Form 4419 - Application For Filing Information Returns Electronically (Fire)
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2(See Instructions on back)
IRS Use Only
Department of the Treasury – Internal Revenue Service
Application for Filing Information
4419
OMB No.
Form
Returns Electronically (FIRE)
1545-0387
(Rev. June 2012)
IRS/IRB encourages transmitters who file for
multiple payers to submit one application
and use the assigned TCC for all payers.
1. Transmitter and/or Payer Information
Legal Name (associated with EIN in Box 3)
Mailing Address
City
State
ZIP
2. Person to contact about this request
Name
Title
Email Address
Telephone Number
5. What Tax Year will electronic filing
3. Employer Identification Number (EIN)
4. Is the request for a Foreign
begin?
Transmitter without a TIN?
Social Security Number Not Permitted
Yes
6. Will TCC be used for Electronic Extension of Time Files only?
Yes
7. Type of return to be reported (Check the box(es) next to the returns you will file electronically.)
Important: Form W-2 information is sent to the Social Security Administration (SSA) only. Do not use Form 4419
to request authorization to file this information electronically. Contact SSA for W-2 electronic filing information at
1-800-772-6270.
Note: For the forms referenced below, electronic filing does not refer to online fill-in forms.
Form 8027,
Form 8955-SSA, Annual
Forms 1097,
Form 1042-S,
1098, 1099,
Foreign Person’s
Employer’s Annual
Registration Statement
3921, 3922,
U.S. Source Income
Information Return
Identifying Separated
of Tip Income and
Participants with Deferred
5498 and W-2G
Subject to Withholding
Allocated Tips
Vested Benefits
See Publication 1220
See Publication 1187
See Publication 1239
See Publication 4810
8. Check the appropriate box:
I have a service provider who will file
I have or will have software. (Name of software if known)
my data for me.
Under penalties of perjury, I declare that I have examined this document, including any accompanying
statements, and, to the best of my knowledge and belief, it is true, correct, and complete.
Name
Title
9. Person
responsible
for preparation
Signature
(A computer generated signature is not acceptable.)
of tax reports
Date
4419
Catalog Number 41639J
Form
(Rev. 6-2012)
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