Form 9041 - Application For Electronic/magnetic Media Filing Of Forms 1041, 1065, And 5500-C/r
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1
2Department of the Treasury — Internal Revenue Service
OMB Number
9041
Form
Application for Electronic/Magnetic Media Filing of
1545-1079
(Rev. October 1990)
Expires: 07-31-92
Forms 1041, 1065, and 5500-C/R
a. Firm's name
b. Employer identification number
(See instructions.)
(EIN must have 9 digits.)
d. Contact person's name
c. P.O. Box and street address
1.
e. City
h. Daytime telephone number
f. State
g. ZIP code
(Include area code.)
(
)
Indicate which forms you will file by checking each appropriate box.
Form 1041, U.S. Fiduciary Income Tax Return
2.
Form 1065, U.S. Partnership Return of Income
Form 5500-C/R, Return/Report of Employee Benefit Plan (with fewer than 100 Participants)
a. Have you ever had an electronic filer identification number
b. If yes to 3a, please provide your EFIN or MTIN.
(EFIN) or magnetic media transmission identification
EFIN or MTIN
Year
number (MTIN)?
Individual
3.
Business
Yes
No
Employee plans
a. Will you transmit returns directly to the IRS?
b. Will you transmit returns over telephone lines?
Yes
No
Not sure at this time
Yes
No
Not sure at this time
d. Will you develop or modify software that prepares returns for
c. Will you transmit or send data to another office
through which the data is transmitted to IRS?
electronic/magnetic media filing?
Yes
No
Not sure at this time
Yes
No
Not sure at this time
e. Will you obtain appropriate signatures for the electronic/magnetic media returns?
Yes
No, another filer will
4.
f. Will you file on:
magnetic tape?
No
Not sure at this time
Yes
Mitron?
Yes
No
Not sure at this time
3½ inch floppy diskette?
Yes
No
Not sure at this time
5¼ inch floppy diskette?
Yes
No
Not sure at this time
g. If you file Form 5500-C/R, will you test your software using:
your live data?
IRS test package?
Not sure at this time?
h. If you file returns on magnetic tape or diskette, check the method in which you would like to receive the Acknowledgment Report.
Fax
Mail
(If box is checked, please provide your FAX telephone number)
(
)
)
a. Are you a plan administrator
Yes
No
Not applicable
(Form 5500-C/R)? (See instructions.)
If 5a is yes, please provide:
b. Name of plan administrator
c. Plan administrator's EIN
(must have 9 digits)
5.
d. Street address
h. Plan administrator's phone number
(Include area code.)
e. City
f. State
g. ZIP code
(
)
May we give your name and address to firms that offer services related to electronic/magnetic media filing?
(See instructions.)
6.
Yes
No
Which software and transmission service will you use? Write their names below.
(See instructions.)
Transmitter
Software Company
7.
I
9041
Cat. No. 10333U
Form
(Rev. 10-90)
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