Lines 1a to 2
Name of the organization, employer identification number, and street address with city, state and ZIP code.
3491
Consumer Cooperative Exemption Application
- Agency
- IRS
- Revision
- Rev. October 2023
- Fillable fields
- 29
- Pages
- 2
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 3491: Consumer Cooperative Exemption Application
Form 3491 is the Consumer Cooperative Exemption Application, used for exemption from filing Forms 1099-PATR. The form says it is for certain consumer cooperatives that are engaged primarily in retail sales of goods or services that are generally for personal, living, or family use.
The IRS page explains the background: Form 1099-PATR, Taxable Distributions Received From Cooperatives, is used to report patronage distributions of $10 or more to a recipient during the calendar year. A cooperative uses Form 3491 to ask the IRS for a determination that it does not have to file those returns.
The application asks for the cooperative's details and three years of gross receipts, and the IRS completes the Notice to Applicant at the bottom and returns it. The instructions are printed on page 2. You can fill out the PDF free in your browser on this page and download it without an account.
What's on Form 3491
Lines 3 and 4
Principal activity of the organization and the month and day on which its annual accounting period ends.
Line 5: prior returns
Whether the organization has filed a federal income tax return, and if so the form numbers and the IRS location where filed.
Line 6: gross receipts
A table for the first, second and third preceding years: retail sales receipts, other receipts, total receipts and the retail percentage.
Signature
A penalties of perjury declaration with the officer's signature, title and date.
Notice to Applicant
A section the form says is to be completed by the Internal Revenue Service, with approved and not approved boxes and a Director signature.
How to fill out Form 3491
- 1
Lines 1a to 2
Enter the organization's name, EIN and address. The instructions say to show a P.O. box instead of the street address only if the Post Office does not deliver mail to the street address.
- 2
Lines 3 and 4
Describe the principal activity and enter the month and day the annual accounting period ends.
- 3
Line 5
Check Yes or No. If Yes, enter the form number of each federal income tax return filed and the IRS location where it was filed.
- 4
Line 6a
For the first preceding year, enter retail receipts in column (1), other receipts in column (2), the total in column (3), and in column (4) divide (1) by (3) and multiply by 100.
- 5
Lines 6b to 6d
The form says that if line a, column (4), is at least 85%, do not complete lines b, c and d. Otherwise fill in the second and third preceding years and the totals.
- 6
Sign
An authorized officer signs and dates the form and enters a title. The Notice to Applicant section is left for the IRS.
Why fill Form 3491 on indox
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Where to send it and what happens next
Where to file
The instructions say to send two copies to Department of the Treasury, Internal Revenue Service, Mail Stop 4-G08.151, Philadelphia, PA 19255-0633.
Address change
The instructions note a new filing address, and the IRS page lists "Updated Address for Filing Form 3491, Consumer Cooperative Exemption Application" dated 18-APR-2023.
IRS response
The instructions say the IRS will return the application showing whether it has or has not been approved.
Start of the exemption
The period of exemption begins with the date the first payment is made during the calendar year in which exemption is approved.
End of the exemption
It ends on the date the first payment is made after the end of the cooperative's first tax year in which less than 70% of gross receipts is from qualifying retail sales.
Related forms
Who files Form 3491?
The instructions say any cooperative requesting exemption under section 6044(c) from filing Form 1099-PATR files Form 3491 and receives a determination from the IRS.
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Questions about Form 3491
What does an approved Form 3491 do?
It exempts the cooperative from filing Form 1099-PATR for the period of exemption described in the instructions.
What is the 85% test?
The instructions say 85% of gross receipts for the preceding tax year, or 85% of total gross receipts for the preceding 3 tax years, came from retail sales of goods or services generally for personal, living, or family use.
When does the exemption end?
On the date of the first payment after the end of the first tax year in which less than 70% of gross receipts is from qualifying retail sales.
How many copies are sent?
The form says "File in duplicate" and the instructions say to send two copies.
Who signs Form 3491?
An officer authorized to sign for the cooperative, under penalties of perjury.
What is Form 1099-PATR?
The IRS page says it is used to report patronage distributions of $10 or more to a recipient during the calendar year.