Fillable F13551 Form 13551 (Rev. 6-2019)

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F13551 Form 13551 (Rev. 6-2019)

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Catalog Number 38262Q www.irs.gov
Form 13551 (Rev. 6-2019)
Form 13551
(June 2019)
Department of the Treasury - Internal Revenue Service
Application to Participate in the
IRS Acceptance Agent Program
(Read the instructions carefully before completing this Form)
OMB Number 1545-1896
For Official Use Only
Control number
Check the type of acceptance agent for
which you are applying
Acceptance Agent (AA)
Certifying Acceptance Agent (CAA)
Application Type
New
Renewal
Amended (attach signed explanation)
If you are amending your application, select the reason below
Authorized Representative Business Location
Acceptance Agent Type
Other
1. Check the box that best describes Organization status
Financial Institution
Educational Institution
Casino
Partnership
Government Agency or Military Organization
Corporation
LLC
Sole Proprietorship
Other
Professional Status of Authorized Representative (Individual
Listed on Line 5)
Tax Preparer CPA*
ERO
Attorney*
Enrolled Agent* (Enter number)
Other
(specify)
*See instructions for proof requirements
2. Legal Name of Business (If an entity, also enter location where organized or created)
and Name and PTIN of Principal Partner or Owner of the Business (See Instructions)
3. Business Electronic Filing Identification Number (EFIN)
4. Business Employer Identification Number (EIN) (Required)
5. Name and PTIN of Authorized Representative of the Business
(first, middle, last, PTIN)
6. Date of birth
(month, day, year)
7. Social Security Number (SSN) or Individual Taxpayer
Identification Number (ITIN)
8. Home address (street, city/county, state/country, and ZIP code/
foreign postal code) of individual listed on Line 5
9. Check the appropriate box
U.S. Citizen
Nonresident Alien**
U.S. Resident Alien*
*Attach copy of green card
**Attach copy of visa if residing
in the U.S.
10. Have you ever been assessed any preparer penalties,
been convicted of a crime, failed to file personal tax
returns, or pay tax liabilities, or been convicted of any
criminal offense under the U.S. Internal Revenue laws
Yes No
(Attach an explanation and fingerprint cards for a “Yes”
response.)
11. Doing Business As (DBA) name (complete only if the business is operating under a name which is different than the business name listed on Line 2)
12. Business location address* Street City/County State/Country ZIP Code/Foreign Postal Code
*If more than one location, attach continuation sheets for each location and authorized representative(s) with required information.
13. Business telephone number
( )
Fax number
( )
Email
14. Mailing address of the Business if different from the location address on line 12
Number and street City/County State/Country ZIP Code/Foreign Postal Code
15. Does the Business provide tax related services year round
Yes No
If “No,” provide a brief explanation why
15a. How many Form W-7 applications does the Business plan to submit within a 12-month calendar period
16. Complete the following information for Primary Contact if different than the authorized representative on Line 5 (see instructions)
Primary Contact name (first, middle initial, last)
Title Email address
Phone number ( ) Fax number ( )
17. Complete the following information for Alternate Contact if different than the individual listed on Line 5 (see instructions)
Alternate Contact name (first, middle initial, last)
Title Email address
Phone number ( ) Fax number ( )
18. Identify the activities performed by you or your organization (tax preparation, University, etc.) as well as the type of customers that you will service (foreign
investors, foreign students, etc.) to validate your request for Acceptance Agent status (see instructions)
19. If you would like to be included on the published list of Acceptance Agents located on the IRS website, check here
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. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for
Acceptance Agents and related publications each year of our participation. Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational
structure changes, a new application must be filed. I further understand that noncompliance will result in the institution and/or the individuals listed on this application, being suspended
from participation in the IRS Acceptance Agent Program. I am authorized to make and sign this statement on behalf of the institution.
20. Name and title of Authorized Representative from line 5 (type or print)
21. Signature of Authorized Representative
22. Date
Name and title of Principal, Partner or Owner from line 2 (type or print)
Signature of Principal, Partner or Owner
Date
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Your response is voluntary. 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 estimated average time to complete this form is 30 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for
making this form simpler, we will 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, Washington, DC 20224. Do NOT send this form to this
address. Instead, enclose it with the magnetic tape and send it to the Service Center to which you submit your tapes or send it to the transmission reception site that received your transmitted returns.
Page 2
Catalog Number 38262Q www.irs.gov
Form 13551 (Rev. 6-2019)
Instructions for Form 13551, Application to Participate in the IRS Acceptance Agent Program
General Instructions
Purpose of this Form. All persons who wish to participate in the TIN (Taxpayer Identification Number)
Acceptance Agent Program must apply by completing this application.
What is an Acceptance Agent/Certifying Acceptance Agent. Acceptance agents are individuals or
entities (colleges, financial institutions, accounting firms, etc.) that have entered into formal agreements
with the IRS that permit them to assist alien individuals and other foreign persons with obtaining TINs.
The type of duties that you are permitted to perform is based upon your application to become an
Acceptance Agent (AA) or a Certifying Acceptance Agent (CAA). (See Revenue Procedure 2006-10 for
additional information.)
Who May Apply. Persons eligible to become acceptance agents include a financial institution defined in
section 265(b)(5) of the Internal Revenue Code (Code) or §1.165-12(c)(1)(iv) of the regulations, a
college or university that is an educational organization defined in §1.501(c)(3)-1(d)(3)(i), a federal
agency defined in section 6402(h) of the Code, state and local governments, including agencies
responsible for vital records, community-based organizations defined in section 501(c)(3) or (d) of the
Code, persons that provide assistance to taxpayers in the preparation of their tax returns, and any other
person or categories of persons that may be authorized by regulations or IRS procedures. An eligible
person may be a U.S. person or a foreign person. Each individual listed as a Principal, Partner or
Owner of the business, authorized representative or primary/ alternate contact of the business must
have attained the age of 18 as of the date of this application.
When to Apply. New and renewal applications may be submitted year-round. However, to prevent
interruption of your business operations, a renewal application should be submitted at least six months
before the expiration date of your Agreement. It can take up to 120 days (four months) from the time
that you submit your application to receive your approved Acceptance Agent Agreement from IRS.
How to Apply. All new and renewing persons will be required to complete Form 13551 (Application to
Participate in the IRS Acceptance Agent Program). In addition, there must be an attached fingerprint
card or proof of professional status for each individual listed on Line 5 as an Authorized Representative
(see instructions for fingerprint cards below.) Prior to applying for Acceptance Agent Status, mandatory
Acceptance Agent training must be completed and the certificate at the end of the training must be
signed and attached to your Form 13551 when submitting it to IRS. To be valid, the mandatory training
certificate must be dated within 120 days of the date entered on Line 22. The training is available online
at www.IRS.gov/itinagents. Original forensic document training certificates for new and renewal
applications submitted by CAAs must also be attached. Note: Your application to become a CAA will
not be processed if you do not attach a signed mandatory Acceptance Agent training certificate. If
applying as a CAA, you must also attach an original forensic document training certificate for each
Authorized Representative.
Fingerprint Cards. Each individual listed as a responsible party or authorized representative of the
business must be age 18 or older as of the date of this application. If the authorized representative is an
Electronic Return Originator (ERO), fingerprint cards are not required. The authorized representative
must be listed as a Responsible Official on the EFIN to be exempt from the fingerprint requirement. If
the authorized representative is an attorney, CPA or enrolled agent, but not an ERO, evidence of U.S.
professional status may be submitted instead of the fingerprint card. If an ERO, include your EFIN on
Line 3. The following organizations are exempt from the fingerprinting requirement: a financial institution
within the meaning of I.R.C. 265(b)(5) or Treasury Regulations 1.1 65-1 2(c)(1)(iv), a college or
university that qualifies as an educational organization under Treasury Regulations 1.501 (c)(3)-l (d)(3)
(i), a casino, Federal agencies as defined in IRC 6402(g) an ERO in good standing with the IRS and
foreign nationals without a Social Security Number (SSN) residing outside the United States. (Evidence
of your professional status may be obtained by contacting the issuing authority.)
Note: Individuals CANNOT take their own fingerprints. The fingerprint card used for the Acceptance
Agent Program is unique, and should be obtained by calling the IRS Austin Campus at 1-866-255-0654.
If the authorized representative of the business changes, the business must submit an amended
application, including a new fingerprint card, if required, for the authorized representative. Your
application will not be processed if you do not provide a completed fingerprint card or evidence of
professional status and the original signature of both the authorized representative and the principal,
partner or owner or owner of the business. Faxed copies or photocopies of this application will not be
accepted.
When to Update Information. Acceptance Agents must notify the IRS within 30 days of all changes to
the information they originally submitted on this application, by completing another Form 13551,
checking the “amended” box and attaching a signed statement explaining the changes. This is important
for several reasons. If information is not up-to-date on our database, you may not receive important IRS
information or correspondence. Be sure to fully complete the application and only change the
information that is different from what was originally submitted on Form 13551. The revised Form 13551
will not change your address of record for tax purposes, nor will it automatically update information
associated with your Employer Identification Number (EIN). It can take up to 90 days to process an
amended application.
Where to Apply. Faxed copies or photocopies of this application will not be accepted. Mail Form
13551, along with your completed fingerprint card or evidence of professional status if required, forensic
document training certificate (if applying as a CAA), and mandatory Acceptance Agent training
certificate to:
Internal Revenue Service
3651 S. IH 35
Stop 6380AUSC
Austin, TX 78741
Note: Be sure that your application is complete and contains the signatures of both the authorized
representative and principal, partner or owner of the original business. (See instructions for Line 20.) To
be valid, the mandatory training certification must be dated within 120 days of the date entered on Line
22.
Who to Contact for Assistance. If you need additional assistance in completing this application you
can email the ITIN Policy Section at itinprogramoffice@irs.gov
where someone will respond to you.
For additional information about Acceptance Agents, refer to Revenue Procedure 2006-10. For
additional information about the Form W-7, see Publication 1915 Understanding Your Individual
Taxpayer Identification Number - ITIN.
How To Complete The Form Check the applicable box to indicate if you are (1) a New applicant, (i.e.,
the first time that the business is applying for AA/CAA status or your agreement has already expired),
(2) seeking Renewal of a AA/CAA Agreement that will be expiring or (3) Amending information on a
business that is already an AA/CAA (i.e. submitting an application for a new authorized representative;
changing primary or alternate contacts, etc.). See Revenue Procedure 2006-10 for additional
information on Acceptance Agents. For additional information on submitting an amended application,
see “When to Update Information” above.
Line 1. Check the box which best describes the organizational status of the business. If the “Other” box
is checked, please insert a brief explanation that best describes the organizational status. Also check
the box that best describes the professional status of the applicant. CPAs, Attorneys and Enrolled
Agents must attach a copy of an unexpired credential. For example, a valid CPA license, a record from
the state bar, or Enrolled Agent enrollment card. If the “Other” box is checked, please insert a brief
explanation that best describes the professional status. If you are applying for Acceptance Agent status
as a nonprofit organization, attach a copy of your IRS exemption letter.
Line 2. Enter the legal name of the business and the name of the principal, partner or owner of the
business along with their PTIN (Preparer Tax Identification Number) if one was issued. A PTIN must be
obtained by all enrolled agents, as well as all tax return preparers who are compensated for preparing,
or assisting in the preparation of, all or substantially all of any U.S. federal tax return. If your firm is a
sole proprietorship, enter the name of the sole proprietor. If the applicant is an entity, provide the state,
including the District of Columbia (or if outside the United States, the country under whose laws the
entity was created or organized). If submitting an amended application and the legal name of the
business is not changing, be sure this entry is identical to the one on your original application. The
Principal, Partner or Owner of the business is defined below: For entitles with shares of interests traded
on a public exchange, or which are registered with the Securities and Exchange Commission, that
individual is (a) the “principal” officer if the business is a corporation, (b) a general “partner”, if a
partnership, (c) the “owner” of an entity that is disregarded as separate from its owner, or (d) a grantor,
owner or trustor, if a trust. For all other entities, it is the person who has a level of control over, or
entitlement to, the funds or assets in the entity that, as a practical matter, enables the individual,
directly or indirectly, to control, manage or direct the entity and the disposition of its funds and assets
Line 3. If the business is already an authorized IRS e-file provider, enter the EFIN (Electronic Filing
Identification Number). An authorized IRS e-file provider is a business (sole proprietorship, partnership,
corporation or other entity) that has been accepted into the IRS e-filing program and has been assigned
an electronic filing identification number. The EFIN must be the registered number for the location
specified and EIN.
Line 4. Enter the IRS issued Employer Identification Number (EIN). Note: All applicants must obtain an
EIN before submitting this application.
Line 5. Enter the name, title and PTIN of the authorized representative. This person will be the official
point of contact with the IRS and is responsible for ensuring that all requirements of the Acceptance
Agent program are followed. They are the only individuals, other than the principal, partner or owner (if
also listed as an authorized representative), who have authority to sign the Certificates of Accuracy.
Each business location is permitted to select up to ten authorized representatives. If you need extra
space to add additional authorized representatives for the business location listed on Page 1, or for
additional business locations, use the continuation sheet attached to the Form 13551.
Line 6. Enter the date of birth of the authorized representative of the business listed on Line 5. This
information should be entered in mm/dd/yyyy format (i.e. April 15, 1950, should be entered as
04/15/1950).
Line 7. Enter the Social Security Number or TIN of the authorized representative of the business. If you
are a foreign national living outside the U.S. and do not have an SSN or ITIN, please enter N/A.
Line 8. Enter the complete home address of the authorized representative of the business (street, city/
county, state/country and zip code/foreign postal code).
Line 9. Check the box which describes the legal status (in the U.S.) of the person entered on line 5.
Attach a copy of the green card or visa, if you are not a U.S. citizen but are residing in the U.S.
Line 10. If you answered “Yes” to the suitability question in box 10, please provide an explanation
including dates and circumstances and why you believe that it should not affect your fitness to be an
AA/CAA. You will also need to attach fingerprint cards with your application.
Line 11. For the purpose of becoming an acceptance agent, if a “doing business as” (DBA) name is
used other than the name provided on Line 2, enter that information here and include a brief
explanation. Use an additional sheet of paper if you need more space. Note: The business will be
authorized to operate as an AA/CAA only under the name provided here or on Line 2.
Line 12. Enter the complete street address, city/county, state/country and zip code/foreign postal code
where the business is located. Note: A post office box (P.O. Box) will not be accepted as part of the
address.
Line 13. Enter the telephone number, fax number, and email address of the business. If, in addition to
the business telephone, there is another number where you would like to be contacted by IRS, you may
enter that information on this line also, notating that it is the alternative telephone number.
Line 14. This line should be completed only if you are using a business mailing address that is different
from the address entered on Line 12. Note:The same mailing address can not be used for multiple
business locations.
Line 15. Check the “yes” or “no” box to indicate if the business provides tax related services year round
(January through December). If the answer is “no”, provide a brief explanation why the business does
not provide tax related services year round.
Line 15a. Enter the volume of Forms W-7 that you anticipate filing during a 12 month calendar period.
Lines 16 and 17. Enter the name of the primary and alternate contact(s) only if different than the
authorized representative(s) of the business (individual listed on Line 5 or on the continuation sheet(s)
to the application). This is the person that has been authorized by the business to contact the ITIN
Operations to inquire about the status of W-7 applications, but they are not permitted to sign the Form
W-7(COA). Also provide the person’s business title, telephone and fax numbers and their email
address. Each business location may have one primary and one alternate contact.
Line 18. You may attach a separate statement to provide a detailed description of the activities
performed by the business which would validate this request for Acceptance Agent status. For example,
a tax preparation firm preparing U.S. federal income tax returns for nonresident alien real estate
investors who do not qualify for an SSN, would validate this request for Acceptance Agent status.
Line 19. The principal, partner or owner of the business may request to be included on a public list of
acceptance agents published by the IRS on its website by checking this box.
Lines 20 and 21. Both the authorized representative and the principal, partner or owner must print and
sign their name on this application. By signing the application you are authorizing the Internal Revenue
Service to conduct suitability checks as referenced in the Revenue Procedure.
Line 22. Enter the date that this application is signed.
Pages 3 and 4 – (Continuation sheets)
Note: Must be attached to a Form 13551 when submitted to IRS. Use pages 3 and 4 to add additional
authorized representatives or a primary and alternate contact for a business location. If the business
operates at more than one location, use a separate continuation sheet for each additional office. The
continuation pages must also be signed and dated by the Principal, Partner or Owner of the Business
(signature space provided on page 4) and each additional authorized representative, pursuant to the
signature requirements for Form 13551, Lines 20 and 21.
Page 3
Catalog Number 38262Q www.irs.gov
Form 13551 (Rev. 6-2019)
Form 13551
(June 2019)
Department of the Treasury - Internal Revenue Service
Continuation Sheet for Additional Authorized Representatives
(see Form 13551 instructions)
OMB Number
1545-1896
Legal Name of the Business (Page 1, Line 2 (and 11, if applicable))
Business EFIN Business EIN
Business location address Street City/County State/Country ZIP Code/Foreign Postal Code
Information and Signature of Additional Authorized Representative
Professional Status of
Authorized
Representative (Line 5)
Tax Preparer
CPA*
Attorney*
Enrolled Agent*
number
Other
*See instructions for
proof requirements
5. Name and PTIN of Authorized Representative of
the Business (first, middle, last, PTIN)
6. Date of birth
(month, day, year)
7. Social Security Number (SSN) or Taxpayer
Identification Number (ITIN)
8. Home address (street, city/county, state/country,
and ZIP code/foreign postal code) of individual
listed on Line 5
9. Check the appropriate box
U.S. Citizen
U.S. Resident Alien*
Nonresident Alien**
*Attach copy of green card
**Attach copy of visa if residing
in the U.S.
10. Have you ever been assessed any preparer
penalties, been convicted of a crime, failed to
file personal tax returns, or pay tax liabilities,
or been convicted of any criminal offense
under the U.S. Internal Revenue laws
Yes No
(Attach an explanation and fingerprint cards
for a “Yes” response.)
13. Business telephone number
( )
Fax number
( )
Email
14. Mailing address of the Business if different from the location address on line 12
Number and street City/County State/Country ZIP Code/Foreign Postal Code
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. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for
Acceptance Agents and related publications each year of our participation.
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that
noncompliance will result in the institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance Agent Program. I am authorized to
make and sign this statement on behalf of the institution.
Name and title of Authorized Representative from line 5 (type or print)
Signature of Authorized Representative
Date
Information and Signature of Additional Authorized Representative
Professional Status of
Authorized
Representative (Line 5)
Tax Preparer
CPA*
Attorney*
Enrolled Agent*
number
Other
*See instructions for
proof requirements
5. Name and PTIN of Authorized Representative of
the Business (first, middle, last, PTIN)
6. Date of birth
(month, day, year)
7. Social Security Number (SSN) or Taxpayer
Identification Number (ITIN)
8. Home address (street, city/county, state/country,
and ZIP code/foreign postal code) of individual
listed on Line 5
9. Check the appropriate box
U.S. Citizen
Nonresident Alien**
U.S. Resident Alien*
*Attach copy of green card
**Attach copy of visa if residing
in the U.S.
10. Have you ever been assessed any preparer
penalties, been convicted of a crime, failed to
file personal tax returns, or pay tax liabilities,
or been convicted of any criminal offense
under the U.S. Internal Revenue laws
Yes No
(Attach an explanation and fingerprint cards
for a “Yes” response.)
13. Business telephone number
( )
Fax number
( )
Email
14. Mailing address of the Business if different from the location address on line 12
Number and street City/County State/Country ZIP Code/Foreign Postal Code
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. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for
Acceptance Agents and related publications each year of our participation.
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that
noncompliance will result in the institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance Agent Program. I am authorized to
make and sign this statement on behalf of the institution.
Name and title of Authorized Representative from line 5 (type or print)
Signature of Authorized Representative
Date
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Your response is voluntary. 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 estimated average time to complete this form is 30 minutes. If you have comments concerning the accuracy of this
time estimate or suggestions for making this form simpler, we will 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, Washington, DC 20224. Do NOT send this form to this address. Instead, enclose it with the magnetic tape and send it to the Service
Center to which you submit your tapes or send it to the transmission reception site that received your transmitted returns.
Page 4
Catalog Number 38262Q www.irs.gov
Form 13551 (Rev. 6-2019)
Information and Signature of Additional Authorized Representative
Professional Status of
Authorized
Representative (Line 5)
Tax Preparer
CPA*
Attorney*
Enrolled Agent*
number
Other
*See instructions for
proof requirements
5. Name and PTIN of Authorized Representative of
the Business (first, middle, last, PTIN)
6. Date of birth
(month, day, year)
7. Social Security Number (SSN) or Taxpayer
Identification Number (ITIN)
8. Home address (street, city/county, state/country,
and ZIP code/foreign postal code) of individual
listed on Line 5
9. Check the appropriate box
U.S. Citizen
U.S. Resident Alien*
Nonresident Alien**
*Attach copy of green card
**Attach copy of visa if residing
in the U.S.
10. Have you ever been assessed any preparer
penalties, been convicted of a crime, failed to
file personal tax returns, or pay tax liabilities,
or been convicted of any criminal offense
under the U.S. Internal Revenue laws
Yes No
(Attach an explanation and fingerprint cards
for a “Yes” response.)
13. Business telephone number
( )
Fax number
( )
Email
14. Mailing address of the Business if different from the location address on line 12
Number and street City/County State/Country ZIP Code/Foreign Postal Code
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. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for
Acceptance Agents and related publications each year of our participation.
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that
noncompliance will result in the institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance Agent Program. I am authorized to
make and sign this statement on behalf of the institution.
Name and title of Authorized Representative from line 5 (type or print)
Signature of Authorized Representative
Date
Information and Signature of Additional Authorized Representative
Professional Status of
Authorized
Representative (Line 5)
Tax Preparer
CPA*
Attorney*
Enrolled Agent*
number
Other
*See instructions for
proof requirements
5. Name and PTIN of Authorized Representative of
the Business (first, middle, last, PTIN)
6. Date of birth
(month, day, year)
7. Social Security Number (SSN) or Taxpayer
Identification Number (ITIN)
8. Home address (street, city/county, state/country,
and ZIP code/foreign postal code) of individual
listed on Line 5
9. Check the appropriate box
U.S. Citizen
Nonresident Alien**
U.S. Resident Alien*
*Attach copy of green card
**Attach copy of visa if residing
in the U.S.
10. Have you ever been assessed any preparer
penalties, been convicted of a crime, failed to
file personal tax returns, or pay tax liabilities,
or been convicted of any criminal offense
under the U.S. Internal Revenue laws
Yes No
(Attach an explanation and fingerprint cards
for a “Yes” response.)
13. Business telephone number
( )
Fax number
( )
Email
14. Mailing address of the Business if different from the location address on line 12
Number and street City/County State/Country ZIP Code/Foreign Postal Code
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. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for
Acceptance Agents and related publications each year of our participation.
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that
noncompliance will result in the institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance Agent Program. I am authorized to
make and sign this statement on behalf of the institution.
Name and title of Authorized Representative from line 5 (type or print)
Signature of Authorized Representative
Date
Names and Contact Information for Primary and Alternate Contacts at the business location listed above. (Complete only if primary and alternate
contacts for this business location are not already listed as the primary and alternate contacts on page 1, line 16 of the attached Form 13551.
16. Complete information for primary contact if not listed on attached Form 13551
Name (first, middle initial, last) and Title
Phone number
( )
Fax number
( )
Email
Complete information for alternate contact if not listed on attached Form 13551
Name (first, middle initial, last) and Title
Phone number
( )
Fax number
( )
Email
Signature of Principal, Partner or Owner of Business
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. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for Acceptance Agents and related publications each year of our
participation.
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that noncompliance will result in the
institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance Agent Program. I am authorized to make and sign this statement on behalf of the institution.
Name and title of Principal, Partner or Owner from line 2 (type or print)
Signature of Principal, Partner or Owner
Date
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Your response is voluntary. 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 estimated average time to complete this form is 30 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for
making this form simpler, we will 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, Washington, DC 20224. Do NOT send this form to this
address. Instead, enclose it with the magnetic tape and send it to the Service Center to which you submit your tapes or send it to the transmission reception site that received your transmitted returns.
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F13551 Form 13551 (Rev. 6-2019)

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Completed 4 March 2020

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