Form 23-EP Application for Enrollment to Practice Before the Intern

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 23-EP, PAGE 1 of 2
MARGINS: TOP 13 mm (1⁄ 2 ") CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20
FLAT SIZE: 216 mm (81⁄ 2 ") x 279 mm (11")
PERFORATE: NONE

Date

Action

23-EP

Revised proofs
requested

Application for Enrollment to Practice Before the Internal Revenue
Service as an Enrolled Retirement Plan Agent (ERPA)

(Rev. April 2009)
Department of the Treasury
Internal Revenue Service

Signature

O.K. to print

PRINTS: HEAD TO HEAD
INK: BLACK

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

Form

Date

OMB No. 9999-9999

See instructions on page 2.

Important things you need to do before you file this form:
● Take and pass the Special Enrollment Examination.
● Read Circular 230.
● Visit www.pay.gov to file and pay electronically or enclose a check or money order for
$125 made payable to the Internal Revenue Service.

For IRS use:
Enrollment Number:
Date Enrolled:

This fee is non-refundable.
Check here if you are a former Internal Revenue Service employee
and enter the date you separated from the Service
/
/
Part 1. Tell us about yourself
1

Social Security Number

2

Print full legal name

3

—

—

Last

First

Number

Street

Current address

City

4
5

Intial

Suite or room number

State

ZIP code

Country

Enter the candidate number assigned to you by [VENDOR]
Do you have an EIN
No
Yes
If Yes, enter the Employer Identification Numbers (EINs) below.
Enter the Employer Identification Numbers (EINs) below.
EIN

Name

5a
5b
5c
6

Have you ever appeared before or been sanctioned by a licensing board, regulatory body, federal
or state agency for alleged misconduct

No

Yes

7

Has any application you filed with a court, government department, commission, or agency for
admission to practice ever been denied or rejected

No

Yes

8

Has any Internal Revenue Service office ever held you ineligible for limited practice without
enrollment
Have you been convicted, or fined $500 or more, for violating any law, excluding traffic tickets

9

10

No
Yes
No
Yes
Note: If you answered “Yes” to question 6, 7, 8, or 9, describe the nature of the offense, tell us when it occurred, and
provide details on a separate page.
Are you a
CPA
Attorney or
both.
If you checked any box, enter the U.S. States where you are licensed to practice. If no boxes are checked,
proceed to Part 2.

10a

10b

10c

10d

Part 2: Sign here
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.

✗

Sign your
name here
Email address

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

/

Date
Best daytime phone
Cat. No. 51483V

(

)

/

–
Form

23-EP

(Rev. 4-2009)

7
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 23-EP, PAGE 2 of 2
MARGINS: TOP 13 mm (1⁄ 2 ") CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20
FLAT SIZE: 216 mm (81⁄ 2 ") x 279 mm (11")
PERFORATE: NONE

PRINTS: HEAD TO HEAD
INK: BLACK

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

Form 23-EP (Rev. 4-2009)

What is New
Filing and paying electronically
For faster processing and convenience, you may submit your
application and pay your fee elctronically. Please visit www.pay.gov
for additional information on how to file and pay electronically.

Instructions
You must take and pass the Special Enrollment Examination
(SEE) before you can apply for Enrolled Retirement Plan
Agent (ERPA) status. If you did not pass the required SEE,
go to [Vendor website] and register to take the test.

Page

2

If you want to use regular mail, send it to:
U.S. Treasury/Enrollment
P.O. Box 894191
Los Angeles, CA 90189-4191

How long will it take to process this request?
It will generally take about 60 days for us to process your
request. Your status is not effective until we approve your
request.
You are not authorized to practice before the IRS on
anyone’s behalf, until your request has been approved.

Special instructions for former IRS employees

Who do I call if I have questions?

If you are a former IRS employee who held a position that
qualifies you for ERPA status, you are not required to take
the SEE. Check the box at the top of the form to tell us you
are a former IRS employee who meets the exception criteria.
If you checked the box, you must enter your date of
separation (mm-dd-yyyy).

To check on the status of your request, call 1-313-234-1280.
Please allow 60 days for processing before calling to check
on the status of your application.

Note: You must apply for enrollment within 3 years from the
date you separated from the Service.

Filling out the form
It is important that you answer all questions in Part 1, as
required, and that you sign your name in Part 2 so that we
can process your request. Failure to complete the form, as
requested, could result in processing delays.

Enclose the fee
Enclose a check or money order for $125 made payable to
the Internal Revenue Service. You may also submit your
application and pay your fee elctronically. Please visit
www.pay.gov.
Effective October 1, 2007, all personal check remittances
will be debited from your account electronically, within 24
hours of receipt. Please visit www.irs.gov for more detailed
information.

What we will do when we receive your form
As part of the application process, we will check your filing
history to verify that you have timely filed and paid all federal
taxes. If you own or have any interest in a business, we will
also check the history of your business tax return filings.
Note: It is important that you file any delinquent tax returns
and that you pay any taxes owed before you file this form.
An intentionally false statement or omission identified with
your application is a violation of 18 U.S.C. 1001 and may
also be grounds for denial of your application.

Where to send this form
You can use overnight mail or regular mail to send us this
form.
If you want to use overnight mail, send it to:
Internal Revenue Service
Attn: Box 4191
5860 Uplander Way
Culver City, CA 90230

Privacy Act and Paperwork Reduction Act Notice. Section
330 of title 31, United States Code, authorizes the IRS to
collect this information. The primary use of the information is
to administer the enrolled retirement plan agent program.
Information may be disclosed to: public authorities for use in
law enforcement and in connection with employment,
contracting, licensing, and other benefits; courts and other
adjudicative bodies and the Department of Justice for
litigation purposes; contractors to perform the contract; third
parties during the course of an investigation; the general
public to identify individuals currently or formerly eligible to
represent taxpayers, including their location; and professional
organizations or associations to assist them in meeting their
responsibilities in connection with the administration and
maintenance of standards of conduct and discipline.
Applying for enrollment is voluntary, however, providing the
information requested on this form is a requirement to obtain
the benefit of enrollment. Failure to provide the requested
information could delay or prevent processing of your
application. Providing false information could subject you to
penalties.
Notwithstanding any other provision of law, no person is
required to respond to, nor shall any person be subject to a
penalty for failure to comply with, a collection of information
subject to the requirements of the Paperwork Reduction Act,
unless that collection of information displays a currently valid
OMB Control Number. Public reporting burden for this
collection of information is estimated to average 1 hour, 12
minutes per response, including the time for reviewing the
instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden,
to: IRS/Office of Professional Responsibility; SE:OPR; 1111
Constitution Avenue, NW; Washington, DC 20224.