Federal Claim for Reimbursement of Bank Charges

Claim for Reimbursement of Bank Charges
Form 8546 (Rev. 2-2013)
Form

8546

Department of the Treasury – Internal Revenue Service

(Rev. February 2013)

Claim for Reimbursement of Bank Charges

Instructions
Please carefully read the instructions on the back of this form and provide the information requested. Use additional
sheet(s) if necessary. Submit this form to the address of the IRS office which served the levy, the address of the office
that misplaced the payment or the address that you used to file your tax return for Direct Debit Installment Agreement
Request.
1. Name and address of claimants (Number, street, city, state, and ZIP code)

2. Telephone number (including area code)
3. Best time to call

4. Amount of claim
$

5. Social security or employer identification number

(Disclosure is voluntary. Omission may delay your claim
or prevent locating your records.)

Electronic Funds Transfer (EFT) Information
(See instructions on the back of this form.)

6. Name(s) on bank account

7. American Bankers Association (ABA) number

8. Bank name and address (Number, street, city, state, ZIP code)

9. Bank account number

10. Type of account
Checking

Savings

11. Description of claim (State the circumstances which resulted in the loss for which you are claiming reimbursement.)

I certify that the amount of my claim covers only bank charges which resulted from either an
erroneous IRS levy, processing error by the Service for a Direct Debit Installment
Agreement or having to stop payment on a check which was lost or misplaced by the IRS. I
agree to accept this amount in full satisfaction and final settlement of this incident.

Certification

12. Signature of claimants (This signature should be used in all future correspondence.)

Civil Penalty for Presenting
Fraudulent Claim or Making False Statements

Civil Penalty for Presenting
Fraudulent Claim
The claimant shall be liable to the United States for the sum of
$2,000 plus double the amount of damages sustained by the
United States. (See R S § 3490, 5438, 31 USC 3729.)
Catalog Number 63488O

13. Date of claim

Fine of not more than $10,000 or imprisonment for not more
than 5 years or both. (See 62 Stat. 698, 749; 18 USC 287, 1001.)

www.irs.gov

Form 8546 (Rev. 2-2013)

Instructions
Please complete all blocks. Write "NONE" if the block does not apply.
2. records showing the bank charges caused by the erroneous
levy, the request for replacement of a lost or misplaced
check, or DDIA processing error on the part of the Service,
and
3. records showing that the bank charges have been paid.

Use this form only for reimbursement of bank charges for:
1. an erroneous levy, or
2. stopping payment on a check that the IRS lost or misplaced.
3. Direct Debit Installment Agreement (DDIA) processing error
on the part of the Service.
The claimants must sign this form. If the bank account involved
is a joint account, each owner on the account must sign the
Form 8546 as a claimant for erroneous levy. DDIA processing
error claims on joint returns also require signature of both
spouses. However, an authorized agent or legal representative
can file and sign the claim if the claimant can't because of
disability, death, or other acceptable reason. Include proof of
authorization if the claim is being filed on behalf of someone.
Claims must be made within one year of the date the claim
accrues and are limited to $1,000. (See 31 USC 3723)

Records to support your claim must include bank statements and
correspondence.
If you have any questions about this claim, please contact the
IRS office that issued the levy or requested replacement of your
check. The address is on your copy of the levy or the request for
a new check. If your questions relate to a Direct Debit Installment
Agreement, please contact the IRS at 1-800-829-1040 or mail
your questions to the address that you used to file your tax
return.
If IRS approves your claim, the money can be sent to your bank
by electronic funds transfer (EFT), or we can send you a check.
Payment by EFT will be faster, safer, and more convenient for
you. If you want us to pay your claim by EFT, we need the bank
information in items 6 through 10. The American Bankers
Association (ABA) number (item 7) is the first nine digits in the
number at the bottom of your checks. If you have no checking
account, ask your bank what its ABA number is. If you do not
complete items 6 through 10, a check will be sent to you.

Please attach verification of the amount you are claiming.
Include any documentation you may have explaining or
acknowledging the IRS error. Also, include:
1. a copy of the levy (if the charges were caused by an
erroneous levy),

Internal Revenue Policy P-5-39
Reimbursement of Bank Charges Due to Erroneous Levy and Service Loss or Misplacement of Taxpayer
Checks, or Direct Debit Installment Agreement Processing Errors.
The Service recognizes that there are circumstances when an
erroneous use of its unique enforcement powers may cause taxpayers to incur certain bank charges. Taxpayers who incur bank
charges due to an erroneous levy or a Direct Debit Installment
Agreement (DDIA) processing error on the part of the Service
may file a claim for reimbursement of those expenses. Bank
charges include a financial institution's customary charge for
complying with the levy instructions as well as charges for
overdrafts that are a direct consequence of an erroneous levy or
DDIA processing error on the part of the Service. In addition,
there are times when a taxpayer's check may be lost or
misplaced in processing. When the Service asks for a
replacement check, the taxpayer maybe reimbursed for bank
charges incurred in stopping payment on the original check. The
charges must have been paid by the taxpayer and must not have
been waived or reimbursed by the financial institution. Claims
must be filed with the District Director or Service Center Director
within one year after accrual of the expense.
The following criteria must be present in all erroneous levy
cases:

(3) Prior to the levy, the taxpayer did not refuse (either orally or
in writing) to timely respond to Service inquiries or provide information relevant to the liability for which the levy was made.
The following criteria must be present in all lost check cases:
(1) The Service acknowledges it lost or misplaced the check
during processing;
(2) the Service asks the taxpayer for a replacement of the payment; and
(3) the Service is satisfied that the replacement payment has
been received.
The following criteria must be present in all DDIA processing
error cases.
(1) The Service failed to act timely, took an incorrect or
improper action, or a systemic failure caused the bank fees;
(2) The taxpayer must not have contributed to the continuation
or compounding of the error that caused the bank fees; and
(3) Prior to the processing error, the taxpayer did not refuse
(either orally or in writing) to timely respond to the Service’s
inquiries or provide sufficient information for the DDIA processing
change to be made.

(1) The Service acknowledges the levy was erroneous;
(2) The taxpayers must not have contributed to the
continuation or compounding of the error; and

In compliance with the Privacy Act of 1974, the following is provided.
Solicitation of the information is authorized by Title 31 USC
3723; 31 CFR 3.20 et seq. Disclosure of the information is
voluntary.
The principal purpose of this information will be for our internal
use in processing your claim under 31 USC 3723, or for any
court proceedings which may ensue from the filing of this claim.
Catalog Number 63488O

We may disclose the information on this form relevant to the
processing of your claim or to any court proceedings resulting
from your claim. We may give the information to the Department
of Justice for the purpose of seeking legal advice or recommending prosecutions for fraudulent claims or the making of false
statements.

www.irs.gov

Form 8546 (Rev. 2-2013)