0421 Form 15115 (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f15115.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(April 2021)

Department of the Treasury - Internal Revenue Service Request for Missing Information on the Application for Enrollment or

Renewal of Enrollment to Practice before the IRS

Complete the information requested below, sign, and either fax or mail this form to the fax number or address shown at the top of the accompanying Letter 5499.

Your name (print/type) Your Social Security Number Your preparer tax ID number

Your mailing address

Your enrollment status (Form 8554) (check one)

I want to remain in active status

I want to remain or be put in inactive retirement status

I completed hours of continuing education and hours of Ethics training for the

enrollment renewal cycle.

Your answer to Question 6 (Form 23 or Form 8554) Yes No

Your answer to Question 7 (Form 23 or Form 8554) Yes No

Your answer to Question 8 (Form 23 or Form 8554) Yes No

Your answer to Question 9 (Form 23 or Form 8554) Yes No

Your answer to Question 10 (Form 23 or Form 8554) Yes No

Your answer to Question 11 (Form 23 or Form 8554) Yes No

Your answer to Question 12 (Form 23) Yes No

Continuing education certificates for the enrollment renewal cycle.

Special Enrollment Examination Passing Score Reports (3)

Your active preparer tax identification number (PTIN)

Your signature

Under penalties of perjury, I declare the information I’ve provided above is true, correct, and complete to the best of my knowledge and belief.

Signature Date Enrolled Agent number

Catalog Number 69809R www.irs.gov Form 15115 (Rev. 4-2021)