13803 ApplApplication to Participate in the Income Verificatio

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OMB Number 1545-2032

Department of the Treasury - Internal Revenue Service

Form

13803

(June 2022)

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

For Official Use Only
Control number

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

Add new location

Cancellation

Address change

Sole proprietorship

Corporation

LLC

1b. Existing IVES participant ID number (if applicable)
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

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Credit Check

Banking Service

Licensing Requirement

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

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5. Employer Identification 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 than listed on line 4)

7. Business location address (required)
Street address

City

State

Zip Code

Business telephone number

Fax number

Business e-mail address (optional)

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 IVES account principal (principal, company official, partner, or owner of business) (required)
IVES account principal (first, middle initial, last)

Title

Date of Birth (mm/dd/yyyy)

Social Security Number

E-mail address

Home street address

City

State

Telephone number

Zip Code

10. Business point of contact (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

E-mail address

MI

11a. Have any individuals listed on Line 9 and/or Line 10 been convicted of a felony in the last 10
years? (Attach and explanation for a Yes response)

Yes

No

11b. Are all those listed on this application current with their individual and business tax filing and payments,
including any corporation and employment tax obligations? (Attach an explanation for a No response)

Yes

No

If using a different EIN than listed in Line 5 to meet business filing requirements, list that here

EIN

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

www.irs.gov

Form 13803 (Rev. 6-2022)

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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. If
assigning a responsible official, all fields are required
Responsible official name (first, middle initial, last)

Title

Date of Birth (mm/dd/yyyy)

Social Security Number

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 receive via a Form 4506-C request for the purpose(s)
the taxpayer/requester intended. Failing to complete this section will result in the application being rejected and returned

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 suspension or permanent expulsion from the program.
Name and title of IVES account principal (type or print)

Signature of IVES account principal

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Date signed

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Fax your application to the IVES application line: 844-251-8254
The IRS conducts a suitability check on the applicant, and on all listed individuals 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.
The IVES account principal listed on Line 9 must sign the application agreement indicating understanding of the Privacy Act restrictions
relating to the use of this service.
Note: Electronic signatures are not permitted on the application agreement.
Non-Transferable: Acceptance for participation is not transferable. If this business is sold or its organizational structure changes, a
new application must be filed. 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.

Catalog Number 48547A

www.irs.gov

Form 13803 (Rev. 6-2022)

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