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It is form number 8948 which is still in draft form. I do like the cover letter as well. Don't think you can overkill CYA on compliance issues. I know I use a client interview form that asks all the due diligence for EITC which I require the client to sign prior to preparing the return. Stays in their file with the 8867. Here is a link to the draft form:

http://www.irs.gov/pub/irs-dft/f8948--dft.pdf

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