Form 15101 - Provide A Social Security Number (Ssn) For Adoptive Child
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1
2Department of the Treasury - Internal Revenue Service
15101
Form
Provide a Social Security Number (SSN)
(October 2017)
for Adoptive Child
Complete this form, and fax or mail it to us at:
Standard:
Overnight:
Internal Revenue Service
Internal Revenue Service
Stop 6182
3651 S. Interregional Hwy 35
Austin, TX 73301-0066
Stop 6182
Austin, TX 78741
Fax number: (855) 250-1731
If you have any questions contact us at (737) 800-5511 (not toll free)
Contact Information
Name
Taxpayer Identification Number
Name
Taxpayer Identification Number
If you changed your address, write your new address below.
Address
City
State
ZIP code
Primary telephone number
Best time to call
Secondary telephone number Best time to call
a.m.
a.m.
p.m.
p.m.
I received social security number
Name of adoptee
I was assigned the following ATIN
Original signatures of adoptive parents
Name
Signature
Date
(print/type)
Name
Signature
Date
(print/type)
15101
Catalog Number 69796Z
Form
(Rev. 10-2017)
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