Form 78-656 - Efile Pay Access Request printable pdf download

Purpose of this form: This form is used solely to unlock or reset a password. To update your e-mail address, go into eFile

& Pay, and on the Main Menu Screen, choose “Change a Profile.” To update your business information, please complete the

Request for Change, Correction, or Cancellation of Tax Permit form on our Web site,

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Section 1: Action Requested (check one)

Unlock Password: Check if you know your password, but simply have been locked out of the eFile & Pay system.

Reset Password: Check to delete the existing password and allow the user to create another password.

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Section 2: eFile & Pay Information

To unlock or reset your password, please provide the following information:

Business eFile Number (BEN): ____________________________ Permit Number: _______________________________

Primary User’s Telephone Number: ________________________ Email Address: ________________________________

Primary User’s Full Name: ______________________________________________ Date: __________________________

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Section 3: Authorization

By completing and faxing this form, you authorize the Iowa Department of Revenue to respond by telephone or e-mail

indicating the password has been unlocked or reset.

Signature of Authorized Person: ____________________________________________________________________

Print Name of Authorized Person: ___________________________________________________________________

Position/Title: ____________________________________________________ Date: _________________________

Note: This form must be signed by the business owner, responsible party, or person with Power of Attorney. In the case of

a partnership, one signature must be that of a partner. In the case of a club or society, one signature must be that of the

chairman or secretary.

___________________________________________________________________________________________________

Fax this form to: 515-242-6487, ATTN: Taxpayer Services.

NOTE: If your eFile & Pay Access Request form is received by noon, central time, Monday thru Friday, our goal is to e-mail

or call you the same business day. Otherwise, your request will be processed the following business day.

78-656 (06/19/12)

Form 78-656 - Efile Pay Access Request