Instructions for F Instructions for Form 1024- A

Instructions for Form 1024-A

Department of the Treasury
Internal Revenue Service

(January 2018)

Application for Recognition of Exemption Under Section 501(c)(4) of the Internal
Revenue Code
Section references are to the Internal
Revenue Code unless otherwise noted.
Note. Keep a copy of the completed Form
1024-A in the organization’s permanent
records.

Future Developments

For the latest information about
developments related to Form 1024-A and
its instructions, such as legislation
enacted after they were published, go to
IRS.gov/Form1024A.

General Instructions

User fee. Along with Form 1024-A, also
submit Form 8718, User Fee for Exempt
Organization Determination Letter
Request, and the user fee called for in the
Form 8718. You can get Form 8718, and
additional forms and publications at
IRS.gov. For fee information, see Rev.
Proc. 2018-5, 2018-1 I.R.B. 233, available
at IRS.gov/irb/2018-01_IRB, or latest
annual update. For information on future
updates to the user fee, go to IRS.gov/
Form1024A.

Helpful information. For additional
information, see:
Pub. 557, Tax-Exempt Status for Your
Organization;
Pub 598, Tax on Unrelated Business
Income of Exempt Organizations; and
IRS.gov/Charities.

Purpose of Form

Form 1024-A is used by organizations to
apply for recognition of exemption under
section 501(c)(4).
Section 501(c)(4) organizations aren’t
required to file Form 1024-A to be
tax-exempt, except as described below.
However, organizations may wish to file
Form 1024-A to receive a determination
letter of IRS recognition of their section
501(c)(4) status in order to obtain certain
incidental benefits such as:
Public recognition of tax-exempt status,
Possible exemption from certain state
taxes,
Advance assurance to donors of
deductibility of contributions (in certain
cases), and
Nonprofit mailing privileges, etc.
Organizations that have been
auto-revoked are required to apply for
reinstatement, even if they were not
required to apply for tax-exempt status
initially. See Rev. Proc. 2014-11, 2014-3
Jan 12, 2018

I.R.B. 441 at IRS.gov/irb/2014-3_IRB.html.
As such, these organizations are required
to file Form 1024-A.
Note. Most organizations operating under
section 501(c)(4) are required to notify the
IRS that they are operating under section
501(c)(4) within 60 days of formation by
filing Form 8976 (see Rev. Proc. 2016-41,
2016-30 I.R.B. 165 at IRS.gov/irb/
2016-30_IRB/ar09). This requirement isn’t
met by submitting Form 1024-A,
requesting recognition of exemption under
section 501(c)(4).

The IRS will determine the
organization’s tax-exempt status and
whether any annual returns must be filed.

Private Delivery Service

Organizations can use certain private
delivery services (PDS) designated by the
IRS to meet the "timely mailing as timely
filing" rule for tax returns. Go to IRS.gov/
PDS for the list of PDS.
The PDS can tell you how to get written
proof of the mail date. If you're using PDS,
send your application, user fee and all
other required information to:

Note. Generally, Form 1024-A isn’t used
to apply for a group exemption letter. For
information on how to apply for a group
exemption letter, see Pub. 557.
Note. Tax benefits for certain
homeowners associations under section
528 are available to organizations that
aren’t exempt from federal income tax. To
elect these benefits, file a properly
completed and timely filed (including
extensions) Form 1120-H, U.S. Income
Tax Return for Homeowners Associations,
instead of Form 1024-A.

What To File
Attachments
For any attachments submitted with
Form 1024-A:
Show the organization’s name,
address, and employer identification
number (EIN);
Identify the part and line item number to
which the attachment relates;
Use 8-1/2 x 11 inch paper for any
attachments; and
Include any court decisions, rulings,
opinions, etc., that will assist us in
processing your application. Generally,
attachments in the form of tape recordings
aren’t acceptable unless accompanied by
a transcript.

Where To File

File the completed Form 1024-A
application, user fee payment, and all
other required information to:
Internal Revenue Service
Attention: EO Determination Letters
Stop 31
P.O. Box 12192
Covington, KY 41012-0192

Cat. No. 69752X

Internal Revenue Service
Attention: EO Determination Letters
Stop 31
201 West Rivercenter Boulevard
Covington, KY 41011
Private delivery services can't
deliver items to P.O. boxes. You
CAUTION must use the U.S. Postal Service
to mail any items to an IRS P.O. box
address.

!

Signature Requirements

An officer, director, or trustee who is
authorized to sign, or another person
authorized by a power of attorney, must
sign the Form 1024-A application. Attach
a power of attorney to the application. You
may use Form 2848, Power of Attorney
and Declaration of Representative, for this
purpose.

After You Submit Form 1024-A

We will acknowledge receiving your
application in writing. You may expect to
receive this notice within 21 days of the
postmark date of the Form 1024-A. Read
the notice thoroughly because it will
provide further information about the
processing of your Form 1024-A.
Generally, we assign applications in
the order we receive them. Unless the
application is approved for expedited
processing, it will be worked in the order
received.
No additional information needed. If
our review shows that you qualify, we will
send you a letter stating that you are
exempt under section 501(c)(4).
Additional information needed. If the
review shows that we need additional
information or changes, we will call or
write you. Examples of the types of
questions you may be asked are available

at IRS.gov. If the additional information
indicates that you qualify, we will send you
a letter stating that you are exempt under
section 501(c)(4). If we conclude that you
do not qualify for exemption, we will send
you a letter that explains our position and
your appeal rights.

Language and Currency
Requirements

Language requirements. Complete
Form 1024-A and its statements in
English. Provide an English translation if
the organizational document or bylaws are
in any other language. See the conformed
copy requirements in the instructions
under Part II. You may be asked to provide
English translations of foreign language
publications that the organization
produces or distributes and that are
submitted with the application.
Financial requirements. Report all
financial information in U.S. dollars
(specify the conversion rate used).
Combine amounts from within and outside
the United States and report the total for
each item on the financial statements.

Example:
Gross investment
income
From U.S. sources
From non-U.S. sources
Amount to report on
income statement

$4,000
1,000
______
$5,000

Annual Information Return

If an annual information return is due while
the organization’s application for
recognition of exempt status is pending
with the IRS (including any appeal of a
proposed adverse determination), the
organization should file Form 990, Return
of Organization Exempt From Income Tax,
or Form 990-EZ, Short Form Return of
Organization Exempt From Income Tax, at
the following address. Indicate that the
application is pending.
Internal Revenue Service
Ogden Service Center
Ogden, UT 84201–0027
The organization may also be eligible
to file Form 990-N, Electronic Notice
(e-Postcard) for Tax-Exempt
Organizations Not Required to File Form
990 or Form 990-EZ, available at IRS.gov.
If an organization has unrelated
business income of $1,000 or more, file
Form 990-T, Exempt Organization
Business Income Tax return.

Public Inspection

Information available for public
inspection. If the IRS approves the
organization’s application for section
501(c)(4) status, the following items will be
open to public inspection.
The complete application and any
supporting documents.
Any correspondence between the
organization and the IRS concerning Form
1024-A, including Form 2848.
The letter the IRS issues approving
your exemption.
Annual information returns (Form 990,
990-EZ, or 990-N) including schedules,
except for the names and addresses of
contributors and other identifying
information about contributors.
Information not available for public
inspection. The following items won’t be
open for public inspection.
Any information relating to a trade
secret, patent, style of work, or apparatus
that, if released, would adversely affect
the organization. The IRS must approve
withholding this information.
Any other information that would
adversely affect national defense. The IRS
must approve withholding this information.
User fee check.
Contributors’ names and addresses
and other identifying information about
contributors included with Form 990 or
990-EZ.
Form 990-T.
Applicants must identify this
information by clearly marking it
CAUTION “NOT SUBJECT TO PUBLIC
INSPECTION,” and must attach a
statement to explain why the organization
asks that the information be withheld. If
the IRS agrees, the information will be
withheld.

!

Making documents available for public
inspection. Both the organization and
the IRS must make the information that is
subject to disclosure available for public
inspection. The public can request this
information by submitting Form 4506-A,
Request for Public Inspection or Copy of
Exempt or Political Organization IRS
Form. The public may also request
inspection of the information or a copy of
the information directly from you.
An exempt organization may post the
documents required to be available for
public inspection on its own website. The
information return and exemption
application materials must be posted
exactly as filed with the IRS. Only the
information that isn't open for public
inspection may be deleted.
If an exempt organization posts the
documents on its website, it must provide
notice of the website address where the
documents may be found, but it need not
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provide copies of the information.
However, documents posted on an
organization's website must still be made
available for public inspection without
charge at its main office during regular
business hours.
Documents aren't considered available
for public inspection on a website if the
otherwise disclosable information is edited
or subject to editing by a third party when
posted. See Pub. 557 for additional
guidance on public inspection.
In the case of organizing documents
and bylaws, see the instructions under
Part II.

Specific Instructions
Part I. Identification of
Applicant
Line 1. Full name of organization.
Enter the organization’s name exactly as it
appears in its organizing documents,
including amendments. If the organization
will be operating under another name,
show the other name in parentheses.
Line 2. c/o Name. If you have an “in care
of” name, enter it here.
Line 3. Mailing address. Enter your
complete address where all
correspondence will be sent. If mail is not
delivered to the street address and you
have a P.O. Box, show the box number
instead of the street address.
For a foreign address, enter the
information in the following order: city,
province or state, and country. Follow the
country's practice in placing the postal
code in the address. Don’t abbreviate the
country name.
Line 4. Employer identification number
(EIN). All organizations must have an
EIN. Enter the nine-digit EIN the IRS
assigned to the organization. If the
organization doesn’t have an EIN, it must
apply for one. An EIN can be applied for
by visiting the IRS website at IRS.gov/EIN.
The organization may also apply for an
EIN by faxing or mailing Form SS-4 to the
IRS. Organizations outside the United
States or U.S. possessions may also
apply for an EIN by calling 267-941-1099
(toll call). Don’t apply for an EIN more than
once.
Line 5. Month the annual accounting
period ends. Enter the month the
organization's annual accounting period
ends. The organization's accounting
period is usually the 12-month period that
is the organization's tax year. The
organization's first tax year depends on
the accounting period it chooses. The first
tax year could be less than 12 months.
Lines 6a, b, and c. Person to contact.
Enter the name and telephone number of
Instructions for Form 1024-A

the person to be contacted during
business hours if more information is
needed. The contact person should be an
officer, director, or a person with power of
attorney who is familiar with the
organization's activities and who is
authorized to act on its behalf. Attach
Form 2848 or other power of attorney.
Line 7. Organization’s website. Enter
your complete website address if you
have one. Also, list any websites
maintained on your behalf. The
information on your website should be
consistent with the information in your
Form 1024-A.

Part II. Organizational Structure
Type of Organization and
Organizational Documents
Organizing instrument. Submit a
conformed copy of the organizing
instrument. If the organization doesn't
have an organizing instrument, it won't
qualify for exempt status. A conformed
copy is one that agrees with the original
and all amendments to it. The conformed
copy may be:
• A photocopy of the original signed and
dated organizing document; or
• A copy of the organizing document that
is unsigned but is sent with a written
declaration, signed by an authorized
individual, that states that the copy is a
complete and accurate copy of the original
signed and dated document.
If you file Form 1024-A within 27
months after the end of the month
CAUTION in which you were legally formed,
and we approve the application, the legal
date of formation will be the effective date
of your exempt status. If you do not file
Form 1024-A within 27 months of
formation, you may not qualify for exempt
status before the date we receive Form
1024-A. The date considered to be the
date we receive Form 1024-A is generally
the postmark date.

!

Line 1. Corporation. A “corporation” is
an entity organized under a Federal or
state statute, or a statute of a federally
recognized Indian tribal or Alaskan native
government. A corporation's organizing
document is its “articles of incorporation.”
Certification of filing. If formed under
state statute, your articles of incorporation
must show certification of filing. This
means your articles show evidence that on
a specific date they were filed with and
approved by an appropriate state
authority. The document must be an exact
copy of what is on file with your state.
Substitute Articles of Incorporation.
If you don’t have a copy of your articles of
incorporation showing evidence of having
been filed and approved by an appropriate
Instructions for Form 1024-A

state official, you may submit a substitute
copy of your articles of incorporation. This
substitute copy may be handwritten,
typed, printed, or otherwise reproduced. It
must be accompanied by a declaration,
signed by an officer authorized to sign for
you, that it is a complete and correct copy
of the articles of incorporation and that it
contains all the powers, principles,
purposes, functions, and other provisions
by which you currently govern yourself.
Line 2. Limited Liability Company
(LLC). In the case of a limited liability
company, the state approved articles of
organization must be submitted along with
the operating agreement if one has been
adopted. For more information on
requirements for LLCs applying for
recognition of exemption, see IRS.gov.
Line 3. Unincorporated association.
An “unincorporated association” formed
under state law must have at least two
members who have signed a written
document for a specifically defined
purpose.
The articles of organization of an
unincorporated association must include
the name of your organization, your
purpose, the date the document was
adopted, and the signatures of at least two
individuals. If your copy doesn’t contain
the proper signatures and date of
adoption, you may submit a written
declaration that states your copy is a
complete and accurate copy of the signed
and dated original. Your declaration
should clearly indicate the original date of
adoption.
Bylaws may be considered an

TIP organizing document only if they

are properly structured (includes
name, purpose, signatures, and intent to
form an organization).
Line 4. Trust. In the case of a trust, a
copy of the signed and dated trust
instrument must be furnished. Generally, a
trust must be funded with property, such
as money, real estate, or personal
property to be legally created. Enter the
date that the trust was funded.
Line 5. Bylaws. “Bylaws” are generally
the internal rules and regulations of an
organization. If you have bylaws, you
should submit a current copy.
Bylaws don’t need to be signed unless
they are the organizing document as
described in Line 3 above.

Part III. Activities

Describe completely and in detail your
past, present, and planned activities. Do
not refer to or repeat the purposes in your
organizing document. You may refer to
other parts of the application rather than
repeat information provided elsewhere.

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For each past, present, or planned
activity, include information that answers
the following questions.
What is the activity?
Who conducts the activity?
Where is the activity conducted (for
example, Los Angeles and San Francisco,
California)?
How does the activity further your
exempt purposes?
What percentage of your total time is
allocated to the activity?
How is the activity funded? (This should
agree with the financial data in Part VI.)
List any alternate names under which
you operate, including any “aka” (also
known as) or “dba” (doing business as)
names.
If you have a website, you may attach a
print out of your website page to support
your narrative description of activities.

Part IV. Officers, Directors,
Trustees, Employees, and
Independent Contractors
Line 1. Enter the name, title, and mailing
addresses of the organization's principal
officers, directors, or trustees. Don't give
the address of the organization.
Line 2. Describe business relationships
between the organization and any of your
officers, directors, trustees, employees,
members, or independent contractors
other than their position with you as an
officer, director, trustee, employee,
member, or independent contractor.
Describe family or business relationships
between your officers, directors, trustees,
employees, members, or independent
contractors other than their position with
you as an officer, director, trustee,
employee, member, or independent
contractor.
“Family relationships” include the
individual’s spouse, ancestors, children,
grandchildren, great-grandchildren,
siblings (whether by whole or half blood),
and the spouses of children,
grandchildren, great-grandchildren, and
siblings.
“Business relationships” include
employment and contractual relationships,
and common ownership of a business
where any officers, directors, or trustees,
individually or together, possess more
than a 35% ownership interest in common.
“Ownership” means voting power in a
corporation, profits interest in a
partnership, or beneficial interest in a trust.
Line 3a. Answer each item with
information about compensation paid to
your officers, directors, trustees,
employees, members, or independent
contractors.
Line 3b. A “conflict of interest” arises
when a person in a position of authority
over an organization, such as a director,

officer, or manager, may benefit
personally from a decision he or she could
make. Adoption of a conflict of interest
policy is not required to obtain tax-exempt
status. However, by adopting a policy, you
will be choosing to put in place procedures
that will help you avoid the possibility that
those in positions of authority may receive
an inappropriate benefit.
“Reasonable compensation” is the
amount that would ordinarily be paid for
like services by like organizations under
like circumstances as of the date the
compensation arrangement is made.
Establishing and documenting reasonable
compensation is important because
excessive compensation may result in
excise taxes on both the individual and the
organization. In addition, this may
jeopardize the organization’s tax
exemption.

longer exists and that had purpose(s)
similar to your purpose(s).

current year and proposed budgets for the
following 2 years.

Line 4. Indicate your organization’s
current or planned connection with any
tax-exempt or nonexempt organization.

Any applicant that has been in
existence more than 1 year but seeks
recognition of exemption only for the
current year and future years (rather than
from the date of its formation), should give
financial data for the current year and
proposed budgets for the following 2
years.

Line 3c. A “fixed payment” means a
payment that is either a set dollar amount
or fixed through a specific formula where
the amount doesn’t depend on discretion.
For example, a base salary of $200,000
that is adjusted annually based on the
increase in the Consumer Price Index is a
fixed payment.
A “non-fixed payment” means a
payment that depends on discretion. For
example, a bonus of up to $100,000 that is
based on an evaluation of performance by
the governing board is a non-fixed
payment because the governing body has
discretion over whether the bonus is paid
and the amount of the bonus.

Line 9. Answer “Yes” if the organization is
a membership organization formed to own
and maintain common green areas,
streets, and sidewalks and to enforce
covenants to preserve the appearance of
the development.

Part V. Your Specific Activities
Line 1. Provide the specified information
about political expenditures whether they
were made to support or to oppose
particular candidates.
Line 2. If your organization (including any
predecessor organization) lost its section
501(c)(3) status due to carrying on
propaganda or otherwise attempting to
influence legislation or due to participating
in, or intervening in, any political campaign
on behalf of (or in opposition to) any
candidate for public office, then your
organization will not be treated as an
organization described in section 501(c)
(4). This rule will not apply if your
organization was a church or
church-affiliated organization described in
section 501(h)(5) in the tax year
immediately preceding the tax year in
which section 501(c)(3) status was lost.
Line 3. You are a “successor” if you have:
Substantially taken over all of the
assets or activities of another
organization;
Been converted or merged from
another organization; or
Installed the same officers, directors, or
trustees as another organization that no

Line 5. If your organization is a
membership organization, submit the
requested information.
Line 6. Indicate if the organization
distributes, or plans to distribute, any of its
property or funds (such as a distribution of
profits) to its shareholders or members.
Line 7. Indicate if the organization
performs any services for any other
organization or individual for which it
received a fee.
Line 8. Provide the specified information
about leased property whether it is used
for exempt functions or for other purposes.

Line 10. Answer “Yes” if the
organization’s membership is limited to
employees of a designated person or
persons in a particular municipality and
whose net earnings will be devoted
exclusively to charitable, educational, or
recreational purposes.
Line 11. A “foreign country” is a country
other than the United States, its territories
and possessions, and the District of
Columbia.
In describing your grants or activities,
include the answers to the following
questions.
In which countries do you plan to make
grants or conduct activities?
What practices and procedures do you
have in place to ensure that foreign
expenditures or grants are not diverted to
support terrorism or other non-exempt
activities?
If you plan to distribute funds or goods,
what funds or goods have been or will be
distributed and for what purposes?
How do you process grant requests,
including your application, review, and
approval process for the grant requests
you receive?
How do you ensure the funds or goods
are used for the intended purposes?

Part VI. Financial Data

The Statement of Revenue and Expenses
must be completed for the current year
and each of the 2 years immediately
before it (or the years the organization has
existed, if less than 3).
Any applicant that has existed for less
than 1 year must give financial data for the
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We may request financial data for more
than 3 years if necessary.
All financial information for the current
year must cover the period beginning on
the first day of the organization's
established annual accounting period and
ending on any day that is within 60 days of
the date of this application.
If the date of this application is less
than 60 days after the first day of the
current accounting period, no financial
information is required for the current year.
Financial information is required for the
2 preceding years regardless of the
current year requirements.
Note. If no financial information is
required for the current year, the
preceding year's financial information can
end on any day that is within 60 days of
the date of this application.
Prepare the statements using the
method of accounting and the accounting
period the organization uses in keeping its
books and records.
If the organization uses a method other
than the cash receipts and disbursements
method, attach a statement explaining the
method used.

A. Statement of Revenue and
Expenses
Line 1. Include funds or other items of
value that you receive as gifts, grants, or
contributions.
Line 2. Include amounts received from
members to provide support to the
organization. Do not include payments
from members or on behalf of members to
purchase admissions, merchandise,
services, or use of facilities.
Line 3. Include gross income from
dividends, interest, payments received on
securities, loans, rents, and royalties that
are held for investment purposes.
Line 4. Net income from unrelated
business activities generally includes
income from any trade or business activity
that is regularly carried on, not conducted
with substantially all (at least 85%)
volunteer labor, and not related to your
exempt purposes. (This amount can be
taken from Form 990-T, if filed.)
See Pub. 598 for additional information
regarding unrelated business income.
Instructions for Form 1024-A

Line 5. Include the amount collected by
any local tax authority from the public on
your behalf.
Line 6. To determine the value of
services or facilities furnished by a
governmental unit, use the fair market
value of the services or facilities furnished
to you. Do not include the value of
services or facilities generally provided to
the public without charge.
Line 7. Enter the total income from all
sources not reported on lines 1 through 6,
or lines 9 and 11. Submit an itemized list
showing each type and amount of income
included on this line. Also, briefly describe
each type of income.
Line 8. Add lines 1 through 7 and enter
the amount.
Line 9. “Gross receipts” is income from
activities that you conduct to further your
exempt purposes (excluding amounts
listed on other lines). It includes payments
by a governmental unit that may be called
a “grant,” but that is actually payment for a
service or facility for the use of the
government payer, rather than for the
direct benefit of the public.
Line 10. Add lines 8 and 9 and enter the
amount.
Line 11. Attach a schedule with total
amounts entered (rather than each
individual transaction) for each category.

light, power, and other utilities, outside
janitorial services, mortgage interest, real
estate taxes, and similar expenses.
Line 19. Submit an itemized list showing
the type and amount of each significant
expense for which a separate line is not
provided.
Line 20. Add lines 13 through 19 and
enter the amount on line 20.

B. Balance Sheet
Line 1. Enter the total interest and noninterest-bearing cash in checking and
savings accounts, temporary cash
investments (money market funds, CDs,
treasury bills, or other obligations that
mature in less than 1 year), change funds,
and petty cash funds.
Line 2. Enter the total accounts
receivable that arose from the sale of
goods and/or performance of services.
Line 3. Enter the amount of materials,
goods, and supplies purchased or
manufactured by the organization and
held to be sold or used in some future
period.
Line 4. Attach a schedule that shows the
name of the borrower, a brief description
of the obligation, the rate of return on the
principal indebtedness, the due date, and
the amount due.

Line 14. If distributions have been made,
submit an itemized list showing the name
of each recipient, a brief description of the
purposes or conditions of payment, and
the amount paid.

Line 5. Attach a schedule listing the
organization's corporate stock holdings.
For stock of closely held corporations,
the schedule should show the name of the
corporation, a brief summary of the
corporation's capital structure, the number
of shares held, and their value as carried
on the organization's books. If such
valuation doesn't reflect current fair market
value, also include fair market value.
For stock traded on an organized
exchange or in substantial quantities over
the counter, the schedule should show the
name of the corporation, a description of
the stock and the principal exchange on
which it is traded, the number of shares
held, and their value as carried on the
organization's books.

Line 15. If payments have been made,
submit an itemized list showing the name
of each recipient, a brief description of the
purposes or condition of payment, and
amount paid. Do not include any amounts
on line 14.

Line 6. Attach a schedule that shows the
borrower's name, purpose of loan,
repayment terms, interest rate, and
original amount of loan. Report each loan
separately, even if more than one loan
was made to the same person.

Line 16. Enter the total amount of
compensation. Be consistent with
information provided in Part IV, lines 3a,
3b, and 3c.

Line 7. Enter the book value of U.S.,
state, or municipal government securities
held. Also enter the book value of
buildings and equipment held for
investment purposes. Attach a schedule
identifying each.

Line 12. Combine lines 10 and 11 and
enter the amount.
Line 13. Fundraising expenses include
the total expenses incurred by you for
soliciting gifts, grants, and contributions
included on line 1. Where you allocate a
portion of your other expenses to
fundraising, submit an itemized list
describing the amounts allocated. Include
fees paid to professional fundraisers for
soliciting gifts, grants, and contributions.

Line 17. Enter the total amount of
employees’ salaries and wages not
reported on line 16 above.
Line 18. Enter the amount paid for the
use of office space or other facilities, heat,
Instructions for Form 1024-A

Line 8. Enter the book value of buildings
and equipment not held for investment.
This includes plant and equipment used
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by the organization in conducting its
exempt activities. Attach a schedule listing
these assets held at the end of the current
tax-year period and the cost or other
basis.
Line 9. Enter the book value of land not
held for investment.
Line 10. Enter the book value of each
category of assets not reported on lines 1
through 9. Attach a schedule listing each.
Line 11. Add lines 1 through 10 and enter
the amount on line 11.
Line 12. Enter the total of accounts
payable to suppliers and others, such as
salaries payable, accrued payroll taxes,
and interest payable.
Line 13. Enter the unpaid portion of
grants and contributions that the
organization has made a commitment to
pay to other organizations or individuals.
Line 14. Enter the total of mortgages and
other notes payable at the end of the year.
Attach a schedule that shows each item
separately and the lender's name,
purpose of loan, repayment terms, interest
rate, and original amount.
Line 15. Enter the amount of each liability
not reported on lines 12 through 14.
Attach a separate schedule.
Line 16. Add lines 12 through 15 and
enter the amount on line 16.
Line 17. Under fund accounting, an
organization segregates its assets,
liabilities, and net assets into separate
funds according to restrictions on the use
of certain assets. Each fund is like a
separate entity in that it has a
self-balancing set of accounts showing
assets, liabilities, equity (fund balance),
income, and expenses. If the organization
uses fund accounting, report the total of all
fund balances on line 17.
If the organization doesn't use fund
accounting, report only the “net assets”
account balances, such as capital stock,
paid-in capital, and retained earnings or
accumulated income.
Line 18. Add lines 16 and 17 and enter
the amount on line 18.

Part VII. Annual Filing
Requirements

Certain organizations aren't required to file
an information return (Form 990 or Form
990-EZ) or notice (Form 990-N).
Generally, organizations not required to
file Form 990, or Form 990-EZ, or Form
990-N include churches, certain church
affiliated organizations, and certain
affiliates of a governmental unit. Note that
organizations that are exempt from filing
Form 990 or Form 990-EZ because of
gross receipts are generally required to
submit Form 990-N if they choose not to

file Form 990 or Form 990-EZ. For more
information, see the Instructions for Form
990 and Form 990-EZ. See IRS.gov for
more information.

Part IX. User Fee Information
and Signature

An officer, director, or trustee who is
authorized to sign, or another person
authorized by a power of attorney, must
sign the Form 1024-A application. Attach
a power of attorney to the application. You
may use Form 2848 for this purpose. The
signature must be accompanied by the
title or authority of the signer and the date.

Form 1024-A
Parts I–III
Parts IV–VII

Comments and suggestions. If you
have comments concerning the accuracy
of these time estimates or suggestions for
making this form simpler, we would be
happy to hear from you. You can send us

Please type or clearly print the
accompanying information.
Paperwork Reduction Act Notice. We
ask for the information on this form to carry
out the Internal Revenue laws of the
United States. If you want your
organization to be recognized as tax
exempt by the IRS, you are required to
give us this information. We need it to
determine whether the organization meets
the legal requirements for tax-exempt
status.
The organization isn't required to
provide the information requested on a

Learning about
the law or the
form

Recordkeeping
4 hr., 4 min.
12 hr., 40 min.

40 min.

comments from IRS.gov/FormComments.
Or you can send your comments to
Internal Revenue Service, Tax Forms and
Publications Division, 1111 Constitution
Ave. NW, IR-6526, Washington, DC

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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. The rules
governing the confidentiality of the Form
1024-A application are covered in section
6104.
The time needed to complete and file
this form will vary depending on individual
circumstances.
The estimated average times are:

Preparing and
sending the form
to the IRS
4 min.
2 hr., 5 min.

20224. Don’t send Form 1024-A to this
address. Instead, see Where To File,
earlier.

Instructions for Form 1024-A

Procedural Checklist
Make sure the application is complete.
If you do not complete all applicable parts or do not provide all required attachments, we may
return the incomplete application for the organization to resubmit with the missing information or
attachments. This will delay the processing of the application and may delay the effective date of
your organization’s exempt status. The organization may also incur additional user fees.

Have you . . .
Attached Form 8718 (User Fee for Exempt Organization Determination Letter Request) and the appropriate
fee?
Prepared the application for mailing? (See Where To File addresses in Form 8718.)
Completed all parts of the application?
Shown your organization’s Employer Identification Number (EIN)?
a. If your organization has an EIN, write it in the space provided.
b. If this is a newly formed organization and does not have an Employer Identification Number, obtain an EIN.
See Specific Instructions, Part I.
If applicable, described your organization’s specific activities as directed in Part III of the application?
Included a conformed copy of the complete organizing instrument? (Part II of the application.)
Had the application signed by one of the following:
a. An officer or trustee who is authorized to sign (for example, president, treasurer); or
b. A person authorized by a power of attorney (submit Form 2848 or other power of attorney)?
If applicable, enclosed financial statements (Part VI)?
a. Current year (must include period up to within 60 days of the date the application is filed) and 2 preceding
years. If the organization has been in existence less than 1 year, it must submit proposed budgets for 2
years showing the amounts and types of receipts and expenditures anticipated.
b. Detailed breakdown of revenue and expenses (no lump sums).

Note: During the technical review of a completed application, it may be necessary to contact the
organization for more specific or additional information.

Do not send this checklist with the application.

Instructions for Form 1024-A

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