Form 13803 - Application To Participate In The Income Verification Express Service (Ives) Program Page 2
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213. Complete the following information for the responsible official. The responsible official is an individual with responsibility for the
operation and IVES users at the business location listed above. A principal listed above may also be a responsible official.
Responsible 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
14.
By marking this box, you agree to review Publication 4557, Safeguarding Taxpayer Data and abide by the guidelines of the
publication. In addition, you can only use taxpayer information that you recieve via a Form 4506-T or Form 45-6 T-EZ request
for the purpose
the taxpayer/requestor intended. Failing to complete this section will result in the application being rejected
(s)
and returned.
Where to fax your application: Fax your application to your closest IVES location listed below:
IVES location
Fax number
Austin, Texas
877-477-9603
Cincinnati, Ohio
877-477-0578
Fresno, California
877-477-0576
Kansas City, Missouri
877-477-9601
Ogden, Utah
877-477-0580
The IRS conducts a suitability check on the applicant, and on all Principals listed on the application to determine the applicant's
suitability to be an IVES participant. After an applicant passes the suitability check and the IRS completes processing the application,
the IRS notifies the applicant of acceptance to participate in the program.
A responsible company official must sign the application agreement indicating understanding of the Privacy Act restrictions relating to
the use of this service.
Non-Transferable: Acceptance for participation is not transferable. I understand if this business is sold or its organizational structures
changes, a new application must be filed. I further understand noncompliance will result in the business and/or the individuals listed on
this application, being suspended from participation in the IVES program.
Privacy Act Notice: Our right to ask for information is 5 U.S.C 301 and the Internal Revenue Code Section 6109 and applicable
regulations. The registration information we are requesting is used to create an account for you, authenticate your identity and for billing
purposes. We may disclose the information to the Department of Justice, to enforce the tax laws, civil and criminal, to cities, states, the
District of Columbia and U.S. commonwealths or possessions to carry out their tax laws. we may give it to other countries under a tax
treaty, to federal and state agencies to enforce federal non-tax criminal laws, or to federal law enforcement and intelligence agencies to
combat terrorism. Your participation in the Income Verification Express Services (IVES) program is voluntary; however, if you do not
provide all or part of the information required to create your account, you will not be eligible for access to IVES.
Under the penalties of Perjury, I declare I have examined this application and read all accompanying information, and to the best of my
knowledge and belief, the information being provided is true, correct, and complete. In addition, I have read the Internal Revenue
Service rules and procedures for participating in the Income Verification Express Service program and I agree to abide by them and to
pay resulting fees timely. I understand failure to do so will result in a temporary or permanent exclusion from the program.
Name and title of Principal, Partner or Owner
Signature of Principal, Partner or Owner
Date signed
(type or print)
13803
Catalog Number 48547A
Form
(Rev. 9-2016)
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