004 Federal Returns Filed (during Jan - April 2005)* Total Value in $ of 2004 Federal Refunds Claimed* Total Value in $ of 2004 EITC Refunds Claimed* Total Value in $ of 2004 Child Tax Credit Refunds Claimed* Total # of 2004 State Returns Filed (during Jan - April 2005)* Total Value in $ of 2004 State Refunds Claimed during the ax Year 2004 Filing Season* Average AGI per client* Total # of Prior Year Federal Returns Filed during the Tax Year 2004 Filing Season (Jan. - April 2005)* Total Value in $ of Prior Year Federal Refunds Claimed during the 2004 Tax Year Filing Season* Total # of 2004 Local and Other Returns Filed during the Tax Year 2004 Filing Season Total Value in $ of Local and Other Refunds Claimed during the Tax Year 2004 Filing Season Total unduplicated # of active Volunteers during the Tax Year 2004 Filing Season Total # of Free Tax Prep Sites Operated in Tax Year 2004 Filing Season (Jan. - April 2005) Cities and States of Free Tax Prep Sites Operated in Tax Year 2004 Filing Season SECTION A: BASIC INFORMATION
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This survey consists of two sections: Section A asks for general contact and program information and should take about 4 minutes to complete. Section B is for free tax preparation programs only, and asks for accurate data on programmatic outcomes from last tax season, and takes about 7 minutes. To complete Section B, we recommend that you have this data on hand as you complete the survey. Click here for a list of the data we require and a few suggested tools for obtaining this data from TaxWise. By completing this survey, Coalition affiliates can be included in our web-based National Tax Preparation Program Locator. Click here for a sample listing. 1. First Name 2. Last Name 3. Title 4. Organization 5. Street Address 6. City 7. State 8. Zip Code 9. Phone (example 555-555-5555) 10. Fax 11. Email 12. Website 13. What IRS SPEC Regional Territory do you belong to? Area 1 – Area 2 – Area 3 Area 4 – MI, WI, IL, IN, OH, KY, WV Area 5 – Area 6 – Area 7 - CA 14. Is your organization a member of a state or local coalition? □Yes □No COALITIONS ONLY FOR NEXT 4 QUESTIONS 15.Coalition name
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(example 555-555-5555)
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16. Number of organizations in the coalition 17. Primary coalition contact person 18. Primary coalition contact person phone number. 19. Do you have a telephone or hotline number for clients to call to obtain information on your free tax preparation and/or EITC Outreach services? (choose one answer) □ No, we do not have a number and do not plan to have one in the future. □ No, we do not have a number but plan to next tax season. □ Yes, we have a number. 20. Would you like your organization included in the Coalition’s web-based National Program Locator at www.tax-coalition.org/programs.cfm? □ Yes □ No 21. Will you or a member of your organization be attending the Coalition’s 2005 National Conference in Chicago, IL? □ Yes □ No □ Don’t know 22. Type of organization □ Community based non-profit organization □ State and local government □ National organizations that have free tax preparation in multiple states NATIONAL ORGANIZATIONS WITH MULTIPLE STATES ONLY FOR NEXT 2 QUESTIONS 23. Is there a contact person who can help local organizations identify your closest membership organization? □ Yes □ No 24. If so, please provide name, phone number and email address. 25. Please provide the web page that includes the best list of your members that provide free tax preparation programs. ************************** SECTION B: PROGRAMMATIC DATA Before proceeding, please check the answer that best describes your program or organization. 26. My organization provides the following services during the Tax Season 2004 Filing Season (Jan. – April 2005): (please select one) □ EITC Outreach □ Free Tax Preparation Services □ Both EITC Outreach and Free Tax Preparation □ None of the above
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27. Supplemental Services provided at tax preparation site (please check all that apply): □ Clients can open bank accounts at site □ Clients are referred to low-cost banking services □ Clients can fill out applications for other benefit programs on site (LIHEAP, food stamps, housing, health insurance, etc.) □ Clients receive information about other benefit programs on site □ Clients can sign up for financial education or Individual Development Account (IDA) program on site □ Clients are offered low-cost Refund Application Loans (RALs) on site □ Clients are provided with warning of the high costs of RALs and other fringe financial services □ Other: 28. What, if an, additional partnerships do you have with the for-profit organizations? □ Name of for-profit □ Nature of partnership You have identified that your organization provided some form of free tax preparation services during the Tax year 2004 filing season (Jan. – April 2005). If this is incorrect, please press the back button and re-evaluate your answer to Question 26. In this section we ask free tax preparation practitioners to provide us with data on programmatic outcomes from the Tax Year 2004 Filing Season (Jan. – April 2005). All data in this section must be accurate. The Coalition has a Data Collection Tool available at www.tax-coalition.org for your use to obtain accurate data from TaxWise for questions 29-39. If you do not have data for a particular question, please choose “Not Applicable.” 29. What is the total number of 2004 federal income tax returns your organization filed during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Don’t know □ Total # 30. What is the total value of 2004 federal income tax returns your organization filed during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Don’t know □ Total in $ 31. What is the total value of 2004 federal Earned Income Tax Credit (EITC) refunds claimed by your clients during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Don’t know □ Total in $ 32. What is the total value of 2004 federal Child Tax Credit refunds claimed by your clients during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Don’t know □ Total in $ 33. What is the total number of 2004 sate income tax returns your organization prepared and filed during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Not applicable (i.e., your state has no state income tax) □ Don’t know □ Total #
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34. What is the total value of 2004 state income tax refunds claimed during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Not applicable □ Don’t know □ Total in $ 35. What was the average AGI per client during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Don’t know □ Total in $ 36. What is the total number of prior year federal income tax returns (2003 and earlier) your organization filed during the Tax Year 2004 Filing Season (Jan. – April 2005)? (Prior year returns refer to those federal returns completed for clients who did not file taxes in previous years or who needed to amend their prior year federal returns) □ Don’t know □ Not applicable □ Total # 37. What is the total value of prior year refunds (2003 and earlier) your organization prepared during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Not applicable □ Don’t know □ Total in $ 38. What is the total number of 2004 local and other returns your organization prepared and filed during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Not applicable (i.e., your area has no local income tax) □ Don’t know □ Total # 39. What is the total value of 2004 local and other refunds claimed by your clients during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Not applicable □ Don’t know □ Total in $ 40. What is the total, unduplicated number of active volunteers who assisted in providing free tax preparation during the Tax Year 2004 Filing Season (Jan. – April 2005)? (Terminology Note: The term “unduplicated” means that each individual is counted one time, regardless of the number of times they provided or were provided a service. Please count each individual volunteer, not the number of times a volunteer provided a service. □ Don’t know □ Total # 41. What is the total number of tax sites your organization operated during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Don’t know □ Total #
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42. Please list the cities and states that you operated tax sites during Tax Year 2004 Filing Season (Jan. – April 2005)? (For example, Chicago, Illinois; Springfield, Illinois) □ Don’t know □ Sites operated in Tax Year 2004:
43. Please provide two successes your organization experienced during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Success #1 □ Success #2 44. Please provide two challenges your organization experienced during the Tax Year 2004 Filing Season (Jan. – April 2005)? □ Challenge #1 □ Challenge #2 45. Please enter any additional information or comments on this survey.
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