Free DR-370061 - Florida

Refund Sampling Results

DR-370061 R. 05/09

This form is a checklist to provide guidance on specific sampling plan results the Department of Revenue needs to evaluate your sample. You must first complete and submit a Refund Sampling Methodology Application (Form DR-370060) to the Department and receive approval of your sampling plan before submitting this form. You must also complete and submit an Application for Refund (Form DR-26S) with this form. The final evaluation of the sample and a summary of all the overall conclusions related to your sampling methodology must be provided with this form to the Department. Please include any printouts of population parameters, copies of WinSample reports, sample point invoices, spreadsheets, formulas/calculations, and any other necessary supporting documentation as required by Rule 12-26.003, Florida Administrative Code (F.A.C.). Your results must show that the sample was completed in accordance with Rule 12-26.004, F.A.C., and your approved sampling plan. We may require that the sample be expanded to reach an acceptable final accuracy for the projection of the refund amount. Please include your approval number in the appropriate box. You must provide an explanation if you are unable to supply any of the requested information.

Check the items below that are attached Statistical Sampling Results Approval #
Provide the results of your sampling plan in detail including all formulas and calculations.

Non-statistical Sampling Results Approval #
Provide the results of your sampling plan in detail including all formulas and calculations.



Population size Sample size Method used to determine sample size Sample points Copy of WinSample report Method of selecting and using spares Stratum boundaries Method of determining stratum boundaries Number of strata Detail threshold amount

Type of sample (imaging, journals, time periods,
microfiche, etc)

If stratification is used:



For sample analysis:

Precision amount Confidence level Method used to calculate precision The estimator used (difference or mean) Projected refund amount Other pertinent sampling plan results



Beginning range number for each range Ending range number for each range Number of ranges Population size Sample size Method used to determine sample size Sample points Copy of WinSample report Method of establishing correspondence Method of selecting and using spares The estimator used (difference or mean) Projected refund amount Other pertinent sampling plan results

Mail completed form, attachments, and documentation to: Florida Department of Revenue Refunds Subprocess PO Box 6470 Tallahassee, FL 32314-6470 For more information on completing this application call: 850-488-8937

www.myflorida.com/dor