Form 8633 Application fo Participate in the IRS e-file Program

8
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Date

Form

I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8633, PAGE 1 OF 6
MARGINS; TOP 13mm (1⁄2"), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 648mm (251⁄2") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

8633

Action

Date

O.K. to print
Revised proofs
requested

For Official Use Only
EFIN:
ETIN:

Application to Participate in the
IRS e-file Program

(Rev. July 2003)
Department of the Treasury
Internal Revenue Service

Signature

OMB Number 1545-0991

Please check the box(es) that apply to this application:
New

Revised EFIN:

Add New Location

Reapply EFIN and /or Previous EFIN

1a Please check the box which describes your firm. (Check one box only)

b

Sole proprietorship
Partnership (number of partners with 5% or more interest) 䊳
Limited Liability Partnership
Personal Service Corporation
Limited Liability Company
State Government Agency
Local Government Agency
Credit Union
Association
Firm’s Employer Identification Number (EIN) or Social Security Number (SSN)

c

Firm’s legal name as shown on firm’s tax return

d

Doing Business As (DBA) name (if other than the name in item 1c)

e

Business location address

f

Business telephone number (

g

Mailing address of the Firm if
Country
different from the location
address only (street or P.O. box)

Country

City

Street

)

Fax Number (

Primary Contact Name
(first, middle initial, last)

j

Alternate Contact Name
(first, middle initial, last)

2
a

ZIP Code/Country Code

State

ZIP Code/Country Code

Address

h Is the firm open 12 months a year? Yes
No
If you answer “No,” please give address and telephone number
that are available 12 months of the year.
i

State

)
City

Street

Corporation
Federal Government Agency
Volunteer Organization

Telephone number

(

Title:

)

E-mail address (optional):

Phone Number: (
Title:

)

(
)
Fax Number:
E-mail address (optional):

Phone Number: (

)

Fax Number:

Please answer the following questions by checking the
appropriate box or boxes.

Yes No

3

Will you originate the submission of electronic returns
to the IRS? (Electronic Return Originator)

b Will you file as a Reporting Agent for Forms 940/941 as
defined in Revenue Procedure 96-17? (Reporting Agent)
Note: If you answer No to 2b, skip to 2c. Check Yes in
box 2c if you transmit returns you prepared.

Will you transmit returns prepared by you or those of another
ERO? (Transmitter)
d Will you transmit individual or business income tax return
information prepared by a taxpayer using commercially
purchased software or software you provide through an
on-line Internet site? (On-line Provider)

TCE (Tax Counseling for the Elderly)

4

5

Will you write electronic filing software? (Software Developer)
Will you receive tax return information from EROs, or
from taxpayers who have prepared their own returns
using commercial software, or on an Internet site,
process the information, and either forward it to a
transmitter, or send the information back to the ERO?
(Intermediate Service Provider)

Check the individual and/or business form types you will e-file for:
940

941

990

1040

ETD

1041

1065

1120

1120 POL

State Ack

If you are a transmitter/software developer and checked the 940
or 941 box, please check the software format which applies:
940

XML

Non-EDI

On-line Non-EDI

941

XML

Non-EDI

EDI

On-line

On-line Non-EDI
Yes No

6

(If you answer YES, please follow the instructions on
Page 3 for Line 2d.)
f

Employee Member Benefit

Check the 1120 box for 1120 and 1120S. Check the 990 box for
990, 990-EZ, and 8868. See instructions for additional information
on check boxes State Ack and ETD.

c

e

)

If you are a Not for Profit service, check the one box that applies
below:
TAC (Tax Assistance Center)
VITA
Military Base

Are you currently listed on the IRS Reporting Agent’s File
(RAF) for this EIN?
(If you answer NO, you must furnish complete,
signed copies of your Forms 8655 for the clients for
whom you intend to file returns. You must also
furnish a list of your clients containing the Business
Name and EIN (Agents List).

(

See Paperwork Reduction Act Notice and Privacy Act Notice on page 4.

Has the firm failed to file business tax returns, or pay
tax liabilites under U.S. Internal Revenue laws? (Please
attach an explanation for a “Yes” response.)

Cat. No. 64225N

Form

8633

(Rev. 7-2003)

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8633, PAGE 2 OF 6
MARGINS; TOP 13mm (1⁄2"), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 648mm (251⁄2") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8633 (Rev. 7-2003)

7

Page

2

Principals of Your Firm or Organization

Do not complete this section if you are adding a new location or you checked a box on Line 3, Page 1. If you are a sole proprietor, list your name, home address,
social security number, and respond to each question. If your firm is a partnership, list the name, home address, social security number, and respond to each question
for each partner who has a five percent (5%) or more interest in the partnership. If you are a partnership and no partners have at least 5% interest in the partnership,
list the name, title, home address, social security number, and respond to each question for at least one individual authorized to act for the firm in legal and/or tax
matters. (You may use continuation sheets.) If your firm is a corporation, list the name, title, home address, social security number, and respond to each question for
the President, Vice-President, Secretary, and Treasurer of the corporation. The signature of each person listed authorizes the Internal Revenue Service to conduct a
credit check on that individual.
Type or print name (first, middle, last)

U.S. citizenship?

Are you a/an:
Legal
resident
alien

Title:
Home address

Yes
No
Social Security Number

attorney
banking official
C.P.A.
enrolled agent

officer of a
publicly owned
corporation
None apply
(Fingerprint
Card Required)

Are you licensed or bonded
in accordance with state or
local requirements?
Yes
No
Not applicable

enrolled agent #_________
Have you ever been assessed any preparer penalties, been convicted of a
crime, failed to file personal tax returns, or pay tax liabilites, or been convicted
of any criminal offense under the U.S. Internal Revenue laws?
Yes
No
(Please attach an explanation for a “Yes” response.)
Date of birth (month, day, year)

Signature

U.S. citizenship?

Are you a/an:

Add

Delete

E-mail (optional):
Type or print name (first, middle, last)

Legal
resident
alien

Title:
Home address

Yes
No
Social Security Number

attorney
banking official
C.P.A.
enrolled agent

officer of a
publicly owned
corporation
None apply
(Fingerprint
Card Required)

Are you licensed or bonded
in accordance with state or
local requirements?
Yes
No
Not applicable

enrolled agent #_________
Have you ever been assessed any preparer penalties, been convicted of a
crime, failed to file personal tax returns, or pay tax liabilites, or been convicted
of any criminal offense under the U.S. Internal Revenue laws?
Yes
No
(Please attach an explanation for a “Yes” response.)
Date of birth (month, day, year)

Signature

Add

Delete

E-mail (optional):

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Responsible Official (Please complete this section and provide signature even if it is the same as Line 7.) A Not for Profit service
selected in a box on Line 3, Page 1, must complete this section.

The responsible official is the individual with responsibility for and authority over the operations at designated sites. The responsible official is the first point of contact
with the IRS, has the authority to sign revised applications, and is responsible for ensuring that all requirements of the IRS e-file program are adhered to. A responsible
official may be responsible for more than one office. A principal listed in Section 7 may also be a responsible official.
Name of responsible official (first, middle initial, last)

Title:
Home address

U.S. citizenship?

Are you a/an:
Legal
resident
alien

Yes
No
Social Security Number

attorney
banking official
C.P.A.
enrolled agent

officer of a
publicly owned
corporation
None apply
(Fingerprint
Card Required)

Are you licensed or bonded
in accordance with state or
local requirements?
Yes
No
Not applicable

enrolled agent #_________
Have you ever been assessed any preparer penalties, been convicted of a
crime, failed to file personal tax returns, or pay tax liabilites, or been convicted
of any criminal offense under the U.S. Internal Revenue laws?
Yes
No
(Please attach an explanation for a “Yes” response.)
Date of birth (month, day, year)

Signature

E-mail (optional):

Applicant Agreement
Under the penalties of perjury, I declare that I have examined this application and read all accompanying information, and to the best of my knowledge and belief,
the information being provided is true, correct, and complete. This firm and employees will comply with all of the provisions of the Revenue Procedure for Electronic
Filing of Individual Income Tax Returns and Business Tax Returns, and related publications, for each year of our participation.
Acceptance for participation is not transferable. I understand that if this firm is sold or its organizational structure changes, a new application must be filed. I
further understand that noncompliance will result in the firm’s and/or the individuals listed on this application, being suspended from participation in the IRS e-file
program. I am authorized to make and sign this statement on behalf of the firm.
9

Name and title of Principal, Partner, or Owner (type or print)

10

Signature of Principal, Partner, or Owner

11

Date

8
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8633, PAGE 3 OF 6
MARGINS; TOP 13mm (1⁄2"), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 648mm (251⁄2") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8633 (Rev. 7-2003)

New! New! This Form 8633 is the new
combined form to use to apply to be an
authorized e-file provider of any of the
Individual or Business e-file programs.

Filing Requirements
Who to Contact for Answers: If you
have questions and don’t know where to
get answers, call toll free,
1-866-255-0654. If this is a foreign call,
call the non-toll-free number
01-512-416-7750. For additional
information about Business e-file
programs, see the following publications:
Publication 1524, Procedures for the
Form 1065 e-file Programs; Publication
1525, File Specifications for Form 1065
e-file; Publication 1855, Technical
Specifications Guide for the Electronic
Filing of Form 941; Publication 3715,
Technical Specifications Guide for the
Electronic Filing of Form 940;
Publication 1437, Procedures for
Electronic Filing of Form 1041; and
Publication 1438, File Specifications for
Form 1041.
Who Must File Form 8633. (1) New
applicants (including foreign filers) and
(2) Current participants revising a
previously submitted Form 8633, in
accordance with the IRS e-file program
requirements outlined in Publication
1345, Handbook For Authorized IRS
e-file Providers. In some instances, you
may revise your application by calling
1-866-255-0654.
Note: Those transmitters and software
developers who are planning to transmit
Forms 990, 990-EZ, 1120, 1120S,
1120-POL, or 8868 through the Internet
must apply using the on-line e-file
application instead of completing
Form 8633.
When to File: New Applications— Year
Round Application Acceptance.
Effective August 1, 2003, paper
applications are accepted all year for
individuals and business e-file programs.
This change allows individual and
business e-file applicants the
opportunity to apply to participate in the
e-file program at any given time.
Additionally, the on-line e-file application
offers the same year round application
process. It is recommended that you
submit your completed application 45
days prior to the date you intend to
begin filing returns electronically
(business and/or individual).
Reapply—complete an application to
reapply to the program if you were
suspended and want to be reconsidered
or if you were dropped from the program
and would like to continue. Please
remember to include your previously
assigned EFIN.
Where to File. Send Form(s) 8633 to the
Andover Campus. (See Page 4 for
mailing addresses.)

Page

How to Complete the Form
Page 1
Please check all boxes which apply to
this application.
Line 1b.—If your firm is a partnership or
a corporation, provide the firm’s
employer identification number (EIN). If
your firm is a sole proprietorship, with
employees, provide the business
employer identification number (EIN). If
you do not have employees, provide
your social security number (SSN).
Line 1c.—If your firm is a sole
proprietorship, enter the name of the
sole proprietor. If your firm is a
partnership or corporation, enter the
name shown on the firm’s tax return. If
submitting a revised application, and the
firm’s legal name is not changing, be
sure this entry is identical to your
original application.
Line 1d.—If, for the purpose of IRS
e-file, you or your firm use a “doing
business as” (DBA) name(s) other than
the name on line 1a, include the name(s)
on this line. Use an attachment sheet if
necessary to list all names.
Line 1e.—Address of the location of the
firm. A Post Office box (P.O. box) will not
be accepted as the location of your firm.
Line 1g.—Mailing address if different
from the business address. Include P.O.
box if applicable. You must provide a
year-round mailing address.
Lines 1i and 1j.—Contact names must
be available on a daily basis to answer
IRS questions during testing and
throughout the processing year.
Line 2d.—1040 on-line filing applicants
must also provide the following
information on a separate sheet of
paper:
1. The brand name of the software the
applicant will be using, has developed,
or will be transmitting, including the
name of the software developer; the
name of the transmitter for the software;
the retail cost of the software; any
additional costs for transmitting the
electronic portion of the taxpayer’s
return; whether the software can be
used for Federal/State returns; whether
the software is available on the Internet
and if so, the Internet address; the
professional package name of the
software submitted for testing;
2. The applicant’s point of contact
(including telephone number) for matters
relating to on-line filing, and the
applicant’s customer service number;
3. The procedures the applicant will use
to ensure that no more than five returns
are transmitted from one software
package or from one e-mail address;
and
4. The website URL of the on-line filer
Line 3.—Check the box that applies.

3

Line 4.— ETD - (Forms 56, 2350, 2688,
4868, 9465) Electronic Transmittted
Documents - stand alone documents
that are e-filed apart from any other
returns but for the purpose of e-file
application, are grouped together to
establish the need for a transmitter
communications test.
State Ack (Restricted to Software
Developers or Transmitters) acknowledgement files transmitted by
the state taxing agency to the IRS,
containing the results of the state e-filed
returns for pick-up by the original
transmitter of the return.
Line 6.—Misrepresentation when
answering this question will result in the
rejection of your application to
participate in the IRS e-file Program. If
your application is denied, you will be
able to apply again for participation two
years from the date of the denial letter.

Page 2
Lines 7 and 8.—Each individual listed
must be a U.S. citizen or legal resident
alien (lawful permanent resident), have
attained the age of 21 as of the date of
the application, and if applying to be an
Electronic Return Originator, meet state
and local licensing and/or bonding
requirements. Fingerprints must be taken
by a trained specialist. Individuals
CANNOT take their own fingerprints.
The e-file program fingerprint cards are
unique and should be obtained by
calling the Andover Campus at
1-866-255-0654.
Unless you marked a box on Line 3,
Page 1, or your only “Yes” response in
section 2 is question e, you must
provide a completed fingerprint card for
each responsible official, corporate
officer, owner, or partner listed on Lines
7 and 8. If a corporate officer, owner, or
partner changes, a completed fingerprint
card must be provided for each new
corporate officer, owner, or partner. If the
corporate officer, owner, or partner is an
attorney, banking official who is bonded
and has been fingerprinted in the last
two years, CPA, enrolled agent, or an
officer of a publicly owned corporation,
evidence of current professional status
may be submitted in lieu of the
fingerprint card (see Revenue
Procedures). Your application will not
be processed if you do not provide a
completed fingerprint card or
evidence of professional status and
the signature of each responsible
official, corporate officer, partner, and
owner.
Line 6 instruction also applies to Line
7 and Line 8. Attach an explanation for a
“Yes” response to the suitability
question.
Lines 9–11—Signature Lines.—A
principal, partner, or the owner of the
firm must sign new applications.
Responsible Officials may sign revised
applications.

8
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8633, PAGE 4 OF 6
MARGINS; TOP 13mm (1⁄2"), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 648mm (251⁄2") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8633 (Rev. 7-2003)

Page

4

Mail your application(s) to the address shown below.
Daytime:

Internal Revenue Service
Andover Campus
Attn: EFU Acceptance
Testing Stop 983
P.O. Box 4099
Woburn, MA 01888-4099

Overnight Mail: Internal Revenue Service
Andover Campus
Attn: EFU Acceptance
Testing Stop 983
310 Lowell Street
Andover, MA 05501-0001

NOTE: The Andover Campus is a secured building, unauthorized access not permitted. Applications/Fingerprint cards
received/disbursed by MAIL ONLY.
Call 1-866-255-0654 to obtain fingerprint cards. Approved fingerprint cards can only be obtained at the Andover Campus.
Privacy Act Notice.—The Privacy Act of
1974 requires that when we ask for
information we tell you our legal right to
ask for the information, why we are
asking for it, and how it will be used. We
must also tell you what could happen if
we do not receive it, and whether your
response is voluntary, required to obtain
a benefit, or mandatory.
Our legal right to ask for information is
5 U.S.C. 301, 5 U.S.C. 500, 551-559,
31 U.S.C. 330, and Executive Order
9397.
We are asking for this information to
verify your standing as a person
qualified to participate in the electronic
filing program. The information you
provide may be disclosed to the FBI and
other agencies for background checks,
to credit bureaus for credit checks, and
to third parties to determine your
suitability.
The IRS also may be compelled to
disclose information to the public. In
response to requests made under 5

U.S.C. 552, the Freedom of Information
Act, information that may be released
could include your name and business
address and whether you are licensed or
bonded in accordance with state or local
requirements.
Your response is voluntary. However, if
you do not provide the requested
information, you could be disqualified
from participating in the IRS e-file
program.
If you provide fraudulent information,
you may be subject to criminal
prosecution.
Paperwork Reduction Act Notice. We
ask for the information on this form to
carry out the Internal Revenue laws of
the United States. You must give us the
information if you wish to participate in
the IRS e-file program. We need it to
process your application to file individual
income tax returns electronically.
You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act

unless the form displays a valid OMB
control number. Books or records
relating to a form or its instructions must
be retained as long as their contents
may become material in the
administration of any Internal Revenue
law.
Generally, tax returns and return
information are confidential, as required
by Code section 6103. The time needed
to complete this form will vary
depending on the individual
circumstances. The estimated time is 60
minutes. If you have comments
concerning the accuracy of this time
estimate or suggestions for making this
form simpler, we would be happy to
hear from you.
You can write to the Tax Products
Coordinating Committee, Western Area
Distribution Center, Rancho Cordova, CA
95743-0001. DO NOT send this
application to this office. Instead, see
Where to File on page 3.

8
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8633, PAGE 5 OF 6 (Page 6 is blank)
MARGINS; TOP 13mm (1⁄2"), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 648mm (251⁄2") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Page

Form 8633 (Rev. 7-2003)

5

FORM 8633 ACCURACY CHECKLIST
Please answer this checklist after you have completed your application. Failure to correctly provide all of the information
needed on your application can result in the application being returned to you.
1. Is your Form 8633 the most current application?
Yes
No
If the revision date is not July 2003, your application may be returned.
2. Did you complete 1e and 1g?
Yes
No
Your application may be returned to you if 1e and 1g are incomplete. However, if your business address in 1e is the same
as your mailing address, you are not required to complete 1g.
3.

Did you read all of Section 7? Did you provide us with a fingerprint card for all principals of your firm who are not
exempt, evidence of professional status on those who are exempt, and all original signatures?
Yes
No
Acceptable evidence of current professional status consists of the following:
CPA CERTIFICATION—copy of current state license. (LPAs are not considered exempt/fingerprint cards required)
ENROLLED AGENT—copy of current enrollment card issued by the IRS
ATTORNEY—copy of credentials
BANK OFFICIAL—a copy of the bonding certificate and proof of fingerprinting within the last two years
OFFICER OF A PUBLICLY OWNED CORPORATION—a copy on corporate letterhead which carries the name of the officer,
the stock symbol, the exchange where listed, and the name under which the stock is traded for the individual listed in
section 7 or 8 on Form 8633.

4.

Have the principals and responsible officials of your firm reached age 21 as of the date on your
application?
Yes
No
Your application will be rejected if anyone listed is under the age of 21.

5.

Have you been suspended from the IRS e-file program?
Yes
No
If you answer Yes, your suspension period must be complete. Please call the Andover Campus at: 1-866-255-0654 (toll
free) to verify this information.

6.

Did you remember to provide original signatures for 7, 8, and 10?
Yes
No
If you failed to provide signatures in the areas listed above, your application will be returned.

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