Treasury
Internal Revenue Service
01.2021
- Go to www.irs.gov/Form8821 for instructions and the latest information
- Don’t sign this form unless all applicable lines have been completed
- Don’t use Form 8821 to request copies of your tax returns or to authorize someone to represent you
- See instructions
- OMB No
- 1545-1165
- For IRS Use Only
- Received by:
- Name
- Telephone
- Function
- DateTaxpayer information
- Taxpayer must sign and date this form on line 6
- Taxpayer name and address Taxpayer identification number(s)
- Daytime telephone number Plan number (if applicable)Designee(s)
- If you wish to name more than two designees, attach a list to this form
- Check here if a list of additional designees is attached
- Name and address
- Check if to be sent copies of notices and communications
- CAF No
- PTIN
- Telephone No
- Fax No
- Check if new: Address Telephone No
- Fax No
- Name and address
- Check if to be sent copies of notices and communications
- CAF No
- PTIN
- Telephone No
- Fax No
- Check if new: Address Telephone No
- Fax No.Tax information
- Each designee is authorized to inspect and/or receive confidential tax information for the type of tax, forms, periods, and specific matters you list below
- See the line 3 instructions
- By checking here, I authorize access to my IRS records via an Intermediate Service Provider
- (a)
- Type of Tax Information (Income
- Employment, Payroll, Excise, Estate, Gift
- Civil Penalty, Sec
- 4980H Payments, etc.) (b)
- Tax Form Number (1040, 941, 720, etc.) (c)
- Year(s) or Period(s) (d)
- Specific Tax MattersSpecific use not recorded on the Centralized Authorization File (CAF)
- If the tax information authorization is for a specific use not recorded on CAF, check this box
- See the instructions
- If you check this box, skip line 5
- Retention/revocation of prior tax information authorizations
- If the line 4 box is checked, skip this line
- If the line 4 box isn’t checked, the IRS will automatically revoke all prior tax information authorizations on file unless you check the line 5 box and attach a copy of the tax information authorization(s) that you want to retain
- To revoke a prior tax information authorization(s) without submitting a new authorization, see the line 5 instructions.Taxpayer signature
- If signed by a corporate officer, partner, guardian, partnership representative (or designated individual, if applicable), executor, receiver, administrator, trustee, or individual other than the taxpayer, I certify that I have the legal authority to execute this form with respect to the tax matters and tax periods shown on line 3 above
- IF NOT COMPLETED, SIGNED, AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED
- DON’T SIGN THIS FORM IF IT IS BLANK OR INCOMPLETE
- Signature Date
- Print Name Title (if applicable)
- For Privacy Act and Paperwork Reduction Act Notice, see the instructions
- Cat
- No
- 11596P Form 8821 (Rev
- 01-2021)