PEERREVIEWPROGRAMCHANGEFORM
ThepurposeofthisformistoassistAICPAmembersrequiredtobeenrolledinapracticemonitoringprogram.Usethisformto
notifyAICPAoffirmoremploymentchangesthatmayimpactyourpeerreviewand/orthefirm’senrollmentinpeerreview.
Forassistancewiththisform,pleasecontactyourAdministeringEntityifenrolledintheAICPAPeerReviewProgram.Youmay
alsocontacttheAICPAadministrativeteamPeerReviewHotlineat919Ͳ402Ͳ4502.
ChangeFormInstructions
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Completethepagesmostappropriateforyourfirm’ssituation.PleasereadtheDescriptionofChangesFIRSTtoensure
youcompletethesectionthatisthemostappropriate.Eachsectioncontainsanareaforcommentstoincludeadditional
informationpertinenttoyoursituation,ifnecessary.
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Pleaseprintlegiblyortypethisinformation.ThisformcanalsobefoundonourwebsiteatAICPA.org.
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ThePeerReviewProgramonlyappliestotheaccountingandauditing(A&A)portionofafirm’spracticeandexcludestaxor
managementconsultingservices.Refertoparagraph.06ofthePeerReviewStandardsforacompletelistingoftheA&A
engagementsthatareinthescopeofthePeerReviewProgram.Also,engagementssubjecttopermanentinspectionby
thePCAOBasdescribedinInterpretation6Ͳ9ofthePeerReviewStandardsInterpretationsareexcludedfromthescopeof
thePeerReviewProgram.Thereforeunlessotherwisestated,useoftheterm“A&A”throughoutthisformONLYapplies
tothoseengagementsinthescopeofthepeerreviewprogramasdescribedabove.
Ifyouneedassistanceincompletingthisform,contacttheCaliforniaSocietyofCPAsPeerReviewProgramat(650)522Ͳ
3094or(800)922Ͳ5272.
Email,faxormailthecompletedpagesthatapplytoyourfirmchangesto:
CalCPAPeerReviewProgram
1800GatewayDr,Ste.200
SanMateo,CA94404
Fax:(650)522Ͳ3080
Email:[email protected]
NOTE:Allchangeformsmustgothroughtheadministeringentityforverificationpurposes.Onceyouradministeringentity
determinestheformhasallrequiredinformation,itwillbeforwardedtotheAICPA.AICPAstaffdeterminestheimpacttothe
firm’s(firms’)peerreview(s)onacasebycasebasis.
DescriptionofFirmChanges
ChangeinEmployment
Page3
Ifyouaremovingbetweenpublicaccountingfirms,retiringorchangingyourindustry,completethissection.Note:If
youareleavingorjoiningapublicaccountingfirm,andA&Ahoursofeitherfirmareimpactedbythischange,thisis
considered a Firm Dissolution or Firm Merger for the purpose of peer review. Please complete the Firm
Dissolution/Change in Ownership or Firm Merger section instead of this section. If you are leaving or joining a public
accountingfirmandtheA&ApracticeofeitherfirmisNOTimpacted,pleasecompletethissection.
FirmNameChange
Page5
Ifyourfirmisundergoingafirmnamechangeduetooneofthefollowing,completethissection:
x
ApartnerisleavingthefirmandthedepartureisnotimpactingtheA&Ahoursofthisfirm.
x
ApartnerisjoiningthefirmandtheadditionisnotimpactingtheA&Ahoursofthefirm.
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Astaffmemberhasbeenpromotedtopartnerimpactingthefirmname.
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Afirmnameischangedforcommercialpurposes(i.e.PLLC,LLC,PC)ormarketingpurposes
Ifthefirmnamechangeisforanyotherreason,pleasecheckthedescriptionsbelowtodetermineiftheyapplytothe
change.
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Note:IfapartnerisleavingthefirmandnoneoftheA&Ahoursremainwiththefirm,completeeithertheFirmPurchaseor
FirmSalesection.ThiscategoryshouldNOTbecompletedifyouareanindividualchangingfirms/jobs.TheChangein
Employmentsectionshouldbeused.
FirmDissolutionorChangeinOwnership
Page6 Forpeerreviewpurposes,adissolutionoftheA&Apracticeoccurswhenapartner(s)leavesafirmandaportionofthe
hoursdonotremainwiththefirm.Whenthisoccurs,theAICPAwilldeterminewhetherthereisasuccessorfirmand
whetheranynewfirmsareformed.ThisdecisionismadebyevaluatingthestatusoftheA&Aengagementsperformed
in the 12 month period prior to the effective date of the dissolution. The 12 month period should only include
engagements with periods ended during the 12 months prior to the dissolution where the reports on those
engagementshavebeenissued.Thestatusofthepartners,andpossiblystaff,inadditiontootherrelevantinformation
is also factored into the decision. Note: Change in ownership for peer review purposes is any change in the firm’s
ownershipthataffectstheA&Ahoursinthefirm.
The administering entities and the AICPA will not be responsible for determining if the information submitted is
accurate. If conflicting information between parties is submitted, all affected firms will be considered new firms for
peerreviewpurposesandnoneofthefirmswillbegivensuccessorfirmstatuswhichwouldincludepeerreviewhistory.
FirmMerger
Page8 Ifyourfirmiscombiningwithanotherfirm,completethissection.Thisincludessituationswhereapartnerhasleftone
firmorafirmwasdissolved,andthatpartnerisjoininganotherfirmandbringingA&Aengagementswithhim/her.
FirmPurchase
Page10
Ifyourfirmispurchasinganotherfirm,completethissection.
FirmSale
Page12
Ifyouaresellingyourpractice,completethissection
Pleasereviewtheinformationbelowregardingfirmmergers,purchasesandsales.
IMPORTANTINFORMATIONRELATEDTOAFIRMMERGER,PURCHASEORSALE:
Forpeerreviewpurposes,aFirmMergeriswhentwoormorefirmsbegintopracticeasonefirm.Thismayalso
includeonefirmacquiringanotherfirm,includingownersandengagements.Theresultingfirm’sstatusanddue
date for peer review will be determined by the AICPA, on a case by case basis, based on the information
provided.
Forpeerreviewpurposes,aFirmPurchase/SaleiswhenafirmpurchasestheA&Apracticefromanotherfirm(or
firms).ThisordinarilymeansapartnerhassoldhisorherA&Apracticetoanotherfirmandretired,orbecomes
an employee (nonͲowner). The nature of each firm’s practice will determine whether the purchasing firm is
deemedasuccessorfirmoranewfirmandthepeerreviewduedate.
In completing this form, each original firm should calculate the A&A hours that are being brought to the
“combined” firm. The percentage of the A&A hours should be calculated based on the A&A hours for the
engagementsperformedwithreportsissuedbytheoriginalfirmsinthe12monthperiodpriortotheeffective
dateofthemerger.The12monthperiodshouldonlyincludeengagementswithfiscalyearendsduringthe12
monthspriortothedissolutionoftheoriginalfirmswherethereportsonthoseengagementshavebeenissued.
There should be agreement as to the number and percentage of hours that each firm is contributing to the
“combined”firm.Thefirm'sstatusandduedateforpeerreviewwillbedeterminedbytheAICPAbasedonthis
informationonacasebycasebasis.
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ChangeinEmployment
This section of the form should be completed if you are moving between public accounting firms, retiring or changing your
industry.
IfyouareleavingorjoiningapublicaccountingfirmandtheA&ApracticeofeitherfirmisNOTimpacted,pleasecompletethis
section.Alsoindividualsthatarenolongerpartnersduetoretirementorachangeofindustry(i.e.publicaccountingtoprivate
accounting),shouldcompletethissection.IfyouareleavingorjoiningapublicaccountingfirmandA&Ahoursareimpacted,
this section should ONLY be completed in conjunction with other applicable sections that address the change (firm merger,
dissolution,saleorpurchase.)
IfyouprimarilyserveinanEducationorBusinessIndustrycapacityandalsoperformpublicaccountingrelatedserviceswhich
require practice monitoring, for the purposes of peer review, you will need to reflect your business category as Public
Accounting.
MemberName:_____________________________________________AICPAMember#:____________________________
ChangeofIndustry&RetirementSection
Telluswhichcategoryyouwillbeworkinginandprovideyourtitle:
BusinessCategory Title
පPublicAccounting
________________________________________________________________________
පBusiness/Industry
________________________________________________________________________
පEducation ________________________________________________________________________
පGovernment ________________________________________________________________________
පLawFirm ________________________________________________________________________
පTemporarilyLefttheWorkforce පRetired
Ifyouhaveretired,pleasetellusthedateofyourretirement:_____________________
WillyoucontinuetoperformanyA&Aworkafteryourdateofretirement?Yes______No_______
Ifno,signtheformandprovideuswithyourcontactinformationonthefollowingpage.Ifyes,youwilllikelyremainsubjectto
peerreviewandyoushouldprovidethename&addressoftheorganizationinthespacebelowwhereyouwillcontinueto
performA&Aworkfollowingretirement:
Leaving/JoiningaPublicAccountingFirmSection
(andtheA&Apracticeisnotimpacted)
ILeftFirm/CompanyName:_________________________________________________________________________________
Address:________________________________________________________________________________________________
PhoneNumber:_________________________________EmailAddress:__________________________________________
IJoinedFirm/CompanyName:_______________________________________________________________________________
Address:________________________________________________________________________________________________
PhoneNumber:__________________________________ EmailAddress:_________________________________________
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ChangeinEmployment(continued)
Commentsregardingthechangeinemployment:
Signature:__________________________________________________Today’sDate:_______________________________
EmailAddress:______________________________________________PhoneNumber:_____________________________
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FirmNameChange
Note:Ifapartnerisjoiningorleavingafirm,pleaserefertotheinstructionsonthebottomofpage1.
AICPAMemberName:____________________________________________________________________________________
AICPAMember#:_________________________________________________________________________________________
OriginalFirmName:_______________________________________________________________________________________
OriginalFirmNumber:_____________________________________________________________________________________
NewFirmName:__________________________________________________________________________________________
ReasonforNameChange:__________________________________________________________________________________
________________________________________________________________________________________________________
Comments:
Signature:_____________________________________________________Today’sDate:____________________________
Title:______________________________________________PhoneNumber:_____________________________________
EmailAddress:___________________________________________________________________________________________
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FirmDissolutionorChangeinOwnership
Forpeerreviewpurposes,adissolutionoftheA&Apracticeoccurswhenapartner(s)leavesafirmandaportionoftheA&A
hoursdonotremainwiththefirm.Whenthisoccurs,theAICPAwilldeterminewhetherthereisasuccessorfirmandwhether
anynewfirmsareformed.ThedecisionismadebyevalutatingthepercentageofA&Ahourscalculatedonengagementswith
periodsendedduringthe12monthspriortothedissolution,Thestatusofthepartners,andpossiblystaff,inadditiontoother
relevantinformationisalsofactoredintothedecision.ThisalsoappliesintheeventofChangeinOwnership.
Inordertomaketheappropriatechanges,youMUSTprovidealltheinformationneededincludingcontactinformationforall
parties. It is preferable for all involved partners to discuss A&A percentages and be in agreement PRIOR to submitting this
form.TheconsolidatedtotalMUSTequal100%inordertoproperlycompletethissection.Theadministeringentitiesandthe
AICPAwillnotberesponsiblefordeterminingiftheinformationsubmittedisaccurate.Ifconflictinginformationissubmitted,
all affected firms will be considered new firms for peer review purposes and none of the firms will be given successor firm
statuswhichwouldincludepeerreviewhistory.
EffectiveDateof AICPA
DissolutionorChangeinOwnership:_____________________________FirmNumber:______________________________
OriginalFirmName:_______________________________________________________________________________________
List thenamesand addressesof any resulting firm(s) below. Please attach a list that identifies eachAICPAmember of the
dissolvingfirminordertopreservetheirAICPAmembership.ForeachAICPAmember,thelistshouldinclude:first&lastname;
AICPAMembernumber;thenameofthefirmtheywillbeemployedbyafterthedissolution(oriftheyareretiringormovingto
business/industry)andtheirpositionattheresultingfirm,ifapplicable.
Any AICPA members who will not be working for the resulting firm MUST contact Member Services at (888) 777Ͳ7077
immediately to preserve their AICPA membership status. The entity administering your peer review is not responsible for
managingAICPAmembershipissues.
ResultingFirmName(1):___________________________________________________________________________________
FirmAddress:____________________________________________________________________________________________
PhoneNumber:_____________________________EmailAddress:______________________________________________
ManagingPartnerName(s):________________________________________________________________________________
PeerReviewContactPerson:________________________________________________________________________________
QualityControlPartner(s):__________________________________________________________________________________
A&Ahours/percentageforthisfirm:
ResultingFirmName(2):___________________________________________________________________________________
FirmAddress:____________________________________________________________________________________________
PhoneNumber:_____________________________EmailAddress:______________________________________________
ManagingPartnerName(s):________________________________________________________________________________ 6
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FirmDissolutionorChangeinOwnership(continued)
PeerReviewContactPerson:________________________________________________________________________________
QualityControlPartner(s):__________________________________________________________________________________
A&Ahours/percentageforthisfirm:
ResultingFirmName(3):___________________________________________________________________________________
(ifapplicable)
FirmAddress:____________________________________________________________________________________________
PhoneNumber:______________________________EmailAddress:_____________________________________________
ManagingPartnerName(s):________________________________________________________________________________ PeerReviewContactPerson:_______________________________________________________________________________
QualityControlPartner(s):_________________________________________________________________________________
A&Ahours/percentageforthisfirm:
FIRMS’A&APERCENTAGES
GrandTotalmustequal100%
Firm1A&Apercentage:
Firm2A&Apercentage:
Firm3A&Apercentage:
(ifapplicable)
GrandTotal:
100%
Comments:
Completedby:__________________________________________PhoneNumber:_________________________________
Signature(s)ofpartner(s):__________________________________________________________________________________
________________________________________________________________________________________________________
Today’sDate:_______________________________EmailAddress:______________________________________________
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FirmMerger
Foreachfirm,indicatethepercentageofA&Ahoursbroughtintotheresultingfirm.Basedontheeffectivedateofthemerger,
the percentage of A&A hours should be calculated on engagements with periods ended during the 12 months prior to the
merger,wherethereportsonthoseengagementshavebeenissued.TheconsolidatedpercentagefromallfirmsMUSTTOTAL
100%inordertocompletethissection.Thereshouldbeanagreementastothenumberandpercentageofthosehoursthat
eachfirmiscontributing.Thefirm’sstatusandduedateforpeerreviewwillbedeterminedbytheAICPAonacasebycase
basis.
PleasereviewtheIMPORTANTINFORMATIONRELATEDTOFIRMMERGERSonpage2beforeproceeding.
EffectiveDateofMerger:____________________________________
ResultingFirmName:______________________________________________________________________________________
________________________________________________________________________________________________________
Please attach a list that details each AICPA member who will be practicing at the resulting firm. The listing must include
informationforeachAICPAmember:first&lastname;AICPAMembernumber;thenameofthefirmtheywereemployedby
beforethemergerandtheirpositionattheresultingfirm(staff,partner,solepractitioner).
Any AICPA members who will not be working for the resulting firm MUST contact Member Services at (888) 777Ͳ7077
immediately to preserve their AICPA membership status. The entity administering your peer review is not responsible for
managingAICPAmembershipissues.
Istheoriginalfirmstillinexistence? Yes______No______
Ifyes,isthefirmstillperforminganyattestservices?Yes______No______
Ifyes,whattypeofattestservices?___________________________________________________________________
________________________________________________________________________________________________
Theareabelowallowsyoutolistthenamesandaddressesofthemergingfirm(s).Foreachfirm,indicatethepercentageof
A&Ahoursthateachfirmiscontributingtotheresultingfirm.TheconsolidatedpercentagefromallfirmsMUSTtotal100%in
ordertocompletethissection.
OriginalFirmName(1):____________________________________________________________________________________
FirmAddress:____________________________________________________________________________________________
PhoneNumber:____________________________EmailAddress:_______________________________________________
FirmNumber:_____________________________
A&Ahours/percentageforthisfirm:
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FirmMerger(continued)
OriginalFirmName(2):____________________________________________________________________________________
FirmAddress:____________________________________________________________________________________________
PhoneNumber:______________________________EmailAddress:_____________________________________________
FirmNumber:_________________________________
A&Ahours/percentageforthisfirm:
OriginalFirmName(3)(ifapplicable):_________________________________________________________________________
FirmAddress:____________________________________________________________________________________________
PhoneNumber:______________________________EmailAddress:_____________________________________________
FirmNumber:_______________________________
A&Ahours/percentageforthisfirm:
FIRMS’A&APERCENTAGES
GrandTotalcombinedmergedfirmsmustequal100%
Firm1A&Apercentage:
Firm2A&Apercentage:
Firm3A&Apercentage:
GrandTotal:
100%
Comments:
SignatureofPartner:___________________________________________________Date:____________________________
Title:__________________________________________________PhoneNumber:_________________________________
EmailAddress:__________________________________________
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FirmPurchase
If you purchased a firm or a firm’s A&A hours, please complete this section. If you purchased more than one firm, include
additionalinformationinthecommentssection.PLEASEreviewtheIMPORTANTINFORMATIONrelatedtofirmpurchaseson
page2beforeproceeding.Completepertinentsectionsonly.
Effectivedateofpurchase: ___________________________
Listthenamesandaddressesofthefirm(s)involved.IndicatethenumberofA&Ahoursbroughtintotheresultingfirm.The
consolidatedpercentagefromallfirms(basedonA&Ahours)shouldtotal100%inordertocompletethissection.
NameofPurchasedFirm:___________________________________________________________________________________
FirmAddress:____________________________________________________________________________________________
PhoneNumber:______________________________EmailAddress:_____________________________________________
FirmNumber:_______________________________
A&Ahours/percentageforthisfirm:
PurchasingFirmName:_____________________________________________________________________________________
ResultingFirmName(ifdifferent):____________________________________________________________________________
FirmAddress:____________________________________________________________________________________________
PhoneNumber:______________________________EmailAddress:_____________________________________________
FirmNumber:_______________________________
A&Ahours/percentageforthisfirm:
NameofSecondFirm(ifapplicable):__________________________________________________________________________
FirmAddress:____________________________________________________________________________________________
PhoneNumber:______________________________EmailAddress:_____________________________________________
FirmNumber:_______________________________
A&Ahours/percentageforthisfirm:
FIRMS’A&APERCENTAGES
GrandTotalshouldequal100%
PurchasedfirmnameA&Apercentage:
PurchasingfirmnameA&Apercentage:
10
Secondfirm(ifapplicable)A&Apercentage:
GrandTotal:
100%
03/2014
FirmPurchase(continued)
YoushouldattachalistthatdetailseachAICPAmemberwhowillbepracticingattheresultingfirm.Thelistingneedstoinclude
informationsuchas:first&lastname;AICPAMembernumber;thenameofthefirmtheywereemployedbybeforepurchase
andtheirpositionattheresultingfirm(staff,partner,solepractitioner).
AnyAICPAmembersimpactedbythesetransactionsshouldcontactAICPAMemberServicesat(888)777Ͳ7077immediatelyto
preserve their AICPA membership status. The entity administering your peer review is not responsible for managing AICPA
membershipissues.
Isthepurchasedfirmstillinexistence?Yes______No______
Ifyes,isthefirmperforminganyattestservices?Yes______No______Unknown______
Ifyes,whattypeofattestservices?__________________________________________________________________________
________________________________________________________________________________________________________
Comments:
Signature of Partner: ______________________________________________________________________________________
Title:______________________________________________________Today’sDate:_______________________________
PhoneNumber:______________________________EmailAddress:_____________________________________________
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FirmSale
If you are reporting the sale ofyour firm or your firm’s A&A hours, you should complete this section. In order to make the
appropriate changes, you must provide all the information needed including addresses of all parties. PLEASE review the
IMPORTANTINFORMATIONrelatedtofirmsaleonpage2beforeproceedingwiththissection.
EffectiveDateofSale:__________________________________
NameofFirmSold:________________________________________________________________________________________
NameofPurchasingFirm:__________________________________________________________________________________
ResultingFirmName(ifdifferent):____________________________________________________________________________
Didyouworkforthefirmbeforethesale?______________
Inwhatcapacity? Staff______SolePractitioner______Partner______Shareholder______
Other(PleaseList)___________________________________________________
Isyourfirmstillinexistence?Yes_____No_____Ifyes,areyouperforminganyattestservices?Yes_____No_____
Ifyes,whattypeofattestservicesareyouperforming?__________________________________________________________
________________________________________________________________________________________________________
Any AICPA members impacted by this transaction should contact AICPA Member Services at (888) 777Ͳ7077 immediately to
preserve their AICPA membership status. The entity administering your peer review is not responsible for managing AICPA
membershipissues.
Comments:
Signature of Partner: ______________________________________________________________________________________
Title:________________________________________________________Today’sDate:______________________________
PhoneNumber:_____________________________EmailAddress:______________________________________________
Submitcompletedformbymail,faxoremailtoCalCPAPeerReviewProgram
(Seepage1forcontactinformation)
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