Federal Form W-12 (IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal) (2024)

IRS Paid Preparer Tax Identification Number (PTIN) Application and Renewal
Form W-12 (Rev. October 2023)
W-12IRS Paid Preparer Tax Identification Number (PTIN)Application and RenewalForm(Rev. October 2023)Department of the TreasuryInternal Revenue ServiceGo to www.irs.gov/FormW12 for instructions and the latest information.1 Name and PTIN First name(Print in ink orType)Middle nameInitial application2 Year ofApplication/Renewal3 SSN and Dateof BirthYou mustprovide yourSSN or checkthe N/A boxOMB No. 1545-2190Renewal applicationLast name(Enter PTIN: P)If you checked the “Initial application” box and are submitting this form between October 1 and December 31,indicate below whether you want your PTIN to be valid for the current calendar year or the next calendar year.Current calendar yearNext calendar yearPrior year(s) (YYYY): If you are applying for a prior year(s), write each year(s) below. Use the following format.(YYYY) See line 2 instructions for additional guidance.Prior year(s)SSNDate of birth (MM/DD/YYYY)Provide your Social Security Number (SSN). Ifyou have an SSN, you are required to provide it.//Failure to provide your SSN or check the N/Abox will result in your PTIN application beingrejected.If you do not have an SSN,then check the N/A box.N/AStreet address. Use a P.O. box number only if the post office does not deliver mail to your street address.4 PersonalMailingAddress andPhone Number City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.Phone Number ()-5a BusinessBusiness addressCheck here if your business address is the same as your personal mailing address. Ifdifferent, enter it below.MailingAddress andPhone NumberCity or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.Domestic business phone number(b BusinessIdentification)-International business phone numberEXT.+Are you self-employed or an owner, partner, or officer of a tax return preparation business?If “Yes,” then complete this line. If “No,” go to line 6.Enter the business name.Your CAF NumberEINYesNoEFIN-Website address (optional)For Privacy Act and Paperwork Reduction Act Notice, see instructions.Form W-12 (Rev. 10-2023)Cat. No. 55469FFor Internal Use OnlyPID:CS:Date & Int:LTR:Page 2Form W-12 (Rev. 10-2023)6 Email AddressEnter the email address that should be used to contact you.7 Past FelonyConvictionsHave you been convicted of a felony in the past 10 years?You must check a boxYesNoIf “Yes,” youIf “Yes,” list the date and the type of felony conviction(s).must provide anexplanation.If this line isleft blank, yourform will notbe processed8 Address ofYourLast U.S.IndividualIncome TaxReturn Filed9 Filing Statusand Tax Yearon Last U.S.IndividualIncome TaxReturn FiledEnter the address used on your last U.S. individual income tax return you filed.Check here if you have never filed a U.S. income tax return or do not have a U.S. income tax filingrequirement. If this is an initial application, See line 8 instructions for documents that must be submittedwith this form.SingleHead of HouseholdMarried filing jointlyQualifying widow(er) with dependent childMarried filing separatelyTax Year (YYYY)Note: If your last return was filed more than 4 years ago, see instructions.10 Federal TaxComplianceAre you current on both your individual and business federal taxes, including any corporate and employmenttax obligations? Note: If you have never filed a U.S. individual income tax return because you are not requiredto do so, check the “Yes” box.You must check a boxYesNoIf this line isleft blank, your If “No,” provide an explanation.form will notbe processed11 Data SecurityI am aware that paid tax return preparers must have a data security plan to provide data and system securityResponsibilities protections for all taxpayer information.Form W-12 (Rev. 10-2023)Page 3Form W-12 (Rev. 10-2023)12 ProfessionalCredentialsCheck all that apply. Note: DO NOT check any professional credentials that are currently expired orretired. Enter state abbreviation and appropriate number(s). If the expiration date is left blank or incomplete,that professional credential will NOT be added when the application is processed.Attorney—Licensed in whichjurisdiction(s):Number(s):Expiration Date(s):Certified Public Accountant (CPA)—Licensed in which jurisdiction(s):Number(s):Expiration Date(s):Enrolled Agent (EA)Number(s):Expiration Date(s):Enrolled ActuaryNumber(s):Expiration Date(s):Enrolled Retirement Plan Agent (ERPA)Number(s):Expiration Date(s):State Regulated Tax Return Preparer—Licensed in which jurisdiction(s):Number(s):Expiration Date(s):Certifying Acceptance Agent (CAA)Number:None13 FeesThe fee is anapplicationprocessing feeand isnonrefundable.The fee to obtain or renew a PTIN is $19.75 for 2024. Full payment must be included with your application, or itwill be rejected. You must submit a separate check or money order for each calendar year. Indicate thecalendar year you intend the payment for on each check or money order.If your payment(s) is returned your PTIN will be placed in Suspended status. You are responsible forsubmitting the proper payment(s) to make your PTIN Active.Make your check or money order payable to IRS Tax Pro PTIN Fee for the correct fee amount required basedon the calendar year(s) you are registering or renewing your PTIN. Do not paper clip, staple, or otherwise attachthe payment to Form W-12. See the PTIN payment fee schedule below.2024 PTIN fee: $19.752023 - 2021 PTIN fee: $19.75No fee is due for years 2020 or prior.SignHereUnder penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief, itis true, correct, and complete. I understand any false or misleading information may result in criminal penalties and/orthe denial or termination of a PTIN.CAUTION: If you're a foreign preparer that resides outside of the U.S. and you obtain a PTIN without a SocialSecurity number, you are not authorized to prepare returns in the U.S. for compensation.Your signature (Please use blue or black ink)How To FileDate (MM/DD/YYYY)//Online. Go to the webpage www.irs.gov/ptin for information. Follow the instructions to submit Form W-12. If you submit yourapplication online, your PTIN generally will be provided to you immediately after you complete the application.By mail. Complete Form W-12. Send the form to:IRS Tax Professional PTIN Processing CenterPO Box 380638San Antonio, TX 78268Note: Allow 6 weeks for processing of PTIN applications. For additional information, refer to the separate Instructions for Form W-12.If your application is incomplete and you do not supply the required information upon request, the IRS will be unable to process yourapplication.For Internal Use OnlyForm W-12 (Rev. 10-2023)

Extracted from PDF file 2023-federal-form-w-12.pdf, last modified October 2023

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