This form contains 45 fields organized into 5 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Authorization
topmostSubform[0].Page1[0].c1_1[0]_1 CheckBox
Check this box if you want to authorize the designee to receive tax information.
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect tax information.
Authorization Details
topmostSubform[0].Page1[0].c1_3[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].c1_4[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].c1_5[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].c1_6[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].c1_7[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].c1_8[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].c1_9[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].c1_10[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].c1_11[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your tax information for the current tax year.
topmostSubform[0].Page1[0].c1_12[0]_1 CheckBox
Check this box if you want to authorize the designee to inspect and/or receive your tax information for the previous tax year.
Designee Information
Name and address Text
Enter the full name and address of the designee authorized to receive the tax information.
CAF No Text
Enter the Centralized Authorization File (CAF) number of the designee, if applicable.
PTIN Text
Enter the Preparer Tax Identification Number (PTIN) of the designee, if applicable. Maximum length is 11 characters.
Max length: 11 characters
Telephone No Text
Enter the telephone number of the designee.
Fax No Text
Enter the fax number of the designee.
Name and address Text
Enter the name and address of the designee you are authorizing to inspect and/or receive your confidential tax information.
CAF No Text
Enter the Centralized Authorization File (CAF) number of the designee. This number is assigned by the IRS.
PTIN Text
Enter the Preparer Tax Identification Number (PTIN) of the designee. This number is used by tax preparers.
Max length: 11 characters
Telephone No Text
Enter the telephone number of the designee.
Fax No Text
Enter the fax number of the designee.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow1[0].f1_20[0 Text
Enter the name of the first designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow1[0].f1_21[0 Text
Enter the address of the first designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow1[0].f1_22[0 Text
Enter the telephone number of the first designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow1[0].f1_23[0 Text
Enter the CAF number of the first designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow2[0].f1_24[0 Text
Enter the name of the second designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow2[0].f1_25[0 Text
Enter the address of the second designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow2[0].f1_26[0 Text
Enter the telephone number of the second designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow2[0].f1_27[0 Text
Enter the CAF number of the second designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow3[0].f1_28[0 Text
Enter the name of the third designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow3[0].f1_29[0 Text
Enter the address of the third designee authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow3[0].f1_30[0 Text
Enter the name of the designee who is authorized to inspect and/or receive your confidential tax information.
topmostSubform[0].Page1[0].Table_Line3[0].BodyRow3[0].f1_31[0 Text
Enter the address of the designee who is authorized to inspect and/or receive your confidential tax information.
IRS Use Only
Received by Text
This field is for the IRS representative to fill out when they receive the form.
Name Text
Enter the full name of the IRS representative who received the form.
Telephone Text
Enter the telephone number of the IRS representative who received the form.
Function Text
Enter the function or role of the IRS representative who received the form.
Date Text
Enter the date when the IRS representative received the form.
Taxpayer Information
Taxpayer name and address Text
Enter the full name and address of the taxpayer authorizing the release of tax information.
Taxpayer identification number(s) Text
Enter the taxpayer's identification number(s), such as Social Security Number (SSN) or Employer Identification Number (EIN).
Daytime telephone number Text
Enter the taxpayer's daytime telephone number.
Plan number (if applicable) Text
Enter the plan number if applicable, such as for retirement plans.
Print Name Text
Print your full name as it appears on your tax return.
Title (if applicable) Text
If applicable, enter your title (e.g., President, Trustee) when signing on behalf of an entity.