Fillable Form 911 - Application For Taxpayer Assistance Order (Atao) (Page 2 of 3) in pdf

(For Internal Revenue Service only)

Section III.

Taxpayer Name

Taxpayer Identification Number (TIN)

Name of Initiating Employee

Employee Telephone Number

Operating Division or Function

Office

How Identified & Received

)

IRS Received Date

(Check the appropriate box

IRS Function Identified Issue as Meeting TAS Criteria

❑ (r) Functional referral (Functional area identified TP/Rep issue as meeting TAS criteria)

❑ (x) Congressional correspondence/inquiry not addressed to TAS but referred for TAS handling

Taxpayer or Representative Requested TAS Assistance

❑ (c) Taxpayer or representative filed Form 911 or sent other correspondence to TAS

❑ (n) Taxpayer or representative called into a National Taxpayer Advocate (NTA) Toll-Free site

❑ (p) Taxpayer or representative called TAS (other than NTA Toll-Free)

❑ (s) Functional referral (Taxpayer or representative specifically requested TAS assistance)

❑ (w) Taxpayer or representative sought TAS assistance in a TAS walk-in area

❑ (y) Congressional corresp/inquiry addressed to TAS or any Congressional specifically requesting TAS assistance

TAS Criteria

(Check the appropriate box)

❑ (1) Taxpayer is suffering or about to suffer a significant hardship

❑ (2) Taxpayer is facing an immediate threat of adverse action

❑ (3) Taxpayer will incur significant costs, including fees for professional representation, if relief is not granted

❑ (4) Taxpayer will suffer irreparable injury or long-term adverse impact if relief is not granted

❑ (5) Taxpayer experienced an IRS delay of more than 30 calendar days in resolving an account-related problem or inquiry

❑ (6) Taxpayer did not receive a response or resolution to their problem by the date promised

❑ (7) A system or procedure has either failed to operate as intended or failed to resolve a taxpayer problem or dispute with the IRS

❑ (8) Congressional Duplicate of any criteria or non-criteria case already in TAS or on TAMIS

❑ (9) Any issue/problem not meeting the above TAS criteria but kept in TAS for handling and resolution

Initiating Employee: What actions did you take to help resolve the problem?

Initiating Employee: State reason(s) why relief was not provided.

Section III Instructions (For Internal Revenue Service only)

Enter your name.

Enter your telephone number.

Enter your function (i.e.; ACS, Collection, Examination, Customer Service, etc.). If you are now part of one of the new Business Operating Divisions

(Wage & Investment Income, Small Business/Self-Employed, Large/Mid-Size Business, Tax-Exempt/Govt Entity), enter the name of the division.

Enter the number/Organization Code for your office. (e.g.; 18 for AUSC, 95 for Los Angeles).

Check the appropriate box that best reflects how the taxpayer informed us of the problem. For example, did TP call or write an IRS function or TAS?

Did TP specifically request TAS assistance/handling or did the function identify the issue as meeting TAS criteria?

The IRS Received Date is the date TP/Rep first informed the IRS of the problem. Enter the date the TP/Rep first called, walked in or wrote the IRS to

seek assistance with getting the problem resolved.

Check the box that best describes the reason/justification for Taxpayer Advocate Service (TAS) assistance and handling.

Indicate the actions you took to help resolve taxpayer's problem.

State the reason(s) that prevented you from resolving taxpayer's problem and from providing relief. For example, levy proceeds cannot be returned

since they were already applied to a valid liability; an overpayment cannot be refunded since the refund statute expired; or current law precludes a

specific interest abatement.

(For Taxpayer Advocate Service only)

Section IV.

1. TAMIS CF#

2. BOD/Client

3. How Recd Code

4. Criteria Code

5. IRS Recd Date

6. TAS Recd Date

7. Reopen Ind

8. Func/Unit Assigned

9. Employee Assigned

10. Major Issue Code

11. ATAO Code/Subcode

12. PSD Code

13. Special Case Code

14. Complexity Code

15. Outreach

16. Local Use Code

17. Relief Date

18. TAS Clsd Date

ÿ TP __|__|__|__|__|

ÿ Case __|

19. Cust Satisfact Cde

20. Root Cause Code

Hardship

Taxpayer Advocate Signature

Date

Yes

911

Form

(Rev. 3-2000)

Cat. No. 16965S

Form 911 - Application For Taxpayer Assistance Order (Atao) Page 2

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