Form 4419 - Application For Filing Information Returns Magnetically/electronically
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1
24419
IRS Use
OMB No.
Application for Filing Information
Only
1545-0387
Form
Returns Magnetically/Electronically
(Rev. February 1997)
Department of the Treasury
(Please type or print when completing this form—see instructions on back.)
Internal Revenue Service
1 Name and address of transmitter (street, city, state, and ZIP Code)
2 Person to contact about this request
Name:
Title:
Telephone number: (
)
3 Employer identification number (EIN)
4 Tax year you wish to begin filing on magnetic media
5 Are you a service bureau developing and/or transmitting files?
Yes
No
If you are acting as transmitter for a group of payers, submit one Form 4419. Attach a list of the names and EINs of the payers
for whom you will be submitting files.
6 Will you be using your TCC only for transmitting requests for extension of time to file?
Yes
No
Type of Return To Be Reported
7
(Check all forms that you wish to file.)
Important: Form W-2 information is sent to the Social Security Administration only. For more information on filing Forms W-2
magnetically, contact the Social Security Administration.
Form 1042S ( Tape, 3
1
⁄
or 5
1
⁄
inch diskette or IRP-BBS)
2
4
Forms 1098, 1099-series, 5498, and W-2G
Form 8027 ( Tape, 3
1
⁄
or 5
1
⁄
inch diskette)
2
4
( Tape, tape cartr idge, 5
1
⁄
" or 3
1
⁄
" diskette or electronic
4
2
filing via Infor mation Reporting Program Bulletin Board
Form 8596 ( Tape, 3
1
⁄
or 5
1
⁄
inch diskette)
2
4
System (IRP-BBS) or mainframe to mainframe. )
Form W-4 ( Tape, 3
1
⁄
or 5
1
⁄
inch diskette)
2
4
Type of Filing
Magnetic Tape/Cartridge Parameters
8
( Check appropriate box(es))
Density
Track
Type of Media
(tape only)
(cartr idge only)
Tape (9-track only)
Cartridge
1600 BPI
6250 BPI
18-Track
36-Track
Diskette Parameters
9
( Check appropr iate box(es))
Type of Media
Hardware
Software/Operating System
Recording Mode
ASCII
5
1
⁄
" Diskette
4
EBCDIC (System 36 compatible only)
3
1
⁄
" Diskette
ASCII only
2
Electronic Filing
10
( Check appropr iate box)
Information Reporting Program Bulletin Board System (IRP-BBS)
3780 protocols
(asynchronous)
(bisynchronous)
Name (type or print)
Title
11 Person responsible
for preparation of
Signature
Date
tax reports
4419
For Paperwork Reduction Act Notice, see back of form.
Cat. No. 41639J
Form
(Rev. 2-97)
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