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2002 or US/Company 2002) in addition

authorize a third party appointee to

name, contact customer service. For

to Form 8802. For copies of these

request additional Forms 6166 for a

businesses, the number is

forms, contact HM Revenue and

country not identified in your current

1-800-829-4933. For individuals, the

Customs:

Form 8802, you must include in line 10,

number is 1-800-829-1040.

•

On the Internet at

a written statement authorizing the third

Line 2. Applicant’s

party appointee to request Form 6166

covering the same tax period for any

Address

•

Telephone at: 44-115-974-0897 if

country.

calling from outside the U.K., or

Foreign Claim Form

Do not enter a P.O. box number

0115-974-0897 if calling from the U.K.

or C/O address. Certification

Check the box if you have included with

Send the completed U.K. form to the

may be denied if the applicant

Form 8802 a foreign claim form sent to

CAUTION

IRS with your completed Form 8802.

enters a P.O. box or C/O address.

you by a foreign country. The

submission or omission of a foreign

Enter your address for the calendar

claim form will not affect your residency

year for which you are requesting

Specific Instructions

certification. If the IRS does not have

certification. If you are an individual

an agreement with the foreign country

who lived outside the United States

Check Boxes at Top of

to date stamp, or otherwise process the

during the year for which certification is

form, we will not process it and such

requested, the special rules under

Page 1

foreign claim form will be mailed back

Individuals With Residency Outside the

to you.

United States, on page 3, may apply to

Additional Requests

you.

Note. For more information about

foreign countries with which the IRS

Check this box if Form 8802 is being

Line 3a. Mailing Address

has an agreement to process a foreign

submitted to request additional Form(s)

claim form, call the U.S. residency

6166 for a tax period for which the IRS

Form 6166 and any related

has previously issued a Form 6166 to

certification unit at (267) 941-1000 (not

correspondence may be mailed to you

a toll-free number).

you. Additional requests on a separate

or to a third party appointee. If you

Form 8802 will require a

provide an address on line 3a it will be

Applicant’s Name and

non-refundable user fee of $85. See

used for all mail correspondence

User Fee on page 2.

relating to your Form 6166 request. If

U.S. Taxpayer

you do not indicate a mailing address

An applicant can only use this

Identification Number

on line 3a, Form 6166 will be mailed to

additional request procedure if there

the address on line 2.

are no changes to the applicant’s tax

As part of certifying U.S. residency, the

information provided on the original

IRS must be able to match the name(s)

Line 3b. Third Party

Form 8802. An applicant may use this

and taxpayer identification number(s)

procedure to obtain a Form 6166 for

Appointee’s Information

(TIN(s)) on this application to those

any country or countries, whether or not

previously verified on either the U.S.

If the mailing address entered on line

the country was identified on a

return filed for the tax period for which

3a is for a third party appointee, you

previously filed Form 8802. An

certification is to be based or on other

must provide written authorization for

additional request for Form 6166 using

documentation you provide.

the IRS to release the certification to

this procedure must be made within 12

Enter the applicant’s name and TIN

the third party. By filling out the

months of the most recently issued

exactly as they appear on the U.S.

appointee’s information in lines 3a and

Form 6166 relating to the same tax

return filed for the tax period(s) for

3b (name and address), written

period.

which certification will be based. If the

authorization will be deemed to have

Additional documentation. If you are

applicant was not required to file a U.S.

been provided when you sign and date

requesting certification for a previously

return, enter the applicant’s name and

the Form 8802. You are not required to

identified country and if additional

TIN as they appear on documentation

enter a phone number or a fax number

documentation was necessary for the

previously provided to the IRS (for

of your third party appointee. However,

original application, it does not need to

example, Form 8832, Entity

by providing a phone number or fax

be resubmitted with the request for an

Classification Election) or on

number, you are authorizing the IRS to

additional Form 6166. In the signature

documentation provided by the IRS (for

call or fax your third party appointee.

line of the additional request form, write

example, a determination letter).

The Centralized Authorization File

“See attached copy of the original Form

Joint return. If a joint income tax

(CAF) contains information on third

8802.” Attach a copy of the original

return was filed for a tax period for

parties authorized to represent

Form 8802.

which certification will be based, enter

taxpayers before the IRS and/or receive

If you are requesting Form 6166 for

the spouse’s name and TIN exactly as

and inspect confidential tax information.

a country not identified on a previously

they appear on the return filed.

If your appointee has a CAF number,

filed Form 8802 that requires

enter it on line 3b.

Change in taxpayer’s name. If the

documentation not previously

taxpayer’s name has changed since the

submitted, you must include that

In general, you do not need to fill out

most recent Form 8802 was filed with

line 3b if you have attached Form 2848

documentation with the additional

the IRS, the Form 8802 and tax

request. Sign and date the additional

or Form 8821. In line 3b, write “See

disclosure authorization for each

attached authorization.” Attach a Form

request form. Attach a copy of the

individual or entity must be submitted

original Form 8802.

2848 or Form 8821 for each additional

under the taxpayer’s new name. In

third party that you wish to authorize to

Additional request made by third

addition, documentation of the name

receive your tax information.

party appointees. Third party

change must be submitted with Form

Form 8821, Taxpayer Information

appointees cannot use this special

8802 (for example, trust agreement,

procedure to request additional Form(s)

Authorization, and Form 2848, Power

corporate charter).

of Attorney and Declaration of

6166 for countries that were not

originally authorized by the taxpayer in

Certification will not be issued if the

Representative. Form 8821 is used to

their previously signed and dated Form

name change has not been updated in

authorize disclosure of tax information

8802. If you anticipate using the

the IRS database. For information on

to a third party designee of the

additional request procedure to

how to update the IRS on your new

taxpayer. Form 8821 cannot be used to

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Instructions For Form 8802 - Application For United States Residency Certification - 2012 Page 4

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