Form 4419 Application for Filing Information Returns Electronicall

(See Instructions on back)
IRS Use Only

Department of the Treasury – Internal Revenue Service

Form

4419

(Rev. 6-2008)

Application for Filing Information Returns
Electronically (FIRE)

OMB No.
1545-0387

Please type or print in BLACK ink.

1. Transmitter information
Name
Address

City

State

Zip

2. Person to contact about this request
Name
Title

Email address

Telephone number

3. Taxpayer Identification Number (TIN) 4. Foreign Transmitter without a TIN
Yes

5. Tax year you wish to begin filing
electronically

6. Will you be using your TCC only for transmitting requests for extension of time to file?

Yes

No

7. Type of Return To Be Reported (Check all forms you wish to file)
Important: Form W-2 information is sent to the Social Security Administration (SSA) only. Do not use Form 4419 to
request authorization to file this information electronically. Contact SSA for W-2 electronic filing information at
1-800-772-6270.
Forms 1098, 1099, 5498
and W-2G

Form 1042-S, Foreign Person’s
U.S. Source Income Subject to
Withholding

Form 8027, Employer’s Annual
Information Return of Tip Income
and Allocated Tips

8. Check the appropriate box
I have or will have software which will
format my data into the IRS required format.

I have a service provider who will file
my data for me.

Note: For the forms referenced in Box 7, electronic filing does not refer to on-line fill-in forms.
Title

Name (type or print)
9. Person
responsible for
preparation of
tax reports
Signature

Date

General Instructions
Paperwork Reduction Act Notice. We ask for the information on these forms to carry out the Internal Revenue Laws of the United
States. 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 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 Code section 6103.
The time needed to provide this information would vary depending on individual circumstances. The estimated average time is:

Preparing Form 4419 . . . . . . . . . . . . . . . . . . . . . . 20 min.
Cat. No. 41639J

Form 4419 (Rev. 6-2008)

Page 2

Form 4419 (Rev. 6-2008)

If you have comments concerning the accuracy of this
time estimate or suggestions for making this form 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 THE FORM TO THIS OFFICE. Instead,
see the instructions below on where to file. When
completing this form, please type or print clearly in
BLACK ink.
Purpose of Form. File Form 4419 to request authorization
to file any of the forms shown in Block 7 electronically.
Please be sure to complete all appropriate blocks. If your
application is approved, a five-character alpha-numeric
Transmitter Control Code (TCC) will be assigned to your
organization.
If any information on the form should change, please write
to IRS/Enterprise Computing Center - Martinsburg so we
can update our database. It is not necessary to submit a
new Form 4419.
NOTE: Do NOT use Form 4419 to request authorization
to file Forms W-2 electronically. Contact SSA at
1-800-772-6270 if you have any questions concerning
the filing of Forms W-2 .

Specific Instructions
Block 1
Enter the name and complete address of the person or
organization that will submit the electronic files
(transmitter).
Block 2
Enter the name, title, email address (if available) and
telephone number (with area code) of the person to
contact about this application if IRS needs additional
information. This should be a person who is
knowledgeable about electronic filing of information
returns.
Block 3
Enter the Taxpayer Identification Number (TIN) of the
organization transmitting the electronic files. A TIN can be
either an Employer Identification Number (EIN) or a Social
Security Number (SSN).
Block 4
If you are a foreign transmitter who does not have a
nine-digit Taxpayer Identification Number, check this box.
Block 5
Enter the tax year that you wish to start filing electronically.

Block 6
Indicate if you are requesting this Transmitter Control
Code solely for filing electronic requests for an extension
of time to file information returns.
Block 7
Check the box next to all of the returns you will file with
IRS electronically.
A separate TCC will be assigned for each box checked
in Block 7. Please make sure you submit your electronic
files using the correct TCC.
Thereafter, if you need to add any of the forms identified
in Block 7, it will be necessary to submit another Form
4419 to IRS so another TCC can be assigned.
Block 8
Indicate if your company will be filing your data with a
software package or if you have contracted to have a
service provider file your data for you. Note: The FIRE
System does not provide an on-line fill-in option for
the forms listed in Box 7. You must transmit your
data in a specific format required by IRS.
Block 9
The form must be signed and dated by an official of the
company or organization requesting authorization to
report electronically.
Mailing Address:
Send your Form 4419 to the address below:
Internal Revenue Service
Enterprise Computing Center - Martinsburg
Information Reporting Program
230 Murall Drive
Kearneysville, WV 25430
In order to ensure timely filing, submit Form 4419 at
least 30 days before the due date of the return. If you
prefer, the Form 4419 can be faxed toll-free to (877)
477-0572, but do not do both (faxing and mailing).
If your application is approved, IRS will assign a TCC to
your organization. We will not issue your TCC without a
signed Form 4419, and we will not issue a TCC over the
phone or by email. If you do not receive a reply from
IRS within 30 days, contact us at the telephone number
shown below. Do not submit any files until you receive
your TCC.
For further information concerning the filing of information
returns with IRS electronically, you may access
www.irs.gov for Publication 1220 for the current tax year.
If you do not have internet access, you may contact the
IRS Enterprise Computing Center - Martinsburg toll-free
at (866) 455-7438 between 8:30 a.m. and 4:30 p.m.
Eastern Standard Time.