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IRS Paid Preparer Tax Identification Number (PTIN)
Form W-12 OMB No. 1545-2190
(Rev. October 2022) Application and Renewal
Department of the Treasury
Internal Revenue Service Go to www.irs.gov/FormW12 for instructions and the latest information.
1 Name and PTIN First name Middle name Last name
(Print in ink or
Type)
Initial application Renewal application (Enter PTIN: P )
2 Year of If you checked the “Initial application” box and are submitting this form between October 1 and December 31,
Application/ indicate below whether you want your PTIN to be valid for the current calendar year or the next calendar year.
Renewal
Current calendar year Next calendar year
Prior 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)
3 SSN and Date Provide your Social Security Number (SSN). If you SSN Date of birth (MM/DD/YYYY)
of Birth have an SSN, you are required to provide it. If you
- - / /
You must do not have an SSN, then check the N/A box.
provide your N/A
SSN or check Failure to provide your SSN or check the N/A
the N/A box box will result in your PTIN application being
rejected.
4 Personal Street address. Use a P.O. box number only if the post office does not deliver mail to your street address.
Mailing
Address and
Phone Number City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.

Phone Number ( ) -

5a Business Business address Check here if your business address is the same as your personal mailing address. If
Mailing different, enter it below.
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.

Domestic business phone number International business phone number
( ) - EXT. +
b Business Are you self-employed or an owner, partner, or officer of a tax return preparation business? Yes No
Identification If “Yes,” then complete this line. If “No,” go to line 6.
Enter the business name.

Your CAF Number EIN EFIN
-
Website address (optional)

6 Email Address Enter the email address that should be used to contact you.

For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 55469F Form W-12 (Rev. 10-2022)
For Internal Use Only
PTIN
Case#
Date

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Form W-12 (Rev. 10-2022)                                                                                                     Page 2
7 Past Felony            Have you been convicted of a felony in the past 10 years?                                    Yes
  Convictions                                                                                                         No
  You must check 
  a box. If “Yes,”       If “Yes,” list the date and the type of felony conviction(s).
  you must 
  provide an 
  explanation.

If this is your initial application for a PTIN, continue to line 8. If you are renewing your PTIN, go to line 10.
8 Address of             Enter the address used on your last U.S. individual income tax return you filed.
  Your 
  Last U.S. 
  Individual  
  Income Tax             Check here if you have never filed a U.S. income tax return or do not have a U.S. income tax filing 
  Return Filed           requirement. See line 8 instructions for documents that must be submitted with this form and continue to  
                         line 10.
9 Filing Status          Single                                   Head of Household
  and Tax Year 
  on Last U.S.           Married filing jointly                   Qualifying widow(er) with dependent child
  Individual 
  Income Tax             Married filing separately                Tax Year (YYYY) 
  Return Filed
                         Note: If your last return was filed more than 4 years ago, see instructions.
10 Federal Tax           Are you current on both your individual and business federal taxes, including any corporate and employment 
  Compliance             tax obligations? Note: If you have never filed a U.S. individual income tax return because you are not required 
                         to do so, check the “Yes” box.                                                               Yes
                                                                                                                      No
                         If “No,” provide an explanation.

11 Data Security         I am aware that paid tax return preparers must have a data security plan to provide data and system security 
  Responsibilities       protections for all taxpayer information.
                                                                                                                 Form W-12 (Rev. 10-2022)

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Form W-12 (Rev. 10-2022) Page 3
12 Professional Check all that apply. Note: DO NOT check any professional credentials that are currently expired or
Credentials retired. Enter state abbreviation and appropriate number(s). If the expiration date is left blank or incomplete,
then NO professional credential will be added when the application is processed.

Attorney—Licensed in which
jurisdiction(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 Actuary Number(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:

None
13 Fees The fee to obtain or renew a PTIN is $30.75 for 2023. Full payment must be included with your application, or it
The fee is an will be rejected. If your application is incomplete and you do not supply the required information upon request,
application the IRS will be unable to process your application.
processing fee Make your check or money order payable to IRS Tax Pro PTIN Fee for the total fee amount required based on
and is the calendar year(s) you are registering or renewing your PTIN. Do not paper clip, staple, or otherwise attach the
nonrefundable. payment to Form W-12. See the PTIN payment fee schedule below.
2023 PTIN fee: $30.75
2022 PTIN fee: $35.95
2021 PTIN fee: $35.95
No fee is due for years 2020 or prior.
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. I understand any false or misleading information may result in criminal penalties and/or
the denial or termination of a PTIN.
Sign
Your signature (Please use blue or black ink) Date (MM/DD/YYYY)
Here
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How To File
Online. Go to the webpage www.irs.gov/ptin for information. Follow the instructions to submit Form W-12. If you submit your
application 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 Center
PO Box 380638
San Antonio, TX 78268
Note: Allow 4 to 6 weeks for processing of PTIN applications. For additional information, refer to the separate Instructions for
Form W-12.
For Internal Use Only Form W-12 (Rev. 10-2022)

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