Irs Complaint Form (Page 2 of 3) in pdf

Irs Complaint Form Page 2

4. What is the preferred method for us to contact you about this complaint?

Telephone

E-mail

Fax

U.S. Mail

5. Do you need special accommodations for us to communicate with you about this complaint?

(Check all that apply.)

Braille

TDD/TTY

Large Print

E-mail

Foreign language interpreter (specify language

6. To your best recollection, on what date(s) did the alleged discrimination take place?

7. Complaints of discrimination must generally be filed within 180 days of the alleged incident. If

the most recent date was more than 180 days ago, you may request a waiver of the time filing

requirement. If you wish to request a waiver, please explain why you were unable to file your

complaint within 180 days of the alleged incident.

8. Please explain, with as much detail as possible, what happened, who was involved, why you

believe it happened, and how you were discriminated against. If possible, be sure to include an

explanation of how you were treated differently from other persons.

9. The IRS, Low Income Tax Clinic (LITC) employees, Volunteer Income Tax Assistance

(VITA) and Tax Counseling for the Elderly (TCE) volunteers, may not retaliate against any

person who has made a complaint, testified, assisted or participated in any manner in any

investigation or proceeding under the statutes, executive orders, and regulations governing

federal programs. If you believe that an IRS or LITC employee, or a VITA or TCE volunteer,

has retaliated against you for filing a complaint of discrimination, please explain below.

Irs Complaint Form Page 2