Form 8633 - Application To Participate In The Irs E-File Program - 2003
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1
28633
For Official Use Only
Form
EFIN:
ETIN:
Application to Participate in the
(Rev. July 2003)
IRS e-file Program
Department of the Treasury
OMB Number 1545-0991
Internal Revenue Service
Please check the box(es) that apply to this application:
New
Revised EFIN:
Add New Location
Reapply EFIN and /or Previous EFIN
1a
Please check the box which describes your firm. (Check one box only)
Sole proprietorship
Partnership (number of partners with 5% or more interest)
Corporation
Limited Liability Company
Limited Liability Partnership
Personal Service Corporation
Federal Government Agency
State Government Agency
Local Government Agency
Credit Union
Association
Volunteer Organization
b
Firm’s Employer Identification Number (EIN) or Social Security Number (SSN)
c
Firm’s legal name as shown on firm’s tax return
d
Doing Business As (DBA) name (if other than the name in item 1c)
e
Business location address
Country
Street
City
State
ZIP Code/Country Code
(
)
f
Business telephone number
Fax Number (
)
g
Mailing address of the Firm if
Country
Street
City
State
ZIP Code/Country Code
different from the location
address only (street or P.O. box)
h
Is the firm open 12 months a year? Yes
No
Address
Telephone number
If you answer “No,” please give address and telephone number
that are available 12 months of the year.
(
)
i
Primary Contact Name
Title:
E-mail address (optional):
(first, middle initial, last)
(
)
Phone Number: (
)
Fax Number:
j
Alternate Contact Name
Title:
E-mail address (optional):
(first, middle initial, last)
(
)
Phone Number: (
)
Fax Number:
Yes No
2
Please answer the following questions by checking the
3
If you are a Not for Profit service, check the one box that applies
below:
appropriate box or boxes.
VITA
TAC (Tax Assistance Center)
a
Will you originate the submission of electronic returns
TCE (Tax Counseling for the Elderly)
to the IRS? (Electronic Return Originator)
Military Base
Employee Member Benefit
b
Will you file as a Reporting Agent for Forms 940/941 as
defined in Revenue Procedure 96-17? (Reporting Agent)
4
Check the individual and/or business form types you will e-file for:
Note: If you answer No to 2b, skip to 2c. Check Yes in
940
941
990
1040
ETD
box 2c if you transmit returns you prepared.
1041
1065
1120
1120 POL
State Ack
Are you currently listed on the IRS Reporting Agent’s File
(RAF) for this EIN?
Check the 1120 box for 1120 and 1120S. Check the 990 box for
990, 990-EZ, and 8868. See instructions for additional information
(If you answer NO, you must furnish complete,
on check boxes State Ack and ETD.
signed copies of your Forms 8655 for the clients for
whom you intend to file returns. You must also
5
If you are a transmitter/software developer and checked the 940
or 941 box, please check the software format which applies:
furnish a list of your clients containing the Business
Name and EIN (Agents List).
940
XML
Non-EDI
On-line Non-EDI
c
Will you transmit returns prepared by you or those of another
941
XML
Non-EDI
EDI
ERO? (Transmitter)
On-line
On-line Non-EDI
d
Will you transmit individual or business income tax return
information prepared by a taxpayer using commercially
purchased software or software you provide through an
Yes No
on-line Internet site? (On-line Provider)
6
Has the firm failed to file business tax returns, or pay
(If you answer YES, please follow the instructions on
tax liabilites under U.S. Internal Revenue laws? (Please
Page 3 for Line 2d.)
attach an explanation for a “Yes” response.)
e
Will you write electronic filing software? (Software Developer)
f
Will you receive tax return information from EROs, or
from taxpayers who have prepared their own returns
using commercial software, or on an Internet site,
process the information, and either forward it to a
transmitter, or send the information back to the ERO?
(Intermediate Service Provider)
8633
See Paperwork Reduction Act Notice and Privacy Act Notice on page 4.
Cat. No. 64225N
Form
(Rev. 7-2003)
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