Fillable Form 911 - Application For Taxpayer Assistance Order (Atao) (Page 3 of 3) in pdf

Instructions

When to use this form:

Use this form to request relief if any of the following apply to you:

You are suffering or about to suffer a significant hardship;

You are facing an immediate threat of adverse action;

You will incur significant costs, including fees for professional representation, if relief is not granted;

You will suffer irreparable injury or long-term adverse impact if relief is not granted;

You experienced an IRS delay of more than 30 calendar days in resolving an account-related problem or inquiry;

You did not receive a response or resolution to your problem by the date promised;

A system or procedure has either failed to operate as intended or failed to resolve your problem or dispute with the IRS.

If an IRS office will not grant the relief requested or will not grant the relief in time to avoid the significant hardship, you may submit this form. No

enforcement action will be taken while we are reviewing your application.

Where to Submit This Form:

Submit this application to the Taxpayer Advocate office located in the state or city where you reside. For the address

of the Taxpayer Advocate in your state or city or for additional information call the National Taxpayer Advocate Toll-Free Number 1-877-777-4778.

Third Party Contact:

You should understand that in order to respond to this request you are also authorizing the Taxpayer Advocate Service to

contact third parties when necessary and that you will not receive further notice regarding contacted parties. See IRC 7602(c).

Overseas Taxpayers:

Taxpayers residing overseas can submit this application by mail to the Taxpayer Advocate, Internal Revenue Service,

PO Box 193479, San Juan, Puerto Rico 00919 or in person at 2 Ponce de Leon Avenue, Mercantil Plaza Building, Room GF05A, Hato Rey PR 00918. The

application can also be faxed to (787) 759-4535.

Caution:

Incomplete applications or applications submitted to an Advocate office outside of your geographical location may result in delays. If you do not

hear from us within one week of submitting Form 911, please contact the Taxpayer Advocate office where you originally submitted your application.

Section I Instructions--Taxpayer Information

Enter your name(s) as shown on the tax return that relates to this application for relief.

Enter your current mailing address, including street number and name and apartment number.

Enter your city, town or post office, state and ZIP code.

Enter your Social Security Number.

Enter the Social Security Number of your spouse if this application relates to a jointly filed return.

Enter the number of the Federal tax return or form that relates to this application. For example, an individual taxpayer with an income tax issue

would enter Form 1040.

Enter the quarterly, annual or other tax period that relates to this application. For example, if this request involves an income tax issue, enter the

calendar or fiscal year; if an employment tax issue, enter the calendar quarter.

Enter your Employer Identification Number if this relief request involves a business or non-individual entity (e.g.; a partnership, corporation, trust,

self-employed individual with employees).

Enter your E-mail address.

10.

Enter your fax number including the area code.

11.

Enter the name of the individual we should contact. For partnerships, corporations, trusts, etc., enter the name of the individual authorized to act

on the entity's behalf.

12.

Enter your daytime telephone number including the area code.

13.

Indicate the best time to call you. Please specify a.m. or p.m. hours.

14.

Describe the problem and the significant hardship it is creating for you. Specify the actions that the IRS has taken (or not taken) to cause the

problem and ensuing hardship. If the problem involves an IRS delay of more than 30 days in resolving your issue, indicate the date you

first contacted the IRS for assistance in resolving your problem.

15.

Describe the relief you are seeking. Specify the actions that you want taken and that you believe necessary to relieve the significant hardship.

Furnish if applicable any relevant proof and corroboration as to why relief is warranted or why you cannot or should not meet current IRS demands

to satisfy your tax obligations.

16.&18. If this application is a joint relief request relating to a joint tax liability, both spouses should sign in the appropriate blocks. If only one spouse is

requesting relief relating to a joint tax liability, only the requesting spouse has to sign the application. If this application is being submitted for

another individual, only a person authorized and empowered to act on that individual's behalf should sign the application.

NOTE: The signing of this application allows the IRS by law to suspend, for the period of time it takes the Advocate to review and decide upon

your request, any applicable statutory periods of limitation relating to the assessment or collection of taxes..

17.&19. Enter the date the application was signed.

Section II Instructions--Representative Information

Taxpayers:

If you wish to have a representative act on your behalf, you must give him/her power of attorney or tax information authorization for the tax

return(s) and period(s)involved. For additional information see Form 2848, Power of Attorney and Declaration of Representative or Form 8821, Tax

Information Authorization, and the accompanying instructions.

Representatives:

If you are an authorized representative submitting this request on behalf of the taxpayer identified in Section I, complete Blocks 1

through 7 of Section II. Attach a copy of Form 2848, Form 8821 or other power of attorney. Enter your Centralized Authorization File (CAF) number in Block

3 of Section II. The CAF number is the unique number that the IRS assigns to a representative after Form 2848 or Form 8821 is filed with an IRS office.

Paperwork Reduction Act Notice:

We ask for the information on this form to carry out the Internal Revenue laws of the United States. Your

response is voluntary. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form

displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material

in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103.

Although the time needed to complete this form may vary depending on individual circumstances, the estimated average time is 30 minutes. Should you

have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, please write to the Internal Revenue Service,

Attention: Tax Forms Committee, Western Area Distribution Center, Rancho Cordova, CA 95743-0001.

911

Form

(Rev. 3-2000)

Cat. No. 16965S