Federal Request for Taxpayer Advocate Service Assistance (And Application for Taxpayer Assistance Order)

Request for Taxpayer Advocate Service Assistance (And Application for Taxpayer Assistance Order)
Form  911 (Rev. 1-2022)
Form

911

(January 2022)

Department of the Treasury - Internal Revenue Service

Request for Taxpayer Advocate Service Assistance

OMB Number
1545-1504

(And Application for Taxpayer Assistance Order)

Section I – Taxpayer Information (See Pages 3 and 4 for Form 911 Filing Requirements and Instructions for Completing this Form.)
1a. Taxpayer name as shown on tax return

1b. Taxpayer Identifying Number (SSN, ITIN, EIN)

2a. Spouse's name as shown on tax return (if joint return)

2b. Spouse's Taxpayer Identifying Number (SSN, ITIN)

3a. Taxpayer current street address (number, street, & apt. number)
3b. City
4. Fax number (if applicable)

3c. State (or foreign country)

3d. ZIP code

7a. Daytime phone number

7b.

5. Email address

6. Person to contact if no authorized representative
8. Best time to call

Check here if you consent to have
confidential information about your
tax issue left on your answering
machine or voice message at this
number.

Check if Cell Phone

9. Preferred language (if applicable)
TTY/TDD Line

Interpreter needed - Specify language other than English (including sign language)

Other (specify)
10. Tax form number (1040, 941, 720, etc.)

11. Tax year(s) or period(s)

12a. Describe the tax issue you are experiencing and any difficulties it may be creating
(If more space is needed, attach additional sheets.) (See instructions for completing Lines 12a and 12b)

12b. Describe the relief/assistance you are requesting (if more space is needed, attach additional sheets)

I understand that Taxpayer Advocate Service employees may contact third parties in order to respond to this request and I authorize
such contacts to be made. Further, by authorizing the Taxpayer Advocate Service to contact third parties, I understand that I will not
receive notice, pursuant to section 7602(c) of the Internal Revenue Code, of third parties contacted in connection with this request.
13a. Signature of taxpayer or corporate officer, and title, if applicable

13b. Date signed

14a. Signature of spouse (if joint assistance request)

14b. Date signed

Section II – Representative Information (Attach Form 2848 if not already on file with the IRS.)
1. Name of authorized representative

2. Centralized Authorization File (CAF) number

3. Current mailing address

4. Daytime phone number
Check if
Cell Phone

5. Fax number
6. Signature of representative
Catalog Number 16965S

7. Date signed
www.irs.gov

Form 911 (Rev. 1-2022)

Page 2

Section III – Initiating Employee Information (Section III is to be completed by the IRS only)
Taxpayer name
1. Name of employee

Taxpayer Identifying Number (TIN)
2. Phone number

3a. Function

3b. Operating division

5. How identified and received (check the appropriate box)

4. Organization code no.
6. IRS received date

IRS function identified issue as meeting Taxpayer Advocate Service (TAS) criteria
(r) Functional referral (function identified taxpayer issue as meeting TAS criteria)
(x) Congressional correspondence/inquiry not addressed to TAS but referred for TAS handling
Name of senator/representative
Taxpayer or representative requested TAS assistance
(n) Taxpayer or representative called into a National Taxpayer Advocate (NTA) toll-free site
(s) Functional referral (taxpayer or representative specifically requested TAS assistance)
7. TAS criteria (Check the appropriate box. NOTE: Checkbox 9 is for TAS Use Only)
(1) The taxpayer is experiencing economic harm or is about to suffer economic harm.
(2) The taxpayer is facing an immediate threat of adverse action.
(3) The taxpayer will incur significant costs if relief is not granted (including fees for professional representation).
(4) The taxpayer will suffer irreparable injury or long-term adverse impact if relief is not granted.
(if any items 1-4 are checked, complete Question 9 below)

(5) The taxpayer has experienced a delay of more than 30 days to resolve a tax account problem.
(6) The taxpayer did not receive a response or resolution to their problem or inquiry by the date promised.
(7) A system or procedure has either failed to operate as intended or failed to resolve the taxpayer's problem or dispute within
the IRS.
(8) The manner in which the tax laws are being administered raise considerations of equity or have impaired or will impair the
taxpayer's rights.
(9) The NTA determines compelling public policy warrants assistance to an individual or group of taxpayers (TAS Use Only)
8. What action(s) did you take to help resolve the issue? (This block MUST be completed by the initiating employee)
If you were unable to resolve the issue, state the reason why (if applicable)

9. Provide a description of the Taxpayer's situation, and where appropriate, explain the circumstances that are creating the economic
burden and how the Taxpayer could be adversely affected if the requested assistance is not provided

(This block MUST be completed by the initiating employee)

10. How did the taxpayer learn about the Taxpayer Advocate Service
IRS forms or publications
Catalog Number 16965S

Media

IRS employee
www.irs.gov

Other (specify)
Form 911 (Rev. 1-2022)

Page 3

Instructions for completing Form 911
Important Things You Should Know
• Remember to furnish any documentation you believe would assist us in resolving the issue, as this may result in a quicker
resolution of your issue.
• You can expect a Taxpayer Advocate Service employee to attempt call you to discuss your Form 911. If unable to reach you by
phone, we will mail you a letter.
• If you are a low-income taxpayer who needs help in resolving a tax dispute with the Internal Revenue Service and cannot afford
representation, you may qualify for free or low-cost assistance from a Low Income Taxpayer Clinic (LITC). For more information,
see Publication 4134 or visit our LITC page at: https://www.taxpayeradvocate.irs.gov/about-us/low-income-taxpayer-clinics-litc/.

Form 911 Filing Requirements
The Taxpayer Advocate Service (TAS) is an independent organization within the Internal Revenue Service (IRS) that helps taxpayers
and protects taxpayers' rights. We can offer you help if your tax problem is causing a financial difficulty, you’ve tried and been unable to
resolve your issue with the IRS, or you believe an IRS system, process, or procedure just isn't working as it should. If you qualify for our
assistance, which is always free, we will do everything possible to help you. Visit www.taxpayeradvocate.irs.gov or call 877-777-4778.
Where to Send this Form:
• The quickest method is Fax. TAS has at least one office in every state, the District of Columbia, and Puerto Rico. Submit this
request to the TAS office in your geographic area. You can find the fax number in the government listings in your local telephone
directory, on our website at www.taxpayeradvocate.irs.gov/contact-us/submit-a-request-for-assistance/, or in Publication 1546,
Taxpayer Advocate Service - Your Voice at the IRS, Local Offices by State and Location on p. 11.
• You also can mail this form. You can find the mailing address and phone number (voice) of your local Taxpayer Advocate
office in your phone book, on our website, and in Pub. 1546, or get this information by calling our toll-free number:
1-877-777-4778.
Note: If you are you sending the form from overseas, use Fax number: 1-304-707-9793 (Not a toll-free number for U.S.
taxpayers) or mail it to: Taxpayer Advocate Service, Internal Revenue Service, PO Box 11996, San Juan, Puerto Rico 00922.
• Be sure to fill out the form completely and submit it to the TAS office nearest you so we can work your issue as soon as
possible.
What Happens Next?
If you don't receive a response within 30 days of submitting Form 911, call 877-777-4778 for assistance.
Important Notes: Please be aware that by submitting this form, you are authorizing TAS to contact third parties as necessary to
respond to your request, and you may not receive further notice about these contacts. For more information see IRC 7602(c).
Caution: TAS will not consider frivolous arguments raised on this form. You can find examples of frivolous arguments in Publication
2105, Why do I have to Pay Taxes? If you use this form to raise frivolous arguments, you may be subject to a penalty of $5,000, in
addition to any other penalty provided by law.
Paperwork Reduction Act Notice: We ask for the information on this form to carry out the Internal Revenue laws of the United
States. Your response is voluntary. You are not required to provide the information requested on a form that is subject to the
Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions
must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by Code section 6103. Although the time needed to complete this form may
vary depending on individual circumstances, the estimated average time is 30 minutes.
Should you have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, please write to:
Internal Revenue Service, Tax Products Coordinating Committee, Room 6406, 1111 Constitution Ave. NW, Washington, DC 20224.

Instructions for Section I
1a.

Enter the taxpayer's name as shown on the tax return that relates to this request for assistance.

1b.

Enter your Taxpayer Identifying Number. If you're an individual this will be either a Social Security Number (SSN) or Individual
Taxpayer Identification Number (ITIN). If you're a business entity this will be your Employer Identification Number (EIN) (e.g. a
partnership, corporation, trust or self-employed individual with employees).

2a.

Enter your spouse's name (if applicable) if this request relates to a jointly filed return.

2b.

Enter your spouse's Taxpayer Identifying Number (SSN or ITIN) if this request relates to a jointly filed return.

3a-d.

Enter your current mailing address, including street number and name, city, state, or foreign country, and zip code.

4.

Enter your fax number, including the area code.

5.

Enter your email address. TAS may use email to receive and share information with you about your case, but only after
discussing the use of email with you and obtaining your consent.
Instructions for Section I
continue on the next page

Catalog Number 16965S

www.irs.gov

►

Form 911 (Rev. 1-2022)

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Instructions for Section I 6.

7a.

(Continued from Page 3)

Enter the name of the individual we should contact if Section II is not being used. For partnerships, corporations, trusts, etc.,
enter the name of the individual authorized to act on the entity's behalf. If the contact person is not the taxpayer or other
authorized individual, please see the Instructions for Section II.
Enter your daytime telephone number, including the area code. If this is a cell phone number, please check the box.

7b.

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, please check the box. 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.

Indicate the best time to call you. Please specify A.M. or P.M. hours.

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 that relates 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 that relates to this request. For example, if this request involves an
income tax issue, enter the calendar or fiscal year, if an employment tax issue, enter the calendar quarter.

12a.

Describe the tax issue you are experiencing and any difficulties it may be creating. Specify the actions that 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. See Section III for a specific list of TAS criteria. For further information on the
services TAS provides, see Publication 1546, Taxpayer Advocate Service - 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.
Furnish any documentation you believe would assist us in resolving the issue.

13-14. 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 that individual's behalf should sign the request. Requests for corporations must be signed by an officer
and include the officer's title.
Note: The signing of this request allows the IRS by law to suspend any applicable statutory periods of limitation relating to the
assessment or collection of taxes. However, it 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 or tax information
authorization for the tax return(s) and period(s) involved. For additional information see Form 2848, Power of Attorney and Declaration
of Representative, or Form 8821, Tax Information Authorization, and the accompanying instructions.
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 that the IRS assigns to a
representative after Form 2848 or Form 8821 is filed with an IRS office.
Note: Form 8821 does not authorize your appointee to advocate your position with respect to the Federal tax laws; to execute waivers,
consents, or closing agreements; or to otherwise represent you before the IRS. Form 8821 does authorize anyone you designate to
inspect and/or receive your confidential tax information in any office of the IRS, for the type of tax and tax periods you list on
Form 8821.

Instructions for Section III

(For IRS Use Only) Please complete this section in its entirety.

Enter the taxpayer's name and taxpayer identifying number from the first page of this form.
1-5.
Enter your name, phone number, Function (e.g., ACS, Collection, Examination, Customer Service, etc.), Operating Division
(W&I, SB/SE, LB&I, or TE/GE), the Organization code number for your office (e.g., 18 for AUSC, 95 for Los Angeles), and
Check the appropriate box that best reflects how the need for TAS assistance was identified. Enter the date the taxpayer or
representative called or visited an IRS office to request TAS assistance. Or enter the date when the IRS received the
Congressional correspondence/inquiry or a written request for TAS assistance from the taxpayer or representative. If the IRS
identified the taxpayer's issue as meeting TAS criteria, enter the date this determination was made.
6.

Check the box that best describes the reason TAS assistance is requested. Box 9 is for TAS Use Only.

7.

State the action(s) you took to help resolve the taxpayer's issue. State the reason(s) that prevented you from resolving the
taxpayer's issue. For example, levy proceeds cannot be returned because they were already applied to a valid liability; an
overpayment cannot be refunded because the statutory period for issuing a refund expired; or current law precludes a specific
interest abatement.

8.

Provide a description of the taxpayer's situation, and where appropriate, explain the circumstances that are creating the
economic burden and how the taxpayer could be adversely affected if the requested assistance is not provided.

9.

Ask the taxpayer how he or she learned about the TAS and indicate the response here.

Catalog Number 16965S

www.irs.gov

Form 911 (Rev. 1-2022)