Form 13803 Income Verification Express Service

_______________________________________________________
Form 13803
(May 2006)

Department of the Treasury-Internal Revenue Service

OMB Number

Income Verification Express Service
Application and Employee Delegation Form

The following information is required to complete the e-services enrollment process for
IVES users and to identify delegates receiving transcripts on behalf of the principle
account holder
Principal
Last Name (required)

First (required)

SSN (required)

DOB (required)

M.

Business Information
Official Business Name (required)

Doing Business As (required)

IFS Account Number
(required)

Street Address (required)

Billing Address (required)

Business EIN/SSN (required)

Business Phone (required)

Fax (required)

Business E-mail address

POC (if different than the principle)

POC's Telephone Numbe

POC's E-Mail Address

Delegates
Last Name

First

MI

SSN (required)

E-mail Address

(over)

__________________________________________________________________________
Form 13803 (5-2006)

Catalog Number 48547A

__________________________________________________________________________________________

Delegates (continued)
Last Name

First

SSN (required)

E-mail Address

Last Name

First

SSN (required)

E-mail Address

Lat Name

First

SSN (required)

E-mail Address

MI

MI

MI

I acknowledge that I have read the Internal Revenue Service’s rules and
procedures for participating in the Income Verification Express Service, and I
agree that ____________________________
[insert name of applicant]
will abide by all published rules and procedures and understand that failure to do
so will result in temporary or permanent exclusion from the program.
__________________________________________________________________________
Privacy Act Notice:
Our right to ask for information is 5 U.S.C. 301 and the Internal Revenue Code Section 6109 and
applicable regulations. The registration information we are requesting is used to create an
account for you and authenticate your identity. We may disclose the information to the
Department of Justice, to enforce the tax laws, civil and criminal, to cities, states, the District of
Columbia and U. S. commonwealths or possessions to carry out their tax laws. We may give it to
other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal
laws, or to federal law enforcement and intelligence agencies to combat terrorism. Your
participation in the Income Verification Express Service (IVES) program is voluntary, however,
if you do not provide all or part of the information required to create your account and
authenticate your identity, you will not be eligible for access to IVES.
__________________________________________________________________________
Form 13803 (5-2006)

Catalog Number 48547A