Federal Request for Appeals Review

Request for Appeals Review
Form 12203 (Rev. 8-2022)
Form

12203

(August 2022)

Department of the Treasury - Internal Revenue Service

Request for Appeals Review

This form is to be used to request an Appeals review upon completion of an examination (audit) if you do not agree with our
proposed changes from the audit. Complete the information in the spaces below, including your signature and the date.
Taxpayer name(s)

Taxpayer Identification Number(s)

Mailing address

Tax form number

City

Tax period(s) ended

State

ZIP Code

Your telephone number(s)

Best time to call

Identify the item(s) (for example: filing status, exemptions, interest or dividends) you disagree with in the proposed change or assessment
report you received with the enclosed letter. Tell us why you disagree. You can add more pages if this is not enough space.
Disagreed item

Reason why you disagree

Disagreed item

Reason why you disagree

Disagreed item

Reason why you disagree

Disagreed item

Reason why you disagree

Name of Taxpayer

Signature

Date

Name of Taxpayer

Signature

Date

Name and signature of authorized representative (If a representative is signing this form, please attach a copy of your completed
Form 2848, Power of Attorney and Declaration of Representative.)
Name

Signature

Your telephone number

Best time to call

Catalog Number 27136N

www.irs.gov

Date

Form 12203 (Rev. 8-2022)

Purpose of this form: Use this form to request a review in the Internal Revenue Service Independent Office of Appeals (Appeals)
when you receive Internal Revenue Service (IRS) proposed adjustments from an examination/audit of $25,000 or less to a tax year
examined in the IRS letter you received with this form.
When you take no action and your case involves income taxes, we will send you a formal Notice of Deficiency and bill for the amount
you owe. The Notice of Deficiency allows you to go to the Tax Court and tells you the procedure to follow.
When you don't agree with the IRS proposed adjustments or changes and you have submitted all supporting
information, explanations, or documents, you may:
(1) discuss the IRS findings with the person identified (or their supervisor) in the heading on the IRS letter that provided you this
information; and if you can't reach agreement,
(2) appeal your case by requesting an Appeals Review.
If you want to request an Appeals Review, complete this form and return it in the envelope provided to the address in the heading of
the IRS letter.
The IRS Independent Office of Appeals is independent of the IRS office proposing the action you disagree with. Appeals conferences
are conducted in an informal manner. Most differences are settled in these conferences without expensive and time consuming court
trials. Appeals will independently consider the reason(s) you disagree, except for moral, religious, political, constitutional, conscientious
objection, or similar grounds.
You can represent yourself in Appeals. If you want to be represented by another person, the person you choose must be an
attorney, a certified public accountant, or an enrolled agent authorized to practice before the IRS. If you plan to have your
representative talk to us without you, we need a signed copy of a completed power of attorney (Form 2848, Power of Attorney and
Declaration of Representative).
If you don't reach an agreement in Appeals, the Appeals office will send you a Notice of Deficiency. After you receive the Notice of
Deficiency, you may take your case to the United States Tax Court before paying the amount due as shown on the Notice of Deficiency.
If you want to proceed in the United States Court of Federal Claims or your United States District Court, see Publication 5, Your Appeal
Rights and How to Prepare a Protest if You Disagree, for more information.
You can get more information about your appeal rights by visiting the IRS Internet Web Site at http://www.irs.gov or the Appeals Web
Site at http://www.irs.gov/appeals. You also can order blank tax forms, schedules, instructions and publications by calling toll-free
1-800-829-3676. Once you've placed your order, allow two weeks for delivery. For IRS Tax Fax Services, call (703) 487-4160 (not a
toll-free number).

PRIVACY ACT STATEMENT
Under the Privacy Act of 1974, we must tell you that our legal right to ask for information is Internal Revenue Code Sections 6001, 6011, 6012(a) and
their regulations. They say that you must furnish us with records or statements for any tax for which you are liable, including the withholding of taxes by
your employer. We ask for information to carry out the Internal Revenue laws of the United States, and you are required to give us this information. We
may give the
information to the Department of Justice for civil and criminal litigation, other federal agencies, states, cities, and the District of Columbia for use in
administering their tax laws. If you don't provide this information, or provide fraudulent information, the law provides that you may be charged penalties
and, in certain cases, you
may be subject to criminal prosecution. We may also have to disallow the exemptions, exclusions, credits, deductions, or adjustments shown on the tax
return. This could make your tax higher or delay any refund. Interest may also be charged.
Catalog Number 27136N

www.irs.gov

Form 12203 (Rev. 8-2022)