Form 4419 Application for Filing Information Returns Electronicall

OMB Number
1545-0387

Department of the Treasury - Internal Revenue Service

Form

4419

(June 2018)

Application for Filing Information
Returns Electronically (FIRE)

IRS Use Only

Revised Form 4419
Current Transmitter Control Code (TCC) (revised only) (refer to instructions page 2)
1. Transmitter and/or Payer information
Legal name (associated with EIN in Block 2)

Mailing address

City

State

ZIP code

2. Employer Identification Number (EIN) (SSN not permitted)

4. What Tax Year will electronic filing begin

3. Is the request for a foreign transmitter without a TIN
Yes
No

5. Check the box(es) next to the returns you will file electronically
Note: IRS encourages transmitters who file for multiple payers to submit one application and use the assigned TCC for all payers.
Forms 1097, 1098, 1099, 3921, 3922, 5498 and W-2G (See Publication 1220)
Form 1042-S, Foreign Person’s U.S. Source Income Subject to Withholding (See Publication 1187)
Form 8027, Employer’s Annual Information Return of Tip Income and Allocated Tips (See Publication 1239)
Form 8955-SSA, Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits
(See Publication 4810)

I have read the following FIRE System requirement: In order to file electronically through the FIRE System, you must have
software or a service provider that will create the file in the standard ASCII format. The FIRE System does not provide an on-line
fill-in option. You must transmit your data in the specific format required by IRS.
6. Person to contact about this request
Name

Position title

Email address

7.

Telephone number

I have read the Affidavit in the Instructions on page 2 and I am authorized to sign the document on behalf of the transmitter and/
or payer.

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.
8. Official of the company or organization
Name

Position title

Signature (a computer generated signature is not acceptable)

Date

For Privacy Act and Paperwork Reduction Act Notice, see Instructions.

Catalog Number 41639J

www.irs.gov

Form 4419 (Rev. 6-2018)

Page 2

General Instructions
Purpose of Form: Submit Form 4419 to request authorization to
electronically file any of the forms shown in Block 6. Complete all
required information. If your application is approved, a five-character
alphanumeric Transmitter Control Code (TCC) will be assigned to your
organization.
Note: In order to file electronically through the FIRE System, you must
have software or a service provider that will create the file in the standard
ASCII format. A scanned or PDF document will not be accepted.
Forms W-2: Do not use Form 4419 to request authorization to
electronically file Form W-2. Form W-2 information is only sent to the
Social Security Administration (SSA). Refer to Social Security
Administration (SSA) website at https://www.ssa.gov/.
This application is subject to review before the approval to transmit
electronically is granted and may require additional documentation at the
request of the IRS. If a determination is made concerning the validity of
the information returns transmitted electronically, IRS has the authority to
revoke the TCC and terminate the release of files.

Block 7 – Affidavit. This application must be completed and submitted
by: (a) the owner, if the applicant is a sole proprietorship, (b) the
president, vice president, or other principal officer, if the applicant is a
corporation, (c) a responsible and duly authorized member or officer
having knowledge of its affairs, if the applicant is a partnership,
government entity, or other unincorporated organization, or (d) the
fiduciary, if the applicant is a trust or an estate.
Check the box to confirm that you have read the affidavit and are
authorized to sign on behalf of the transmitter and/or payer. Required.
Block 8 - The form must be signed and dated by an official of the
company or organization requesting authorization to file electronically.
Required.
For further information concerning the electronic filing of information
returns, visit IRS.gov. The following publications are available:
• Publication 1220, Specifications for Electronically Filing Form 1097,
1098, 1099, 3921, 3922, 5498, and W-2G
• Publication 1187, Specifications for Electronically Filing Form
1042-S, Foreign Person's U.S. Source Income Subject to
Withholding

You may not need more than one TCC. Transmitters who file for
multiple payers may submit one application and use the assigned
Transmitter Control Code (TCC) for all payers. You may transmit files for
as many companies as you need under the one TCC.

• Publication 1239, Specifications for Electronically Filing Form 8027,
Employers Annual Information Return of Tip Income and Allocated
Tips

We will delete your TCC if you don’t file your information returns for two
consecutive tax years. Once deleted from our database, you will need to
submit another Form 4419.
Revised Form 4419 information: Check the box located at the top of
Form 4419 and provide the current TCC assigned to the business. A
revised Form 4419 can only be submitted if you are updating information
for a previously submitted and approved Form 4419 for the following
information:
• Block 1 - Legal name and address
• Block 6 - Person to contact or contact information

• Publication 4810, Specifications for Electronically Filing Form
8955-SSA, Annual Registration Statement Identifying Separated
Participants and Deferred Vested Benefits Paperwork

How to submit Form 4419:
• Fill-In Form 4419 at https://fire.irs.gov.
• Mail or Fax Form 4419 to:
Internal Revenue Service
230 Murall Drive, Mail Stop 4360
Kearneysville, WV 25430
Fax: (877) 477-0572 (within the U.S)
(304) 579-4105 (International)

Note: A revised Form 4419 can only be submitted on paper.
Changes to the blocks listed below require you to submit a new Form
4419. A new TCC will be assigned to the transmitter/payer.
(Do not check the Revised box.)
• Block 2 - EIN
• Block 5 - Type of return to be reported

Contact the IRS Monday through Friday
• (866) 455-7438 (Toll Free)
• (304) 263-8700 (International)
Note: A TCC will not be issued over the phone or via email.
If you don’t receive your TCC within 45 days, contact the IRS at the
phone numbers listed above.

Specific Instructions
Due Date: Submit Form 4419 at least 45 days before the due date of the
return to ensure timely filing.
When completing this form, please print or type clearly.
Block 1 - Enter the legal name associated with the EIN in Block 2 and
the complete address of the organization that will submit electronic files
(transmitter and/or payer). Required.
Block 2 - Enter the Employer Identification Number (EIN), Qualified
Intermediary Number (QI-EIN), Withholding Partnership Number
(WP-EIN), or Withholding Trust Number (WT-EIN) of the organization
transmitting the electronic files. Social Security Numbers (SSN) are not
permitted. Required.
Block 3 - Check the appropriate box to indicate if you are a foreign
transmitter who does not have a nine-digit Taxpayer Identification
Number. Required.
Block 4 - Enter the tax year that you wish to begin filing electronically.
Required.
Block 5 - Only check the box next to the returns you will electronically
file with the IRS. A separate TCC will be assigned for each box checked
in Block 5. Required.
Check the box to indicate you have read the requirements to transmit
information returns through the FIRE System.
Block 6 - Enter the name, position title, email address and telephone
number (with area code) of the person to contact about this application.
This should be a person who is knowledgeable about the electronic filing
of your information returns. Required.

Catalog Number 41639J

Privacy Act and Paperwork Reduction Act Notice
The authority for requesting this information is Internal Revenue Code sections
7801, 6011(f) and 6109. The primary purpose for requesting the information is to
identify you and to verify your fitness to transmit returns using the Filing Information
Returns Electronically (FIRE) System. Your response is mandatory if you are
required to file returns electronically. If you do not provide all or part of the
information, we may not be able to process your application; providing false or
fraudulent information may subject you to penalties. We may give this information
to the Department of Justice for use in civil and/or criminal litigation, to the public to
help identify approved electronic filing practitioners, and to cities, states, the District
of Columbia, and U.S. commonwealths and possessions for use in administering
their tax laws. We may also disclose this information to other countries under a tax
treaty, to federal and state agencies to enforce federal nontax criminal laws, and to
federal law enforcement and intelligence agencies to combat terrorism.
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 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. Write to the Tax
Forms Committee, Western Area Distribution Center, Rancho Cordova, CA
95743-0001. DO NOT SEND FORM 4419 TO THIS OFFICE. Refer to the
instructions above on where to mail or fax.

www.irs.gov

Form 4419 (Rev. 6-2018)