Form 5526 - Ftd Adjustment Action Request - State Of Missouri
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1Department of the Treasury — Internal Revenue Service
5526
Form
FTD Adjustment Action Request
(Rev. 10-2006)
To the Federal Reserve Bank of St. Louis:
Please adjust the Treasury Tax and Loan (TT&L) Account or other related
Federal tax deposit record as indicated below:
Depositary name
Micro
Serial
Number
Service
Depositary address
FRB
Bank Account
Branch
Transmittal
Center
Number
Serial Number
Code
Code
Code
08
Payment Date
Total FTDs
MM
DD
YY
FRB
IRS
(Dollars)
(Cents)
FRB original amount
FRB day batch (mmdd)
reported
$
(“x” one)
Amt of
Credit (+)
adjust-
ment
$
Debit (-)
215-DT #
Control #
IRS adjusted amount
5515-DV #
Control #
received
$
Reason(s) for Adjustment
(See item(s) checked below and/or “Remarks”)
0. No reason code has been selected,
5. To reverse duplicate deposit included in
this adjustment will not be processed.
F R B Day Batch
1. A mistake was made in entering the total
TLN or TSN #
amount from the back of the transmittal form
6. Item received is not an FTD coupon.
to the front.
7. FRB verification error or bank error.
2. An amount(s) was entered on the back of the
99. Other.
transmittal form for which no FTD coupon(s)
101. Special Adjustment.
was received.
102. Adjustment to a deposit made with the FRB.
3. The money total shown on the front of the
transmittal form does not agree with the correct
103. Adjustment for a bank not serviced by the
Service Center.
total of the individual FTD coupon(s).
104. $50,000 or more.
4. An FTD coupon(s) was received for which the
amount was not included in the total transmittal
105. Transmittal/FTD coupons not received within 12
amount.
calendar days of FRB date.
Remarks
Preparation date (mmddyyyy)
Name of FTD Technician
5526
Catalog Number 27640A
Form
(Rev. 10-2006)
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