SSA-1694 Current Version

Form Approved
OMB No. 0960-0731

Social Security Administration

Request for Business Entity Taxpayer Information
BUSINESS INFORMATION
Employer Identification Number (EIN)

Name of the Business Entity

Tax Mailing Address
P.O. Box, Street, Apt., or Suite No.
State

City
ZIP Code or Postal Zone
Country

PERJURY STATEMENT
I declare under penalty of perjury that I have examined all of the information on this request and it is true to the best
of my knowledge. I am aware that if I knowingly and willingly make any false representation about any material fact
provided herein or knowingly and willingly make any false representation to obtain information from Social Security
records, and/or attempt to deceive the Social Security Administration as to my true identity, I could be criminally
punished by a fine or imprisonment or both.

Printed Name

Signature

Date

/
Contact Name

Phone Number (including area code)

FOR AGENCY USE ONLY:

Form SSA-1694 (09-2006)

/

Page 1

IMPORTANT INFORMATION

Purpose of Form
The Social Security Administration (SSA) is required to file an information return (i.e., Form 1099-MISC) with
the Internal Revenue Service (IRS) when payments of $600 or more have been made to appointed representatives
associated with a business entity as employees or partners. In order to meet this requirement, SSA must obtain the
name, employer identification number (EIN), and address of the business entity.

Instructions for Completing the Form
Employer Identification Number
Please enter your EIN. If you do not have an EIN, please apply for one immediately by filing an SS-4, Application
for Employer Identification Number, with the IRS. You can apply for an EIN online by accessing the IRS website
at www.irs.gov.
Name of Business Entity
Enter your business name as shown on required Federal tax documents. Normally, this will match the name used
when you filed a Form SS-4 to apply for an EIN.
Tax Mailing Address
Please enter your tax mailing address. SSA will mail Form 1099-MISC to you at this address if payments of $600
or more are made to appointed representatives associated with your business entity during a tax year.

Privacy Act Notice
We are required by section 206(a) and 1631(d) of the Social Security Act to ask you to give us the information on
this form. The information is needed to identify appointed representatives associated with a business entity as
employees or partners and to facilitate issuance of appropriate return information for reporting purposes. Although
the responses on this form are voluntary, without this information, you may not receive the Form 1099-MISC.
The information obtained on this form is almost never used for any purpose other than that stated above.
However, sometimes the law requires us to disclose the facts on this form without your consent. For example, we
must release this information to another person or government agency if federal law requires that we do so or to
contractors, as necessary, to assist SSA in the efficient administration of its programs.
Explanations about the reasons why information you provide us may be used or given out are available in Social
Security offices. If you want to learn more about this, contact any Social Security office.

Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. 3507, as amended by section 2 of the Paperwork
Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of
Management and Budget control number. We estimate that it will take 20 minutes to read the instructions, gather
the facts, and answer the questions. SEND THE COMPLETED FORM TO YOUR LOCAL SOCIAL
SECURITY OFFICE. The office is listed under U.S. Government agencies in your telephone directory or
you may call Social Security at 1-800-772-1213. You may send comments on our time estimate above to SSA,
6401 Security Boulevard, Baltimore, MD, 21235-6401. Send only comments relating to our time estimate to
this address, not the completed form.
Form SSA-1694 (09-2006)

Page 2