Application For Certified Public Accountant (Cpa) License - California Page 3
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3PERSONAL INFORMATION COLLECTION AND ACCESS
The information provided in this form will be used by the California Board of Accountancy (CBA), to
determine qualifications for a Certified Public Accountant License. Business and Professions Code
(BPC) sections 27, 141, 480, 5019, and 5080 through 5095 authorize the collection of this information.
Failure to provide any of the required information is grounds for rejection of the application as being
incomplete.
Information provided may be transferred to the Department of Justice, a District Attorney, a City Attorney,
or to another government agency as may be necessary to permit the CBA, or the transferee agency, to
perform its statutory or constitutional duties, or otherwise transferred or disclosed as provided in Civil
Code section 1798.24.
Each individual has the right to review his or her file, except as otherwise provided by the Information
Practices Act. Certain information provided may be disclosed to a member of the public, upon request,
under the California Public Records Act.
Disclosure of your social security number is mandatory and collection is authorized by BPC sections 30
and 31. Your social security number will be used exclusively for tax enforcement purposes and
investigation of violations of cash-pay reporting laws as set forth in Section 329 of the Unemployment
Insurance Code, for compliance with any judgment or order for family support in accordance with section
17520 of the Family Code, or for verification of licensure or examination status by a licensing or
examination board. If you fail to disclose your social security number, you may be reported to the
Franchise Tax Board (FTB) and be assessed a penalty of $100.
Effective July 1, 2012, the State Board of Equalization (BOE) and the FTB may share taxpayer
information with the CBA. You are required to pay your state tax obligation. This application may be
denied or your license may be suspended if the state tax obligation is not paid and your name appears
on either the BOE or FTB certified list of top 500 tax delinquencies.
Your name and residence address or alternative address (“address of record”) listed on this application
or personal data card will be disclosed to the public upon request through license verification on the CBA
website, if and when you become licensed per BPC section 27.
The Executive Officer of the CBA is responsible for maintaining the information in this application, and
may be contacted at 2000 Evergreen Street, Suite 250, Sacramento, CA 95815, telephone number
(916) 263-3680 regarding questions about this notice or access to records.
DEFINITION OF DISCIPLINARY ACTION
For the purposes of responding to question 11, “disciplinary action” is an administrative action that
resulted in a restriction or penalty being placed on any professional license you have or have possessed,
such as a revocation, suspension, probation, consent order, or letter of reprimand. It includes all
discipline, penalty or sanctions imposed by the Public Company Accounting Oversight Board or the
United States Securities and Exchange Commission. It does not include other types of administrative
actions such as citations and fines, orders of abatement, or orders to take specified continuing education
courses. If yes, provide a detailed explanation and a copy of all documents relating to the disciplinary
action.
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