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Form 5434: Joint Board for the Enrollment of Actuaries Application for Enrollment
IRS Form 5434 is the Joint Board for the Enrollment of Actuaries Application for Enrollment, used by individuals seeking enrollment as actuaries. The application requires a $680 fee and detailed employment records.
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IRS Form 5434 - Joint Board for the Enrollment of Actuaries Application for Enrollment
IRS Form 5434 is the Joint Board for the Enrollment of Actuaries Application for Enrollment, used by individuals seeking enrollment as actuaries. The application requires a $680 fee and detailed employment records.
Risk Radar
Scan points- 1Submitting false or misleading information can cause denial of enrollment and penalties.
- 2Failing to include the required $680 application fee when mailing the form, which results in rejection.
- 3Omitting the required signature and date on the declaration page, causing the application to be invalid.
- 4Not providing employment dates in the required mm‑yyyy format on Schedule A, leading to processing delays.
- 5Combining multiple employment periods into one Schedule A instead of filing separate schedules for each period.
Plain English
This form lets a person apply to become an enrolled actuary. It asks for personal details, a full work history, and a $680 application fee. After signing, the form is sent to the IRS Office of Enrollment.
Submission Date
- Filing date: 2023-11-17 22:10:20
- 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 you are applying for enrollment as an actuary with the Joint Board.
- Do not use it when you are not seeking enrollment as an actuary.
- Check Schedule A instead when you need to submit the employment record portion separately.
Form selector
Use this form or another form?
Applying for initial enrollment as an actuary
Primary application required for enrollment
✓ Verify fee and signature
Providing detailed employment history for the last 10 years
Schedule captures employment record required for enrollment
✓ Confirm dates and supervisor info
Submitting payment electronically via Pay.gov
Electronic payment option listed on the form
✓ Ensure payment confirmation is attached
Deadline or filing window
Not stated in the official source.
Checklist
What you need before filling it out
Full legal name
Legal name as on Social Security record · Form field 1
Email address
Current email address · Form field 6
Social Security Number
SSN number · Form field 7
Tax compliance question (Item 13)
Details of any missed filings · Attachment to item 13
Signature
Applicant's handwritten signature · Signature line 16
Before you submit
- 1Verify full legal name matches SSN
- 2Confirm email address is correct
- 3Answer enrollment status options accurately
- 4Respond to tax compliance questions truthfully
- 5Complete Schedule A with employment dates and supervisor details
- 6Attach separate pages for any “Yes” answers
- 7Include the $680 fee (check or electronic payment confirmation)
- 8Sign the declaration
- 9Date the signature
- 10Review the form for completeness
- 11Keep a copy of the completed form
How to file this form
- 1Fill out personal information sections on Form 5434
- 2Complete Schedule A employment record for the past 10 years
- 3Attach any required explanatory pages for “Yes” answers
- 4Pay the $680 application fee via www.pay.gov or include check payable to IRS
- 5Sign and date the application
- 6Mail the completed form and payment to Internal Revenue Service, Office of Enrollment, 127 International Drive, Room - EA125, Franklin, TN 37067
- 7Retain a copy of the mailed package and payment receipt as proof of filing
Known limitations
- 1An applicant may be denied enrollment if false or misleading information is submitted (section 901.12(f)(3)).
- 2Applying for enrollment is voluntary; you are not required to apply.
- 3No person is required to respond to, nor subject to a penalty for failure to comply with, a collection of information subject to the Paperwork Reduction Act unless the form displays a valid OMB Control Number.
- 4Failure to provide the requested information could delay or prevent processing of the application.
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->Form 5434 (Rev. 11-2023) is the current edition; the source does not indicate any newer revision.
What changed or needs a fresh check
- Edition date — confirm the revision reads 11-2023
- Fee — confirm the application fee is $680
- Mailing address — confirm the check or money order is payable to the Internal Revenue Service and mailed to Internal Revenue Service, Office of Enrollment, 127 International Drive, Room - EA125, Franklin, TN 37067
- Signature — confirm the applicant signs and dates the form
Quick Facts
Downloads
After you file
- 1Keep the signed Form 5434 and all attached schedules in a safe place for at least three years after enrollment.
- 2Retain the receipt or electronic confirmation of the $680 application fee payment.
- 3Expect a written enrollment decision from the Joint Board after the agency processes the application.
- 4If an error is discovered, submit a corrected Form 5434 with a cover letter explaining the correction.
- 5Store any mailed check or money order copy used for payment for your records.
Sources
- SRCForm p.1 — application fee is $680.
- SRCForm p.1 — fee may be paid electronically at www.pay.gov or by check payable to the Internal Revenue Service.
- SRCForm p.1 — submission address is Internal Revenue Service, Office of Enrollment, 127 International Drive, Room - EA125, Franklin, TN 37067.
- SRCForm p.4 — complete a separate Schedule A for each employer or period of employment.
- SRCForm p.4 — treat multiple periods with the same employer as separate Schedule A blocks.
- SRCForm p.4 — provide names, titles, addresses, and telephone numbers of several individuals to certify experience for different periods.
- SRCForm p.4 — false or misleading information may result in denial of enrollment (section 901.12(f)(3)).
- SRCForm p.4 — providing false information could subject you to penalties.
- SRCForm p.4 — no penalty for failure to comply with a collection of information subject to the Paperwork Reduction Act unless a valid OMB Control Number is displayed.
- SRCForm p.4 — failure to provide requested information could delay or prevent processing of your application.
Common confusion points
Do I need to submit a separate Schedule A for each employer?
The instructions state to complete a separate Schedule A for each employer or period of employment.
→ Verify you have a distinct Schedule A attached for every employer listed.
What if I worked for the same employer in two periods, one with pension actuarial experience?
The form requires treating each distinct period as a separate Schedule A.
→ Number each employment block and attach a separate Schedule A for each period.
Can one supervisor certify all my experience periods?
The instructions allow providing several individuals to certify different periods if needed.
→ List each certifier with name, title, address, and phone for the specific periods they cover.
Is the $680 fee mandatory, and how should I pay it?
The form specifies a $680 application fee payable either electronically via www.pay.gov or by check/money order payable to the IRS.
→ Include a check for $680 payable to the Internal Revenue Service or pay electronically before submission.
What are the consequences of providing false information?
Section 901.12(f)(3) states false or misleading information can lead to denial of enrollment and penalties.
→ Ensure all statements are accurate before signing and submitting.
Do I have to comply with the Paperwork Reduction Act request?
The notice says no penalty applies for non‑compliance unless a valid OMB Control Number is displayed.
→ Confirm the form shows OMB Number 1545-0951 and understand you may ignore the PRA request without penalty.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 5434 – file an amended application to correct false or misleading information and avoid penalties.
Questions about IRS Form 5434
What is IRS Form 5434 used for?
This form lets a person apply to become an enrolled actuary. It asks for personal details, a full work history, and a $680 application fee. After signing, the form is sent to the IRS Office of Enrollment.
Who must file IRS Form 5434?
Individuals who want to become enrolled actuaries must file IRS Form 5434.
What information does IRS Form 5434 require?
The form gathers the applicant’s legal name, other names, business name, address, signature, and a Schedule A that records employment dates, position titles, business type, and supervisor contact information.
Where do I file IRS Form 5434?
Submit the completed form and $680 payment to the Internal Revenue Service, Office of Enrollment, 127 International Drive, Room EA125, Franklin, TN 37067, or file electronically at www.pay.gov.
How do I complete IRS Form 5434?
First, read the instructions on pages 3‑4. Then complete the main application fields (legal name, address, etc.) and sign and date the declaration. Next, prepare a separate Schedule A for each employer, listing dates, titles, business type, and supervisor details. Finally, pay the $680 fee either electronically at www.pay.gov or by check payable to the IRS and send the package to the Office of Enrollment.
What happens if IRS Form 5434 is filed incorrectly?
Providing false or misleading information can lead to denial of enrollment and may subject the applicant to penalties.
Do I need to submit a separate Schedule A for each employer?
The instructions state to complete a separate Schedule A for each employer or period of employment. Verify you have a distinct Schedule A attached for every employer listed.
What if I worked for the same employer in two periods, one with pension actuarial experience?
The form requires treating each distinct period as a separate Schedule A. Number each employment block and attach a separate Schedule A for each period.
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