IRS Form W-12 "IRS Paid Preparer Tax Identification Number (Ptin) Application and Renewal"

What Is IRS Form W-12?

This is a tax form that was released by the Internal Revenue Service (IRS) - a subdivision of the U.S. Department of the Treasury on October 1, 2020. Check the official IRS-issued instructions before completing and submitting the form.

Form Details:

  • A 3-page form available for download in PDF;
  • Actual and valid for filing 2020 taxes;
  • Editable, printable, and free;
  • Fill out the form in our online filing application.

Download a fillable version of IRS Form W-12 through the link below or browse more documents in our library of IRS Forms.

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W-12
IRS Paid Preparer Tax Identification Number (PTIN)
Form
Application and Renewal
OMB No. 1545-2190
(Rev. May 2021)
Department of the Treasury
Go to www.irs.gov/FormW12 for instructions and the latest information.
Internal Revenue Service
1 Name and PTIN
First name
Middle name
Last name
(Print in ink or
Type)
Initial application
Renewal application
(Enter PTIN: P
)
2 Year of
If you checked the “Initial application” box and are submitting this form between October 1 and December 31,
Application/
indicate below whether you want your PTIN to be valid for the current calendar year or the next calendar year.
Renewal
Current calendar year
Next calendar year
Prior year(s) (YYYY): Check box(es) below for the prior year(s) you are renewing your PTIN. See line 2
instructions for additional guidance. If you are applying for a prior year(s), write each year(s) below. Use the
following format. (YYYY)
2020
2021
2022
Other prior year(s)
3 SSN and Date
Provide your Social Security Number (SSN). If you
SSN
Date of birth (MM/DD/YYYY)
of Birth
have an SSN, you are required to provide it. If you
-
-
/
/
do not have an SSN, then check the N/A box.
You must
provide your
N/A
SSN or check
Failure to provide your SSN or check the N/A
the N/A box
box will result in your PTIN application being
rejected.
Street address. Use a P.O. box number only if the post office does not deliver mail to your street address.
4 Personal
Mailing
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.
Phone Number (
)
-
5a Business
Business address
Check here if your business address is the same as your personal mailing address. If
Mailing
different, enter it below.
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.
Domestic business phone number
International business phone number
-
EXT.
+
(
)
b Business
Yes
No
Are you self-employed or an owner, partner, or officer of a tax return preparation business?
Identification
If “Yes,” then complete this line. If “No,” go to line 6.
Enter the business name.
Your CAF Number
EIN
EFIN
-
Website address (optional)
6 Email Address
Enter the email address that should be used to contact you.
W-12
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 5-2021)
Cat. No. 55469F
For Internal Use Only
F:
E:
A:
W-12
IRS Paid Preparer Tax Identification Number (PTIN)
Form
Application and Renewal
OMB No. 1545-2190
(Rev. May 2021)
Department of the Treasury
Go to www.irs.gov/FormW12 for instructions and the latest information.
Internal Revenue Service
1 Name and PTIN
First name
Middle name
Last name
(Print in ink or
Type)
Initial application
Renewal application
(Enter PTIN: P
)
2 Year of
If you checked the “Initial application” box and are submitting this form between October 1 and December 31,
Application/
indicate below whether you want your PTIN to be valid for the current calendar year or the next calendar year.
Renewal
Current calendar year
Next calendar year
Prior year(s) (YYYY): Check box(es) below for the prior year(s) you are renewing your PTIN. See line 2
instructions for additional guidance. If you are applying for a prior year(s), write each year(s) below. Use the
following format. (YYYY)
2020
2021
2022
Other prior year(s)
3 SSN and Date
Provide your Social Security Number (SSN). If you
SSN
Date of birth (MM/DD/YYYY)
of Birth
have an SSN, you are required to provide it. If you
-
-
/
/
do not have an SSN, then check the N/A box.
You must
provide your
N/A
SSN or check
Failure to provide your SSN or check the N/A
the N/A box
box will result in your PTIN application being
rejected.
Street address. Use a P.O. box number only if the post office does not deliver mail to your street address.
4 Personal
Mailing
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.
Phone Number (
)
-
5a Business
Business address
Check here if your business address is the same as your personal mailing address. If
Mailing
different, enter it below.
Address and
Phone Number
City or town, state or province, country, and ZIP or foreign postal code. Do not abbreviate name of country.
Domestic business phone number
International business phone number
-
EXT.
+
(
)
b Business
Yes
No
Are you self-employed or an owner, partner, or officer of a tax return preparation business?
Identification
If “Yes,” then complete this line. If “No,” go to line 6.
Enter the business name.
Your CAF Number
EIN
EFIN
-
Website address (optional)
6 Email Address
Enter the email address that should be used to contact you.
W-12
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 5-2021)
Cat. No. 55469F
For Internal Use Only
F:
E:
A:
2
Form W-12 (Rev. 5-2021)
Page
7 Past Felony
Yes
Have you been convicted of a felony in the past 10 years?
Convictions
No
You must check
If “Yes,” list the date and the type of felony conviction(s).
a box. If “Yes,”
you must
provide an
explanation.
If this is your initial application for a PTIN, continue to line 8. If you are renewing your PTIN, go to line 10.
8 Address of
Enter the address used on your last U.S. individual income tax return you filed.
Your
Last U.S.
Individual
Income Tax
Check here if you have never filed a U.S. income tax return or do not have a U.S. income tax filing
Return Filed
requirement. See line 8 instructions for documents that must be submitted with this form and continue to
line 10.
9 Filing Status
Single
Head of Household
and Tax Year
on Last U.S.
Married filing jointly
Qualifying widow(er) with dependent child
Individual
Income Tax
Married filing separately
Tax Year (YYYY)
Return Filed
Note: If your last return was filed more than 4 years ago, see instructions.
10 Federal Tax
Are you current on both your individual and business federal taxes, including any corporate and employment
Compliance
tax obligations? Note: If you have never filed a U.S. individual income tax return because you are not required
to do so, check the “Yes” box.
Yes
No
If “No,” provide an explanation.
11 Data Security
I am aware that paid tax return preparers must have a data security plan to provide data and system security
Responsibilities
protections for all taxpayer information.
W-12
Form
(Rev. 5-2021)
3
Form W-12 (Rev. 5-2021)
Page
12 Professional
Check all that apply. Note: DO NOT check any professional credentials that are currently expired or
Credentials
retired. Enter state abbreviation and appropriate number(s). If the expiration date is left blank or incomplete,
then NO professional credential will be added when the application is processed.
Attorney—Licensed in which
jurisdiction(s):
Number(s):
Expiration Date(s):
Certified Public Accountant (CPA)—
Licensed in which jurisdiction(s):
Number(s):
Expiration Date(s):
Number(s):
Expiration Date(s):
Enrolled Agent (EA)
Number(s):
Expiration Date(s):
Enrolled Actuary
Number(s):
Expiration Date(s):
Enrolled Retirement Plan Agent (ERPA)
State Regulated Tax Return Preparer
—Licensed in which jurisdiction(s):
Number(s):
Expiration Date(s):
Number:
Certifying Acceptance Agent (CAA)
None
13 Fees
If you are applying for a PTIN or renewing your PTIN, your fee is $35.95. The fee is an application processing
fee and is nonrefundable. Full payment must be included with your application or it will be rejected. If your
application is incomplete and you do not supply the required information upon request, the IRS will be unable
to process your application. Make your check or money order payable to IRS Tax Pro PTIN Fee. Do not
paper clip, staple, or otherwise attach the payment to Form W-12. Separate payments are required for each
year you are applying for. No payment is due for 2020 and prior years.
Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief, it
Sign
is true, correct, and complete. I understand any false or misleading information may result in criminal penalties and/or
the denial or termination of a PTIN.
Your signature (Please use blue or black ink)
Date (MM/DD/YYYY)
Here
/
/
How To File
Online. Go to the webpage www.irs.gov/ptin for information. Follow the instructions to submit Form W-12. If you submit your
application online, your PTIN generally will be provided to you immediately after you complete the application.
By mail. Complete Form W-12. Send the form to:
IRS Tax Professional PTIN Processing Center
PO Box 380638
San Antonio, TX 78268
Note: Allow 4 to 6 weeks for processing of PTIN applications. For additional information, refer to the separate Instructions for
Form W-12.
For Internal Use Only
W-12
Form
(Rev. 5-2021)
Page of 3