1017 Form W-7A (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/fw7a.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

Form

W-7A¶

(Rev. October 2017)

Department of the Treasury Internal Revenue Service

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Application for Taxpayer Identification Number for Pending U.S. Adoptions¶

Go to www.irs.gov/FormW7A for instructions and the latest information.

OMB No. 1545-0074

Note: Don't file this form 1	m if you are eligible to obtain a U.S. social		l security number (SSN) for your ad		doptive child.
1 Adoptive parent(s) information (see instructions)	1aParent’s last name	1aParent’s last name	First name	First name	Social security number	Social security number
1 Adoptive parent(s) information (see instructions)	1bParent’s last name	1bParent’s last name	First name	First name	Social security number	Social security number
2 Adoptive parent(s) address (see instructions)	Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions.	Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions.	Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions.	Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions.	Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions.	Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions.
2 Adoptive parent(s) address (see instructions)	City or town, state, and ZIP code	City or town, state, and ZIP code	City or town, state, and ZIP code	City or town, state, and ZIP code	City or town, state, and ZIP code	City or town, state, and ZIP code
3 Child’s name: As it will appear ▶ on your tax return Birth name if different and known . . ▶	3aLast name	3aLast name	First name	First name	Middle name	Middle name
3 Child’s name: As it will appear ▶ on your tax return Birth name if different and known . . ▶	3bLast name	3bLast name	First name	First name	Middle name	Middle name
4 Child’s birth information	Date of birth (month, day, year)	Female Male	Place of birth (city or town, and state) (If foreign address, see instructions)	Place of birth (city or town, and state) (If foreign address, see instructions)	Place of birth (city or town, and state) (If foreign address, see instructions)	Place of birth (city or town, and state) (If foreign address, see instructions)
5 Placement agency information	Name	Name	Address	Address	Address	Date child was placed with adoptive parents
Sign Here Keep a copy of this form for your records.	Note:Be sure to attach the required documentation to Form W-7A. See instructions.	Note:Be sure to attach the required documentation to Form W-7A. See instructions.	Note:Be sure to attach the required documentation to Form W-7A. See instructions.	Note:Be sure to attach the required documentation to Form W-7A. See instructions.	Note:Be sure to attach the required documentation to Form W-7A. See instructions.	Note:Be sure to attach the required documentation to Form W-7A. See instructions.
Sign Here Keep a copy of this form for your records.	Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of parent ▲ Date (month, day, year) Daytime phone number	Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of parent ▲ Date (month, day, year) Daytime phone number	Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of parent ▲ Date (month, day, year) Daytime phone number	Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of parent ▲ Date (month, day, year) Daytime phone number	Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of parent ▲ Date (month, day, year) Daytime phone number	Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of parent ▲ Date (month, day, year) Daytime phone number
Sign Here Keep a copy of this form for your records.	Signature of parent ▲	Signature of parent ▲	Signature of parent ▲	Date (month, day, year)	Daytime phone number	Daytime phone number

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