Fillable Form 2159 - Payroll Deduction Agreement - Department Of The Treasury

Form 2159 - Payroll Deduction Agreement - Department Of The Treasury - 2007 Page 4

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INSTRUCTIONS TO EMPLOYER

This payroll deduction agreement requires your approval. If you agree to participate,

please complete the spaces provided under the employer section on the front of this form.

WHAT YOU SHOULD DO

•

Enter the name and telephone number of a contact person.

(This will allow us

to contact you if your employee’s liability is satisfied ahead of time.)

•

Indicate when you will forward payments to IRS.

•

Sign and date the form.

•

After you and your employee have completed and signed the form, please

return it

to IRS. Use the IRS address on the letter the employee

(all parts)

received with the form or the address shown on the front of the form.

HOW TO MAKE PAYMENTS

Please deduct the amount your employee agreed with the IRS to have

deducted from each wage or salary payment due the employee.

Make your check payable to the “United States Treasury.” To insure

proper credit, please write your employee’s name and social security

number on each payment.

Send the money to the IRS mailing address printed on the letter that came

with the agreement. Your employee should give you a copy of this letter. If

there is no letter, use the IRS address shown on the front of the form.

Note: The amount of the liability shown on the form may not include all penalties and

interest provided by law. Please continue to make payments unless IRS notifies you

that the liability has been satisfied. When the amount owed, as shown on the form, is

paid in full and IRS hasn’t notified you that the liability has been satisfied, please call

the appropriate telephone number below to request the final balance due.

If you need assistance, please call the telephone number on the letter that came with

the agreement or write to the address shown on the letter. If there’s no letter, please

call the appropriate telephone number below or write IRS at the address shown on

the front of the form.

For assistance, call:

1-800-829-0115

(Business),

1-800-829-8374

, or

(Individual – Self-Employed/Business Owners)

1-800-829-0922

(Individuals – Wage Earners)

THANK YOU FOR YOUR COOPERATION

Catalog No. 21475H

2159

Form

(Rev. 1-2007)

Form 2159 - Payroll Deduction Agreement - Department Of The Treasury - 2007 Page 4

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