For Official Use Only
Department of the Treasury - Internal Revenue Service
Control Number:
13803
Application to Participate in the Income
Form
Verification Express Service (IVES) Program
(September 2016)
OMB Number
(Please read the instructions carefully before submitting this form)
1545-2032
1. Check the type of application you are submitting:
New
Renewal
Amended
Add New Location
Cancellation
Address Change
2. Check the box that describes your organization status:
Government Agency
Partnership
Sole Proprietorship
Corporation
LLC
Other
(Specify)
3. Reason
for using the IVES Program:
(s)
(Select all that apply)
Mortgage Services
Background Check
Credit Check
Banking Service
Licensing Requirement
Other
(Specify)
4. Legal name of business
5. Employer Identificaton Number
(required)
(EIN) or Social Security Number (SSN)(required)
6. Doing Business As (DBA) name
(Complete only if the business is operating under a different business name listed on line 4)
7. Business location address
(required)
Street address
City
State
Zip Code
Business telephone number
Fax number
Business e-mail address
(required)
(required)
8. Billing address required if different from the location address on line 7
Street address
City
State
Zip Code
9. Complete the following information for the principal, company official, partner, or owner of business.
Company official name
Title
Telephone number
(first, middle initial, last)
Date of Birth
Social Security Number
E-mail address
(mm/dd/yyyy) (required)
(required)
Home street address
City
State
Zip Code
10. Primary contact name
. A contact must be available on a day to day basis to answer IRS
(required if different than the principal)
questions during testing and through the processing year.
Last name
First name
MI
Telephone number
E-mail address
(required)
(required)
11a. Have you been convicted of a felony in the last 10 years?
(Attach an explanation for a Yes response)
Yes
No
11b. Are you current with your individual and business taxes, including any corporation and employment tax
Yes
No
obligations?
(Attach an explanation for a No response)
12. Estimated annual volume of IVES product requests:
13803
Catalog Number 48547A
Form
(Rev. 9-2016)
1
2
