Department of the Treasury — Internal Revenue Service
FTD Adjustment Action Request
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:
FRB original amount
FRB day batch (mmdd)
IRS adjusted amount
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
transmittal form for which no FTD coupon(s)
101. Special Adjustment.
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
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
calendar days of FRB date.
Preparation date (mmddyyyy)
Name of FTD Technician
Catalog Number 27640A