Form Tpg-196 - Individual Tsc Password Reset Request - Department Of Revenue Services, State Of Connecticut
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State of Connecticut
TPG-196
Department of Revenue Services
25 Sigourney Street Ste. 2
Individual TSC Password Reset Request
Hartford CT 06106-5032
Complete this form in blue or black ink only.
TPG-196 (Rev. 03/13)
Purpose: Individuals who established an online account with the Department of Revenue Services (DRS), Taxpayer Service Center
(TSC-IND) and cannot remember their password or their answers to the security questions may use TPG-196 to request a temporary
password to access their account.
Part 1 - Personal Information
(joint fi lers, see instructions below)
In order to authenticate your identity, print your name(s) and mailing address exactly as they appear on your last return already on fi le with
DRS for this TSC account. This request will not be processed if the following information is not accurately completed and clearly printed.
Primary fi ler Last name
First name
Middle initial Last 4 digits of primary fi ler’s Social Security Number (SSN)
__
__
__
__
Secondary fi ler (required for joint accounts) Last name
First name
Middle initial Last 4 digits of secondary fi ler’s SSN
__
__
__
__
Address
Number and street
PO box
City or town
State
ZIP code
Part 2 - Verifi cation
Your password reset request will not be processed if the following information is not accurately completed and clearly printed.
1. Enter the TSC email address (as originally entered in the TSC):
2 0
2. Enter the tax year of a prior income tax already on fi le with DRS.
2.
___________________
__ __
3. Enter the Federal adjusted gross income (AGI) from income tax return for tax
00
year entered above. Enter amount from Section 2, Line 1.
3.
Part 3 - Confi rmation Method
Indicate the delivery method DRS should use to send your new temporary password. Select only one method and provide
any specifi c information.
Mail to the same mailing address listed in Part 1 - Personal Information.
Email to a different email address. Enter new email address:
Fax to the following FAX number:
Instructions for joint fi lers
How to Submit Request
You must use the SSN and password created by the primary fi ler to
Submit
your
completed
request
using
access the TSC. The primary fi ler is generally the fi rst person listed on
one of the following:
the joint return.
FAX to:
860-297-4929
If you are not the primary taxpayer, we cannot provide you with a
password to access the joint account unless both the primary and
MAIL to:
Department of Revenue Services
secondary sign and date TPG-196.
TPS – TSC Coordinator
If there has been a change in fi ling status since your last
25 Sigourney Street
return, you may not be able to fi le your return using the TSC.
Hartford CT 06106
For additional information, visit the DRS website at
and select FAQs.
If you are not the primary taxpayer listed above, both primary and secondary fi lers must sign below.
Declaration: I declare under penalty of law that I have examined this document and, to the best of my knowledge and belief, it is true,
complete, and correct. I understand that the penalty for willfully delivering a false return or document to the DRS is subject to a fi ne of not
more than $5,000, or imprisonment for not more than fi ve years, or both.
Primary fi ler’s signature
Date
Phone
Sign Here
(
)
Keep a copy
Secondary fi ler’s signature
Date
Phone
for your
records.
(
)
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