Form 8546 - Claim For Reimbursement Of Bank Charges Page 2

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Please complete all blocks. Write "NONE" if the block does not apply.
Use this form only for reimbursement of bank charges for:
check, or DDIA processing error on the part of the Service,
1. an erroneous levy, or
3. records showing that the bank charges have been paid.
2. stopping payment on a check that the IRS lost or misplaced.
3. Direct Debit Installment Agreement (DDIA) processing error
Records to support your claim must include bank statements and
on the part of the Service.
The claimant must sign this form. However, an authorized agent
If you have any questions about this claim, please contact the IRS
or legal representative can file and sign the claim if the claimant
office that issued the levy or requested replacement of your
can't because of disability, death, or other acceptable reason.
check. The address is on your copy of the levy or the request for
Include proof of authorization if the claim is being filed on behalf
a new check. If your questions relate to a Direct Debit Installment
of someone.
Agreement, please contact the IRS at 1-800-829-1040 or mail your
questions to the address that you used to file your tax return.
Claims must be made within one year of the date the claim
accrues and are limited to $1,000. (See 31 USC 3723)
If IRS approves your claim, the money can be sent to your bank by
electronic funds transfer
, or we can send you a check.
Please attach verification of the amount you are claiming. Include
Payment by EFT will be faster, safer, and more convenient for you.
any documentation you may have explaining or acknowledging
If you want us to pay your claim by EFT, we need the bank
the IRS error. Also, include:
information in items 6 through 10. The American Bankers
is the first nine digits in the
(item 7)
1. a copy of the levy (if the charges were caused by an
number at the bottom of your checks. If you have no checking
erroneous levy),
account, ask your bank what its ABA number is. If you do not
2. records showing the bank charges caused by the erroneous
complete items 6 through 10, a check will be sent to you.
levy, the request for replacement of a lost or misplaced
Internal Revenue Policy P-5-39
Reimbursement of Bank Charges Due to Erroneous Levy and Service Loss or Misplacement of Taxpayer
Checks, or Direct Debit Installment Agreement Processing Errors.
The Service recognizes that there are circumstances when an
(3) Prior to the levy, the taxpayer did not refuse (either orally or
in writing) to timely respond to Service inquiries or provide infor-
erroneous use of its unique enforcement powers may cause tax-
payers to incur certain bank charges. Taxpayers who incur bank
mation relevant to the liability for which the levy was made.
charges due to an erroneous levy or a Direct Debit Installment
Agreement (DDIA) processing error on the part of the Service
The following criteria must be present in all lost check cases:
(1) The Service acknowledges it lost or misplaced the check
may file a claim for reimbursement of those expenses. Bank
charges include a financial institution's customary charge for
during processing;
complying with the levy instructions as well as charges for
(2) the Service asks the taxpayer for a replacement of the pay-
ment; and
overdrafts that are a direct consequence of an erroneous levy or
DDIA processing error on the part of the Service. In addition,
(3) the Service is satisfied that the replacement payment has
there are times when a taxpayer's check may be lost or
been received.
misplaced in processing. When the Service asks for a
replacement check, the taxpayer maybe reimbursed for bank
The following criteria must be present in all DDIA processing
charges incurred in stopping payment on the original check. The
error cases.
(1) The Service failed to act timely, took an incorrect or
charges must have been paid by the taxpayer and must not have
been waived or reimbursed by the financial institution. Claims
improper action, or a systemic failure caused the bank fees;
must be filed with the District Director or Service Center Director
within one year after accrual of the expense.
(2) The taxpayer must not have contributed to the continuation
or compounding of the error that caused the bank fees; and
The following criteria must be present in all erroneous levy
(3) Prior to the processing error, the taxpayer did not refuse
(either orally or in writing) to timely respond to the Service’s
(1) The Service acknowledges the levy was erroneous;
(2) The taxpayers must not have contributed to the continuation
inquiries or provide sufficient information for the DDIA processing
or compounding of the error; and
change to be made.
In compliance with the Privacy Act of 1974, the following is provided.
claim. We may disclose the information on this form relevant to
Solicitation of the information is authorized by Title 31 USC
3723; 31 CFR 3.20 et seq. Disclosure of the information is
the processing of your claim or to any court proceedings resulting
from your claim. We may give the information to the Department
of Justice for the purpose of seeking legal advice or recommend-
The principal purpose of this information will be for our internal
ing prosecutions for fraudulent claims or the making of false
use in processing your claim under 31 USC 3723, or for any
court proceedings which may ensue from the filing of this
(Rev. 7-2011)


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