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Catalog Number 33392H www.irs.gov
Form
10301 (Rev. 1-2017)
Instructions for Form 10301, CD Encryption Code Authorization For CP2100/972CG Notices
General Instructions
Use Form 10301 to authorize a contact person to receive an
encryption code required to read a compact disk (CD) containing:
• Notice CP2100, Please check your Backup Withholding List
• Notice 972CG, A Penalty is proposed for your Information
Returns
Revise Form 10301 Information - Check the box located at the
top of the form and complete form with current company
information.
Timeframe - Allow 5 business days from the date IRS receives
this form.
Specific Instructions
Complete this form with black ink.
All fields marked with an asterisk (*) are required fields.
Block 1 - Check the box for Original or Revised.
Block 2 - Enter the legal name and complete street address of
the company (payer) receiving the CD containing CP2100/
972CG Notices.
Block 3 - Enter the nine-digit Taxpayer Identification Number
(TIN) [Employer Identification Number (EIN) or the Social
Security Number (SSN)] of the payer.
Block 4 - Enter the name and telephone number of the primary
contact person authorized to receive the encryption code. It is
the responsibility of the contact person to know company's PIN.
Block 5 - Enter the name and telephone number of the
secondary contact person authorized to receive the encryption
code. It is the responsibility the contact person to know
company's PIN.
Block 6 - Enter a self-assigned ten digit PIN. The PIN must be
ten alphanumeric characters. Special characters are not allowed.
This PIN is used to authorize the contact to receive the
encryption code. Retain the PIN for future reference. The
encryption code will not be provided prior to PIN verification.
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 company.
Block 8 - Form 10301 must be signed and dated by an official of
the company or organization. If you have a power of attorney,
attach a copy to this form.
Note: This Form 10301 automatically revokes all prior
authorizations.
Where to file
Internal Revenue Service
230 Murall Drive, Mail Stop 4360
Kearneysville, WV 25430
Fax:
(877) 477-0572 (within the U.S)
(304) 579-4105 (International)
Please either fax or mail, do not do both.
Upon receipt of the CD, the primary or secondary contact is
required to call the IRS to receive the encryption code.
Assistance is available Monday through Friday at:
• (866) 455-7438 (Toll Free)
• (304) 263-8700 (International)
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 10301 is 15 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 10301 to this address.
