Form 13287 - Bank Payment Problem Identification
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1Department of the Treasury – Internal Revenue Service
13287
Form
Bank Payment Problem Identification
(October 2002)
1. Name of Bank
2. Federal employer identification number
(Enter complete legal name of responsible bank)
of bank
(FEIN)
3. Bank branch street address
4. Branch number of bank where problem
occurred
6. American Banking Association
(ABA)
5. City, State, ZIP Code
number
8. Telephone number
7. Bank contact name and title
(Please print)
(
)
9. FAX number
(
)
10. Number of payments
11. Payment / Combined payments amount
12. Type of payment
(“x” proper box)
Fed wire
delayed
$
ACH credit
ACH debit
Coupon
13. Date t/p requested
14. Date pyt trans-
15. Number of days
16. Date IRS was con-
17. Method of contact
(“x” proper box)
payment
mitted
payment late
(mmddyyyy)
(mmddyyyy)
tacted
(mmddyyyy)
Phone
FAX
Letter
18. Problem involved multiple payments
19. Deposit made more than 48 hours after
20. IRS contacted within 48 hours of
problem discovered
problem discovery
Yes
No
No
Yes
Yes
No
(See attached list.)
(Explain in Item 21.)
(Explain in Item 21.)
21. Explanation
(Items 19 and 20)
22. Brief explanation why payment could not be processed as taxpayer requested
By signing below, I understand that the financial institution listed above will accept
responsibility for the payment
delay.
(s)
Signature
23. Name
24. Title
(Please print)
Authorization of
Bank Official
25. Signature
26. Date
(To be completed by Internal Revenue Service)
27. History
28. Taxpayer correspondence
date
(mmddyyyy)
29. Date Bank's completed Form
13287 rec'd at IRS
(mmddyyyy)
30. Resolution
31. Method of contact
(“x” proper box)
Phone
FAX
Letter
32. Taxpayer employer
Multiple TINs
33. MFT code
34. Tax period
(s)
(s)
identification number
(EIN)
Yes
(See attached list.)
35. TC 971
Payment date
Intended payment
36. Transaction code
for adjustment
) to account
(s)
(s
(TC 181, ADX 48/24/34)
date
(mmddyyyy)
(mmddyyyy)
Action code 30
37. IRS contact name
38. IRS contact employee number
39. IRS contact phone number
(Please print)
(
)
40. IDRS input date
41. Master File projected 23C posting date
42. Date information FAXd to Federal
(mmddyyyy)
(mmddyyyy)
Reserve Board
(FRB) (mmddyyyy)
13287
Catalog No. 34294M
Form
(10-2002)
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