Form 23 Application for Enrollment to Practice Before OMB Number (November 2022) the Internal Revenue Service 1545-0950 Department of the Treasury Internal Revenue Service See Instructions on Page 3 Before you file this form, you must: • Take and pass all three parts of the Special Enrollment Examination For IRS use: • Obtain a Preparer Tax Identification Number (PTIN) • Read Circular 230 Date Enrolled: The $140 application fee is non-refundable. Check here if you are a former Internal Revenue Service Employee, and enter the date you separated Enrollment Number: from the Service / /. Part 1. Tell Us About Yourself 1 Your Social Security Number If you do not have an SSN, please check this box. 2 Date of Birth mm/dd/yyyy 3 Your Full Legal Name First MI Last 4 Your Current Address Number Street Suite or Apt. Number City State Zip Code Country Your email Address: Your Telephone Number: 5 Enter your PTIN number issued by the IRS: 6 Do you have an Employer Identification Number (EIN)? Yes No If Yes, enter all EINs, business names, and addresses below (attach additional pages, if necessary): EIN Business Name Business Address For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 16233B Form 23 (Rev. 11-2022) |
Form 23 (Rev. 11-2022) Page 2 7 Do you have a Centralized Authorization File (CAF) number? Yes No If “Yes”, enter all CAF numbers assigned to you (attach additional pages, if necessary): 8 Are you current with your individual and business taxes, including any corporate and employment tax obligations? If "NO," provide a written explanation. Yes No NOTE: Note should read "If you answer "YES" to question 9, 10, 11, or 12, please provide a written explanation of the matter, including the date when the matter occurred, and any additional information about the matter you would like us to consider. 9 Have you been sanctioned by a federal or state licensing authority? Yes No 10 Has any application you filed with a court, government department, commission, or agency for admission to practice ever been denied? Yes No 11 Have you been convicted of a tax crime or any felony? Yes No 12 Have you been permanently enjoined from preparing tax returns, or representing others before the IRS? Yes No 13 Are you a CPA? Yes No If “Yes”, enter the states where you are licensed to practice. 14 Are you an Attorney? Yes No If “Yes”, enter the states where you are licensed to practice. Part 2. Sign here Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete. Signature Date Form 23 (Rev. 11-2022) Filling out this form: It is important to answer all questions on the form. Failure to answer any questions or sign the form could result in processing delays. An intentionally false statement or omission identified with your application is a violation of Circular 230 10.51(a)(4) and 18 U.S.C. 1001 and may be grounds for suspension or disbarment from practice. |
Form 23 (Rev. 11-2022) Page 3 Instructions: Who do I call if I have questions? • You must obtain a PTIN before completing this form. Please allow 60 days for processing before calling to check on the status of your application. To check on the status of • You must take and pass the Special Enrollment Examination your application you may call 1-855-472-5540. (SEE) before you can apply. You may register for the examination at www.Prometric.com/see. Privacy Act and Paperwork Reduction Act Notice. Section Former IRS Employees: 330 of title 31 of the United States Code authorizes us to collect Please Note: Your eligibility to practice may be limited based this information. We ask for this information to administer the upon your work experience. program of enrollment to practice before the IRS. Applying for renewal of enrollment is voluntary; however, if you apply you You may request a waiver to take the SEE through the must provide the information requested on this form. Failure to submission of an application within three (3) years from the date provide this information may delay or prevent processing your of your separation with the Internal Revenue Service (IRS). Please application; providing false or fraudulent information may check the box at the top of the form which indicates you are subject you to penalties. Generally, this information is requesting a waiver from taking the SEE. See Circular 230 confidential pursuant to the Privacy Act. However, certain Section 10.4(d) for more information. To gain full enrollment disclosures are authorized under the Act, including disclosure status you must take and pass the SEE before you can apply. to: the Department of Justice, and courts and other adjudicative You may register for the examination at www.Prometric.com/see. bodies, with respect to civil or criminal proceedings; public authorities and professional organizations for their use in What if I don't have a Social Security connection with employment, licensing, disciplinary, regulatory, Number? and enforcement responsibilities; contractors as needed to If you are living and working in the United States (U.S.), you are perform the contract; third parties as needed in an investigation; required to have a Social Security Number (SSN). If you are the general public to assist them in identifying enrolled working outside of the U.S. and you do not have an SSN or an individuals; state tax agencies for tax administration purposes; ITIN check the box on line 1. appropriate persons when the security of information may have been compromised for their use to prevent, mitigate or remedy Electronic Application and Payments harm. You are not required to provide the information requested on You can renew and pay electronically by visiting a form that is subject to the requirements of the Paperwork www.pay.gov. Reduction Act unless the form displays a valid OMB control If you are mailing your application: number. Books and records relating to a form or its instructions should be retained as long as their contents may become Enclose a check or money order in the amount of $140 made material in the administration of the law. The time needed to payable to the United States Treasury. complete and file this form will vary depending on individual circumstances. The estimated average time is 15 minutes, Where to send this form: including recordkeeping, learning about the law or the form, Internal Revenue Service preparing the form, and copying and sending the form to the Enrolled Agent Policy & Management IRS. 127 International Dr Room - EA125 If you have comments concerning the accuracy of this time Franklin, TN 37067 estimate or suggestions for making this form simpler, we would What do you check when you receive be happy to hear from you. You can write to Office of Enrolled Agent Policy & Management; P.O. Box 33968; Detroit, MI, my form? 48232. Do not send this form to this address; instead see the As part of the evaluation of your enrollment application, the IRS Where to send this form section of the instructions. may conduct a suitability check that includes a background check and a review of your personal and business tax compliance. How long will it take to process my application for enrollment? It generally takes about 60 days to process applications. Your enrollment status is not effective until we approve your request. You are not authorized to practice before the IRS as an EA until enrollment has been granted. |