6069 Instructions for Form 6069

Instructions for Form 6069

Department of the Treasury
Internal Revenue Service

(Rev. December 2021)

Return of Certain Excise Taxes on Mine Operators, Black Lung Trusts, and Other
Persons Under Sections 4951, 4952, and 4953
Section references are to the Internal Revenue
Code unless otherwise noted.

Future Developments

For the latest information about
developments related to Form 6069 and
its instructions, such as legislation
enacted after they were published, go to
IRS.gov/Form6069.

What’s New
Revised form. Form 6069 has been
substantially reformatted to expand its
use. Previously, Form 6069 was used
exclusively by coal mine operators to
compute their maximum allowable income
tax deduction under section 192 and to
determine the amount of any excise tax
imposed under section 4953 for
contributions that exceed the allowable
deduction. For tax years beginning on or
after January 1, 2021, Form 6069 will also
be used by section 501(c)(21) black lung
benefit trusts to report and pay excise
taxes imposed under section 4951
(self-dealing) and 4952 (taxable
expenditures).

General Instructions
Purpose of Form
Black lung benefit trusts and certain
other persons. The Black Lung Benefits
Revenue Act of 1977 (the Act) amended
the Code to impose an excise tax on the
sale of coal and established a trust fund
under section 501(c)(21) (funded by the
coal tax and certain other revenues) to be
available for expenses of providing
medical benefits when not paid by the
appropriate mine operator. The Act also
added sections 4951 (self-dealing), 4952
(taxable expenditures), and 4953 (excess
contributions by mine operators) to
impose excise taxes on certain acts. For
tax years beginning on or after January 1,
2021, black lung benefit trusts will use
Form 990 to meet reporting requirements
under section 6033. If initial taxes are
imposed on the trust or certain related
parties under section 4951 or 4952, the
trust or related party will report the initial
excise tax using Part II or Part III,
respectively, of Form 6069.
Coal mine operators. A coal mine
operator will now use Part IV of Form 6069
to determine the maximum allowable
income tax deduction (under section 192)
Dec 15, 2021

for contributions made to black lung
benefit trusts. Part IV of the form is also
used to determine the amount of excise
tax imposed under section 4953 for
contributions that are more than the
maximum allowable deduction.

Who Must File

• Any person who is a disqualified person
with respect to a black lung benefit trust
and has incurred liability for the excise tax
on self-dealing transactions under section
4951.
• Any trustee of a black lung benefit trust
that has incurred liability for the excise tax
on the trustee in connection with any
self-dealing transaction (section 4951) or
taxable expenditure (section 4952).
• Any black lung benefit trust that has
incurred liability for the excise tax on
taxable expenditures (under section
4952).
• Any coal mine operator that made
excess contributions (under section 4953)
must file Form 6069. A coal mine operator
can complete Part IV, lines 1 through 7, to
figure the maximum allowable deduction
under section 192. Form 6069 must be
filed only if the amount shown on Part IV,
line 7, is greater than zero.
A coal mine operator should not
file Form 6069 if the information
CAUTION entered in Part IV indicates that no
excess contributions were made.

!

Which Parts To Complete
When filer is a black lung benefit trust.
A trust filing this form for a year in which
there are initial taxes due under section
4951 or 4952 completes Form 6069 as
follows.
• Complete Parts II and III first, providing
complete information about the
self-dealing and taxable expenditure
transactions and showing tax
computations.
• Complete Part I, line 1, only. Do not
include taxes that must be paid by the
trustee or a self-dealer on any other line in
Part I.
When filer is a self-dealer. A self-dealer
liable for initial taxes under section 4951
completes Part II, then Part I.
When filer is a trustee. A trustee liable
for initial excise taxes (sections 4951 and
4952) completes Parts II and III (as
applicable), and then Part I.

Cat. No. 749870

When filer is a coal mine operator. A
coal mine operator completes Part III to
figure the amount of its allowable
contributions for the tax year. The coal
mine operator completes Part I and files
Form 6069 only if contributions exceed the
allowed contribution amount.

When and Where To File

File Form 6069 by the 15th day of the 5th
month after the end of your tax year. If the
regular due date falls on a Saturday,
Sunday, or legal holiday, file on the next
business day. File it with the:
Internal Revenue Service Center
333 W. Pershing Road
Kansas City, MO 64108
To request an extension of time to file
Form 6069, file Form 8868, Application for
Automatic Extension of Time To File an
Exempt Organization Return.

Accounting Methods

Use the accounting method regularly used
in keeping your books and records.

Accounting Periods

Complete the return on the basis of your
established accounting period. If you do
not have an established accounting
period, use the calendar year.

Penalties and Interest

There are penalties for late filing, willful
failure to file, and for filing fraudulent
returns and statements. See sections
6651, 7203, 7206, and 7207. Also see
section 6684 for penalties that relate to
excise tax liability under chapter 42.
Interest charges for any unpaid tax are
charged at the underpayment rate
established under section 6621. The
interest on underpayments is in addition to
any penalties.

Definitions

The term “Black Lung Acts” refers to Part
C of Title IV of the Federal Mine Safety
and Health Act of 1977, and any state law
that provides compensation for disability
or death due to pneumoconiosis (black
lung disease). A black lung benefit claim is
a claim for compensation for disability or
death due to pneumoconiosis under the
Black Lung Acts. Unless otherwise
indicated, the term “trust” as used in these

instructions means the tax-exempt section
501(c)(21) trust or trusts to which the coal
mine operator made contributions for
which it claimed a deduction under section
192.

Self-Dealing (Section 4951)
Self-dealing. For purposes of section
4951, the term “self-dealing” means any
direct or indirect:
• Sale, exchange, or leasing of real or
personal property between a trust
described in section 501(c)(21) and a
disqualified person;
• Lending of money or other extension of
credit between such a trust and a
disqualified person;
• Furnishing of goods, services, or
facilities between such a trust and a
disqualified person;
• Payment of compensation (or payment
or reimbursement of expenses) by such a
trust to a disqualified person; and
• Transfers to, or use by or for the benefit
of, a disqualified person of the income or
assets of such a trust.
Special rules. For purposes of section
4951:
• The transfer of personal property by a
disqualified person to such a trust is
treated as a sale or exchange if the
property is subject to a mortgage or similar
lien;
• If a bank or an insured credit union is a
trustee of the trust or otherwise is a
“disqualified person” with respect to the
trust, any amount invested in checking
accounts, savings accounts, certificates of
deposit, or other time or demand deposits
in that bank or credit union constitutes a
lending of money;
• The furnishing of goods, services, or
facilities by a disqualified person to such a
trust is not an act of self-dealing if the
furnishing is without charge and if the
goods, services, or facilities so furnished
are used exclusively for the purposes
specified in section 501(c)(21)(A); and
• The payment of compensation (and the
payment or reimbursement of expenses)
by such a trust to a disqualified person for
personal services that are reasonable and
necessary to carry out the exempt
purpose of the trust is not an act of
self-dealing if the compensation (or
payment or reimbursement) is not
excessive. See Regulations section
53.4951-1 for additional information.
Taxable period. The term “taxable
period” means, with respect to any act of
self-dealing, the period beginning with the
date on which the act of self-dealing
occurs and ending on the earliest of:
1. The date of mailing of a notice of
deficiency under section 6212, with
respect to the tax imposed by section
4951(a)(1);

2. The date on which the tax imposed
by section 4951(a)(1) is assessed; or
3. The date on which correction of the
act of self-dealing is completed.
Amount involved. The term “amount
involved” means, for any act of
self-dealing, the greater of the amount of
money and the fair market value (FMV) of
the other property given or the amount of
money and the FMV of the other property
received. However, in the case of services
described in section 4951(d)(2)(C), the
amount involved is only the excess
compensation. For purposes of the
preceding sentence, the FMV:
1. For the initial taxes imposed by
section 4951(a), is determined as of the
date on which the act of self-dealing
occurs; and
2. For additional taxes imposed by
section 4951(b), is the highest FMV during
the taxable period.
Correction. The terms “correction” and
“correct” mean, for any act of self-dealing,
undoing the transaction to the extent
possible, but in any case, placing the trust
in a financial position not worse than that
in which it would be if the disqualified
person were dealing under the highest
fiduciary standards.
Disqualified person. The term
“disqualified person” means, for a trust
described in section 501(c)(21), a person
who is:
1. A contributor to the trust;
2. A trustee of the trust;
3. An owner of more than 10% of:
a. The total combined voting power of
a corporation,
b. The profits interest of a partnership,
or
c. The beneficial interest of a trust or
unincorporated enterprise that is a
contributor to the trust;
4. An officer, director, or employee of
a person who is a contributor to the trust;
5. The spouse, ancestor, lineal
descendant, or spouse of a lineal
descendant of an individual described in
(1), (2), (3), or (4);
6. A corporation of which persons
described in (1), (2), (3), (4), or (5) own
more than 35% of the total combined
voting power;
7. A partnership in which persons
described in (1), (2), (3), (4), or (5) own
more than 35% of the profits interest; or
8. A trust or estate in which persons
described in (1), (2), (3), (4), or (5) hold
more than 35% of the beneficial interest.
For purposes of items 3a and 6 above,
indirect stockholdings are taken into
account if they would be taken into
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account under section 267(c), except that,
for purposes of this paragraph, section
267(c)(4) is treated as providing that the
members of the family of an individual are
only those individuals described in item 5.
For purposes of items 3b and c, 7, and 8,
the ownership of profits or beneficial
interests is determined by the rules for
constructive ownership of stock provided
in section 267(c) (other than paragraph
(3)), except that section 267(c)(4) is
treated as providing that the members of
the family of an individual are only those
individuals described in item 5.
Payment of benefits. For purposes of
section 4951, a payment out of assets or
income of a trust described in section
501(c)(21) for the purposes described in
sections 501(c)(21)(A)(i)(I) and 501(c)(21)
(A)(i)(IV) is not considered an act of
self-dealing.

Taxable Expenditures (Section
4952)
Taxable expenditure. For purposes of
section 4952, the term “taxable
expenditure” means any amount paid or
incurred by a trust described in section
501(c)(21) other than for a purpose
specified in that section.
Correction. The terms “correction” and
“correct” mean, with respect to any
taxable expenditure, placing the trust in a
financial position not worse than that in
which it would have been if the taxable
expenditure had not been made:
1. By recovering all or part of the
expenditure to the extent recovery is
possible; and
2. When full recovery is not possible,
by contributions by the person or persons
whose liabilities for black lung benefit
claims (as defined in section 192(e)) are to
be paid out of the trust.
Taxable period. The term “taxable
period” means, with respect to any taxable
expenditure, the period beginning with the
date on which the taxable expenditure
occurs and ending on the earlier of:
1. The date of mailing a notice of
deficiency under section 6212, with
respect to the tax imposed by section
4952(a)(1); or
2. The date on which the tax imposed
by section 4952(a)(1) is assessed.

Specific Instructions
Items A Through I
Item A. Fill in the spaces to show the
calendar year or fiscal year of the
accounting period you are reporting.
A black lung benefit trust filing to report
taxable expenditures (section 4952)

should enter the calendar or fiscal year of
the trust.
Disqualified persons and trustees who
participate in acts of self-dealing with a
black lung benefit trust and who have tax
years different from the trust should use
their own tax years to figure the initial tax
and file the return.
A coal mine operator filing Form 6069
to report the excise tax on excess
contributions (section 4953) should enter
the calendar or fiscal year of the coal mine
operator.
Item B. Check box (1) if you are a black
lung benefit trust liable for the section
4952 tax on taxable expenditures.
Check the appropriate box(es) on line
(2) if you are one or more of the following.
• A disqualified person liable for the
section 4951 excise tax on self-dealing.
• A trustee of a black lung benefit trust
and are liable for the excise tax arising
from your role in connection with a
self-dealing transaction (section 4951) or
taxable expenditure (section 4952).
• A coal mine operator liable for the
section 4953 excise tax on excess
contributions to a black lung benefit trust.
Item C. Enter your name and address in
the appropriate spaces.
Item D. Enter your taxpayer identification
number (TIN) (employer identification
number (EIN) or social security number
(SSN)). A filer other than the black lung
benefit trust should not enter the trust’s
EIN here.
Item E. Check the “Amended return” box
if the filer previously filed a Form 6069
return with the IRS for a tax year and is
now filing another return for the same tax
year to amend the previously filed return.
Complete the entire return (not just the
part that changed) following the form and
instructions for the amended year. Include
a statement that identifies the lines and
amounts being changed and the reason
for each change.
Items F and G. If you checked a box on
line (2) of Item B, enter the name on Item
F and EIN on Item G of the black lung
benefit trust to which the excise taxes
being reported relate.
Items H and I. In Item H, enter the name
and address of the person who has the
filer's books and records. In Item I, enter
the telephone number at which he or she
can be reached.

Rounding Off to Whole
Dollar Amounts

You can round off cents to whole dollars
on your return. If you do round to whole
dollars, you must round all amounts. To
round, drop amounts under 50 cents and
increase amounts from 50 to 99 cents to

the next dollar. For example, $1.39
becomes $1 and $2.50 becomes $3.
If you have to add two or more amounts
to figure the amount to enter on a line,
include cents when adding the amounts
and round off only the total.

Part I. Tax and Payment
Lines 1 through 5. See the specific line
instructions for Parts II through IV for
instructions applicable to each type of filer
regarding amounts to be entered in Part I,
lines 1 through 5.
A coal mine operator should complete
Part I and file Form 6069 only if the
amount carried to Part I, line 2, from Part
IV, line 8, is greater than zero.
Liability for tax. A person's liability for
tax as a self-dealer or trustee under
sections 4951 and 4952 is joint and
several. Therefore, if more than one
person is liable for tax on an act of
self-dealing as a self-dealer or trustee,
they may prorate the tax among
themselves. The IRS may assess a
deficiency against one or more
self-dealers or trustees liable for the tax
under section 4951 or 4952, regardless of
the apportionment of tax shown on the
return, if the amount paid by all those who
are liable for a particular transaction is less
than the total tax due for that transaction.
All other filers report and compute tax
owed on Part I. Payment by a black lung
benefit trust of any taxes owed by any
trustee or self-dealer will result in
additional taxes under the self-dealing
(section 4951) and taxable expenditure
(section 4952) provisions. Trustees and
self-dealers should pay taxes imposed on
them from their own funds.
Tax payments can be made by check
or through the Electronic Federal Tax
Payment System (EFTPS). For more
information about EFTPS or to enroll in
EFTPS, visit the EFTPS website at
EFTPS.gov, or call 800-555-4477. You
can also get Pub. 966, Electronic Federal
Tax Payment System: A Guide to Getting
Started.

Part II. Initial Taxes on
Self-Dealing

Disqualified persons and trustees who
participate in acts of self-dealing with a
black lung benefit trust and who have tax
years different from the trust should use
their own tax years to figure the initial tax
and file the return.
Initial section 4951 taxes on self-dealer. An initial tax of 10% of the amount
involved is imposed for each act of
self-dealing between a disqualified person
and a black lung benefit trust, for each
year (or part of a year) in the taxable
period. The tax is paid by any disqualified
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person (other than a trustee acting only as
such) who participated in the act of
self-dealing.
Initial section 4951 taxes on trustee.
When a tax is imposed on an act of
self-dealing, any trustee who knowingly
participated in such an act must pay a tax
of 2.5% of the amount involved in the act
of self-dealing for each year (or part of a
year) in the taxable period unless
participation in the act was not willful and
was due to reasonable cause.
Line 1. List each act of self-dealing on
line 1, providing the date and a brief
description of each act in columns (b) and
(c).
Line 2. For each act of self-dealing listed
on line 1, provide the following
information.
• In column (b), enter the names of all
disqualified persons who took part in the
acts of self-dealing listed on line 1.
• In column (c), enter the amount
involved in each act of self-dealing.
For each act of self-dealing, multiply
the amount in column (c) by 0.10 and
enter the amount in column (d). If more
than one disqualified person took part in
an act of self-dealing, each disqualified
person is individually liable for the entire
amount of the tax. Nonetheless, the
disqualified persons who are liable for the
tax may prorate the payment among
themselves. If self-dealers prorate the
excise tax, attach a statement showing the
intended allocation of liability among the
self-dealers.
For each act of self-dealing, multiply
the amount in column (c) by 0.025 and
enter the amount in column (e). A trustee
who took part in the act of self-dealing and
who knew that the act was self-dealing
(except for trustees whose participation
was not willful and was due to reasonable
cause) is liable for the tax in column (e).
If more than one trustee took part in the
act of self-dealing, knowing that it was
such an act, and participation was willful
and not due to reasonable cause, each is
individually liable for the entire tax in
connection with the act. Nonetheless, the
trustees liable for the excise tax may
prorate the payment among themselves.
Attach a statement showing the name of
each trustee liable for the tax in column (e)
for each act of self-dealing.
Line 3. Enter on line 3d the total initial tax
on the self-dealer(s) computed on line 2d.
Enter on line 3e the total initial tax on the
trustee(s) computed on line 2e.
For a Form 6069 filed by the trust.
Do not carry amounts from Part II to Part I.
The trust completes Part II to provide
information on the self-dealing
transactions, but must not pay the tax for
which self-dealers and trustees are liable.

For a Form 6069 filed by a
self-dealer. The filer should enter the
amount shown on line 3d, in Part I, line 3a.
In Part I, line 3b, indicate the percentage
of the amount reported on line 3a
apportioned to the filer. Attach a statement
showing detail for proration of the excise
tax on the self-dealing transactions among
the self-dealers.
For a Form 6069 filed by a trustee.
The filer should enter the amount shown
on line 3e, in Part I, line 4a. In Part I,
line 4b, indicate the percentage of the
amount reported on line 4a apportioned to
the filer. Attach a statement showing detail
for proration of the excise tax on
self-dealing among the trustees.
Line 4. Corrective action. The trust and
each self-dealer filing Form 6069 to report
a self-dealing transaction should describe
corrective action taken (or not taken) in
connection with each self-dealing
transaction. In the case of self-dealers and
trustees, the information provided for
line 4 should be limited to transactions for
which the filer incurred excise tax liability
under section 4951.

Part III. Initial Taxes on
Taxable Expenditures and
Tax Computation
Initial section 4952 taxes on trust. An
initial tax of 10% of the amount of the
expenditure is imposed on each taxable
expenditure from the assets of a black
lung benefit trust. The tax is paid from
assets of the trust.
Initial section 4952 taxes on trustee.
When a tax is imposed on the trust for a
taxable expenditure, any trustee who
knowingly agreed to the expenditure must
pay a tax of 2.5% of the amount of the
taxable expenditure, unless such
agreement was not willful and was due to
reasonable cause.
Line 1. List each taxable expenditure on
line 1, providing the name and address of
the recipient of cash or other property
distributed for other than a purpose
described in section 501(c)(21) in column
(b); and a brief description of each
expenditure in column (c).
Line 2. For each taxable expenditure,
provide the date the expenditure was paid
or incurred (column (b)), the amount
(column (c)), and the name of each trustee
liable for the excise tax (column (d)).
Line 3. For each taxable expenditure,
multiply the amount on line 2, column (c),
by 0.10 and enter the amount in column
(b). The black lung benefit trust is liable for
the excise tax shown in column (b).
For each taxable expenditure, multiply
the amount on line 2, column (c), by 0.025
and enter the amount in column (c). A

trustee who took part in the taxable
expenditure and who knew that the act
was a taxable expenditure (except for
trustees whose participation was not willful
and was due to reasonable cause) is liable
for the tax in column (c).
If more than one trustee took part in the
taxable expenditure, knowing that it was
such an act, and participation was willful
and not due to reasonable cause, each is
individually liable for the entire tax in
connection with the act. Nonetheless, the
trustees liable for the excise tax may
prorate the payment among themselves.
Attach a statement showing the name of
each trustee liable for the tax in column
(iii) for each taxable expenditure.
Line 4. Enter on line 4b the total initial tax
on the trust computed on line 3b. Enter on
line 4c the total initial tax on the trustee(s)
computed on line 3c.
For a Form 6069 filed by the trust.
Enter the amount shown in line 4b, in Part
I, line 1.
For a Form 6069 filed by a trustee.
The filer should enter the amount shown
on line 4c, in Part I, line 5a. In Part I,
line 5b, indicate the percentage of the
amount reported on line 5a apportioned to
the filer. Attach a statement showing detail
for the proration of the excise tax on
taxable expenditures among the trustees.
Line 5. Corrective action. The trust
should describe corrective action taken (or
not taken) in connection with each taxable
expenditure.

Part IV. Tax on Coal Mine
Operators Under Section
4953

If you are a coal mine operator completing
Form 6069 only to figure the maximum
allowable deduction under section 192
and do not owe tax on excess
contributions, keep this form with your
records instead of filing it with the IRS.
No deduction is allowed under section
192(a) for any contribution to a trust other
than a contribution in cash or in items in
which the trust may invest under section
501(c)(21)(A)(ii)(II).
Payments made for a particular tax
year that are made no later than the due
date (including extensions) of the mine
operator’s income tax return for that tax
year are considered to have been made
on the last day of that tax year.

Line 1. The determination of amounts
necessary to cover payments for claims
made under the Black Lung Benefits Acts
of 1977 must be based on reasonable
actuarial assumptions. On lines 1a, 1b,
and 1c, enter the annual amounts needed
to fund (with level funding) all claims
against the coal mine operator that were
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filed or expected to be filed by, or on
behalf of, past or present employees for
compensation because of disability or
death, due to pneumoconiosis, under the
Black Lung Acts.
Line 2a. Enter the total amount paid
during the year for any combination of the
following.
• All administrative and other incidental
expenses of operating the trust and
processing claims against the coal mine
operator (including legal, actuarial, and
trustee expenses).
• All direct payments by the trust for
claims against the coal mine operator.
• All payments of premiums exclusively
for insurance to cover the coal mine
operator’s liability for claims filed under the
Black Lung Acts.
• All payments of accident and health
benefits for retired miners and their
spouses and dependents to the extent
allowed by section 501(c)(21)(C).
Line 2b. Enter the FMV of the trust’s
assets at the beginning of the coal mine
operator’s tax year.
Line 3a. When an excess contribution is
made to a black lung benefit trust in the
current tax year and the trust returns part
or all of the current year’s excess
contribution in the same year, show only
the net contribution for the year on this line
(for example, current year’s contribution
less current year’s excess contribution
returned). At your request, a black lung
benefit trust will repay excess
contributions (but not more than the
excess) made to the trust for a tax year.
The repayment is not an act of self-dealing
or a taxable expenditure.
Line 3d. Enter excess contributions
carried over from the previous year.
Line 5. Enter excess contributions carried
over from the prior tax year that were
returned to the contributor in the current
tax year.
Line 7. Excess contributions entered on
this line are carried over to the following
tax year and treated as a contribution for
that tax year.
Line 8. If the amount on line 7 is greater
than zero, multiply that amount by 0.05
and enter the amount here and on Part I,
line 2.

Signature and Verification

Form 6069 filed by a black lung benefit
trust should be signed by the trustee using
the top signature area. Form 6069 filed by:
• A trustee liable for the excise tax on a
trustee’s participation in an act of
self-dealing (section 4951) or a taxable
expenditure (section 4952),
• A self-dealer liable for the excise tax
under section 4951, or

• A mine operator liable for the excise tax
on excess contributions under section
4953,
should be signed using the signature line
below the signature line used by the black
lung benefit trust.
If you are signing on behalf of the black
lung benefit trust and also because of
personal tax liability, you must file two
Forms 6069.
For a corporation (or an association),
the form may be signed by one of the
following: president, vice president,
treasurer, assistant treasurer, chief
accounting officer, or other corporate
officer (such as tax officer). For a
partnership, the form may be signed by a
partner or partners authorized to sign the
partnership return.
If the return is filed on behalf of a trust,
the authorized trustee(s) must sign it.
A receiver, trustee, or assignee
required to file any return on behalf of an
individual, trust, estate, partnership,
association, company, or corporation must
sign the Form 6069 filed for these
taxpayers. Also, a person with a valid
power of attorney may sign for the section
501(c)(21) trust, trustee, self-dealer, or
mine operator. Include a copy of the
power of attorney with the return.

Attachments

If you need more space, attach separate
sheets showing the same information in
the same order as on the printed form.
Show the totals on the printed form.
On each sheet, enter the name and TIN
of the person or entity filing Form 6069.
Also include the name and EIN of the
section 501(c)(21) black lung trust, and, if
applicable, the name and TIN of the
trustee, self-dealer, or mine operator on
each sheet. Use sheets that are the same
size as the form and indicate clearly the
line of the paper form to which the
information relates.

Paid Preparer

Generally, anyone who is paid to prepare
the return must sign the return and fill in
the other blanks in the Paid Preparer Use
Only area. An employee of the filing
organization isn't a paid preparer.
The paid preparer must:

• Sign the return in the space provided

for the preparer's signature;
• Enter the preparer information;
• Enter the preparer tax identification
number (PTIN); and

• Give a copy of the return to the
organization, in addition to the copy to be
filed with the IRS.
Any paid preparer whose
identifying number must be listed
CAUTION on Form 6069 can apply for and
obtain a PTIN. You can apply for a PTIN
online or by filing Form W-12, IRS Paid
Preparer Tax Identification Number (PTIN)
Application and Renewal. For more
information about applying for a PTIN
online, visit the IRS website at IRS.gov/
PTIN.

!

Paid Preparer
Authorization

On the “Sign Here” line, check “Yes” if the
IRS can contact the paid preparer who
signed the return to discuss the return.
This authorization applies only to the
individual whose signature appears in the
Paid Preparer Use Only section of Form
6069. It doesn't apply to the firm, if any,
shown in that section.
By checking the “Yes” box, the
organization is authorizing the IRS to
contact the paid preparer to answer any
questions that arise during the processing
of the return. The organization is also
authorizing the paid preparer to:
• Give the IRS any information missing
from the return;
• Call the IRS for information about
processing the return; and
• Respond to certain IRS notices about
math errors, offsets, and return
preparation.
The organization isn't authorizing the
paid preparer to bind the organization to
anything or otherwise represent the
organization before the IRS.
The authorization will automatically end
no later than the due date (excluding
extensions) for filing of the Form 6069 for
the next tax year. If the organization wants
to expand the paid preparer's
authorization or revoke it before it ends,
see Pub. 947, Practice Before the IRS and
Power of Attorney.
Check “No” if the IRS should contact
the organization listed on the first page of
the Form 6069 rather than the paid
preparer.
Privacy Act and Paperwork Reduction
Act Notice. We ask for the information on
this form to carry out the Internal Revenue
laws of the United States. Section 4953
imposes a tax on excess contributions to a

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black lung benefit trust. You are required
to give us the information. Section 6109
requires you to provide your taxpayer
identification number (EIN or SSN). We
need it to ensure that you are complying
with these laws and to allow us to figure
and collect the right amount of tax. Failure
to provide this information in a timely
manner, or providing false information,
may subject you to penalties. Routine
uses of this information include giving it to
the Department of Justice for civil and
criminal litigation, and to cities, states, and
the District of Columbia for use in the
administration of their taxes. We may also
disclose this information to federal and
state agencies to enforce federal nontax
criminal laws and to combat terrorism.
You are not required to provide the
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.
The time needed to complete and file
this form will vary depending on individual
circumstances. The estimated average
time is:
Recordkeeping . . . . .

7 hr., 10 min.

Learning about the
law or the form . . .

1 hr., 17 min.

Preparing the
form . . . . . . . . . . .

1 hr., 27 min.

Copying,
assembling, and
sending the form
to the IRS . . . . . . .

16 min.

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 comments through IRS.gov/
FormComments. Or you can write to the
Internal Revenue Service, Tax Forms and
Publications, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Don’t
send the tax form to this office. Instead,
see When and Where To File, earlier.