Fillable Application for Security Summit Membership IRS

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Application for Security Summit Membership IRS

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The Application for Security Summit Membership IRS form is 2 pages long and contains:

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  • 6 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

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The Internal Revenue Service (IRS) is a government agency responsible for collecting taxes and administering the federal statutory tax laws of the United States. The IRS provide tax assistance to taxpayers and pursue and resolve fraudulent tax filings.

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Application for Security Summit Membership
You may fax your application to: 855-811-8020
Or send by mail to:
Internal Revenue Service National Public Liaison
Room 7559 CL:NPL
1111 Constitution Ave, NW
Washington, DC 20224
Part I: Applicant Information
Agency/Organization Name Agency/Organization Address
City State ZIP Code
Business Phone
Contact Name Address
City State ZIP Code
E-mail Address Phone Job Title
Part II: Required Criteria and Qualifications
Please see the attached membership criteria document to determine the
appropriate categorization which best aligns with your agency or organization
and submit a short (one to two page) statement (Statement of Interest)
describing your agency’s or organization’s role, mission and functional
responsibilities within the tax ecosystem. Also indicate your expectation of the
Security Summit including your anticipated contribution and benefits expected.
This application is to be signed by the Head of Agency/Senior Executive of the
respective Agency/Organization.
Please select the membership
category you are applying for:
State/City
Software Developer/Electronic
Return Originator (ERO)
Financial Services
Payroll Reporting Agents
Endorsing Organization
Other
Part III: Applicant Signature
I certify that to the best of my knowledge and belief, all of my statements are true, correct, complete
and made in good faith. I have read, understand and attest that my agency/organization meets the
criteria required for Security Summit membership. I agree to immediately notify the designated IRS
Official when adding or removing representatives from our organization/agency participating in
Security Summit activities.
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Application for Security Summit Membership IRS

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Completed 16 December 2019

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