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Fillable Printable Form 4419

Fillable Printable Form 4419

Form 4419

Form 4419

(Refer to Instructions Page 2)
Catalog Number 41639Jwww.irs.gov
Form
4419 (Rev. 4-2016)
Revised Form 4419
Current Transmitter Control Code (TCC)
Form 4419
(April 2016)
Department of the Treasury - Internal Revenue Service
Application for Filing Information
Returns Electronically (FIRE)
IRS encourages transmitters who file for multiple payers to submit one
application and use the assigned TCC for all payers.
OMB Number
1545-0387
IRS Use Only
1. Transmitter and/or Payer information
Legal name(associated with EIN in Block 2)
Mailing address CityState ZIP code
2. Employer Identification Number (EIN) (Social Security Number not permitted)
3. Person to contact about this request
Name
Title
Email address Telephone number
4. Will TCC be used to transmit electronic
Extension of Time Files only?
Yes No
5. Is the request for a foreign transmitter
without a TIN?
Yes No
6. What Tax Year will
electronic filing begin?
7. Check the box(es) next to the returns you will file electronically.
Note: The FIRE System does not provide an on-line fill-in option. You must transmit your data in the specific format
required by IRS.
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)
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.
8. 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.
9. Official of the
company or
organization
NameTitle
Signature (A computer generated signature is not acceptable.)
Date
Page 2
Catalog Number 41639Jwww.irs.gov
Form
4419 (Rev. 4-2016)
General Instructions
Purpose of Form: Submit Form 4419 to request authorization to
electronically file any of the forms shown in Block 7. Complete all
required information. Transmitters who file for multiple payers may
submit one application and use the assigned Transmitter Control Code
(TCC) for all payers. If your application is approved, a five-character
alphanumeric TCC will be assigned to your organization.
Form 4419 can be completed online at //fire.irs.gov.
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 Forms W-2. Form W-2 information is only sent to the
Social Security Administration (SSA). Contact SSA if you have any
questions concerning the electronic filing of Forms W-2 at
1-800-772-6270.
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 3 - Person to contact or contact information
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 7 - Type of return to be reported
Note: A revised Form 4419 can only be submitted on paper.
Specific Instructions
Due Date: In order to ensure timely filing, submit Form 4419 at least 45
days before the due date of the return.
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 - Enter the name, 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.
Block 4 - Check the appropriate box to indicate if you are requesting a
Transmitter Control Code (TCC) solely for the electronic filing of Form
8809, Application for Extension of Time To File Information Returns.
Block 5 - Check the appropriate box to indicate if you are a foreign
transmitter who does not have a nine-digit Taxpayer Identification
Number. Required.
Block 6 - Enter the tax year that you wish to begin filing electronically.
Required.
Block 7 - 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 7.
Block 8 – 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 9 - 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
Publication 1239, Specifications for Electronically Filing Form
8027, Employers Annual Information Return of Tip Income and
Allocated Tips
Publication 4810, Specifications for Electronically Filing Form
8955-SSA, Annual Registration Statement Identifying Separated
Participants and Deferred Vested Benefits Paperwork
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)
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.
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 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.
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