Form 5768

(Rev. September 2016)

Department of the Treasury 

Internal Revenue Service 

Election/Revocation of Election by an Eligible 

Section 501(c)(3) Organization To Make 

Expenditures To Influence Legislation 

(Under Section 501(h) of the Internal Revenue Code)

▶ Information about Form 5768 and its instructions is at www.irs.gov/form5768. 

For IRS 

Use Only ▶

Name of organization Employer identification number

Number and street (or P.O. box no., if mail is not delivered to street address) Room/suite

City, town or post office, and state ZIP + 4

1 Election— As an eligible organization, we hereby elect to have the provisions of section 501(h) of the Code, relating to

expenditures to influence legislation, apply to our tax year ending and all

subsequent tax years until revoked. (Month, day, and year)

Note: This election must be signed and postmarked within the first taxable year to which it applies.

2 Revocation— As an eligible organization, we hereby revoke our election to have the provisions of section 501(h) of the Code,

relating to expenditures to influence legislation, apply to our tax year ending and 

all subsequent tax years (until a new election is made). (Month, day, and year)

Note: This revocation must be signed and postmarked before the first day of the tax year to which it applies.

Under penalties of perjury, I declare that I am authorized to make this (check applicable box) ▶

on behalf of the above named organization.

election revocation

(Signature of officer or trustee) (Type or print name and title) (Date)

General Instructions

Section references are to the Internal 

Revenue Code.

Section 501(c)(3) states that an 

organization exempt under that section 

will lose its tax-exempt status and its 

qualification to receive deductible 

charitable contributions if a substantial 

part of its activities are carried on to 

influence legislation. Section 501(h), 

however, permits certain eligible section 

501(c)(3) organizations to elect to make 

limited expenditures to influence 

legislation. An organization making the 

election will, however, be subject to an 

excise tax under section 4911 if it 

spends more than the amounts 

permitted by that section. Also, the 

organization may lose its exempt status 

if its lobbying expenditures exceed the 

permitted amounts by more than 50% 

over a 4-year period. For any tax year in 

which an election under section 501(h) is 

in effect, an electing organization must 

report the actual and permitted amounts 

of its lobbying expenditures and grass 

roots expenditures (as defined in section 

4911(c)) on its annual return required 

under section 6033. See Part II-A of 

Schedule C (Form 990 or Form 990-EZ). 

Each electing member of an affiliated 

group must report these amounts for 

both itself and the affiliated group as a 

whole.

To make or revoke the election, enter 

the ending date of the tax year to which

the election or revocation applies in item

1 or 2, as applicable, and sign and date 

the form in the spaces provided.

Eligible organizations. A section 

501(c)(3) organization is permitted to

make the election if it is not a

disqualified organization (see below) and

is described in:

1. Section 170(b)(1)(A)(ii) (relating to

educational institutions),

2. Section 170(b)(1)(A)(iii) (relating to

hospitals and medical research

organizations),

3. Section 170(b)(1)(A)(iv) (relating to

organizations supporting government

schools),

4. Section 170(b)(1)(A)(vi) (relating to

organizations publicly supported by

charitable contributions),

5. Section 170(b)(1)(A)(ix) (relating to 

agricultural research organizations),

6. Section 509(a)(2) (relating to

organizations publicly supported by

admissions, sales, etc.), or

7. Section 509(a)(3) (relating to

organizations supporting certain types

of public charities other than those

section 509(a)(3) organizations that

support section 501(c)(4), (5), or (6)

organizations).

Disqualified organizations. The

following types of organizations are not

permitted to make the election:

a. Section 170(b)(1)(A)(i) organizations

(relating to churches),

b. An integrated auxiliary of a church or

of a convention or association of

churches, or

c. A member of an affiliated group of

organizations if one or more members

of such group is described in a or b of 

this paragraph.

Affiliated organizations. Organizations

are members of an affiliated group of

organizations only if (1) the governing

instrument of one such organization

requires it to be bound by the decisions

of the other organization on legislative

issues, or (2) the governing board of one

such organization includes persons (i)

who are specifically designated

representatives of another such

organization or are members of the

governing board, officers, or paid

executive staff members of such other

organization, and (ii) who, by aggregating 

their votes, have sufficient voting power 

to cause or prevent action on legislative 

issues by the first such organization.

For more details, see section 4911 and 

section 501(h).

Note: A private foundation (including a

private operating foundation) is not an

eligible organization.

Where to file. Mail Form 5768 to:

Department of the Treasury 

Internal Revenue Service Center 

Ogden, UT 84201-0027

Cat. No. 12125M Form 5768 (Rev. 9-2016)