Form 23 - Application For Enrollment To Practice Before The Internal Revenue Service
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1
223
Application for Enrollment to Practice Before
Form
the Internal Revenue Service
OMB No. 1545-0950
(Rev. April 2011)
Department of the Treasury
See Instructions on Page 3
Internal Revenue Service
Important things you need to know before you file this form:
• Take and Pass the Special Enrollment Examination
For IRS use:
• Read Circular 230
• The application fee is $30.
Date Enrolled:
Visit to file and pay electronically or enclose a check or money order in the amount of $30.00
payable to the United States Treasury. This fee is non-refundable and applies regardless of your enrollment
status.
Check here if you are a former Internal Revenue Service Employee, and enter the date you separated
Enrollment Number:
from the Service
.
/
/
Part 1. Tell Us About Yourself
1
Your Tax Identification Number
(Social Security Number or Individual Tax
Identification Number)
If you do not have an SSN or ITIN, please check this box.
2
Your Full Legal Name
Last
First
M
3
Your Current Address
Number
Street
Suite or Apt. Number
City
State
Zip Code
Country
Your email Address:
Your Contact Telephone Number:
4
Enter your PTIN number issued by the IRS or Candidate Number assigned by Prometric:
5
Do you have an Employer Identification Number (EIN)?
Yes
No
If Yes, enter all EINs, business names, and addresses below (attach additional pages, if necessary):
EIN
Business Name
Business Address
23
For Privacy Act and Paperwork Reduction Act Notice, see page 3.
Form
(Rev. 4-2011)
Cat. No. 16233B
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