Instructions For Form 843 - Claim For Refund And Request For Abatement

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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 on page 2 of
the Instructions for Form 843 (Rev. December 2013). The address to mail
Form 843 in this case is:
Internal Revenue Service
Mail Stop
4921 IPF
1973 N. Rulon White Blvd.
Ogden, UT 84404
The above address is effective
ONLY
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…
The address shown in the notice.
In response to an IRS notice regarding
a tax or fee related to certain taxes
such as income, employment, gift,
estate, excise, etc.
The service center where you would
For penalties, or for any other reason
be required to file a current year tax
other than an IRS notice (see above)
return for the tax to which your claim
or Letter 4658 or 5067C (see below)
or request relates. See the instructions
for the return you are filing.
Internal Revenue Service
In response to Letter 4658 (Notice
Mail Stop
4921 BPDF
of Branded Prescription Drug Fee)
1973 N. Rulon White Blvd.
Ogden, UT 84404
Note. To ensure proper
processing, write "Branded
Caution. Use this address only
Prescription Drug Fee" across the
if you are claiming a refund of
top of Form 843.
the branded prescription drug
fee.
 
 

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