Sample IRS Form SS-4 "Application for Employer Identification Number (Home Health Care Service Recipients)"

What Is IRS Form SS-4?

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 January 1, 2010. Check the official IRS-issued instructions before completing and submitting the form.

Form Details:

  • A 1-page form available for download in PDF;
  • Actual and valid for filing 2022 taxes;
  • Additional instructions and information can be found on page 1 of the document;
  • A printable and free sample of IRS Form SS-4;
  • Fill out the form in our online filing application.

Download a printable version of IRS Form SS-4 through the link below or browse more documents in our library of IRS Forms.

ADVERTISEMENT
ADVERTISEMENT

Download Sample IRS Form SS-4 "Application for Employer Identification Number (Home Health Care Service Recipients)"

Download PDF

Fill PDF online

Rate (4.6 / 5) 38 votes
Record EIN here when
EINs cannot be applied for online for participant
received. This box is left
direction employers. EINs must be obtained via
blank until EIN is received.
phone, fax or mail using Form SS-4.
Employer can be
participant or
representative serving
as employer. After
employer name, enter
“HHCSR”
Leave Line 2 blank.
Participant employer
should generally not be
established as an LLC
or corp.
Leave 9b blank.
As a default, leave Box
14 unchecked.
Enter 0 in all boxes.
Do not enter any other
number in these
boxes.
In most cases, “no”
should be checked.
Individual listed in Box 1 should sign, date and print name, telephone and fax (if applicable) here. An exception is if a guardian
for the individual listed in Box 1 has been court appointed. If a guardian for the person listed in Box 1 has been court
appointed, guardian should sign, date and attach copy of court appointed guardianship papers with court seal visible.
Example IRS Form SS-4
Used to Obtain Federal Employer Identification Number for a Participant Hiring Employees and Using a
Fiscal/Employer Agent
Record EIN here when
EINs cannot be applied for online for participant
received. This box is left
direction employers. EINs must be obtained via
blank until EIN is received.
phone, fax or mail using Form SS-4.
Employer can be
participant or
representative serving
as employer. After
employer name, enter
“HHCSR”
Leave Line 2 blank.
Participant employer
should generally not be
established as an LLC
or corp.
Leave 9b blank.
As a default, leave Box
14 unchecked.
Enter 0 in all boxes.
Do not enter any other
number in these
boxes.
In most cases, “no”
should be checked.
Individual listed in Box 1 should sign, date and print name, telephone and fax (if applicable) here. An exception is if a guardian
for the individual listed in Box 1 has been court appointed. If a guardian for the person listed in Box 1 has been court
appointed, guardian should sign, date and attach copy of court appointed guardianship papers with court seal visible.
Example IRS Form SS-4
Used to Obtain Federal Employer Identification Number for a Participant Hiring Employees and Using a
Fiscal/Employer Agent