for Enrollment to Practice Before the Internal

Form

for Enrollment to Practice Before the Internal

23-EP Application

Revenue Service as an Enrolled Retirement Plan Agent

(Rev. December 2014)

(ERPA)

Department of the Treasury

Internal Revenue Service

OMB No. 1545-0950

See Instructions on Page 3

Important things you need to know and do before you file this form:

• Take and pass the Enrolled Retirement Plan Agent Special Enrollment Examination

• Read Circular 230

• The application fee is $30.

For IRS use:

Date Enrolled:

Visit www.pay.gov to file and pay electronically. This fee is non-refundable.

Check here if you are a former Internal Revenue Service Employee, and enter the date you separated

from the Service

.

/

/

Enrollment Number:

Part 1. Tell Us About Yourself

1

Your Social Security Number

If you do not have an SSN, please check this box.

2

Date of Birth

mm/dd/yyyy

3

Your Full Legal Name

Last

4

First

MI

Current Address

Number

City

State

Street

Zip Code

Suite or Apt. Number

Country

Your email Address:

Your Contact Telephone Number:

5

Enter your PTIN number issued by the IRS or Candidate Number assigned by the

American Institute of Retirement Education (AIRE).

6

Do you have an Employer Identification Number (EIN)?

Yes

No

If Yes, enter all EINs, business names, and addresses below (attach additional pages, if necessary):

EIN

Business Name

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Business Address

Cat. No. 51483V

Form 23-EP (Rev. 12-2014)

Page 2

Form 23-EP (Rev. 12-2014)

7

Do you have a Centralized Authorization File (CAF) number?

Yes

No

If Yes, enter all CAF numbers assigned to you (attach additional pages, if necessary):

8

Have you been sanctioned by a federal or state licensing authority?

Yes

No

9

Has any application you filed with a court, government department,

commission, or agency for admission to practice ever been denied?

Yes

No

10

Have you been convicted of a tax crime or any felony?

Yes

No

11

Have you been permanently enjoined from preparing tax returns, or

representing others before the IRS?

Yes

No

NOTE: If you answered yes to question 8, 9, 10 or 11, please describe on a separate page, the matter, including the date of

when the matter occurred, and provide any additional information about the matter that you would like us to consider.

12

Are you a CPA?

Yes

No

If Yes, enter the states where you are licensed to practice.

13

Are you an Attorney?

Yes

No

If Yes, enter the States where you are licensed to practice.

14

Are you an Enrolled Agent (EA)?

Yes

No

Part 2. Sign here

Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.

Signature

Date

Form 23-EP (Rev. 12-2014)

Filling out this form:

It is important to answer all questions on the form. Failure to answer any questions or sign the form could result in processing delays.

An intentionally false statement or omission identified with your application is a violation of Circular 230 10.51(a)(4) and 18 U.S.C. 1001

and may be grounds for suspension or disbarment from practice.

Form 23-EP (Rev. 12-2014)

Instructions:

• You must take and pass the EPRA-SEE before you can apply.

You may register for the examination at www.erpaexam.org.

Former IRS Employees:

Please Note: your eligibility to practice may be limited based

upon your work experience.

You may request a waiver to take the ERPA-SEE through the

submission of an application within three (3) years from the date

of your separation with the Internal Revenue Service (IRS).

Please check the box at the top of the form which indicates you

are requesting a waiver from taking the ERPA-SEE. See Circular

230 Section 10.4(d) for more information. To gain full enrollment

status you must take and pass the ERPA-SEE before you can

apply. You may register for the examination at

www.erpaexam.org.

What if I don't have a Social Security

Number?

If you are living and working in the United States (US), you are

required to have a Social Security Number (SSN). If you are

working outside of the US and you do not have an SSN or an

ITIN, check the box on line 1.

Electronic Application and Payments:

You can pay electronically by visiting www.pay.gov.

Where to send this form:

You can use overnight mail or regular mail to send us this form.

If you want to use regular mail:

U.S. Treasury/Enrollment

PO Box 301510

Los Angeles, CA 90030-1510

If you want to use overnight mail:

Internal Revenue Service

Attn: Box 301510

19220 Normandie Ave. Ste. B

Torrance, CA. 90502

How long will it take to process your

application for enrollment?

It generally takes about 60 days to process applications. Your

enrollment status is not effective until we approve your request.

You are not authorized to practice before the IRS as an ERPA

until enrollment has been granted.

Who do I call if I have questions?

Please allow 60 days for processing before calling to check on

the status of your application. To check on the status of your

application, you may call 1-855-472-5540.

Page 3

Privacy Act and Paperwork Reduction Act Notice. Section

330 of title 31 of the United States Code authorizes us to collect

this information. We ask for this information to administer the

program of enrollment to practice before the IRS. Applying for

renewal of enrollment is voluntary; however, if you apply you

must provide the information requested on this form. Failure to

provide this information may delay or prevent processing your

application; providing false or fraudulent information may

subject you to penalties. Generally, this information is

confidential pursuant to the Privacy Act. However, certain

disclosures are authorized under the Act, including disclosure

to: the Department of Justice, and courts and other adjudicative

bodies, with respect to civil or criminal proceedings; public

authorities and professional organizations for their use in

connection with employment, licensing, disciplinary, regulatory,

and enforcement responsibilities; contractors as needed to

perform the contract; third parties as needed in an investigation;

the general public to assist them in identifying enrolled

individuals; state tax agencies for tax administration purposes;

appropriate persons when the security of information may have

been compromised for their use to prevent, mitigate, or remedy

harm.

You are not required to provide the information requested on

a form that is subject to the requirements of the Paperwork

Reduction Act unless the form displays a valid OMB control

number. Books and records relating to a form or its instructions

should be retained as long as their contents may become

material in the administration of the law. The time needed to

complete and file this form will vary depending on individual

circumstances. The estimated average time is 15 minutes,

including recordkeeping, learning about the law or the form,

preparing the form, and copying and sending the form to the

IRS.

If you have comments concerning the accuracy of this time

estimate or suggestions for making this form simpler, we would

be happy to hear from you. You can write to Office of Enrolled

Agent Policy & Management; P.O. Box 33968; Detroit, MI,

48232. Do not send this form to this address; instead see the

Where to send this form section of the instructions.