Fillable Form 843

What is Form 843?

Form 843, Claim for Refund and Request for Abatement, is used by taxpayers in the United States to claim a refund or request an abatement of certain taxes, interest, penalties, fees, and additions to tax. Form 843 can be used to request the following:

• A refund of tax, other than a tax for which a different form must be used
• An abatement of tax, other than income, estate, or gift tax
• A refund to an employee of excess social security, Medicare, or Railroad Retirement Tax Act (RRTA) tax withheld by any one employer, but only if the taxpayer’s employer will not adjust the overcollection
• A refund to an employee of social security or Medicare taxes that were withheld in error, but only if the taxpayer’s employer will not adjust the overcollection
• A refund of excess tier 2 Railroad Retirement Tax Act (RRTA) tax when a taxpayer has had more than one railroad employer for the year and his or her total tier 2 RRTA tax withheld or paid for the year was more than the tier 2 limit
• A refund or abatement of interest, penalties, or additions to tax, caused by certain IRS errors or delays, or certain erroneous written advice from the IRS

How to fill out Form 843?

Taxpayers in the United States can download and print a PDF copy of IRS Form 843 from the Internal Revenue Service (IRS) website that they can manually complete. They can also fill out IRS Form 843 electronically on PDFRun.

To fill out the IRS Gov Form 843, you must provide the following information:

Name

Enter your full legal name along with the full legal name of your spouse if you are both filing for a joint return.

Your social security number (SSN)

Enter your social security number (SSN).

Spouse’s social security number (SSN)

Enter the social security number (SSN) of your spouse.

Employer identification number (EIN)

Enter your employer identification number (EIN).

Address

Enter your residential or home address.

Number

Enter your number.

Street

Enter your street.

Room Number or Suite Number

Enter your room number or suite number.

City or Town

Enter your city or town.

State

Enter your state.

ZIP Code

Enter your ZIP code.

Name and address shown on return

Enter your full legal name and residential or home address if they are different from the information you have entered above.

Daytime telephone number

Enter your daytime telephone number.

Line 1. Period

Enter the tax period or fee year for your tax return.

From

Enter the starting date of your tax period or fee year.

To

Enter the ending date of your tax period or fee year.

Line 2. Amount to be refunded or rebated

Enter the amount that will be refunded or rebated in U.S. dollars.

Line 3. Type of tax or fee

Mark the appropriate box which corresponds to the type of tax or fee that will be refunded or abated or to which the interest, penalty, or addition to tax is related. You may select:

• Employment
• Estate
• Gift
• Excise
• Income
• Fee

Line 4. Type of penalty

If this IRS 843 Form claim or request involves a penalty, enter its type.

Internal Revenue Code (IRC) Section

Enter the Internal Revenue Code (IRC) section on which the penalty involved in this IRS 843 Form claim or request is based.

Line 5a. Interest, penalties, and additions to tax

Mark the box which corresponds to the reason you have requested a claim for refund or abatement. If your reason is not stated in the choices, proceed directly to line 6. You may select:

• Interest was assessed as a result of Internal Revenue Service (IRS) errors or delays
• A penalty or additions to tax was the result of erroneous written advice from the Internal Revenue Service (IRS)
• Reasonable cause of other reason allowed under the law other than erroneous written advice can be shown for not assessing a penalty or addition to tax

Line 5b. Dates of payments

Enter all of the dates of your payments regarding interests, penalties, and additions to your tax.

Line 6. Original return

Mark the appropriate box which corresponds to the type of fee or return you are filing which relates to your tax, interest, penalty, or additions. You may select:

• Form 706, United States Estate (and Generation-Skipping Transfer) Tax Return
• Form 709, United States Gift (and Generation-Skipping Transfer) Tax Return
• Form 940, Employer's Annual Federal Unemployment (FUTA) Tax Return
• Form 941, Employer's Quarterly Federal Tax Return
• Form 943, Employer's Annual Federal Tax Return for Agricultural Employees
• Form 945, Annual Return of Withheld Federal Income Tax
• Form 990-PF, Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation
• Form 1040, U.S. Individual Income Tax Return
• Form 1120, U.S. Corporation Income Tax Return
• Form 4720, Return of Certain Excise Taxes Under Chapters 41 and 42 of the Internal Revenue Code
• Other - Specify the name of the type of fee or return which relates to your tax, interest, penalty, or additions.

Line 7. Explanation

Enter your explanation about why you believe this claim or request should be allowed. Then, show the computation of the amount you have entered in line 2 of this 843 IRS Form. If you are in need of more space for your computation, you may attach additional sheets.

Signature

Both you and your spouse must sign this 843 IRS form if you are filing to request a refund or abatement relating to a joint return. Any claim or request filed by a corporation must be signed by a corporate officer authorized to affix his or her signature. Furthermore, the title of the authorized corporate officer must be entered in this form.

Signature

Affix your signature. If you are filing a claim or request under a corporation, an authorized corporate officer must be the one to affix his or her signature.

Title

Enter your title if you are an authorized corporate officer filing a claim or request under a corporation.

Date

Enter the current date of signing.

Signature of spouse

Have your spouse affix his or her signature if you are both filing for a joint return.

Date

Enter the current date of signing.

Paid Preparer Use Only

Preparer’s Name

Enter your preparer’s full legal name.

Preparer’s Signature

Have your preparer affix his or her signature.

Date

Enter the current date.

Self-employed

Mark the box if your preparer is self-employed; otherwise, leave it blank.

Preparer Tax Identification Number (PTIN)

Enter the preparer tax identification number (PTIN) of your preparer.

Firm’s Name

Enter the name of your preparer’s firm.

Firm’s Address

Enter the address of your preparer’s firm.

Firm’s Employer Identification Number (EIN)

Enter the firm’s employer identification number (EIN).

Phone Number

Enter the phone number of the firm.