Form 8655 Reporting Agent Authorization

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
Form 8655, PAGE 1 of 2
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20 INK: BLACK
FLAT SIZE: 216 mm (81⁄2 "
279 mm (11")
PERFORATE: NONE

8655

Date

Signature

O.K. to print

PRINTS: HEAD to HEAD

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form

Action

Revised proofs
requested

Reporting Agent Authorization

OMB No. 1545-1058

(Rev. May 2005)
Department of the Treasury
Internal Revenue Service

Taxpayer
1a 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

5 Other identification number

Address (number, street, and room or suite no.)
City or town, state, and ZIP code

6

Contact person

7 Daytime telephone number

(

8 Fax number

)

(

)

Reporting Agent
9

10 Employer identification number (EIN)

Name (enter company name or name of business)

11

Address (number, street, and room or suite no.)
City or town, state, and ZIP code

12

13 Daytime telephone number

Contact person

(

14 Fax number

)

(

)

Authorization of Reporting Agent To Sign and File Returns
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

944-PR

945

1042

CT-1

Authorization of Reporting Agent To Make Deposits and Payments
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

1042

1120

CT-1

990-C

990-PF

990-T

1041

Disclosure of Information to Reporting Agents
17a

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 line 15 and/or line 16
b Check here if the reporting agent also wants to receive copies of notices from the IRS

Form W-2 series or Form 1099 series Disclosure Authorization
18a

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
.

State or Local Authorization
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. 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.

Sign
Here

I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer.

䊳

Signature of taxpayer

䊳

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Title
Cat. No. 10241T

䊳

Date
Form

8655 (Rev. 5-2005)

10
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
Form 8655, PAGE 2 of 2
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20 INK: BLACK
FLAT SIZE: 216 mm (81⁄2 "
279 mm (11")
PERFORATE: NONE

PRINTS: HEAD to HEAD

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Page

Form 8655 (Rev. 5-2005)

General Instructions
What’s New
● Magnetic tape is no longer a filing method for the returns on
line 15.
● The “Other” box in line 16 has been deleted. Authority to make
deposits and payments can only be granted for the forms listed in line
16.
● New Forms 944 and 944-PR have been added to line 15. New Form
944 has been added to line 16. Form 944 should be available for
calendar year 2006.
● Lines 18a and 18b have been added to allow taxpayers to grant
reporting agents disclosure authority for the Form W-2 series and Form
1099 series information returns.

Purpose of Form

2

Withdrawing from reporting authority. A reporting agent can
withdraw from authority by filing a statement with the IRS, either on
paper or using a delete process. The statement must be signed by the
reporting agent (if filed on paper) and identify the name and address of
the taxpayer and authorization(s) from which the reporting agent is
withdrawing. For information on the delete process, see Pub. 1474.

Specific Instructions
Line 15
Use the “YYYY” format for annual tax returns. Use the “MM/YYYY”
format for quarterly tax returns, where “MM” is the ending month of the
quarter the named reporting agent is authorized to sign and file tax
returns for the taxpayer. For example, enter “03/2005” on the line for
“941” to indicate you are authorizing the named reporting agent to sign
and file Form 941 for the January–March quarter of 2005 and
subsequent quarters.

Form 8655 is used to authorize a reporting agent to:
● Sign and file certain returns;
● Make deposits and payments for certain returns;
● Receive duplicate copies of tax information, notices, and other
written communication regarding any authority granted; and
● Provide IRS with information to aid in penalty relief determinations
related to the authority granted on Form 8655.

Line 16

Authority Granted

Who Must Sign

Once Form 8655 is signed, any authority granted is effective beginning
with the period indicated on lines 15 or 16 and continues indefinitely
unless revoked by the taxpayer or reporting agent. No authorization or
authority is granted for periods prior to the period(s) indicated on Form
8655. Disclosure authority by checking the box in line 17a is effective
with the dated signature of the taxpayer on Form 8655.
Any authority granted on Form 8655 does not revoke and has no
effect on any authority granted on Forms 2848 or 8821, or any
third-party designee checkbox authority.

Sole proprietorship–The individual owning the business.
Corporation (including an LLC treated as a corporation)–Generally,
Form 8655 can be signed by: (a) an officer having legal authority to
bind the corporation, (b) any person designated by the board of directors
or other governing body, (c) any officer or employee on written request
by any principal officer, and (d) any other person authorized to access
information under section 6103(e).
Partnership (including an LLC treated as a partnership) or an
unincorporated organization–Generally, Form 8655 can be signed by any
person who was a member of the partnership during any part of the tax
period covered by Form 8655.
Single member limited liability company (LLC) treated as a
disregarded entity–The owner of the LLC.
Trust or estate–The fiduciary.

Where To File
Send Form 8655 to:
Internal Revenue Service
Accounts Management Service Center
MS 6748 RAF Team
1973 North Rulon White Blvd.
Ogden, UT 84404
You can fax Form 8655 to the IRS. The number is 801-620-4142.

Additional Information
Additional information concerning reporting agent authorizations may
be found in:
● Pub. 1474, Technical Specifications Guide for Reporting Agent
Authorizations and Federal Tax Depositors, and
● Rev. Proc. 2003-69. You can find Rev. Proc. 2003-69 on
page 403 of Internal Revenue Bulletin 2003-34 at
www.irs.gov/pub/irs-irbs/irb03-34.pdf.

Substitute Form 8655
If you want to prepare and use a substitute Form 8655, see
Pub. 1167, General Rules and Specifications for Substitute Forms and
Schedules. If your 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 IRS.

Revoking an Authorization
If you have a valid Form 8655 on file with the IRS, the filing of a new
Form 8655 revokes the authority of the prior reporting agent beginning
with the period indicated on the new Form 8655. However, the prior
reporting agent is still an authorized reporting agent and retains any
previously granted disclosure authority for the periods prior to the
beginning period of the new reporting agent’s authorization unless
specifically revoked.
If the taxpayer wants to revoke an existing authorization, send a
copy of the previously executed Form 8655 to the IRS at the address
under Where To File, above. Re-sign the copy of the Form 8655 under
the original 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. 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 address of each reporting agent
whose authority is revoked.

Use the “MM/YYYY” format to enter the starting date, where “MM” is
the first month the named reporting agent is authorized to make
deposits or payments for the taxpayer. For example, enter “08/2005”
on the line for “720” to indicate you are authorizing the named
reporting agent to make deposits or payments for Form 720 starting in
August 2005 and all subsequent months.

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. Form 8655 is provided by the IRS for your convenience
and its use is voluntary. If you choose to authorize a reporting agent to
act on your behalf, under section 6109, you must disclose your EIN.
The principal purpose of this disclosure is to secure proper
identification of the taxpayer. We need this information to gain access
to your tax information in our files and properly respond to your
request. If you do not disclose this information, the IRS may suspend
processing your reporting agent authorization and may not be able to
honor your reporting agent authorization until you provide your EIN.
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 agencies and intelligence agencies to combat
terrorism.
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
instructions must be retained as long as their contents may become
material in the administration of any Internal Revenue law.
The time needed to complete and file Form 8655 will vary depending
on individual circumstances. The estimated average time is 6 minutes.
If you have comments concerning the accuracy of this time estimate
or suggestions for making Form 8655 simpler, we would be happy to
hear from you. You can write to the Internal Revenue Service, Tax
Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111
Constitution Ave. NW, IR-6406, Washington, DC 20224. Do not send
Form 8655 to this address. Instead, see Where To File above.