Form 3949-A, Information Referral Instructions
This form contains 74 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Information | ||
| 6. Additional information. Answer these questions, if possible. Otherwise, leave blank. 6a. Are book / records available (If available, do not send now. We will contact you, if they are needed for an investigation). Yes | CheckBox |
Indicate whether books or records related to the alleged violation are available. Select 'Yes' if they are available, but do not send them now. The IRS will contact you if they are needed for an investigation.
|
| 6a. No | CheckBox |
Indicate whether books or records related to the alleged violation are available. Select 'No' if they are not available.
|
| 6b. Do you consider the taxpayer dangerous. Yes | CheckBox |
Indicate whether you consider the taxpayer to be dangerous. Select 'Yes' if you believe the taxpayer poses a danger.
|
| 6b. No | CheckBox |
Indicate whether you consider the taxpayer to be dangerous. Select 'No' if you do not believe the taxpayer poses a danger.
|
| Alleged Violations | ||
| Section B. Describe the Alleged Violation of Income Tax Law. 3. Alleged violation of income tax law (check all that apply). False Exemption | CheckBox |
Check this box if the alleged violation involves claiming false exemptions on tax returns.
|
| 3. False Deductions | CheckBox |
Check this box if the alleged violation involves claiming false deductions on tax returns.
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| 3. Multiple Filings | CheckBox |
Check this box if the alleged violation involves filing multiple tax returns.
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| 3. Organized Crime | CheckBox |
Check this box if the alleged violation involves organized crime activities.
|
| 3. Unsubstantiated Income | CheckBox |
Check this box if the alleged violation involves reporting unsubstantiated income.
|
| 3. Earned Income Credit | CheckBox |
Check this box if the alleged violation involves improper claims of earned income credit.
|
| 3. Public / Political Corruption | CheckBox |
Check this box if the alleged violation involves public or political corruption.
|
| 3. False / Altered Documents | CheckBox |
Check this box if the alleged violation involves using false or altered documents.
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| 3. Unreported Income | CheckBox |
Check this box if the alleged violation involves unreported income.
|
| 3. Narcotics Income | CheckBox |
Check this box if the alleged violation involves income from narcotics.
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| 3. Kickback | CheckBox |
Check this box if the alleged violation involves kickbacks.
|
| 3. Wagering / Gambling | CheckBox |
Check this box if the alleged violation involves wagering or gambling.
|
| 3. Failure to Withhold Tax | CheckBox |
Check this box if the alleged violation involves failure to withhold tax.
|
| 3. Failure to File Return | CheckBox |
Check this box if the person or business being reported failed to file a tax return.
|
| 3. Failure to Pay Tax | CheckBox |
Check this box if the person or business being reported failed to pay taxes.
|
| 3. Other (describe in 5) | CheckBox |
Check this box if the person or business being reported committed other violations not listed, and describe these violations in section 5.
|
| Business Details | ||
| 2a. Name of business | Text |
Enter the name of the business being reported.
|
| 2b. Employer Tax I D number (E I N) | Text |
Enter the Employer Tax ID number (EIN) of the business being reported. Maximum length is 10 characters.
|
| 2c. Telephone number | Text |
Enter the telephone number of the business being reported.
|
| 2d. Street address | Text |
Enter the street address of the business being reported.
|
| 2e. City | Text |
Enter the city where the business being reported is located.
|
| 2f. State | ComboBox |
Select the state where the business being reported is located from the dropdown list.
UT
NM
NE
KS
MO
TN
IA
ME
MN
NJ
MA
NH
WA
VA
LA
DC
HI
MD
SD
ITL
MI
OH
WI
OK
TX
CA
FL
KY
OR
AL
RI
MS
NY
WV
IL
WY
CO
AZ
ND
SC
AR
CT
NC
IN
PA
GA
DE
ID
MT
AK
VT
NV
|
| 2g. ZIP code | Text |
Enter the ZIP code of the business being reported.
|
| 2h. Email address | Text |
Enter the email address of the business being reported.
|
| 2i. Website | Text |
Enter the website of the business being reported.
|
| Financial Information | ||
| 6c. Banks, Financial Institutions used by the taxpayer. Name | Text |
Provide the name of the banks or financial institutions used by the taxpayer.
|
| 6c. Street address | Text |
Provide the street address of the banks or financial institutions used by the taxpayer.
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| 6c. City | Text |
Provide the city where the banks or financial institutions used by the taxpayer are located.
|
| 6c. State | ComboBox |
Select the state where the banks or financial institutions used by the taxpayer are located from the provided list.
UT
NM
NE
KS
MO
TN
IA
ME
MN
NJ
MA
NH
WA
VA
LA
DC
HI
MD
SD
ITL
MI
OH
WI
OK
TX
CA
FL
KY
OR
AL
RI
MS
NY
WV
IL
WY
CO
AZ
ND
SC
AR
CT
NC
IN
PA
GA
DE
ID
MT
AK
VT
NV
|
| 6c. ZIP code | Text |
Provide the ZIP code of the banks or financial institutions used by the taxpayer.
|
| Information About the Person or Business You Are Reporting | ||
| Page 1. Use this form to report suspected tax law violations by a person or a business. CAUTION: READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM. There may be other more appropriate forms specific to your complaint. (For example, if you suspect your identity was stolen, use Form 14039.) Section A. Information About the Person or Business You Are Reporting. Complete 1, if you are reporting an Individual. Complete 2, if you are reporting a business only. Complete 1 and 2 if you are reporting a business and its owner. (Leave blank any lines you do not know.). 1a. Name of individual | Text |
Enter the full name of the individual you are reporting for suspected tax law violations.
|
| 1b. Social Security Number / Taxpayer Identification Number | Text |
Enter the Social Security Number (SSN) or Taxpayer Identification Number (TIN) of the individual you are reporting. This field can contain up to 11 characters.
|
| 1c. Date of birth | Text |
Enter the date of birth of the individual you are reporting.
|
| 1d. Street address | Text |
Enter the street address of the individual you are reporting.
|
| 1e. City | Text |
Enter the city of residence of the individual you are reporting.
|
| 1f. State | ComboBox |
Select the state of residence of the individual you are reporting from the provided list.
UT
NM
NE
KS
MO
TN
IA
ME
MN
NJ
MA
NH
WA
VA
LA
DC
HI
MD
SD
ITL
MI
OH
WI
OK
TX
CA
FL
KY
OR
AL
RI
MS
NY
WV
IL
WY
CO
AZ
ND
SC
AR
CT
NC
IN
PA
GA
DE
ID
MT
AK
VT
NV
|
| 1g. ZIP code | Text |
Enter the ZIP code of the individual you are reporting.
|
| 1h. Occupation | Text |
Enter the occupation of the individual you are reporting.
|
| 1i. Email address | Text |
Enter the email address of the individual you are reporting.
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| 1j. Marital status (check one, if known) Married | CheckBox |
Check this box if the individual you are reporting is married.
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| 1j. Single | CheckBox |
Check this box if the individual you are reporting is single.
|
| Personal Details | ||
| 1j. Head of Household | CheckBox |
Check this box if the person being reported is the head of household.
|
| 1j. Divorced | CheckBox |
Check this box if the person being reported is divorced.
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| 1j. Separated | CheckBox |
Check this box if the person being reported is separated.
|
| 1k. Name of spouse | Text |
Enter the name of the spouse of the person being reported.
|
| 7f. State | ComboBox |
Select the state where the person or business being reported is located.
UT
NM
NE
KS
MO
TN
IA
ME
MN
NJ
MA
NH
WA
VA
LA
DC
HI
MD
SD
ITL
MI
OH
WI
OK
TX
CA
FL
KY
OR
AL
RI
MS
NY
WV
IL
WY
CO
AZ
ND
SC
AR
CT
NC
IN
PA
GA
DE
ID
MT
AK
VT
NV
|
| 7g. ZIP code | Text |
Enter the ZIP code of the person or business being reported.
|
| Reported Party Information | ||
| 6c. Name | Text |
Enter the name of the person or business you are reporting.
|
| 6c. Street address | Text |
Enter the street address of the person or business you are reporting.
|
| 6c. City | Text |
Enter the city of the person or business you are reporting.
|
| 6c. State | ComboBox |
Select the state of the person or business you are reporting from the dropdown list.
UT
NM
NE
KS
MO
TN
IA
ME
MN
NJ
MA
NH
WA
VA
LA
DC
HI
MD
SD
ITL
MI
OH
WI
OK
TX
CA
FL
KY
OR
AL
RI
MS
NY
WV
IL
WY
CO
AZ
ND
SC
AR
CT
NC
IN
PA
GA
DE
ID
MT
AK
VT
NV
|
| 6c. ZIP code | Text |
Enter the ZIP code of the person or business you are reporting.
|
| Unreported Income | ||
| 4. Unreported income and tax years. Fill in Tax Years and dollar amounts, if known (e.g., TY 2010- $10,000). Tax year | Text |
Enter the tax year for which the unreported income is being reported (e.g., 2010).
|
| 4. Income | Text |
Enter the amount of unreported income for the specified tax year.
|
| 4. Tax year | Text |
Enter the tax year for which the unreported income is being reported (e.g., 2011).
|
| 4. Income | Text |
Enter the amount of unreported income for the specified tax year.
|
| 4. Tax year | Text |
Enter the tax year for which the unreported income is being reported (e.g., 2012).
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| 4. Income | Text |
Enter the amount of unreported income for the specified tax year.
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| 4. Tax year | Text |
Enter the tax year for which the unreported income is being reported (e.g., 2013).
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| 4. Income | Text |
Enter the amount of unreported income for the specified tax year.
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| 4. Tax year | Text |
Enter the tax year for which the unreported income is being reported (e.g., 2014).
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| 4. Income | Text |
Enter the amount of unreported income for the specified tax year.
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| 4. Tax year | Text |
Enter the tax year for which the unreported income is being reported (e.g., 2015).
|
| 4. Income | Text |
Enter the amount of unreported income for the specified tax year.
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| Violation Details | ||
| 5. Comments (Briefly describe the facts of the alleged violation-Who / What / Where / When / How you learned about and obtained the information in this report. Attach another sheet, if needed) | Text |
Provide a brief description of the facts related to the alleged tax law violation. Include details such as who was involved, what happened, where and when it occurred, and how you learned about the information. Attach additional sheets if necessary.
|
| Your Information | ||
| Section C. Information About Yourself. (We never share this information with the person or business you are reporting.) This information is not required to process your report, but would be helpful if we need to contact you for any additional information. 7a. Your name | Text |
Enter your name. This information is optional and will not be shared with the person or business you are reporting.
|
| 7b. Telephone number | Text |
Enter your telephone number. This information is optional and will not be shared with the person or business you are reporting.
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| 7c. Best time to call | Text |
Enter the best time to call you. This information is optional and will not be shared with the person or business you are reporting.
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| 7d. Street address | Text |
Enter your street address. This information is optional and will not be shared with the person or business you are reporting.
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| 7e. City | Text |
Enter your city. This information is optional and will not be shared with the person or business you are reporting.
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