Page 4
3a-e. Enter the taxpayer’s current mailing address, including street number and name, city, state or province, foreign country, and ZIP code or Foreign postal.
4.Enter your daytime telephone number, including the area code.
5.Enter your email address. TAS may use email to receive and share information with you if you checked the box in 7a consenting to receive and send encrypted email with the TAS for the duration of the interactions on your tax issue. See line 7(a).
6.Enter your fax number, including area code. (If applicable)
7a. Check the box if you consent to receive and send encrypted email with the Taxpayer Advocate Service for the duration of the interactions on your tax issue. You are not obligated to receive or send encrypted email with the Taxpayer Advocate Service.
7b. Check the box If you have an answering machine or voice mail at this number and you consent to TAS leaving confidential information about your tax issue at this number. You are not obligated to have information about your tax issue left at this number. If other individuals have access to the answering machine or the voice mail and you do not wish for them to receive any confidential information about your tax issue, please do not check the box.
8.For an entity (partnerships, corporations, trusts, estates, tax-exempt organizations, etc.) enter the name of the individual authorized to act on the entity's behalf unless there is an authorized third party identified in Section II.
For an individual taxpayer you will need an authorized third party as discussed in Section II and its instructions before TAS can share your information with someone else. Information can be shared between married taxpayers as long as both were included on the return(s) at issue and a filing status of married filing a joint return was used.
9.Indicate any special communication needs (such as sign language). Specify any language other than English.
10.Enter the number of the federal tax return or form relating to this request. For example, an individual taxpayer with an income tax issue would enter Form 1040.
11.Enter the quarterly, annual, or other tax year or period relating to this request. For example, if this request involves an income tax issue, enter the calendar or fiscal year. If in involves an employment tax issue, enter the calendar quarter.
12a. Describe the federal tax issue you are experiencing and any difficulties it may be creating. Specify the actions the IRS has taken (or not taken) to resolve the issue. If the issue involves an IRS delay of more than 30 days in resolving your issue, indicate the date you first contacted the IRS for assistance. For further information on the services TAS provides, see Publication 1546, The Taxpayer Advocate Service Is Your Voice at the IRS, available at https://www.irs.gov/pub/irs-pdf/p1546.pdf.
12b. Describe the relief/assistance you are requesting. Specify the action you want taken and believe necessary to resolve the issue. Submit any documentation you believe would assist TAS in resolving the issue.
13.Specify how you learned about the Taxpayer Advocate Service.
14-15. If this is a joint assistance request, both spouses must sign and date the request. If only one spouse is requesting assistance, only that spouse must sign the request. If this request is being submitted for another individual, only a person authorized and empowered to act on the individual's behalf should sign the request. Requests for businesses must be signed by a properly authorized officer and include their title.
Note: The signing of this request is not a substitute for any legal or administrative action applicable to your situation and does not suspend any applicable periods for you to perform acts related to assessment or collection, such as petitioning the Tax Court for redetermination of a deficiency or requesting a Collection Due Process hearing.
Instructions for Section II
Taxpayers: If you wish to have a representative act on your behalf, you must give him/her power of attorney via a Form 2848, Power of Attorney and Declaration of Representative. If you wish to only have someone receive tax notices on your tax account, you must have the third party sign a Form 8821, Tax Information Authorization. Read through the instructions on both forms carefully.
•Complete this section only if you have a representative acting on your behalf. Leave any field blank if you don’t know the requested information. Only representatives sign in this section. This is for information purposes only to assist TAS in the case creation process. Include a copy of the Form 2848 or 8821, if available.
Representatives: If you are an authorized representative submitting this request on behalf of the taxpayer identified in Section I, complete Blocks 1 through 7 of Section II. Attach a copy of Form 2848, Form 8821, or other power of attorney. Enter your Centralized Authorization File (CAF) number in Block 2 of Section II. The CAF number is the unique number the IRS assigns to a representative after Form 2848 or Form 8821 is filed with an IRS office. Sign the Form 911 in this section. The taxpayer does not need to sign the Form 911 if it is being submitted by an authorized representative.