 Enlarge image | Note: Form 8655 begins on the next page. The fax number to file Form 8655 has changed. The fax number, listed in the instructions for Form 8655 (Rev. August 2014) under the Where To File section as 801-620-4142, has changed to 855-214-7523 beginning March 1, 2017. |
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Form 8655 Reporting Agent Authorization
(Rev. August 2014) OMB No. 1545-1058
Department of the Treasury
Internal Revenue Service ▶ Information about Form 8655 and its instructions is at www.irs.gov/form8655.
Taxpayer
1 a Name of taxpayer (as distinguished from trade name) 2 Employer identification number (EIN)
1b Trade name, if any 4 If you are a seasonal employer,
check here . . . . . . .
3 Address (number, street, and room or suite no.) 5 Other identification number
City or town, state, and ZIP code
6 Contact person 7 Daytime telephone number 8 Fax number
Reporting Agent
9 Name (enter company name or name of business) 10 Employer identification number (EIN)
11 Address (number, street, and room or suite no.)
City or town, state, and ZIP code
12 Contact person 13 Daytime telephone number 14 Fax number
Authorization of Reporting Agent To Sign and File Returns (Caution: See Authorization Agreement)
15 Use the entry lines below to indicate the tax return(s) to be filed by the reporting agent. Enter the beginning year of annual tax returns or beginning quarter of quarterly
tax returns. See the instructions for how to enter the quarter and year. Once this authority is granted, it is effective until revoked by the taxpayer or reporting agent.
940 941 940-PR 941-PR 941-SS 943
943-PR 944 945 1042 CT-1
Authorization of Reporting Agent To Make Deposits and Payments (Caution: See Authorization Agreement)
16 Use the entry lines below to enter the starting date (the first month and year) of any tax return(s) for which the reporting agent is authorized to make deposits or
payments. See the instructions for how to enter the month and year. Once this authority is granted, it is effective until revoked by the taxpayer or reporting agent.
940 941 943 944 945 720
1041 1042 1120 CT-1 990-PF 990-T
Disclosure of Information to Reporting Agents
17 a Check here to authorize the reporting agent to receive or request copies of tax information and other communications from the IRS related
to the authorization granted on lines 15, 16, and/or line 18 . . . . . . . . . . . . . . . . . . . . . . . .
b Check here if the reporting agent also wants to receive copies of notices from the IRS . . . . . . . . . . . . . . .
Disclosure Authorization
18 a The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS
notices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning .
b The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS
notices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning .
c The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRS
notices relating to the Forms 3921 and 3922. This authority is effective for calendar year forms beginning .
State or Local Authorization (Caution: See Authorization Agreement)
19 Check here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or line 16
Authorization Agreement
I understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and
payments are made and that I may enroll in the Electronic Federal Tax Payment System (EFTPS) to view deposits and payments made on my behalf. If line 15 is
completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16
are completed, the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in
effect until it is revoked by the taxpayer or reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the
authority granted on line 15 and/or line 16, including disclosures required to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt
of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney (Form 2848) or Tax Information Authorization (Form 8821) in effect.
I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer.
Sign
Here
© Signature of taxpayer © Title © Date
For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 10241T Form 8655 (Rev. 8-2014)
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Form 8655 (Rev. 8-2014) Page 2
General Instructions signature. Write “REVOKE” across the top of the form. If you do not have a
copy of the authorization you want to revoke, send a statement to the IRS.
Purpose of Form The statement of revocation must indicate that the authority of the reporting
agent is revoked and must be signed by the taxpayer. Also, list the name and
Use Form 8655 to authorize a reporting agent to: address of each reporting agent whose authority is revoked.
• Sign and file certain returns. Reporting agents must file returns Withdrawing from reporting authority.A reporting agent can withdraw
electronically except as provided under Rev. Proc. 2012-32. You can find from authority by filing a statement with the IRS, either on paper or using a
Rev. Proc. 2012-32 on page 267 of Internal Revenue Bulletin 2012-34 at delete process. The statement must be signed by the reporting agent (if filed
www.irs.gov/pub/irs-irbs/irb12-34.pdf; on paper) and identify the name and address of the taxpayer and
• Make deposits and payments for certain returns; authorization(s) from which the reporting agent is withdrawing. For
information on the delete process, see Pub. 1474.
• Receive duplicate copies of tax information, notices, and other written and/
or electronic communication regarding any authority granted; and
• Provide IRS with information to aid in penalty relief determinations related Specific Instructions
to the authority granted on Form 8655. Line 15
Note. An authorization does not relieve the taxpayer of the responsibility (or Use the “YYYY” format for annual tax returns. Use the “MM/YYYY” format
from liability for failing) to ensure that all tax returns are filed timely and that for quarterly tax returns, where “MM” is the ending month of the quarter the
all federal tax deposits (FTDs) and federal tax payments (FTPs) are made named reporting agent is authorized to sign and file tax returns for the
timely. See section 5.05 of Rev. Proc. 2012-32. Employers who enroll in the taxpayer. For example, enter “09/2014” on the line for “941” to indicate you
Electronic Federal Tax Payment System (EFTPS) can view EFTPS deposits are authorizing the named reporting agent to sign and file Form 941 for the
and payments made on their behalf under their employer identification July–September quarter of 2014 and subsequent quarters.
number (EIN).
Line 16
Authority Granted Use the “MM/YYYY” format to enter the starting date, where “MM” is the first
Once Form 8655 is signed, any authority granted is effective beginning with month the named reporting agent is authorized to make deposits or
the period indicated on lines 15 or 16 and continues indefinitely unless payments for the taxpayer. For example, enter “08/2014” on the line for
revoked by the taxpayer or reporting agent. A new authorization must be “720” to indicate you are authorizing the named reporting agent to make
submitted to the Service for any increase or decrease in the authority of a deposits or payments for Form 720 starting in August 2014 and all
reporting agent to act for its client. The preceding authorization remains in subsequent months.
effect except as modified by the new one. No authorization or authority is
granted for periods prior to the period(s) indicated on Form 8655. Who Must Sign
Where authority is granted for any form, it is also effective for related forms Electronic signature. For guidance on optional electronic signature
such as the corresponding non-English language form, amended return, methods, see Pub. 1474, section 01.03.
(Form 941-X, 941-X(PR), 943-X, 944-X(PR), 945-X, or CT-1X), or payment Sole proprietorship. The individual owning the business.
voucher. In addition to the returns shown on lines 15 and 16, Form 8655 can Corporation (including a limited liability company (LLC) treated as a
be used to provide authorization for Form 944-SP using the entry spaces for corporation). Generally, Form 8655 can be signed by: (a) an officer having
Form 944. The form also can be used to authorize a reporting agent to make legal authority to bind the corporation, (b) any person designated by the
deposits and payments for other returns in the Form 1120 series, such as board of directors or other governing body, (c) any officer or employee on
Form 1120-C, using the entry space for Form 1120 on line 16. written request by any principal officer, and (d) any other person authorized
to access information under section 6103(e).
Disclosure authority granted on line 17a is effective on the date Form 8655
is signed by the taxpayer. Any authority granted on Form 8655 does not Partnership (including an LLC treated as a partnership) or an
revoke and has no effect on any authority granted on Forms 2848 or 8821, or unincorporated organization. Generally, Form 8655 can be signed by any
any third-party designee checkbox authority. person who was a member of the partnership during any part of the tax
period covered by Form 8655.
Where To File Single member LLC treated as a disregarded entity.The owner of the
Send Form 8655 to: LLC.
Trust or estate. The fiduciary.
Internal Revenue Service
Accounts Management Service Center Privacy Act and Paperwork Reduction Act Notice. We ask for the
MS 6748 RAF Team information on this form to carry out the Internal Revenue laws of
1973 North Rulon White Blvd. the United States. Our authority to request this information is Internal
Ogden, UT 84404 Revenue Code sections 6011, 6061, 6109, and 6302 and the regulations
You can fax Form 8655 to the IRS. The number is 801-620-4142. thereunder. We use this information to identify you and record your reporting
agent authorization. You are not required to authorize a reporting agent to
Additional Information act on your behalf. However, if you choose to authorize a reporting agent,
Additional information concerning reporting agent authorizations may be you are required to provide the information requested, including your
found in: identification number. Failure to provide all the information requested may
prevent or delay processing of your authorization; providing false or
• Pub. 1474, Technical Specifications Guide for Reporting Agent fraudulent information may subject you to penalties.
Authorization and Federal Tax Depositors. Routine uses of this information include giving it to the Department of
• Rev. Proc. 2012-32. Justice for civil and criminal litigation, and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
Substitute Form 8655 administering their tax laws. We may also disclose this information to other
countries under a tax treaty, to federal and state agencies to enforce federal
If you want to prepare and use a substitute Form 8655, see Pub. 1167, nontax criminal laws, or to federal law enforcement agencies and intelligence
General Rules and Specifications for Substitute Forms and Schedules. If your agencies to combat terrorism.
substitute Form 8655 is approved, the form approval number must be
printed in the lower left margin of each substitute Form 8655 you file with the You are not required to provide the information requested on a form that is
IRS. subject to the Paperwork Reduction Act unless the form displays a valid
OMB control number. Books or records relating to a form or instructions
Revoking an Authorization must be retained as long as their contents may become material in the
administration of any Internal Revenue law.
If you have a valid Form 8655 on file with the IRS, the filing of a new Form The time needed to complete and file Form 8655 will vary depending on
8655 revokes the authority of the prior reporting agent beginning with the individual circumstances. The estimated average time is 1 hour, 7 minutes.
period indicated on the new Form 8655. However, the prior reporting agent is
still an authorized reporting agent and retains any previously granted If you have comments concerning the accuracy of this time estimate or
disclosure authority for the periods prior to the beginning period of the new suggestions for making Form 8655 simpler, we would be happy to hear from
reporting agent’s authorization unless specifically revoked. you. You can send us comments from www.irs.gov/formspubs. Click on
More Information and then click on Give us feedback. Or you can send your
If the taxpayer wants to revoke an existing authorization, send a copy of comments to Internal Revenue Service, Tax Forms and Publications Division,
the previously executed Form 8655 to the IRS at the address under Where 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send
To File, above. Re-sign the copy of the Form 8655 under the original Form 8655 to this address. Instead, see Where To File, earlier.
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