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

Form

23-EP

(Rev. April 2012)
Department of the Treasury
Internal Revenue Service

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

OMB No. 1545-0950

See Instructions on Page 3

Important things you need to know and do before you file this form:
• Take and pass the Enrolled Retirement Plan Agent Special Enrollment Examination
• Read Circular 230
• The application fee is $30.

For IRS use:
Date Enrolled:

Visit www.pay.gov to file and pay electronically. 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
.
/
/

Enrollment Number:

Part 1. Tell Us About Yourself

1

Your Social Security Number
If you do not have an SSN, please check this box.

2

Your Full Legal Name
Last

3

First

MI

Current Address
Number

City

State

Street

Zip Code

Suite or Apt. Number

Country

Your email Address:

Your Contact Telephone Number:
4

Enter your PTIN number issued by the IRS or Candidate Number assigned by the
American Institute of Retirement Education (AIRE).

5

Do you have an Employer Identification Number (EIN)?
Yes
No
If Yes, enter all EINs, business names, and addresses below (attach additional pages, if necessary):
EIN

Business Name

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Business Address

Cat. No. 51483V

Form 23-EP (Rev. 4-2012)

Page 2

Form 23-EP (Rev. 4-2012)

6

Do you have a Centralized Authorization File (CAF) number?

Yes

No

If Yes, enter all CAF numbers assigned to you (attach additional pages, if necessary):

7

Have you been sanctioned by a federal or state licensing authority?

Yes

No

8

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

Yes

No

Have you been convicted of a tax crime or any felony?

Yes

No

Have you been permanently enjoined from preparing tax returns, or
representing others before the IRS?

Yes

No

9
10

NOTE: If you answered yes to question 7, 8, 9 or 10, please describe on a separate page, the matter, including the date of
when the matter occurred, and provide any additional information about the matter that you would like us to consider.
11

Are you a CPA?

Yes

No

If Yes, enter the states where you are licensed to practice.

12

Are you an Attorney?

Yes

No

If Yes, enter the States where you are licensed to practice.

13

Are you a Registered Tax Return Preparer (RTRP)?

Yes

No

14

Are you an Enrolled Agent (EA)?

Yes

No

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.

Signature

Date
Form 23-EP (Rev. 4-2011)

Filling out this form:
It is important to answer all questions on the form. Failure to answer any questions or sign the form could result in processing delays.
An intentionally false statement or omission identified with your application is a violation of Circular 230 10.51(a)(4) and 18 U.S.C. 1001
and may be grounds for suspension or disbarment from practice.

Page 3

Form 23-EP (Rev. 4-2012)

Instructions:
• You must take and pass the EPRA-SEE before you can apply.
You may register for the examination at www.erpaexam.org.

Former IRS Employees:
Please Note: your eligibility to practice may be limited based
upon your work experience.
You may request a waiver to take the ERPA-SEE through the
submission of an application within three (3) years from the date
of your separation with the Internal Revenue Service (IRS).
Please check the box at the top of the form which indicates you
are requesting a waiver from taking the ERPA-SEE. See Circular
230 Section 10.4(d) for more information. To gain full enrollment
status you must take and pass the ERPA-SEE before you can
apply. You may register for the examination at
www.erpaexam.org.

What if I don't have a Social Security
Number?
If you are living and working in the United States (US), you are
required to have a Social Security Number (SSN). If you are
working outside of the US and you do not have an SSN or an
ITIN, check the box on line 1.

Electronic Application and Payments:
You can pay electronically by visiting www.pay.gov.

Privacy Act and Paperwork Reduction Act Notice. Section
330 of title 31 of the United States Code authorizes us to collect
this information. We ask for this information to administer the
program of enrollment to practice before the IRS. Applying for
renewal of enrollment is voluntary; however, if you apply you
must provide the information requested on this form. Failure to
provide this information may delay or prevent processing your
application; providing false or fraudulent information may
subject you to penalties. Generally, this information is
confidential pursuant to the Privacy Act. However, certain
disclosures are authorized under the Act, including disclosure
to: the Department of Justice, and courts and other adjudicative
bodies, with respect to civil or criminal proceedings; public
authorities and professional organizations for their use in
connection with employment, licensing, disciplinary, regulatory,
and enforcement responsibilities; contractors as needed to
perform the contract; third parties as needed in an investigation;
the general public to assist them in identifying enrolled
individuals; state tax agencies for tax administration purposes;
appropriate persons when the security of information may have
been compromised for their use to prevent, mitigate, or remedy
harm.
You are not required to provide the information requested on
a form that is subject to the requirements of the Paperwork
Reduction Act unless the form displays a valid OMB control
number. Books and records relating to a form or its instructions
should be retained as long as their contents may become
material in the administration of the law. The time needed to
complete and file this form will vary depending on individual
circumstances. The estimated average time is 30 minutes,
including recordkeeping, learning about the law or the form,
preparing the form, and copying and sending the form to the
IRS.

DRAFT AS OF
April 6, 2012

Where to send this form:

You can use overnight mail or regular mail to send us this form.
If you want to use regular mail:

U.S. Treasury/Enrollment
PO Box 301510
Los Angeles, CA 90030-1510

If you want to use overnight mail:
Internal Revenue Service
Attn: Box 301510
19220 Normandie Ave. Ste. B
Torrance, CA. 90502

How long will it take to process your
application for enrollment?
It generally takes about 60 days to process applications. Your
enrollment status is not effective until we approve your request.
You are not authorized to practice before the IRS as an ERPA
until enrollment has been granted.

Who do I call if I have questions?
Please allow 60 days for processing before calling to check on
the status of your application. To check on the status of your
application, you may call 1-313-234-1280.

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 Office of Enrolled
Agent Policy & Management; P.O. Box 33968; Detroit, MI,
48232. Do not send this form to this address; instead see the
Where to send this form section of the instructions.