Fillable Form 2159 - Payroll Deduction Agreement (Page 4 of 6) in pdf

Form 2159 - Payroll Deduction Agreement Page 4

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INSTRUCTIONS TO EMPLOYER

This payroll deduction agreement is subject to 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 all parts of the form,

please return the parts of the form which were requested on the letter the

employee received with the form. Use the IRS address on the letter the employee

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), or

1-800-829-8374 (Individual – Self-Employed/Business Owners), or

1-800-829-0922 (Individuals – Wage Earners)

THANK YOU FOR YOUR COOPERATION

2159

Form

(Rev. 1-2015)

Catalog No. 21475H

Form 2159 - Payroll Deduction Agreement Page 4

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