9789 Tax Form 9789 with Instructions; Individual Confirmation

Please keep this form for future reference.

Tax Form 9789 with Instructions (OMB 1545-1467)
Department of the Treasury

➪

Please retain this form for your records. If changes
or corrections are needed, please complete and
mail to:
EFTPS Enrollment Processing Center
P.O. Box 173788
Denver, Colorado 80217-3788

INDIVIDUAL Confirmation/Update Form –
Use this form to review or modify enrollment information. Critical
errors are defined in the accompanying cover letter. If you have critical
errors, it is necessary to return this form with the corrections/modification
made on the right side. Also, please return this form if you wish to correct
non-critical errors, or update information. If information is correct do
not return this form, but keep it for future reference.
REMEMBER – Both EFTPS payment methods are interchangeable:
• EFTPS online (www.eftps.gov) • EFTPS by phone
For questions regarding EFTPS or this Form please call:

Do not return this form unless you have changes to your information.

EFTPS Customer Service

1-800-316-6541

(24 hours a day, 7 days a week)
(24 hours a day, 7 days a week)

en español
1-800-244-4829
For TDD (hearing impaired) support 1-800-733-4829

(8 a.m. to 8 p.m. Eastern Time)

INSTRUCTIONS: All the information that EFTPS currently has on file about paying your taxes electronically is imprinted on the left side of this form. Problems or critical errors are defined in the
accompanying cover letter. The right side is to be used to update or correct information relating to the problems or errors or any changes you wish to make to the current information. Solid areas on the
right side, indicate information that cannot be modified by this form. When completing this form, please print using all capital letters in blue or black ink.

Taxpayer Information
1. Primary Taxpayer Identification
Number (SSN). Your SSN can be filled in
on this form only if the original SSN you
supplied was rejected. Once an SSN has
been established by EFTPS, it can only
be changed through direct communication with the IRS.
2. Taxpayer Name(s). Your taxpayer
name as it appears on your tax return
and IRS documents can be filled in on
this form only if the original SSN you
supplied was rejected. Once a taxpayer
name has been accepted by EFTPS, it
can only be changed through direct
communication with the IRS.
3. Joint Filer Taxpayer Social Security
Number (SSN). If this is a joint filing
please provide the joint filer’s social
security number. The joint SSN can be
filled in on this form only if the original
joint SSN that was supplied was rejected.
Once an SSN has been established by
EFTPS, it can only be changed through
direct communication with the IRS.
4-6. Primary Taxpayer Address. You
may update the address, city, state, Zip
Code, and province, country and postal
code information. The taxpayer address
can only be changed through direct
communication with the IRS. Form
8822 will automatically update the
address on your EFTPS enrollment.
7. Primary Contact Name. Please fill in
the name of the new contact to whom
future confirmations will be sent.

Please see cover letter
for necessary corrections.

Please print any updates/corrections in this space
Solid areas indicate information that cannot be modified by this form

1. Primary Taxpayer Identification Number (SSN):

1. CORRECTED Primary Taxpayer Identification Number (SSN):

2. Taxpayer Name(s):

2. CORRECTED Taxpayer Name(s):

3. Joint Filer Social Security Number (SSN):

3. CORRECTED Joint Filer Social Security Number (SSN):

4. Primary Taxpayer Address:

PLEASE CALL THE IRS AT
5. City, State and ZIP Code:

6. International: Province, Country, and Postal Code:

1-800-829-1040
OR PREPARE IRS FORM 8822 TO MAKE
CHANGES TO YOUR ADDRESS

Contact Information

Please print any updates/corrections in this space

7. Primary Contact Name:

7. NEW Primary Contact Name:

8. Primary Contact Mailing Address:

8. NEW Primary Contact Mailing Address:

9. City, State, and ZIP Code:

9. NEW City, State, and ZIP Code:

10. International: Province, Country, and Postal Code:

10. NEW Province, Country, and Postal Code:

11. Primary Contact Phone Number:

11. NEW Primary Contact Phone Number:
US
International

8-10. Primary Contact Mailing Address.
Please fill in any associated updates to
the street address, city, state, zip code,
and province, country, and postal codes
for the primary contact.

/

-

011-

area code
12. Primary Contact E-mail Address:

country

city

number

12. NEW Primary Contact E-mail Address:

11. Primary Contact Phone Number.
Please fill in any associated updates to
the primary contact phone number.
12. Primary Contact E-mail Address.
(optional)

(over)

(continued)

Payment Information
13. Payment Method. This information
was gathered on your original enrollment
form for Treasury Department reporting
purposes only. Only EFTPS using the
Internet or phone can be used as a
payment option for individuals.

13. Payment Method:

14. Optional Tax Form Payment Amount
Limit (for EFTPS Internet or phone only).
You may use this form to update a
threshold amount which will warn you if
you exceed this amount when you initiate
a tax payment through EFTPS.

Tax Form Payment Amount Limit

15-19. Financial Institution Information.
You may use this portion of the form to
correct errors or change a bank and/or
bank account from which you can initiate
electronic tax payments.

NOTE: You may also change your
Financial Institution Information using
EFTPS on the Internet or by phone.
CAUTION: You may find it prudent to
delete a RTN/account combination
from EFTPS only after you have
previously added a new RTN/account
combination to take its place, and you
have received confirmation from
EFTPS that the new bank has been
successfully accepted.
20. You may choose to have EFTPS verify
your bank account information with your
financial institution. This process takes
about 10 days. Check YES to have your
account information verified. Check NO
if you would like to use EFTPS more
quickly and elect not to verify your bank
account information with your financial
institution. Once you receive your new
PIN you may use EFTPS immediately.
If #20 is left blank, your bank account
information will be verified.

NOTE: You are responsible for the
accuracy of the bank account information. If the information is incorrect,
your financial institution may return
your payments and you may incur an
IRS penalty.
21. Authorization. This section authorizes
a Financial Agent of the U.S. Treasury to
initiate tax payments from the accounts
you designate.
22. Taxpayer Signature. Regardless of
the changes made on this Confirmation/
Update form, the taxpayer must sign
this section to authorize participation in
EFTPS and must return it to EFTPS.

EFTPS-

Tax Form and Threshold Amount

If signed on behalf of the individual
taxpayer, the signer certifies that they
have the authority to execute this
authorization on behalf of the taxpayer.

EFTPS-Through A
Financial Institution

New Threshold Amount
Print any updates/corrections in this space.

14.

14.

Financial Institution Information

Please print any updates/corrections in this space

15. RTN:

15. NEW RTN:

16. Account Number:

16. NEW Account Number:

17. Type:

17. NEW Type:
Checking

18. State:

18. NEW State:

19. ZIP Code:

19. NEW ZIP Code:
20.

Savings

YES, I elect to have my bank account information verified
with my financial institution.
NO, I elect not to have my bank account information verified
with my financial institution.

Authorization
21. Please read the following Authorization Agreement:
I (as defined as the taxpayer whose signature is below) hereby authorize the contact person (listed in item 7 of this form) and the financial institution(s)
involved in the processing of my Electronic Federal Tax Payment System (EFTPS) payments to receive confidential information necessary to effect
enrollment in EFTPS, electronic payment of taxes, and answer inquiries and resolve issues related to enrollment and payments. This information includes,
but is not limited to, passwords, payment instructions, taxpayer name and identifying number, and payment transaction details. If signed by someone other
than the taxpayer, I certify that I have the authority (i.e., Form 2848 Power of Attorney and Declaration of Representative or other Power of Attorney) to
execute this authorization on behalf of the taxpayer. This authorization is to remain in full force and effect until the designated Financial Agents of the U.S.
Treasury have received notification from me of termination in such time and in such manner to afford a reasonable opportunity to act on it.
By completing the information in boxes 15-19 and signing below, I hereby authorize designated Financial Agents of the U.S. Treasury to initiate EFTPS
debit entries to the financial institution account indicated above, for payment of Federal taxes owed to the IRS upon request by taxpayer or his/her
representative, using the Electronic Federal Tax Payment System (EFTPS). I further authorize the financial institution named above to debit such entries to
the financial institution account indicated above. All debits initiated by the U.S. Treasury designated Financial Agents pursuant to this authorization shall be
made under U.S. Treasury regulations. This authorization is to remain in full force and effect until the designated Financial Agents of the U.S. Treasury have
received written notification from me of termination in such time and in such manner as to afford a reasonable opportunity to act on it.
22. Taxpayer(s) Signature

NOTE: if no changes are made, there is
no need to return this form.
This section also provides authorization
to share the information provided with
your financial institution(s), required for
EFTPS processing.

12. NEW Payment Method: (Check One)

Date
Taxpayer Signature
Print Name

Date
Joint Filer’s Signature
Print Name

Paperwork Reduction Act Notice: In accordance with the Paperwork Reduction Act of 1995, we ask for the information in the Electronic Federal Tax Payment System (EFTPS) Enrollment Form in order to carry out the requirements of 26 United
States Code 6001, 6011, and 6109. You are not required to provide 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 its
instructions 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. This information is
used by the Internal Revenue Service to assure that payment(s) are properly credited to the appropriate account(s). Your response is mandatory if you are required by regulations to use Electronic Funds Transfer to make your Federal Tax Deposits.
The time needed to provide this information will vary depending on individual circumstances. The estimated average time is ten minutes. If you have comments concerning the accuracy of this time estimate or suggestions for reducing this
burden, we would be happy to hear from you. You can write to the IRS Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224. Please do not send the enrollment form to this address.
The Privacy Act of 1974 requires that when we ask individuals for information about themselves, we state our legal right to ask for the information, why we are asking for the information, and how it will be used. We must also tell you what could
happen if we do not receive all or part of it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for information is 5 U.S.C. 301 and Internal Revenue Code sections 6001, 6011, 6012, and
applicable regulations. The information will be used to enroll you in the Electronic Federal Tax Payment System (EFTPS). The information may not be disclosed except as provided by section 6103 of the Internal Revenue Code. We may give the
information to the Department of Justice and to other Federal agencies, as provided by law. We may also give it to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their laws. We may give it to foreign
governments because of tax treaties they have with the United States. Your response is mandatory if you are required by regulations to use electronic funds transfer to make your deposits. If you are not required by regulations to use electronic
funds transfer, your response is voluntary. If you do not provide all or part of the information, you may not be eligible to participate in the EFTPS. If you are required to use electronic funds transfer by regulation, you may be subject to penalties. If
you are not required to use electronic funds transfer to pay taxes owed, you need to pay the taxes due by another method.

U.S. Government Printing Office:
1998–405-503/41607
Cat. No.: 21827B

Form 9789 (5/07)