Form 911, Request for Taxpayer Advocate Service Assistance Instructions

Describe the actions you took to help resolve the taxpayer's issue, or explain why you were unable to resolve it, if applicable.

Check this box only if the National Taxpayer Advocate determines that compelling public policy warrants assistance to an individual or group of taxpayers.

Check this box if the taxpayer has experienced a delay of more than 30 days in resolving a tax account problem.

Check this box if the taxpayer did not receive a response or resolution to their problem or inquiry by the date promised.

Check this box if a system or procedure has failed to operate as intended or failed to resolve the taxpayer’s problem or dispute within the IRS.

Check this box if the way tax laws are being administered raises equity concerns or has impaired or will impair the taxpayer’s rights.

Check this box if the taxpayer is experiencing economic harm or is about to suffer economic harm.

Check this box if the taxpayer is facing an immediate threat of adverse action.

Check this box if the taxpayer will incur significant costs if relief is not granted, including fees for professional representation.

Check this box if the taxpayer will suffer irreparable injury or a long-term adverse impact if relief is not granted.

Enter the taxpayer's fax number, if applicable.

Enter the taxpayer's email address.

Check this box when an IRS function identified the taxpayer’s issue as meeting Taxpayer Advocate Service (TAS) criteria.

Check this box when congressional correspondence or an inquiry was not addressed to TAS but was referred for TAS handling.

Enter the name of the senator or representative whose congressional correspondence or inquiry was referred for Taxpayer Advocate Service handling. Fill only if 'Congressional correspondence or inquiry referred to TAS' is 'Yes'.

Check this box when the taxpayer or an authorized third party called a National Taxpayer Advocate (NTA) toll-free site to request TAS assistance.

Check this box when a taxpayer or representative specifically requested TAS assistance through a functional referral.

Check this box if the taxpayer learned about the Taxpayer Advocate Service through IRS forms or publications.

Check this box if the taxpayer learned about the Taxpayer Advocate Service through the media.

Check this box if the taxpayer learned about the Taxpayer Advocate Service from an IRS employee.

Check this box if the taxpayer learned about the Taxpayer Advocate Service another way, and specify the source on the line provided.

Specify how the taxpayer learned about the Taxpayer Advocate Service if none of the listed sources applies. Fill only if 'Other' is 'Yes'.

Enter the name of the IRS employee initiating this section.

Enter the initiating IRS employee’s phone number.

Enter the IRS function of the employee initiating this form.

Enter the IRS operating division of the employee initiating this form.

Enter the organization code number for the employee initiating this form.

Enter the date the IRS received the request for Taxpayer Advocate Service assistance.

Enter the name of the person the Taxpayer Advocate Service should contact if no third party is authorized.

Enter the daytime phone number where the contact person can be reached.

Check this box if the daytime phone number you provided is a cell phone number.

Check this box if you consent to having confidential information about your tax issue left on your answering machine or voicemail at the daytime phone number provided.

Enter the best time to call the contact person.

Check this box if you need to communicate with the Taxpayer Advocate Service using a TTY/TDD line.

Check this box if you need an interpreter for a language other than English, including sign language, and specify the language.

Specify the language other than English, including sign language, for which you need an interpreter. Fill only if 'Interpreter Needed' is 'Yes'.

Check this box if you have another preferred language or accessibility need, and specify it.

Specify the other preferred language or accessibility need indicated by the Other option. Fill only if 'Other Preferred Language or Accessibility Need' is 'Yes'.

Describe the specific relief or assistance you are requesting from the Taxpayer Advocate Service.

Enter your spouse's name as it appears on the tax return if filing jointly.

Enter your spouse's Social Security number or Individual Taxpayer Identification Number.

Enter the number of the tax form related to the issue for which you are requesting assistance.

Enter the tax year or tax period related to the issue for which you are requesting assistance.

Describe the tax issue you are experiencing and any difficulties it may be creating.

Enter the taxpayer’s current street address, including the street number, street name, and apartment number if applicable.

Enter the city of the taxpayer’s current address.

Enter the state or foreign country of the taxpayer’s current address.

Enter the ZIP code of the taxpayer’s current address.

Enter the taxpayer's name.

Enter the taxpayer's identifying number.

Enter the taxpayer's name exactly as shown on the tax return.

Enter the taxpayer's Social Security number, Individual Taxpayer Identification Number, or Employer Identification Number.

Describe the taxpayer's situation, the circumstances creating any economic burden, and how the taxpayer could be adversely affected if the requested assistance is not provided. Fill only if 'Experiencing or about to suffer economic harm', 'Immediate threat of adverse action', 'Significant costs if relief is not granted', 'Irreparable injury or long-term adverse impact' is 'Yes' for any field.

Enter the authorized third party's daytime phone number.

Check this box if the authorized third party’s daytime phone number is a cell phone.

Enter the fax number of the authorized third party.

Enter the name of the third party authorized to act on your behalf.

Enter the authorized third party’s Centralized Authorization File (CAF) number.

Enter the authorized third party's current mailing address.