Form 3911, Taxpayer Statement Regarding Refund Instructions

Enter the name of the bank where you normally cash or deposit your refund checks. Fill only if 'Direct Deposit' Fill only if Direct Deposit is 'Yes'.

Check this box if the bank account you normally use for cashing or depositing refunds is a checking account. Fill only if 'Direct Deposit' Fill only if Direct Deposit is 'Yes'.

Check this box if the bank account you normally use for cashing or depositing refunds is a savings account. Fill only if 'Direct Deposit' Fill only if Direct Deposit is 'Yes'.

Check this box if the bank account type is neither checking nor savings, and provide the account type on the adjacent line. Fill only if 'Direct Deposit' Fill only if Direct Deposit is 'Yes'.

If your account type is not Checking or Saving, enter the account type here (for example, money market or trust). Fill only if 'Other' Fill only if Other (Account type) is 'Yes'.

Enter the bank routing transit number associated with the account where the refund would be deposited. Fill only if 'Direct Deposit' Fill only if Direct Deposit is 'Yes'.

Enter the bank account number where your refund would be deposited. Fill only if 'Direct Deposit' Fill only if Direct Deposit is 'Yes'.

Enter the date the original return was filed.

Provide the signature of the taxpayer or the person authorized to sign the check; for business returns, enter the name of the authorized signer.

Enter the date the signature for line 10 was signed.

If required, provide the spouse's signature; for business returns, enter the title of the person who signed above. Fill only if 'Spouse's name' Fill only if Spouse's name is filled.

Enter the date the signature for line 11 was signed.

Enter your current mailing street address, including house number and street name or PO Box.

Enter your apartment, unit, suite, or other secondary address identifier if applicable; leave blank if none.

Enter the city or town for your current mailing address.

Enter the two-letter state abbreviation for your current mailing address.

Enter the ZIP code for your current mailing address, including the ZIP+4 extension if available.

Enter the date of the inquiry to which this reply refers.

Enter the tax year or tax period for which you are requesting information about the federal tax refund.

Enter the fax number or return destination to which you should send this completed form.

Enter the name or names exactly as they appear on the tax return for which you are requesting information.

If the mailing address shown on your tax return is different from your current address, enter the street address or PO box as it appears on the return.

Enter the apartment, unit, or suite number shown on the tax return address, if applicable.

Enter the city name exactly as shown on the tax return address.

Enter the state (abbreviation or full name) shown on the tax return address.

Enter the ZIP code that appears on the tax return address.

Enter the three-digit telephone area code for the phone number where you can be reached between 8 a.m. and 4 p.m., including any leading zeros if applicable.

Enter the local telephone number (without the area code) where you can be reached between 8 a.m. and 4 p.m., including any extension if needed.

Check this box if you want your refund issued as a mailed paper check.

Check this box if you want your refund deposited directly into the bank account you provide.

Enter the amount of the refund you are requesting for this return.

Check this box if you never received the refund check.

Check this box if you did receive a refund check but there was a problem with it (then also check whether it was lost, stolen, or destroyed).

Check this box if the refund check you received was lost and you cannot locate it. Fill only if 'I received a refund check, but it was' Fill only if I received a refund check, but it was is 'Yes'.

Check this box if the refund check you received was stolen. Fill only if 'I received a refund check, but it was' Fill only if I received a refund check, but it was is 'Yes'.

Check this box if the refund check you received was destroyed (for example, accidentally destroyed or ruined). Fill only if 'I received a refund check, but it was' Fill only if I received a refund check, but it was is 'Yes'.

Check this box if you received the refund check and you endorsed (signed) it.

Enter the full name of the person you authorized to receive your refund check (first and last name, and middle initial if applicable).

Enter the representative’s complete mailing address, including street and apartment number if any, city, state, and ZIP code.

Enter the spouse’s full name exactly as it appears on tax records (first, middle initial if used, and last name).

Enter the spouse’s taxpayer identification number (for individuals this is usually the Social Security Number or ITIN) without spaces unless the form requires them.

Enter the taxpayer's current full name as shown on tax records; if filing a joint return, enter the first spouse's name here.

Enter the taxpayer's identification number (for an individual, SSN or ITIN; for a business, EIN), using digits as shown on tax records.

Check this box if the refund request is for an individual income tax return (you filed as an individual or joint return).

Check this box if the refund request is for a business tax return (the return was filed by a business entity).

Enter the form number used for this return (the short identifier entered on the 'Form' line to indicate which tax form was filed). Fill only if 'Business' Fill only if Business is 'Yes'.

Check this box if the refund request is for a return type that is neither an individual nor a business return (and specify the type next to this option).

If you checked 'Other' for type of return, enter a brief description or name of that other return type here. Fill only if 'Other' Fill only if Other is 'Yes'.

Enter the tax period for the return (for example, the year or month/year the return covers).