Form 13803 - Lncome Verification Express Service (Ives) Application Page 2
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1
2Principal of Your Firm (required) A principal is an officer, owner, business manager or other
person whose responsibility is to administer your company’s participation in the IVES program.
Last name (required)
First Name (required)
MI
SSN (required)
Date of Birth (required)
Primary Contact Name (if different than the principal). A contact must be available on a day to
day basis to answer IRS questions during testing and throughout the processing year.
Last name
First Name
MI
Telephone Number
E-mail address
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.
Last name (required)
First Name (required)
MI
SSN (required)
Date of Birth (required)
Where to fax your application.
Please 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
Applicant Agreement
The information I have provided on this application is true and correct to the best of my knowledge. 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 that failure to do so will result
in a temporary or permanent exclusion from the program.
Name/title of Principal, partner or owner (type or print)
Signature
Date
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 Service (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.
13803
Form
(Rev. 7-2011)
Catalog Number 48547A
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