Form 4419 - Application For Filing Information Returns Magnetically/electronically

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4419
IRS Use
OMB No.
Application for Filing Information
Only
1545-0387
Form
Returns Magnetically/Electronically
(Rev. May 1997)
Department of the Treasury
(Please type or print in black ink when completing this form—see instructions on back.)
Internal Revenue Service
1 Transmitter information
2 Person to contact about this request
Name
Name
Address
Title
Telephone number (
)
City
State
ZIP
3 Employer identification number (EIN)
4 Tax year you wish to begin filing on magnetic media
5 Will you be using your TCC only for transmitting requests for extension of time to file?
Yes
No
Type of Return To Be Reported
6
(Check all forms that you wish to file.)
Important: Form W-2 information is sent to the Social Security Administration only. Do not use Form 4419 to request
authorization to file information magnetically. Contact SSA to request the appropriate application.
Forms 1098, 1099-series, 5498,
Form 1042S ( Tape, Tape cartr idges, 3-1/2 or 5-1/4 inch diskette or IRP-BBS)
5498-MSA, and W-2G
Form 8027 ( Tape, 3-1/2 or 5-1/4 inch diskette)
(Tape, Cartridges, 5-1/4" or 3-1/2"
diskette or electronic filing via Information
Form 8596 ( Tape, 3-1/2 or 5-1/4 inch diskette)
Returns Program Bulletin Board System
(IRP-BBS) or mainframe to mainframe.)
Form W-4 ( Tape, 3-1/2 or 5-1/4 inch diskette)
Type of Filing
Magnetic Tape/Tape Cartridge Parameters
7
( Check appropriate box(es))
Type of Media
Density (tape only)
Track (cartr idge only)
Tape (9-track only)
Cartridge
1600 BPI
6250 BPI
18-Track
36-Track
Other Cartridge Parameters
( Check appropriate box(es))
Type of Media
Hardware
Recording Mode
8 mm
4 mm
QIC
ASCII
EBCDIC
Diskette Parameters
8
( Check appropr iate box(es))
Type of Media
Hardware
Software/Operating System
Recording Mode
ASCII
5-1/4" Diskette
EBCDIC (System 36 compatible only)
3-1/2" Diskette
ASCII only
Electronic Filing
9
( Check appropr iate box)
Information Returns Program Bulletin Board System (IRP-BBS)
3780 protocols
(asynchronous)
(bisynchronous)
Name (type or print)
Title
10
Person responsible
for preparation of
Signature
Date
tax reports
4419
For Paperwork Reduction Act Notice, see back of form.
Cat. No. 41639J
Form
(Rev. 5-97)

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