Form 8554 - Application For Renewal Of Enrollment To Practice Before The Internal Revenue Service (2005)

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Department of the Treasury – Internal Revenue Service
OMB NUMBER
Form 8554
154-0946
Application for Renewal of Enrollment to Practice
(Rev. February 2005)
Before the Internal Revenue Service
2. Social Security Number
1.
Name: ____________________________________________________________
Self
Spouse
Current Address: ___________________________________________________
3. Telephone Numbers
City: ______________________________State: __________ Zip Code:________
Work
Enrollment number: _________________________________________________
Home
Centralized Authorization File Number (If applicable):_______________________
Fax
4. E-mail Address: __________________________________________________________
5.
Check this box if any information in items 1 – 4 has changed since your last renewal, so we can update our records. Also, attach
a signed and dated statement identifying your prior information, such as your former name and/or address.
6. Optional Consent for IRS to Disclose Enrollment Information
Your enrollment mailing address is confidential. By checking the following box, you are authorizing the Office of Professional
to
Responsibility to disclose your enrollment mailing address and name
the general public, professional organizations and continuing
education providers. Optional Consent Check Box
7. Eligibility Status: Check the appropriate box to select your current status for enrollment to practice before the Internal Revenue
Service.
Active enrollment to practice before the Internal Revenue Service
Retirement Status (In order to retain your eligibility to become active, you must renew your enrollment each cycle.)
Suspended from practice before the Internal Revenue Service by virtue of disciplinary action by the Office of Professional
Responsibility. (You must comply with the requirements for renewal of enrollment during the period of your suspension.)
8. Report of Continuing Professional Education (CPE), see section 10.6(e) of Circular 230 and
If your Social Security Number ends in:
•
0, 1, 2, or 3, you must complete 16 CPE hours, for each calendar year 2002 and 2003.
•
4, 5, or 6 you must complete 16 CPE hours, for each calendar year 2002, 2003 and 2004.
•
7, 8, or 9 you must complete 16 CPE hours, for each calendar year 2002, 2003, 2004 and 2005.
Enter the total hours (for this cycle) of qualifying CPE completed in each category below.
A. [
hrs.] Participant in a formalized education program.
B. [
hrs.] Participant in correspondence or individual study program(s).
C. [
hrs.] Participant in on-line study program.
D. [
hrs.] Instructor, discussion leader, or speaker. (Limited to 50% of the CPE for enrollment cycle.)
E. [
hrs.] Author of published articles or books. (Limited to 25% of the CPE for the enrollment cycle.)
_____________Total Hours
F. Continued Professional Education Earned by Special Enrollment Examination (SEE).
You may substitute taking CPE by retaking and passing the SEE, provided you have also taken the required 16 hours of CPE
in the last year of your enrollment cycle. Check the box if this applies to you and attach a copy of your SEE letter showing your
passing scores.
9. Other Data
A. Have you been convicted of any violation of law (excluding minor traffic violations for which a fine or forfeiture of $500 or less
was imposed) since the issuance or latest renewal of your enrollment? (If ''Yes,'' attach an explanation of the facts specify the
date, name and location of the court, nature of the offense or violation and penalty imposed or other disposition of case.)
Yes
No
B. If you did not timely file or timely pay all your individual or business Federal taxes during the current year or any of the
preceding 3 years, then on a separate sheet of paper, for each year identified, specify: 1. The tax year, 2. Exact name(s) and
address as shown on the return(s), 3. Taxpayer identification number on the return,
4.
Tax Return Form Number,
5. The
amount of tax paid late, penalty and interest, and
amount of tax paid late, penalty and interest, and 6. An explanation, e.g.,
cause of delinquency
cause for each year. The Office of Professional Responsibility will consider any tax compliance
issues in evaluating your renewal. Did you timely file and pay all your individual and business Federal taxes in the
current and preceding 3 years.
Yes
No
Form 8554 (Rev. 02-2005)
Department of the Treasury - Internal Revenue Service
Catalog Number 21842Q

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