Form 4419 Application for Filing Information Returns Electronicall

(See Instructions on back)
IRS Use Only

Department of the Treasury – Internal Revenue Service

Form 4419
(Rev. 5-2010)

Application for Filing Information Returns
Electronically (FIRE)

OMB No.
1545-0387

Please type or print in BLACK ink.

1. Transmitter information
Name
Mailing Address
City

State

ZIP

2. Person to contact about this request
Name
Title

Email address

Telephone number

(

)

3. Employer Identification Number (EIN) 4. Foreign Transmitter without a TIN 5. Tax year you wish to begin filing
electronically
*Social Security Number Not Permitted
Yes
6. Will you be using your TCC only for transmitting requests for extension of time to file?

Yes

No

7. Type of Return To Be Reported (Check only types of forms you currently need to file)
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.
Forms 1097,
1098, 1099,
3921, 3922,
5498 and W-2G

Form 1042-S,
Foreign Person’s
U.S. Source Income
Subject to Withholding

Form 8955-SSA Annual
Registration Statement
Identifying Separated
Participants with Deferred
Vested Benefits

Form 8027,
Employer’s Annual
Information Return
of Tip Income and
Allocated Tips

8. Check the appropriate box:
I have or will have software which will
format my data into the IRS required format.

I have a service provider who will file
my data for me.

Note: For the forms referenced in Box 7, electronic filing does not refer to on-line fill-in forms.
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.

Title

Name (type or print)
9. Person
responsible for
preparation of
tax reports
Signature

Date

Catalog Number 41639J

Form 4419 (Rev. 5-2010)

Page 2

Form 4419 (Rev. 5-2010)

General Instructions
Paperwork Reduction Act Notice. We ask for the
information on these forms to carry out the Internal
Revenue Laws of the United States. 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 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 provide this information would vary
depending on individual circumstances. The estimated
average time is:
Preparing Form 4419 . . . . . . . . . . . . . . . . . . . . . 20 min.
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 Internal Revenue Service, Tax Products
Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111
Constitution Ave. NW, IR-6406, Washington, DC 20224.
DO NOT SEND THE FORM TO THIS OFFICE.
Instead, see the instructions below on where to file.
When completing this form, please type or print
clearly in BLACK ink.
Purpose of Form. File Form 4419 to request
authorization to file any of the forms shown in Block 7
electronically. Please be sure to complete all
appropriate blocks. If your application is approved, a
five-character alpha-numeric Transmitter Control Code
(TCC) will be assigned to your organization.
If any information on the form should change, please
write to IRS/Enterprise Computing Center - Martinsburg
so we can update our database. It is not necessary to
submit a new Form 4419.
NOTE: Do NOT use Form 4419 to request
authorization to file Forms W-2 electronically. Contact
SSA at 1-800-772-6270 if you have any questions
concerning the filing of Forms W-2.

Specific Instructions
Block 1
Enter the name and complete address of the
organization that will submit the electronic files
(transmitter).
Block 2
Enter the name, title, email address (if available) and
telephone number (with area code) of the person to
contact about this application if IRS needs additional
information. This should be a person who is knowledgeable about electronic filing of information returns.
Block 3
Enter the Employer Identification Number (EIN) of the
organization transmitting the electronic files. Social
Security Numbers are not permitted.

Block 4
If you are a foreign transmitter who does not have a
nine-digit Taxpayer Identification Number, check this box.
Block 5
Enter the tax year that you wish to start filing electronically.
Block 6
Indicate if you are requesting this Transmitter Control
Code solely for filing electronic requests for an extension
of time to file information returns.
Block 7
Check the box next to all of the returns you will file with
IRS electronically.
A separate TCC will be assigned for each box checked
in Block 7. Please make sure you submit your electronic
files using the correct TCC.
Thereafter, if you need to add any of the forms identified
in Block 7, it will be necessary to submit another Form
4419 to IRS so another TCC can be assigned.
Block 8
Indicate if your company will be filing your data with a
software package or if you have contracted to have a
service provider file your data for you. Note: The FIRE
System does not provide an on-line fill-in option for
the forms listed in Box 7. You must transmit your
data in a specific format required by IRS.
Block 9
The form must be signed and dated by an official of the
company or organization requesting authorization to
report electronically.
Mailing Address:
Send your Form 4419 to the address below:
Internal Revenue Service
Enterprise Computing Center - Martinsburg
Information Reporting Program
230 Murall Drive
Kearneysville, WV 25430
In order to ensure timely filing, submit Form 4419 at
least 30 days before the due date of the return. If you
prefer, the Form 4419 can be faxed toll-free to
(877) 477-0572, but do not do both (faxing and mailing).
The Form 4419 is subject to review before the approval to
transmit electronically is granted and may require
additional documentation at the request of IRS. We will
not issue your TCC without a signed Form 4419, and we
will not issue a TCC over the phone or by email. If you do
not receive a reply from IRS within 30 days, contact us at
the telephone number shown below. Do not submit any
files until you receive your TCC. For further information
concerning the filing of information returns with IRS
electronically, you may access www.irs.gov for Publication
1220 for the current tax year. If you do not have internet
access, you may contact the IRS Enterprise Computing
Center - Martinsburg toll-free at (866) 455-7438 between
8:30 a.m. and 4:30 p.m. Eastern Standard Time.