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["Return Preparer Office Testing and Fingerprinting Programs"]
["Return Preparer Information to be Collected / Subject to OMB Approval"]
[]
["Information Provided via Form W-12 and entered into TPPS system\n(has already been approved)",null,"Information passed from TPPS to Prometric","Information passed from TPPS to Prometric / LexisNexis and Daon Trusted Identity","Notes"]
["Name","Last name","Last name","Last name"]
[null,"First name and initial","First name","First name"]
[null,null,"Middle name","Middle name","Middle name will be provided at the time the candidate schedules a test and/or fingerprinting appointment"]
["Mailing Address","Street address","Street address","Street address"]
[null,"City","City","City"]
[null,"State","State","State"]
[null,"Zip code","Zip code","Zip code"]
[null,null,"Home phone Number","Home phone number","Home phone number will be provided at the time the candidate schedules a test and/or fingerprinting appointment"]
["SSN and Date of Birth","SSN"]
[null,"Date of birth (month, day, year)","Date of birth (month, day, year)","Date of birth (month, day, year)"]
["Email Address","Email address","Email address"]
["Address of Your Last Individual Income Tax Return Filed","Street address"]
[null,"City"]
[null,"State"]
[null,"Zip code"]
["Filing Status and Tax Year on Last Individual Income Tax Return Filed","[ ] Single                                [ ] Head of Household\n[ ] Married filing jointly          [ ] Qualifying widow(er) with dependent child\n[ ] Married filing separately  Tax Year _____________\n"]
["Federal Tax Compliance","Are you current on both your individual and business federal taxes, including any corporate and employment tax obligations? [ ] Yes   [ ] No\nIf \"no\", provide an explanation._______________________________"]
["Past Felony Convictions","Have you been convicted of a felony in the past 10 years? [ ] Yes   [ ] No\nIf \"Yes\", provide an explanation.______________________________"]
["Business Name and Identification Numbers","Business Name"]
[null,"EIN"]
[null,"EFIN"]
["Business Physical Address"]
[null,"Street Address"]
[null,"City"]
[null,"State"]
[null,"Zip Code"]
["Business Phone Number","Business phone number (domestic)"]
[null,"Business phone number (international)"]
["Business Web Address","Business website address"]
["CAF Number","Central Authorization File (CAF) number(s)"]
["Professional Credentials","Check all that apply and enter appropriate number(s):\n[ ] Attorney - Licensed in which states____________numbers______\n[ ] Certified Public Accountant-Licensed in which states__number___\n[ ] Enrolled Agent______________________________________\n[ ] Enrolled Actuary_____________________________________\n[ ] Enrolled Retirement Plan Agent__________________________\n[ ] Certified Acceptance Agent__________________________________\n[ ] State Regulated Tax Preparer-States_____numbers___________\n[ ] None"]
["Fee","Make check or money order payable to…..","Pay by credit card or e-check","Pay by credit card or e-check"]
["Signature","Signature under penalties of perjury…"]
[null,"Date  "]
[null,null,"IRS Registration File Number (TPPS generated)","IRS Registration File Number (TPPS generated)"]
[null,null,null,"Additional Information to be collected at fingerprinting kiosk:","This information (except for the last item) is required for the FBI background investigation"]
[null,null,null,"Gender"]
[null,null,null,"Race"]
[null,null,null,"Eye color"]
[null,null,null,"Hair color"]
[null,null,null,"Height (feet and inches)"]
[null,null,null,"Weight"]
[null,null,null,"Citizenship (country code for US Citizenship or country of origin)"]
[null,null,null,"Place of birth"]
[null,null,null,"Aliases (all aliases used but not a required field)"]
[null,null,null,"Reason fingerprinted (check all that apply)\n[  ] PTIN   [  ] EFIN   [  ] ITIN"]

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