8275 Disclosure Statement

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM W-7A, PAGE 1 OF 2
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

W-7A

Action

Date

O.K. to print
Revised proofs
requested

Application for Taxpayer Identification Number
for Pending U.S. Adoptions

Form
(Rev. January 2006)

Department of the Treasury
Internal Revenue Service

䊳

Signature

OMB No. 1545-0074

See instructions.

Note. Do not file this form if you are eligible to obtain a U.S. social security number (SSN) for your adoptive child.

1

Adoptive
parent(s)
information

1a Parent’s last name

First name

Social security number

1b Parent’s last name

First name

Social security number

(see instructions)

2

Adoptive
parent(s)
address

Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions.

City or town, state, and ZIP code

(see instructions)

3
4
5

Child’s name:

3a Last name

First name

Middle name

As it will appear 䊳
on your tax return
Birth name if different
䊳
and known

3b Last name

First name

Middle name

Child’s birth
information
Placement
agency
information

Date of birth (month, day, year)
/

/

Place of birth (city or town, and state)
Male

Name

Female
Date child
was placed
with adoptive
parents

Address

/

Sign
Here
Keep a copy of this
form for your
records.

/

Note. Be sure to attach the required documentation to Form W-7A. See page 2.
Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and
to the best of my knowledge and belief, it is true, correct, and complete.
Signature of parent

Date (month, day, year)

Signature of parent

Date (month, day, year)

䊳

/

䊳
General Instructions
Purpose of Form
Use Form W-7A to apply for an Internal Revenue Service (IRS)
adoption taxpayer identification number (ATIN) for a child who
is placed in your home for purposes of legal adoption.
However, do not use Form W-7A if you will be able to obtain a
social security number (SSN) for the child in time to file your
tax return. Also, do not use Form W-7A if the child is not a
U.S. citizen or resident.

What Is an ATIN
An ATIN is a temporary nine-digit number issued by the IRS to
individuals who are in the process of legally adopting a U.S.
citizen or resident child but who cannot get an SSN for that
child in time to file their tax return.
You may be able to use an ATIN on your tax return to take
the following tax benefits based on the child.
● Dependency exemption. See Pub. 501, Exemptions,
Standard Deduction, and Filing Information.
● Credit for child and dependent care expenses. See Pub.
503, Child and Dependent Care Expenses.
● Adoption credit. See Instructions for Form 8839, Qualified
Adoption Expenses.
● Child tax credit. See Pub. 972, Child Tax Credit.

For Paperwork Reduction Act Notice, see back of form.

/

Phone number

/
Phone number

/

However, you cannot use an ATIN to claim the earned
income credit (EIC). When the adoption is final and the child
has an SSN, you can file an amended return for an earlier year
if you could have claimed the EIC in the earlier year except for
the fact that the child did not have an SSN. Use Form 1040X,
Amended U.S. Individual Income Tax Return, and Schedule
EIC, Earned Income Credit.

How Long To Use an ATIN
An ATIN issued to you for your adoptive child will expire 2
years from the date it is issued. You will receive a notice from
the IRS 6 months before the expiration date to remind you that
the ATIN will expire. The notice will explain how you can apply
for an extension if the adoption will not be final by the
expiration date.
After the adoption is final, do not continue using the ATIN.
Instead, you must use an SSN. To apply for an SSN for the
child, fill in Form SS-5, Application for a Social Security Card,
and return it, with the appropriate evidence documents, to the
Social Security Administration (SSA). You can get Form SS-5
online at www.socialsecurity.gov, from your local SSA office,
or by calling the SSA at 1-800-772-1213. It usually takes
about 2 weeks to get an SSN.
If the SSA denies your application for an SSN, contact the
IRS to request an extension or reactivation of the ATIN. When
you request the extension or reactivation of the ATIN, include
the SSA’s denial letter or an explanation with your
correspondence.
Cat. No. 24309E

Form

W-7A

(Rev. 1-2006)

5
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM W-7, PAGE 2 OF 2
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form W-7A (Rev. 1-2006)

Who Must File
File Form W-7A if all of the following apply.
● You have a child living with you who was placed in your
home for legal adoption by an authorized placement agency.
● You cannot obtain the child’s existing SSN even though you
have made a reasonable attempt to obtain it from the birth
parents, the placement agency, and other persons.
● You cannot obtain an SSN for the child from the SSA
because, for example, the adoption is not final.
● You are eligible to claim the child as a dependent on your
tax return.

CAUTION

Do not file Form W-7A if the child is not a U.S.
citizen or resident. Instead, apply for an ITIN using
Form W-7, Application for IRS Individual Taxpayer
Identification Number.

Foster Children
Do not apply for an ATIN for a foster child who has been
placed in your home even if you have filed a petition in court
to adopt the foster child or intend to adopt the child. You will
not need an ATIN for a foster child because you should be
able to obtain the child’s SSN from the foster care agency.

How To File
You must complete Form W-7A, sign it, date it, and mail it
along with the required attachments (see What To Include
With Form W-7A, next) to the address on this page.

What To Include With Form W-7A
You must attach signed and dated documentation to Form
W-7A to prove that the child was placed with you for legal
adoption (not for foster care) by an authorized placement
agency.
In general, one of the following documents will satisfy this
requirement.
● A copy of the placement agreement entered into between
you and an authorized placement agency.
● A copy of the document signed by a hospital official
authorizing the release of a newborn child from the hospital to
you for legal adoption.
● A copy of the court order or other court document ordering
or approving the placement of a child with you for legal
adoption.
● An affidavit signed by the adoption attorney or government
official who placed the child with you for legal adoption
pursuant to state law.

Where To File
Internal Revenue Service
Philadelphia Service Center
ATIN Unit
P.O. Box 447
Bensalem, PA 19020

When To Expect the ATIN
It usually takes 4-8 weeks to get an ATIN. You can check on
the status of your application if it has been at least 8 weeks
from the date you filed the application by calling
215-516-4846. This is not a toll-free number. Be sure to have
a copy of your Form W-7A available when you call.

Specific Instructions
Complete all lines on the form. Enter N/A (not applicable) on
the lines that do not apply.
Line 1. Enter your name and SSN on line 1a. If you and
another person are adopting the child, enter the other
person’s name and SSN on line 1b. If you are married filing

Page

2

jointly, be sure to enter the names and SSNs in the order
shown on your tax return.
Name change. If you changed your name after you filed
your last return because of marriage, divorce, etc., be sure to
report this to your local Social Security Administration office
before filing your Form W-7A. This will prevent delays in
processing your ATIN request.
Line 2. Enter the address where you and the child live.
Enter your post office box number only if your post office
does not deliver mail to your home.
Address change. If you changed your mailing address after
you filed your last return, you should use Form 8822, Change
of Address, to notify the IRS of the change. A new address
shown on Form W-7A will not update your record. You can get
Form 8822 online at www.irs.gov or by calling
1-800-TAX-FORM (1-800-829-3676).
Line 3a. Enter the child’s adoptive name as it will appear on
your tax return.
Line 3b. If you know the child’s birth name, enter it on line 3b.
Line 4. Enter the child’s date of birth and sex. If you know the
child’s place of birth, enter the information on line 4.
Line 5. Enter the name and address of the authorized
placement agency that placed the child with you for legal
adoption. An authorized placement agency may include a
private adoption agency, a government agency, an adoption
attorney, or any other person authorized by state law to place
a child for legal adoption. Also, enter the date the child was
placed with you.
Signature. Form W-7A must be signed and dated by the
adoptive parent(s) applying for the ATIN. If you and another
person are adopting this child, that person must also sign and
date the application.
Privacy Act and Paperwork Reduction Act Notice. We ask
for the information on this form to carry out the Internal
Revenue laws of the United States. The Internal Revenue
Code requires that you furnish an identifying number on your
tax return if you are claiming certain tax benefits during the
process of adopting a U.S. citizen or resident child and cannot
get an SSN for that child until the adoption is final. Form W-7A
must be used to apply for the identification number, an ATIN.
Section 6109 requires that you disclose your taxpayer
identification number (SSN). Routine uses of this information
include giving it to the Department of Justice for civil and
criminal litigation and to cities, states, and the District of
Columbia for use in 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 nontax
criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. If you do not file the form, you
will not be issued an ATIN.
You are required to give us the information. We need it to
ensure that you are complying with these laws and to allow us
to figure and collect the right amount of tax.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be
retained as long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
Internal Revenue Code section 6103.
The average time and expenses required to complete and
file this form will vary depending on individual circumstances.
For the estimated averages, see the instructions for your
income tax return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for your
income tax return.