Form 4419 – Fill Out and Use This PDF

Form 4419

(Rev. Dec. 2006)

Department of the Treasury - Internal Revenue Service

Application for Filing Information Returns

Magnetically/Electronically

(Please type or print in black ink)

IRS Use Only

OMB No.

1545-0387

City

State

Zip

Email address

Telephone number

3.Taxpayer Identification Number (TIN)

4.Foreign Transmitter without a TIN

Yes

5.Tax year you wish to begin filing electronically/magnetically

Forms 1098, 1099, 5498 and W-2G

(Electronic and Tape Cartridge)

Form 1042-S

(Electronic and Tape Cartridge)

Form 8027

(Electronic and Tape Cartridge)

Name (type or print)

Title

Signature

Date

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 or magnetically. 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 if you have any questions concerning the filing of Forms W-2 at 1-800-772-6270.

Specific Instructions

Block 1

Enter the name and complete address of the person or organization that will submit the electronic or magnetic media 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/magnetic filing of information returns.

Block 3

Enter the Taxpayer Identification Number (TIN) of the organization transmitting the electronic and/or magnetic media files. A TIN can be either an Employer Identification Number (EIN) or a Social Security Number (SSN).

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 and/or magnetically.

Block 6

Indicate if you are requesting this Transmitter Control Code solely for filing electronic and/or magnetic 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 and/or magnetically.A separate TCC will be assigned for each box checked in Block 7. Please make sure you submit your electronic/magnetic media 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

Check which method you will use to file your information returns. Tape cartridges must be 18, 36, 128, or 256-track. Electronic filing requires a file formatted according to the specifications in Publication 1220, Specifications for Filing Forms 1098, 1099, 5498 and W-2G Electronically or Magnetically. Electronic filing does not allow for the filing of fill-in forms.

Block 9

The form must be signed and dated by an official of the company or organization requesting authorization to report electronically and/or magnetically.

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 to (304) 264-5602, but do not do both (faxing and mailing).If your application is approved, IRS will assign a TCC to your organization. We will not issue your TCC without a signed Form 4419 from you, and we will not issue a TCC over the phone. 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 either electronically or magnetically, 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.