Form SSA-1694 "Request for Business Entity Taxpayer Information"

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Form Approved
OMB No. 0960-0731
Social Security Administration
Request for Business Entity Taxpayer Information
BUSINESS INFORMATION
Employer Identification Number (EIN)
Name of the Business Entity
Tax Mailing Address
P.O. Box, Street, Apt., or Suite No.
City
State
ZIP Code or Postal Zone
Country
PERJURY STATEMENT
I declare under penalty of perjury that I have examined all of the information on this request and it is true to the best of
my knowledge. I am aware that if I knowingly and willingly make any false representation about any material fact
provided herein or knowingly and willingly make any false representation to obtain information from Social Security
records, and/or attempt to deceive the Social Security Administration as to my true identity, I could be criminally
punished by a fine or imprisonment or both.
Printed Name
Signature
Date
/
/
Contact Name
Phone Number (including area code)
FOR AGENCY USE ONLY:
Form SSA-1694 (01-2019)
Page 1
Form Approved
OMB No. 0960-0731
Social Security Administration
Request for Business Entity Taxpayer Information
BUSINESS INFORMATION
Employer Identification Number (EIN)
Name of the Business Entity
Tax Mailing Address
P.O. Box, Street, Apt., or Suite No.
City
State
ZIP Code or Postal Zone
Country
PERJURY STATEMENT
I declare under penalty of perjury that I have examined all of the information on this request and it is true to the best of
my knowledge. I am aware that if I knowingly and willingly make any false representation about any material fact
provided herein or knowingly and willingly make any false representation to obtain information from Social Security
records, and/or attempt to deceive the Social Security Administration as to my true identity, I could be criminally
punished by a fine or imprisonment or both.
Printed Name
Signature
Date
/
/
Contact Name
Phone Number (including area code)
FOR AGENCY USE ONLY:
Form SSA-1694 (01-2019)
Page 1
IMPORTANT INFORMATION
Purpose of Form
The Social Security Administration (SSA) is required to file an information return (i.e., Form 1099-MISC) with the Internal
Revenue Service (IRS) when payments of $600 or more have been made to appointed representatives associated with a
business entity as employees or partners. In order to meet this requirement, SSA must obtain the name, employer identification
number (EIN), and address of the business entity.
Instructions for Completing the Form
Employer Identification Number
Please enter your EIN. If you do not have an EIN, please apply for one immediately by filing an SS-4, Application for Employer
Identification Number, with the IRS. You can apply for an EIN online by accessing the IRS website at www.irs.gov.
Name of Business Entity
Enter your business name as shown on required Federal tax documents. Normally, this will match the name used when you filed
a Form SS-4 to apply for an EIN.
Tax Mailing Address
Please enter your tax mailing address. SSA will mail Form 1099-MISC to you at this address if payments of $600 or more are
made to appointed representatives associated with your business entity during a tax year.
Privacy Act Statement
Collection and Use of Personal Information
Sections 206(a) and 1631(d) of the Social Security Act, as amended, allow us to collect this information. Furnishing us this
information is voluntary. However, failing to provide all or part of the information may prevent you from serving as an appointed
representative.
We will use the information to identify appointed representatives associated with a business entity as employees or partners, and
to facilitate issuance of appropriate return information for reporting purposes. We may also share your information for the
following purposes, called routine uses:
• To the Internal Revenue Service to permit its auditing of our compliance with the safeguard
provisions of the Internal Revenue Code of 1986, as amended; and
• To contractors and other Federal Agencies, as necessary, for the purpose of assisting the Social
Security Administration in the efficient administration of its programs.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where
authorized,
we may use and disclose this information in computer matching programs, in which our records are compared with
other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0325, entitled Appointed
Representative File, as published in the Federal Register (FR) on October 8, 2009, at 74 FR 51940. Additional information, and a
full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.
Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. 3507, as amended by section 2 of the Paperwork Reduction Act
of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number.
We estimate that it will take 20 minutes to read the instructions, gather the facts, and answer the questions. SEND THE
COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U.S. Government agencies
in your telephone directory or you may call Social Security at 1-800-772-1213. You may send comments on our time
estimate above to SSA, 6401 Security Boulevard, Baltimore, MD, 21235-6401. Send only comments relating to our time
estimate to this address, not the completed form.
Form SSA-1694 (01-2019)
Page 2
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