Income Verification Express Service (IVES) Application

• Legal Form Number: 13803
• Year: 2022
• Issuer: Treasury Department
• Section: Treasury Department

Form 13803 (Rev. 8-2022)

www.irs.govCatalog Number 48547A

Form 13803

(August 2022)

Department of the Treasury - Internal Revenue Service

Application to Participate in the Income

Verification Express Service (IVES) Program

(Please read the instructions carefully before submitting this form)

OMB Number 1545-2032

For Official Use Only

Control number

1a. Check the type of application you are submitting

New Renewal Amended Add new location Cancellation Address change

1b. Existing IVES participant ID number (if applicable)

2. Check the box that describes your organization status

Government agency Partnership Sole proprietorship Corporation LLC

Other (specify)

3. Reason(s) for using the IVES program (select all that apply)

Mortgage Services Background Check Credit Check Banking Service Licensing Requirement

Other (specify)

4. Legal name of business (required)

5. Employer Identification Number (EIN) or Social Security Number (SSN) (required)

6. Doing Business As (DBA) name (complete only if the business is operating under a different business name than listed on line 4)

7. Business location address (required)

Street address City State Zip Code

Business telephone number Fax number Business e-mail address (optional)

8. Billing address (required if different from the location address on line 7)

Street address City State Zip Code

9. Complete the following information for the IVES account principal (principal, company official, partner, or owner of business) (required)

IVES account principal (first, middle initial, last) Title Telephone number

Date of Birth (mm/dd/yyyy) Social Security Number E-mail address

Home street address City State Zip Code

10. Business point of contact (required if different than the principal). A contact must be available on a day-to-day basis to answer IRS

questions during testing and through the processing year

Last name First name MI

Telephone number E-mail address

11a. Have any individuals listed on Line 9 and/or Line 10 been convicted of a felony in the last 10

years? (Attach and explanation for a Yes response) Yes No

11b. Are all those listed on this application current with their individual and business tax filing and payments,

including any corporation and employment tax obligations? (Attach an explanation for a No response)

If using a different EIN than listed in Line 5 to meet business filing requirements, list that here

Yes No

EIN

12. Estimated annual volume of IVES product requests