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pdfMacro International/ScanTron
IRS Customer Survey
P.O. Box 64529
St. Paul, MN 55164-9614
[DATE]
Name1
Name2
Name3
Name4
Address
City, State, Zip
RE: FIRM NAME
PLAN NAME
PLAN NUMBER
Dear JOHN Q & MARY Q SAMPLE:
Recently you received a survey requesting your views about the IRS Employee Plan Determination Letter
Request process. So far, we have not received your completed survey. If you have not already done so,
please take a few minutes to provide your response. If another person was primarily responsible for
dealing with the IRS on this matter, please pass this survey on to them and encourage them to respond.
As described in our previous communication, we are administering a nationwide survey among people
who have interacted with the IRS. We want to know your opinions regarding the service you received in a
recent Employee Plan Determination Letter Request that you handled for your client. Your responses are
critical to the accuracy of this evaluation of the IRS’s service.
Your name was selected through a scientific random sampling process to receive this survey. Your
participation is voluntary. An independent research company will keep your responses confidential. Your
responses will be grouped with others, so that no individual reply can be traced back to a person or case
number. No identifying information will be associated with your responses.
The survey takes less than 8 minutes to complete. Use the postage-paid reply envelope to return your
completed survey. If you have any questions or concerns, please feel free to call Macro International at
1-888-260-0052 or e-mail us at EPDSurvey@mmail.macrointernational.com.
The IRS is committed to improving its performance and service to the American public. A vital step in
this process is to gather reliable information from those who have had contact with IRS employees and
services. Your honest opinions will help bring about these improvements.
Thank you in advance for your cooperation.
Sincerely,
Larry Luskin
Project Director
Macro International Inc.
L4_12184-A_POA
OMB# 1545-1432
Internal Revenue Service (IRS) Customer Satisfaction Survey
Employee Plan Determination Letter Request
You can help the IRS improve its service to the public by answering the questions below. This voluntary survey takes less than
8 minutes to complete.
Your responses will be held confidential by the survey processing center and only aggregate information will be provided to the IRS.
The following questions ask your opinion regarding your most recent IRS employee plan determination request. Regardless
of whether you agree or disagree with the final outcome, please mark the appropriate box on the scale (where 1 means “Very
Dissatisfied” and 7 means “Very Satisfied”) or next to the response that best applies to you.
Overall Satisfaction
Very
Satisfied
Very
Dissatisfied
1
T
2
T
3
T
4
T
5
T
6
T
7
T
Don’t Know
Not Applicable
T
1.
Regardless of whether you agree or disagree with the final outcome,
how would you rate your overall satisfaction with the way your case was
handled by the IRS?
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2.
Overall, how satisfied are you with the length of the process, from
submission of your application through final determination?
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3.
Overall, how satisfied are you with how well the IRS communicated with
you throughout the process (whether in writing or by telephone)?
{ { { { { { {
{
Application
Very
Satisfied
Very
Dissatisfied
How satisfied are you with…
4.
The ease of locating the correct application form and instructions?
5.
The ease of understanding the application form and instructions?
6.
The ease of completing the application form?
7.
The amount of time you had to spend completing your application?
Don’t Know
Not Applicable
1
T
2
T
3
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4
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5
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6
T
7
T
T
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Acknowledgement Letter (Confirming Receipt of Application)
Very
Satisfied
Very
Dissatisfied
1
T
How satisfied are you with…
2
T
7
T
T
{ { { { { { {
{ { { { { { {
{
{
8.
How quickly you received your acknowledgment letter?
9.
How clearly the acknowledgement letter communicated the expected
timeframe until the IRS would contact you?
10.
Did the IRS contact you within the timeframe stated in the acknowledgement letter?
{
{
{
11.
3
T
4
T
5
T
6
T
Don’t Know
Not Applicable
Yes, I received a letter or telephone call within the stated timeframe.
No, I did not receive a letter or telephone call within the stated timeframe.
I initiated contact before the stated timeframe elapsed.
How satisfied are you with the amount of time it took for the IRS to
contact you (following your acknowledgement letter)?
Form 12184-A (Rev. 2-2009)
Cat. No. 26977G
{ { { { { { {
{
Please continue on next page
Department of the Treasury-Internal Revenue Service
PLEASE COMPLETE THIS SECTION IF THE IRS CONTACTED YOU IN WRITING OR BY TELEPHONE
REGARDING YOUR DETERMINATION APPLICATION OR TO ASK FOR MORE INFORMATION.
Additional Information Request (After Receipt of Acknowledgement Letter)
Very
Satisfied
Very
Dissatisfied
1
T
12.
Overall, how satisfied are you with the IRS agent assigned to your case?
2
T
3
T
4
T
5
T
6
T
Don’t Know
Not Applicable
7
T
T
{ { { { { { {
{
{
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How satisfied are you with…
{
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13.
The courtesy of the IRS agent?
14.
The knowledge of the IRS agent?
15.
How well the IRS agent listened to your concerns?
16.
How thoroughly the IRS agent answered your questions?
17.
Communications about the status of your determination?
18.
The consideration given to the information you presented in the original
application or submission?
19.
The description of the additional information the IRS needed to complete
your determination?
{ { { { { { {
{
20.
The explanation of why additional information was requested?
21.
The time given you to respond to additional IRS request(s)?
22.
The amount of time you had to spend responding to IRS requests for
additional information?
{ { { { { { {
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{ { { { { { {
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{
23.
The timeliness of the IRS agent in responding to your inquiries?
{ { { { { { {
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Final Determination
Very
Satisfied
Very
Dissatisfied
1
T
How satisfied are you with…
24.
The ease of understanding the determination letter you received?
2
T
3
T
4
T
5
T
6
T
Don’t Know
Not Applicable
7
T
T
{ { { { { { {
{
Other Information
25.
How many total people are employed by the organization for which this determination was sought?
{
{
{
26.
Sole Proprietor
1–9
10–99
{
{
{
100–499
500–999
1,000 or more
What are the estimated total assets of the plan for which this determination was sought?
{
{
{
Less than $100,000
$100,000 to $499,999
{
{
$1,000,000 to $4,999,999
$5,000,000 or more
$500,000 to $999,999
Form 12184-A (Rev. 2-2009)
Cat. No. 26977G
Please continue on next page
Department of the Treasury-Internal Revenue Service
27.
For this determination, were you…
{
{
An employee/officer of the organization? [Skip to Question 29]
A designated third-party representative/power of attorney (POA)?
ANSWER ONLY IF YOU ARE A DESIGNATED THIRD-PARTY REPRESENTATIVE/POWER OF ATTORNEY (POA)
Very
Satisfied
Very
Dissatisfied
1
T
How satisfied are you with…
2
T
3
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4
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5
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6
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7
T
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28.
If you are a designated third-party representative/power of attorney, how
consistent was the IRS in its handling of this application compared with other
applications you have completed in the past year?
29.
Did you visit the IRS website (www.irs.gov/ep) for assistance or information during the determination process?
{
{
Don’t Know
Not Applicable
T
{
Yes
No
Comments
30.
If you have any suggestions for how the IRS can improve its service, or any other comments, please provide them below.
___________________________________________________________________________________________
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If you have any questions about this survey, please contact the survey processing center at 1-888-260-0052 or
EPDSurvey@mmail.macrointernational.com.
!
If you have been unable to resolve any specific problems with your tax matter through the normal IRS channels,
or now face a significant hardship due to the application of the tax law, we encourage you to contact the Taxpayer
Advocate Service at 1-877-777-4778.
Thank you for completing the survey.
Paperwork Reduction Act Notice
The Paperwork Reduction Act requires that the IRS display an OMB control number on all public information requests. The OMB Control
Number for this study is 1545-1432. Also, if you have any comments regarding the time estimates associated with this study or suggestions
on making this process simpler, please write to: Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP,
1111 Constitution Ave. NW, Washington, DC 20224.
Form 12184-A (Rev. 2-2009)
Cat. No. 26977G
Department of the Treasury-Internal Revenue Service
| File Type | application/pdf |
| File Title | IRS CSS EPDetermPOA_ Letter2.indd |
| Author | marie.e.mikulak |
| File Modified | 2009-10-20 |
| File Created | 2009-03-04 |