Form 13803 Application to Participate in the Income Verification Ex

OMB Number
1545-2032

Department of the Treasury - Internal Revenue Service

Form

Application to Participate in the Income
Verification Express Service (IVES) Program

13803

(April 2018)

For Official Use Only
Control Number:

(Please read the instructions carefully before submitting this form)
1. Check the type of application you are submitting:
New

Renewal

Amended

Add New Location

Cancellation

Address Change

Sole Proprietorship

Corporation

LLC

2. Check the box that describes your organization status:
Government Agency

Partnership

Other (Specify)
3. Reason(s) for using the IVES Program: (Select all that apply)
Mortgage Services

Background Check

Credit Check

Banking Service

Licensing Requirement

Other (Specify)
4. Legal name of business (required)

5. Employer Identificaton Number (EIN) or Social Security Number (SSN)(required)

6. Doing Business As (DBA) name (Complete only if the business is operating under a different business name listed on line 4)

7. Business location address (required)
Street address

City

State

Business telephone number (required)

Fax number (required)

Business e-mail address

Zip Code

8. Billing address required if different from the location address on line 7
Street address

City

State

Zip Code

9. Complete the following information for the principal, company official, partner, or owner of business.
Company official name (first, middle initial, last)

Title

Date of Birth (mm/dd/yyyy) (required)

Social Security Number (required)

E-mail address

Home street address

City

State

Telephone number

Zip Code

10. Primary contact name (required if different than the principal). A contact must be available on a day to day basis to answer IRS
questions during testing and through the processing year.
Last name

First name

Telephone number (required)

E-mail address (required)

MI

11a. Have you been convicted of a felony in the last 10 years? (Attach an explanation for a Yes response)

Yes

No

11b. Are you current with your individual and business taxes, including any corporation and employment tax
obligations? (Attach an explanation for a No response)

Yes

No

12. Estimated annual volume of IVES product requests:
Catalog Number 48547A

www.irs.gov

Form 13803 (Rev. 4-2018)

13. Complete the following information for the responsible official. The responsible official is an individual with responsibility for the
operation and IVES users at the business location listed above. A principal listed above may also be a responsible official.
Responsible official name (first, middle initial, last)

Title

Date of Birth (mm/dd/yyyy) (required)

Social Security Number (required)

E-mail address

Home street address

City

State

14.

Telephone number

Zip Code

By marking this box, you agree to review Publication 4557, Safeguarding Taxpayer Data and abide by the guidelines of the
publication. In addition, you can only use taxpayer information that you recieve via a Form 4506-T or Form 45-6 T-EZ request
for the purpose(s) the taxpayer/requestor intended. Failing to complete this section will result in the application being rejected
and returned.

Where to fax your application: Fax your application to your closest IVES location listed below:
IVES location
Austin, Texas
Fresno, California
Kansas City, Missouri
Ogden, Utah

Fax number
877-477-9603
877-477-0576
877-477-9601
877-477-0580

The IRS conducts a suitability check on the applicant, and on all Principals listed on the application to determine the applicant's
suitability to be an IVES participant. After an applicant passes the suitability check and the IRS completes processing the application,
the IRS notifies the applicant of acceptance to participate in the program.
A responsible company official must sign the application agreement indicating understanding of the Privacy Act restrictions relating to
the use of this service.
Non-Transferable: Acceptance for participation is not transferable. I understand if this business is sold or its organizational structures
changes, a new application must be filed. I further understand noncompliance will result in the business and/or the individuals listed on
this application, being suspended from participation in the IVES program.
Privacy Act Notice: Our right to ask for information is 5 U.S.C 301 and the Internal Revenue Code Section 6109 and applicable
regulations. The registration information we are requesting is used to create an account for you, authenticate your identity and for billing
purposes. We may disclose the information to the Department of Justice, to enforce the tax laws, civil and criminal, to cities, states, the
District of Columbia and U.S. commonwealths or possessions to carry out their tax laws. we may give it to other countries under a tax
treaty, to federal and state agencies to enforce federal non-tax criminal laws, or to federal law enforcement and intelligence agencies to
combat terrorism. Your participation in the Income Verification Express Services (IVES) program is voluntary; however, if you do not
provide all or part of the information required to create your account, you will not be eligible for access to IVES.
Under the penalties of Perjury, I declare I have examined this application and read all accompanying information, and to the best of my
knowledge and belief, the information being provided is true, correct, and complete. In addition, I have read the Internal Revenue
Service rules and procedures for participating in the Income Verification Express Service program and I agree to abide by them and to
pay resulting fees timely. I understand failure to do so will result in a temporary or permanent exclusion from the program.
Name and title of Principal, Partner or Owner (type or print)

Catalog Number 48547A

Signature of Principal, Partner or Owner

www.irs.gov

Date signed

Form 13803 (Rev. 4-2018)