Federal Free Printable Form 12339-B (Rev. 4-2017) for 2017 Federal Information Reporting Program Advisory Committee Membership Application

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Information Reporting Program Advisory Committee Membership Application
Form 12339-B (Rev. 4-2017)

Form 12339-B (April 2017) Department of the Treasury - Internal Revenue Service Information Reporting Program Advisory Committee Membership Application Complete this application and return it to the address below no later than Close of Business on You may also e-mail your application to: [email protected] OMB Number 1545-1791 May 21, 2017. Internal Revenue Service National Public Liaison CL: NPL – Room 7559 IR Attn: IRPAC Program Manager 1111 Constitution Avenue, N.W. Washington, DC 20224 PART I – Applicant Information (Some of the information requested in Part I is required to perform an FBI background check) Name Maiden name or other name(s) used Date(s) names were used Home street address Home telephone number City Date of birth (mm-dd-yyyy) State City of birth ZIP Code State of birth Business name Business address Job title City Business telephone number State Business FAX number ZIP Code Email address PART II – Applicant must complete and submit Form 13775, Tax Check Waiver, with this form PART III – Desired Skills and Qualifications Submit a brief statement addressing your past or current affiliations and dealings with a particular organization or group that you represent and how such dealings will allow you to know the view's or position of that particular organization or group. In addition, submit a short (one or two page) statement, including recent examples, addressing your specific skills and qualifications as they relate to the following: ● ● ● ● ● ● Experience working with tax information reporting. Experience developing and presenting issue resolution and recommendations. Experience developing and implementing customer service initiatives and tools. Experience in change management and improvement. Experience establishing successful strategic partnerships. Ability to examine issues from a macro viewpoint, and effectively communicate recommendations. Catalog Number 48518X www.irs.gov Form 12339-B (Rev. 4-2017) Page 2 PART IV – Applicant Resume Attach a copy of your resume, including prior Treasury and/or IRS employment. State position(s), title(s), and dates of employment. Additionally, list professional credentials, membership in professional organizations, and local liaison activities with IRS, if applicable. PART V – Other IRS Councils/Committees Have you ever been a member of the Internal Revenue Service Advisory Council (formerly known as Commissioner's Advisory Group), Art Advisory Panel, Electronic Tax Administration Advisory Committee, Tax Exempt Advisory Committee or Information Reporting Program Advisory Committee? If so, include name of the councils/committees and dates of membership. Councils/Committee name Dates of Membership PART VI – Applicant Acknowledgement I certify that to the best of my knowledge and belief, all of my statements are true, correct, complete, and made in good faith. Applicant signature Date signed Privacy Act Statement The Privacy Act of 1974 requires that when we ask you for information about yourself, we state our legal right to do so, tell you why we are asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for the information is Public Law 92-463 and Executive Order (E.O.) 9397. We are asking for the information in order to perform Federal income tax, FBI, and practitioner checks as required of all members and applicants to the Advisory Council/Committee. Supplying the information is voluntary and not directly required by law, but facilitates the processing of your application for membership in the IRS Advisory Council/Committee. Requesting your social security number, which is solicited under authority of E.O. 9397, is also voluntary and no right, benefit, or privilege provided by law will be denied as a result of refusal to disclose it. However, not providing all or any part of the information may limit consideration of your application. Paperwork Reduction Act Notice We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of tax. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103.The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is shown below. The estimated burden for all other taxpayers who file this form is approved under OMB control number 1545-1791. Preparing, copying, assembling, and sending the form to the IRS …………………… 1 hour., 30 mins. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to: Internal Revenue Service, 1111 Constitution, Ave, NW, Washington, DC 20224. Do not send the form to this address. Instead, see the return address on the form. Catalog Number 48518X www.irs.gov Form 12339-B (Rev. 4-2017)
Extracted from PDF file 2016-federal-form-12339-b.pdf, last modified April 2017

More about the Federal Form 12339-B Other TY 2016

We last updated the Information Reporting Program Advisory Committee Membership Application in May 2017, so this is the latest version of Form 12339-B, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 12339-B directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 12339-B from the Internal Revenue Service in May 2017.

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Historical Past-Year Versions of Federal Form 12339-B

We have a total of four past-year versions of Form 12339-B in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 12339-B

Form 12339-B (Rev. 4-2017)

Information Reporting Program Advisory Committee Membership Application 2015 Form 12339-B

Form 12339-B (Rev. 1-2015)

Information Reporting Program Advisory Committee Membership Application 2012 Form 12339-B

Form 12339-B (Rev. 3-2012)

Information Reporting Program Advisory Committee Membership Application 2011 Form 12339-B

Form 12339-B (Rev. 2-2011)


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