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Form 14417: Reimbursable Agreement - Non-Federal Entities (State and Local Governments, Foreign Governments, Commercial Organizations, and Private Businesses)
IRS Form 14417 is a reimbursable agreement used by non‑federal entities such as state and local governments, foreign governments, commercial organizations, and private businesses to obtain IRS‑approved funding for products or services. The form requires an estimated end date for the agreement.
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IRS Form 14417 - Reimbursable Agreement - Non-Federal Entities (State and Local Governments, Foreign Governments, Commercial Organizations, and Private Businesses)
IRS Form 14417 is a reimbursable agreement used by non‑federal entities such as state and local governments, foreign governments, commercial organizations, and private businesses to obtain IRS‑approved funding for products or services. The form requires an estimated end date for the agreement.
Risk Radar
Scan points- 1Submitting without the required IRS authorizing signature can trigger civil liability.
- 2Leaving the estimated end date blank prevents the agreement from being valid.
- 3Omitting the cancellation date field creates an incomplete agreement record.
- 4Failing to describe the requested products or services (line 6) makes the purpose unclear.
- 5Not providing the buyer’s program representative telephone or email stops IRS contact.
Plain English
Form 14417 sets up a reimbursable agreement between a buyer and the IRS. It records the services to be provided, the officials who must approve the deal, and how the IRS will be paid. All signatures must be in place before any work starts. The IRS then tracks the agreement through its budget office.
Submission Date
- Filing date: 2024-03-06 12:13:28
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when a non‑federal entity (state or local government, foreign government, commercial organization, or private business) needs to enter a reimbursable agreement with the IRS for advance payment of products or services.
- Do not use it when the agreement does not involve an advance payment to the IRS.
- Check Form 14417 instead when a non‑federal entity needs a reimbursable agreement that does not require an advance payment.
Form selector
Use this form or another form?
Buyer requires multiple approving officials
Section 11a provides fields for additional authorizing/approving officials
✓ Verify Section 11a fields are completed
Advance payment to IRS needed
Page 2 includes advance payment address and payment method options
✓ Ensure a payment method box is checked
Statutory authority citation required
Page 5 pre‑populates Internal Revenue Code section references
✓ Do not alter the pre‑populated statutory authority box
Deadline or filing window
Not stated in the official source.
Checklist
What you need before filling it out
Buyer billing address
Street number, street name, city, state, ZIP · Section 2.c on page 2
Payment method selection
Choice of Paper check, Electronic check via Pay.gov, Money order, or Other · Payment method box on page 6
TIN/EIN verification
IRS Taxpayer Identification Number · Pre‑populated field 9.d on page 6
CFO authorizing official signature
Signature and date of Corporate Budget, Budget Execution Servicewide Reimbursables Coordinator · Field 10.e on page 6
Statutory authority
Internal Revenue Code section references · Field 3 on page 5
Before you submit
- 1Verify the revision date reads Rev. 3‑2023 on the form header
- 2Enter the buyer’s organization name and program representative address accurately
- 3Complete the advance payment address and select the appropriate payment method
- 4Provide the buyer’s and seller’s authorizing/approving officials’ names, titles, contact info, and signatures
- 5Ensure the TIN/EIN field is verified with the finance office
- 6Confirm the statutory authority box is pre‑populated and unchanged
- 7Sign all required signature/date fields and obtain the IRS authorizing official’s signature
How to file this form
- 1Gather buyer and seller official information and advance payment details, then retain them for entry
- 2Complete all required fields on Form 14417, including addresses, contact information, and payment method, then review for completeness
- 3Obtain signatures from the CFO authorizing official and the IRS authorizing official, then verify dates are entered
- 4Attach any supporting documents such as TIN/EIN verification, then double‑check all attachments
- 5Mail the signed form to the IRS advance payment address at Internal Revenue Service – Beckley, P.O. Box 9002, Beckley, WV 25802‑9002, then obtain mailing receipt
- 6Retain a copy of the signed Form 14417 and mailing proof for your records, then file the copy in your records system
Known limitations
- 1Only non‑federal entities (state and local governments, foreign governments, commercial organizations, and private businesses) may use Form 14417 — source: [Form p.1] title line
- 2Agreements operate on a fiscal‑year basis and cannot cross fiscal years — source: [Form p.1] note on agreement period of performance
- 3All fields must be typed except the Authorizing/Approving Officials' signatures, which must be handwritten — source: [Form p.4] field action description
- 4Form must display a valid OMB control number (1545‑2235) to be required under the Paperwork Reduction Act — source: [Form p.1] OMB Number line and [Form p.6] Paperwork Reduction Act notice
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
Almost done reviewing the fields?
Fillable formOpen in Editor->The form shows Rev. 3‑2023 on the header; the source does not reference a separate latest‑information page or list changes from prior editions.
What changed or needs a fresh check
- Edition date — confirm the form shows Rev. 3‑2023 on the header
- Fee — Not stated in the official source
- Mailing address — confirm advance payments are sent to Internal Revenue Service - Beckley P.O. Box 9002 Beckley, WV 25802‑9002
- Signature — confirm all required signature/date fields are completed
Quick Facts
Downloads
After you file
- 1Retain a complete copy of the submitted Form 14417 for your records — Not stated in the official source — verify on the agency site
- 2Keep all supporting books or records as long as their contents may become material in the administration of any Internal Revenue law — source: [Form p.6] retention statement
- 3Expect a signed acknowledgment from the IRS confirming receipt of the agreement — Not stated in the official source — verify on the agency site
- 4If an error is discovered after filing, submit a corrected Form 14417 with a clear indication of the changes — Not stated in the official source — verify on the agency site
- 5Store the IRS agreement tracking number (e.g., RA20XXXXX) for future reference and reporting — source: [Form p.4] field description of IRS agreement tracking number
- 6Maintain the original signatures (handwritten) in the retained copy, as typed signatures are not acceptable for officials — source: [Form p.4] field action note
Sources
- SRCForm p.1 — title line confirms the form is for non‑federal entities
- SRCForm p.1 — note on agreement period of performance states fiscal‑year basis and no cross‑year agreements
- SRCForm p.4 — field action note specifies all information typed except signatures
- SRCForm p.1 — OMB Number 1545‑2235 appears in the header and Paperwork Reduction Act notice on p.6 requires it
- SRCForm p.6 — retention statement requires keeping books or records as long as they may become material
- SRCForm p.4 — description of IRS agreement tracking number format (RA20XXXXX) and contact instructions
- SRCForm p.6 — Paperwork Reduction Act notice clarifies requirement for valid OMB control number
- SRCNot stated in the official source — verify on the agency site
Common confusion points
Do I need to fill in a cancellation date?
The form includes a cancellation date field but it applies only when the agreement is being cancelled.
→ Verify that the agreement action selected is "Cancellation" before entering a date.
Can the agreement span two fiscal years?
IRS agreements operate on a fiscal‑year basis and do not cross fiscal years.
→ Confirm that the end date falls within the same fiscal year as the start date.
Should I type the officials' signatures?
The form states that all information must be typed except signatures.
→ Provide handwritten signatures for all Authorizing/Approving Officials.
What format does the IRS agreement tracking number use?
The tracking number follows the pattern RA + fiscal year + unique project code (e.g., RA20XXXXX).
→ Ensure the entered number matches the RA‑YY‑XXX pattern.
Do I need to attach the Legal Terms and Conditions?
The legal terms are incorporated by reference on pages 3 and 4.
→ Include the referenced pages or ensure the form is printed with them attached.
Is the OMB number required for submission?
The Paperwork Reduction Act requires a valid OMB control number for the form to be mandatory.
→ Verify that OMB Number 1545‑2235 appears on the form before filing.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 14417 – file a cancellation agreement to terminate the reimbursable arrangement
Questions about IRS Form 14417
What is IRS Form 14417 used for?
Form 14417 sets up a reimbursable agreement between a buyer and the IRS. It records the services to be provided, the officials who must approve the deal, and how the IRS will be paid. All signatures must be in place before any work starts. The IRS then tracks the agreement through its budget office.
Who must file IRS Form 14417?
State and local governments, foreign governments, commercial organizations, and private businesses must file IRS Form 14417.
What information does IRS Form 14417 require?
The form collects the agreement’s estimated end and cancellation dates, a description of the requested products or services, the buyer’s program representative contact information, IRS budget office details, payment method, and the names, titles, contact info, and signatures of both buyer and IRS authorizing officials.
How do I complete IRS Form 14417?
First, enter the estimated end date and cancellation date, then describe the requested products or services (line 6). Next, provide the buyer’s program representative address, telephone, fax, and email, and the IRS Budget Office Reimbursables Coordinator’s name, address, and contact details. Then select a payment method and fill the CFO’s name, title, telephone, and email, followed by the buyer’s authorizing official’s information and signature. Finally, the IRS authorizing official signs; only after all signatures can the project start.
What happens if IRS Form 14417 is filed incorrectly?
Section 7431 makes anyone who knowingly or negligently discloses return information liable for civil damages, and work cannot begin until all required signatures are obtained.
Do I need to fill in a cancellation date?
The form includes a cancellation date field but it applies only when the agreement is being cancelled. Verify that the agreement action selected is "Cancellation" before entering a date.
Can the agreement span two fiscal years?
IRS agreements operate on a fiscal‑year basis and do not cross fiscal years. Confirm that the end date falls within the same fiscal year as the start date.
Should I type the officials' signatures?
The form states that all information must be typed except signatures. Provide handwritten signatures for all Authorizing/Approving Officials.
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