Form 843, Claim for Refund and Request for Abatement Instructions
This form contains 85 fields organized into 18 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Alternative Contact Information | ||
| Alternative Name and Address | Text |
Provide the name and address if it is different from the one shown on the return.
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| Daytime Telephone Number | Text |
Enter a daytime telephone number where you can be reached.
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| Amount to be Refunded or Abated | ||
| Refund or Abatement Amount | Number |
Enter the total amount of money to be refunded or abated.
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| Employer Identification Number | ||
| Employer Identification Number (EIN) | Text |
Enter the nine-digit Employer Identification Number (EIN) for the entity filing this form.
|
| Explanation for Claim | ||
| Detailed Claim Explanation | Text |
Provide a detailed explanation of why this claim or request should be allowed and describe how the amount shown on line 2 was computed.
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| Foreign Address | ||
| Foreign Country Name | Text |
Provide the full name of the foreign country.
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| Foreign Province/State/County | Text |
Enter the foreign province, state, or county name for the address.
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| Foreign Postal Code | Text |
Enter the foreign postal code for the address.
|
| Identity Protection PIN | ||
| Taxpayer Identity Protection PIN | Text |
Enter the Identity Protection PIN provided by the IRS to the taxpayer.
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| Mailing Address | ||
| Street Address | Text |
Enter the street number and name, or your P.O. box number if mail is not delivered to a street address.
|
| Apartment/Suite Number | Text |
Enter the apartment, room, or suite number for the mailing address.
|
| City/Town/Post Office | Text |
Enter the city, town, or post office for the mailing address.
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| State | Text |
Enter the two-letter state abbreviation for the mailing address.
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| ZIP Code | Text |
Enter the five or nine-digit ZIP code for the mailing address.
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| Paid Preparer Information | ||
| Preparer's Name | Text |
Enter the full name of the paid preparer.
|
| self-employed | Checkbox |
Check this box if the paid preparer is self-employed.
|
| PTIN | Text |
Enter the Preparer Tax Identification Number (PTIN) of the preparer. Fill only if 'self-employed' is checked.
Depends on:
self-employed
|
| Firm's Name | Text |
Enter the name of the preparer's firm or employer.
|
| Firm's EIN | Text |
Enter the Employer Identification Number (EIN) of the preparer's firm.
|
| Firm's Address | Text |
Enter the complete street address, city, state, and ZIP code of the preparer's firm.
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| Phone Number | Text |
Enter the phone number of the preparer or their firm.
|
| Payment Dates | ||
| Payment Date (a) | Date |
Provide the first date of payment for which you are requesting a refund.
|
| Payment Date (b) | Date |
Provide the second date of payment for which you are requesting a refund.
|
| Payment Date (c) | Date |
Provide the third date of payment for which you are requesting a refund.
|
| Payment Date (d) | Date |
Provide the fourth date of payment for which you are requesting a refund.
|
| Payment Date (e) | Date |
Provide the fifth date of payment for which you are requesting a refund.
|
| Payment Date (f) | Date |
Provide the sixth date of payment for which you are requesting a refund.
|
| Payment Date (g) | Date |
Provide the seventh date of payment for which you are requesting a refund.
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| Payment Date (h) | Date |
Provide the eighth date of payment for which you are requesting a refund.
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| Payment Date (i) | Date |
Provide the ninth date of payment for which you are requesting a refund.
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| Payment Date (j) | Date |
Provide the tenth date of payment for which you are requesting a refund.
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| Payment Date (k) | Date |
Provide the eleventh date of payment for which you are requesting a refund.
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| Payment Date (l) | Date |
Provide the twelfth date of payment for which you are requesting a refund.
|
| Penalty IRC Section | ||
| IRC Section | Text |
Enter the specific Internal Revenue Code section on which the penalty is based. Fill only if 'Civil penalty' is 'Yes'.
Depends on:
Civil penalty
|
| Reason for Filing | ||
| Abatement or Refund of Other Tax | Checkbox |
Check this box if you are requesting an abatement or refund of a tax that is not income, estate, or gift tax.
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| Abatement or Refund of Tax Only Claimable on Form 843 | Checkbox |
Check this box if you are requesting an abatement or refund of a tax that cannot be claimed using any other form except Form 843.
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| Refund for Excess SS/Medicare/RRTA Tax (Single Employer) | Checkbox |
Check this box if you are an employee seeking a refund for excess social security, Medicare, or RRTA tax withheld by a single employer, and that employer will not adjust the overcollection.
|
| Refund for Excess Tier 2 RRTA Tax (Multiple Employers) | Checkbox |
Check this box if you are an employee seeking a refund for excess tier 2 RRTA tax because you had more than one railroad employer during the year and your total tier 2 RRTA tax withheld or paid exceeded the tier 2 limit.
|
| Refund for Erroneous SS/Medicare/RRTA Tax Withholding | Checkbox |
Check this box if you are an employee seeking a refund for social security, Medicare, or RRTA tax withheld in error, and your employer will not adjust the overcollection.
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| Abatement or Refund of Tier 1 RRTA Tax (Employee Representative) | Checkbox |
Check this box if you are an employee representative requesting an abatement or refund of tier 1 RRTA tax.
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| Abatement or Refund of Penalty (Reasonable Cause) | Checkbox |
Check this box if you are requesting an abatement or refund of a penalty or addition to tax due to reasonable cause or another reason allowed by law.
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| Abatement or Refund of Trust Fund Recovery Penalty | Checkbox |
Check this box if you are requesting an abatement or refund of a penalty imposed under section 6672 (Trust Fund Recovery Penalty) for failure to collect and pay over tax or attempting to evade tax.
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| Refund of Penalty for Incorrect Appraisals | Checkbox |
Check this box if you are requesting a refund of a penalty imposed under section 6695A for misstatements due to incorrect appraisals.
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| Refund of Penalty for Misuse of Dyed Fuel | Checkbox |
Check this box if you are requesting a refund of a penalty imposed under section 6715 for the misuse of dyed fuel.
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| Abatement or Refund for Erroneous IRS Advice Penalty | Checkbox |
Check this box if you are requesting an abatement or refund of a penalty or addition to tax attributable to erroneous written advice provided by the IRS, under section 6404(f).
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| Abatement or Refund of Interest (IRS Error/Delay) | Checkbox |
Check this box if you are requesting an abatement or refund of interest due to an IRS error or delay under section 6404(e)(1).
|
| Request for Net Interest Rate of Zero | Checkbox |
Check this box if you are requesting a net interest rate of zero under Revenue Procedure 2000-26.
|
| Abatement or Refund for Disability to Respond to IRS Notice | Checkbox |
Check this box if you are requesting an abatement or refund of assessed penalties, interest, or additions to tax because you were unable to read and timely respond to a standard print notice from the IRS.
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| Refund of Branded Prescription Drug Fee | Checkbox |
Check this box if you are requesting a refund of the branded prescription drug fee.
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| Refund of Annual Health Insurance Provider Fee | Checkbox |
Check this box if you are requesting a refund of the annual fee on health insurance providers.
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| Other Reason for Filing | Checkbox |
Check this box if your reason for filing Form 843 is not covered by any of the other options and you will specify the reason.
|
| Other Reason for Filing | Text |
Enter the specific reason for filing if none of the provided options accurately describe your situation. Fill only if 'Other Reason for Filing' is 'Yes'.
Depends on:
Other Reason for Filing
|
| Reason for Request | ||
| Interest due to IRS errors/delays | Checkbox |
Check this box if your reason for the request is that interest was assessed as a result of IRS errors or delays.
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| Penalty due to erroneous IRS advice | Checkbox |
Check this box if your reason for the request is that a penalty or addition to tax was the result of erroneous written advice from the IRS.
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| Reasonable cause or other reason | Checkbox |
Check this box if your reason for the request is that reasonable cause or another reason allowed under the law can be shown.
|
| None of the above reasons apply | Checkbox |
Check this box if your reason for the request does not fit any of the above descriptions.
|
| Requester Information | ||
| Requester Name | Text |
Enter the full name of the person or entity requesting the refund or abatement.
|
| Requester Social Security Number | Text |
Provide the Social Security Number (SSN) of the person requesting the refund or abatement.
|
| Spouse Information | ||
| Spouse Name | Text |
Enter the full name of the spouse if filing Form 843 relating to a joint return.
|
| Spouse Social Security Number | Text |
Enter the social security number (SSN) of the spouse.
|
| Spouse's Identity Protection PIN | ||
| Spouse's Identity Protection PIN | Text |
Provide your spouse's Identity Protection Personal Identification Number (PIN). Fill only if 'Name of spouse if filing Form 843 relating to a joint return' is not-empty.
Depends on:
Spouse Name
|
| Tax Period | ||
| Beginning Date | Date |
Enter the beginning date of the tax period or fee year.
|
| Ending Date | Date |
Enter the ending date of the tax period or fee year.
|
| Type of Fee or Return | ||
| 706 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 706. Fill only if 'Estate' is 'Yes'.
Depends on:
Estate
|
| 709 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 709. Fill only if 'Gift' is 'Yes'.
Depends on:
Gift
|
| 940 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 940. Fill only if 'Employment' is 'Yes'.
Depends on:
Employment
|
| 941 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 941. Fill only if 'Employment' is 'Yes'.
Depends on:
Employment
|
| 943 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 943. Fill only if 'Employment' is 'Yes'.
Depends on:
Employment
|
| 944 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 944. Fill only if 'Employment' is 'Yes'.
Depends on:
Employment
|
| 945 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 945. Fill only if 'Employment' is 'Yes'.
Depends on:
Employment
|
| 990-PF | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 990-PF. Fill only if 'Income' is 'Yes'.
Depends on:
Income
|
| 1040 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 1040. Fill only if 'Income' is 'Yes'.
Depends on:
Income
|
| 1120 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 1120. Fill only if 'Income' is 'Yes'.
Depends on:
Income
|
| 4720 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to Form 4720. Fill only if 'Excise' is 'Yes'.
Depends on:
Excise
|
| CT-2 | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to CT-2.
|
| Branded Prescription Drug (BPD) Fee | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to the Branded Prescription Drug (BPD) Fee. Fill only if 'Fee' is 'Yes'.
Depends on:
Fee
|
| Other (specify) | Checkbox |
Check this box if the tax, interest, penalty, or addition to tax relates to a type of fee or return not listed, and then specify it. Fill only if 'Fee' is 'Yes'.
Depends on:
Fee
|
| Other Fee or Return Specification | Text |
Provide the specific type of fee or return if it is not listed in the options above. Fill only if 'Other (specify)' is checked.
Depends on:
Other (specify)
|
| Type of Tax or Fee | ||
| Employment | Checkbox |
Check this box if the refund or abatement you are requesting is for an employment tax, or if an interest, penalty, or addition to tax related to an employment tax is involved.
|
| Estate | Checkbox |
Check this box if the refund or abatement you are requesting is for an estate tax, or if an interest, penalty, or addition to tax related to an estate tax is involved.
|
| Gift | Checkbox |
Check this box if the refund or abatement you are requesting is for a gift tax, or if an interest, penalty, or addition to tax related to a gift tax is involved.
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| Excise | Checkbox |
Check this box if the refund or abatement you are requesting is for an excise tax, or if an interest, penalty, or addition to tax related to an excise tax is involved.
|
| Income | Checkbox |
Check this box if the refund or abatement you are requesting is for an income tax, or if an interest, penalty, or addition to tax related to an income tax is involved.
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| Fee | Checkbox |
Check this box if the refund or abatement you are requesting is for a fee, or if an interest, penalty, or addition to tax related to a fee is involved.
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| Civil penalty | Checkbox |
Check this box if the refund or abatement you are requesting is for a civil penalty, or if an interest, penalty, or addition to tax related to a civil penalty is involved.
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