Looking for a Form 843 Templates? Download it for free!

Instructions For Form 843 (Rev. December 2013) (For Use With Form 843 (Rev. August 2011)) - Claim For Refund And Request For Abatement

Note: Instructions for Form 843 (Rev. December 2013) begins on the

next page.

Effective August 28, 2014, if you are filing Form 843 in response to Letter 5067C

(Annual Fee on Health Insurance Providers Final fee), note that the following address is

being added to the Where To File table in the Instructions for Form 843 (Rev.

December 2013). The address to mail Form 843 in this case is:

Internal Revenue Service

4921 IPF

Mailstop

1973 Rulon White Blvd.

Ogden, UT 84201

ONLY

The above address is effective

if you are filing Form 843 in

response to Letter 5067C (Annual Fee on Health Insurance Providers Final Fee).

Please see the modifications to the Where to File Table below.

Where To File

IF you are filing Form 843...

THEN mail the form to...

In response to an IRS notice

The address shown in the notice.

regarding a tax or fee related to

certain taxes such as income,

employment, gift, estate, excise,

etc.

For penalties, or for any other

The service center where you

reason other than an IRS notice

would be required to a file a

(see above) or Letter 4658 or

current year tax return for the tax

5067C (see below)

to which your claim or request

relates. See the instructions for

the return you are filing.

In response to Letter 4658 (Notice

Internal Revenue Service

4921 BPDF

of Branded Prescription Drug Fee)

Mail Stop

1973 Rulon White Blvd.

Note. To ensure proper

Ogden, UT 84201

processing, write “Branded

Caution. Use this address only if

Prescription Drug Fee” across the

top of Form 843.

you are claiming a refund of the

branded prescription drug fee.

In response to Letter 5067C

Internal Revenue Service

4921 IPF

(Annual Fee on Health Insurance

Mail Stop

Providers Final Fee)

1973 Rulon White Blvd.

Ogden, UT 84201

Note. To ensure proper

Caution. Use this address only if

processing, write “Annual Fee on

Health Insurance Providers Final

you are claiming a refund of the

Fee” across the top of Form 843.

health insurance provider fee.

The service center where you filed

For requests of a net interest rate

your most recent return.

of zero

This change will be reflected in the next revision of the Instructions for Form 843.

Instructions For Form 843 (Rev. December 2013) (For Use With Form 843 (Rev. August 2011)) - Claim For Refund And Request For Abatement

Related Articles

Related forms

Related Categories