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You can use Form 843 to request a refund or an

On line 7, provide all of the following information.

abatement of interest, penalties, and additions to tax

1. The tax periods for which you overpaid and underpaid

that relate to your income tax return. However, you

your tax liability. A separate Form 843 is not required for each

CAUTION

cannot use Form 843 to request a refund or an abatement of

separate taxable period involved in the request.

income tax. If you are an employer, you cannot use it to request

2. When you paid the tax if the underpayment is no longer

abatement of FICA tax, RRTA tax, or income tax withholding.

outstanding.

3. When you received your tax refund if the overpayment is

Check the box labeled “Other” if your claim relates to:

no longer outstanding.

Form 944, Employer's Annual Federal Tax Return. Enter “944”

(or “944-SS”) in the space provided.

4. The period(s) that your overpayment and underpayment

Form CT-2, Employee Representative's Quarterly Railroad

overlapped and the overlapping amount. You should provide any

Tax Return. Enter “CT-2” in the space provided.

background material (such as copies of examination reports,

notices, or prior interest computations provided by the IRS)

The branded prescription drug fee. Enter “BPD Fee” in the

space provided.

relating to the overpayment and underpayment.

Line 7

5. A computation, to the extent possible, of the amount of

interest to be credited, refunded, or abated. If you are unable to

Explain in detail your reasons for filing this claim and show your

provide a computation, provide an explanation of why you are

computation for the credit, refund, or abatement. If you attach an

unable to provide the computation. The computation generally

additional sheet(s), include your name and SSN or employer

should be made by applying section 6621(d) to reduce your

identification number (EIN) on it. Also attach appropriate

underpayment interest payable to the IRS. However, if only the

supporting evidence. Include a statement that to the extent of

period of limitation for claiming additional overpayment interest

equivalent amounts of underpayment and overpayment for the

is open on the date you file Form 843, you should make the

period(s) identified and established, the period(s) has (have)

computation by applying section 6621(d) to increase your

been used only once in a request to obtain the net interest rate

overpayment interest payable by the IRS.

of zero under section 6621(d).

6. Section 6621(d) provides for a net interest rate of zero to

the extent of the overlapping underpayment and overpayment of

Refund of excess social security taxes. If you are claiming a

the same taxpayer. If your claim involves more than one tax

refund of excess social security or RRTA tax withheld by one

identification number (TIN), explain why the different TINs can

employer, you must, if possible, attach a statement from the

be treated as the same taxpayer.

employer. The statement should indicate the following.

The amount, if any, the employer has repaid or reimbursed

you for excess taxes withheld.

Privacy Act and Paperwork Reduction Act Notice. We ask

The amount, if any, of credit or refund claimed by the

for the information on this form to carry out the Internal Revenue

employer or authorized by you to be claimed by the employer.

laws of the United States. Sections 6402 and 6404 state the

The employer should include in the statement the fact that it is

conditions under which you may file a claim for refund and

made in support of your claim for refund of employee tax paid by

request for abatement of certain taxes, penalties, and interest.

the employer to the IRS.

Form 843 may be used to file your claim. Section 6109 requires

that you disclose your taxpayer identification number (TIN).

If you cannot obtain a statement from the employer, you

Routine uses of this information include giving it to the

should attach a statement with the same information to the best

Department of Justice for civil or criminal litigation and to cities,

of your knowledge and belief and include in the statement an

states, the District of Columbia, and U.S. commonwealths and

explanation of why you could not obtain a statement from the

possessions for use in administering their tax laws. We may also

employer. Attach a copy of your Form W-2 to prove the amount

give this information to Federal and state agencies to enforce

of social security or RRTA taxes withheld.

Federal nontax criminal laws and to combat terrorism. You are

Refund of social security and Medicare tax withheld in er-

not required to claim a refund or request an abatement;

ror. The same supporting evidence described above must be

however, if you choose to do so you are required to provide the

provided. If you are a nonresident alien, see Pub. 519 for

information requested on this form. Failure to provide all of the

additional information.

requested information may delay or prevent processing your

claim or request; providing false or fraudulent information may

Requesting Net Interest Rate of Zero

subject you to civil or criminal penalties.

on Overlapping Tax Underpayments

You are not required to provide the information requested on

and Overpayments

a form that is subject to the Paperwork Reduction Act unless the

form displays a valid OMB control number. Books or records

If you have paid or are liable for interest on a tax underpayment

relating to a form or its instructions must be retained as long as

and have received or are due interest on a tax overpayment for

their contents may become material in the administration of any

the same period of time, you can request that the IRS compute

Internal Revenue law. Generally, tax returns and return

the interest using the net interest rate of zero.

information are confidential, as required by section 6103.

How To Request a Net Interest Rate of Zero

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated average

You can request a net interest rate of zero by writing on top of

time is:

Form 843 “Request for Net Interest Rate of Zero under Rev.

Proc. 2000-26.” You must provide documentation to substantiate

that you are the taxpayer entitled to receive the interest due on

Recordkeeping

26 min.

. . . . . . . . . . . . . . . . . . . . .

the overpayment.

Learning about the law or the form

20 min.

. . . . . .

Preparing the form

28 min.

Leave line 1 blank. You can enter a dollar amount on line 2 or

. . . . . . . . . . . . . . . . . .

leave it blank. Complete line 3 to indicate the type of tax. More

Copying, assembling, and sending the form

than one box can be checked. Do not complete lines 4 and 5.

to the IRS

20 min.

. . . . . . . . . . . . . . . . . . . . . . . . .

Complete line 6 to indicate the type of return filed. More than one

box can be checked.

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Instructions for Form 843 (Rev. December 2013)

Instructions For Form 843 (Rev. December 2013) (For Use With Form 843 (Rev. August 2011)) - Claim For Refund And Request For Abatement Page 5

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