Items 1 and 2: tracking and contacts
The IRS agreement tracking number, the IRS unique customer number, and program contacts for the Buyer Representative and the IRS Budget Office Reimbursables Coordinator.
14417
Reimbursable Agreement - Non-Federal Entities (State and Local Governments, Foreign Governments, Commercial Organizations, and Private Businesses)
- Agency
- IRS
- Revision
- Rev. 3-2023
- Fillable fields
- 110
- Pages
- 6
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 14417: Reimbursable Agreement - Non-Federal Entities
Form 14417, Reimbursable Agreement - Non-Federal Entities (State and Local Governments, Foreign Governments, Commercial Organizations, and Private Businesses), is an agreement under which the IRS performs services on a cost reimbursable basis for a non-federal entity. On the form, the non-federal entity is the Buyer and the IRS is the Seller.
The form records the agreement tracking number, program contacts on both sides, the statutory authority, the agreement action (new, amendment or cancellation), the period of performance, the products or services requested, a cost estimate, billing and payment details, and the signatures of authorizing officials. Pages 3 and 4 hold the Legal Terms and Conditions, and pages 4 to 6 hold the field-by-field instructions.
The form says all non-federal entities must provide an advance payment before the IRS begins any work. You can fill out the PDF free in your browser on this page and download it without an account.
What's on Form 14417
Items 3 to 5: authority, action and period
Statutory authority (the Internal Revenue Code box is pre-checked), the agreement action, and the start, end and cancellation dates.
Item 6: products and services
A description of the products or services requested, including the bona fide need for the service.
Items 7 and 8: advance payment and costs
The draw-down option (Monthly, Quarterly or Lump-Sum/One-Time) and a breakdown of direct, indirect/overhead and total estimated costs.
Item 9: billing and payment
The Buyer's finance office contact, TIN or EIN, UEI and payment method, plus the IRS office for advance payment inquiries.
Items 10 and 11: signatures
The IRS CFO authorizing official, the Buyer and Seller authorizing officials, and optional co-signatures in item 11a.
How to fill out Form 14417
- 1
Get a tracking number
The instructions say to contact the IRS/Chief Financial Officer/Corporate Budget to establish new agreement tracking numbers, made up of RA, the fiscal year and a project code.
- 2
Enter contacts and dates
Fill in both program contacts, check the agreement action and enter the start and end dates. The form notes that IRS agreements operate on a fiscal year basis and do not cross fiscal years.
- 3
Describe the work
In item 6, enter the products or services the IRS is to provide, including the scope of work or work statement.
- 4
Build the cost estimate
Enter the unit of measure, item quantity and unit price, then direct, indirect/overhead and total estimated costs. The form says total estimated costs must agree with the total current reimbursable agreement amount.
- 5
Add billing details
Enter the Buyer's finance office contact, TIN or EIN and UEI, and check one payment method. The instructions say to check the verified box after confirming the TIN with the finance office.
- 6
Sign
The Buyer's and the IRS authorizing officials sign and date. The instructions say work on the project cannot begin until final signatures have been obtained.
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Payment, timing and legal terms
Advance payment
The form says all non-federal entities must provide an advance payment before the IRS begins any work for the full costs of goods and/or services ordered.
Where to send payment
The form says to make advance payments to Internal Revenue Service - Beckley, P.O. Box 9002, Beckley, WV 25802-9002.
Fiscal year limit
The instructions say funding received from state, local and foreign governments applies to the current fiscal year only, and multi-year funding cannot be retained or applied to future fiscal years.
Cancellation
Either party may cancel by written notice 30 days before cancellation. The Buyer pays actual costs incurred through the cancellation date, plus any termination costs.
Cost changes
If funds advanced exceed actual costs, the difference is returned. If the advance is less, the Buyer pays the additional costs and submits an amended Form 14417 with additional funds.
Disclosure penalties
The legal terms say IRC section 7213 makes unauthorized disclosure of return information a felony punishable by a fine not to exceed $5,000 or imprisonment of not more than 5 years, or both.
Related forms
Who completes Form 14417?
The form is filled in by both sides of the agreement. The instructions say all information must be typed into the form other than the authorizing and approving officials' signatures.
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Questions about Form 14417
Who is the Buyer and who is the Seller?
The Buyer is the non-federal entity, such as a state or local government, foreign government, commercial organization or private business. The Seller is the IRS.
When does the IRS start work?
The form says the IRS begins work after an advance payment, and the instructions say work on the project cannot begin until final signatures have been obtained.
Where are advance payments sent?
The form gives Internal Revenue Service - Beckley, P.O. Box 9002, Beckley, WV 25802-9002.
Can an agreement cross fiscal years?
The form says IRS agreements operate on a fiscal year basis and do not cross fiscal years.
Which payment methods are listed?
Paper check, electronic check via Pay.gov, money order, or other. The instructions say one box is checked, and another method is described.
How is the agreement cancelled?
The legal terms say either the Buyer or the IRS may cancel by giving written notice to the other party 30 days before cancellation.
How long does the form take?
The Paperwork Reduction Act Notice estimates 10 minutes for learning about the law or the form and 20 minutes for preparing and sending it.