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Treasury  \nnternal Revenue Service  \nCheck the box below that indicates your reason for filing Form 843.  \n# Tax\n\n□Abatement or refund of tax other than income,estate,or gift tax  \n□ Abatement or refund of tax that can't be claimed on any form except Form 843  \n□ Refund to employee of excess social security,Medicare,or RRTA tax witheld by any one employer,but only if your employer willnot adjust the overcollection  \n□ Refund to employee of excess tier 2 RRTA tax when,for the year,you had more than one rairoad employer and your total tier2RRTA tax withheld or paid exceeds the tier 2 limit  \n□ Refund to employee of social security,Medicare,or RRTA tax withheld in error,but only if your employer will not adjust theovercollection  \n□ Abatement or refund of tier 1 RRTA tax for an employee representative  \n# Penalty\n\n□ Abatement or refund of a penalty or addition to tax due to reasonable cause or other reason allowed under the law  \n□ Abatement or refund of penalty imposed under section 6672 for failure to collect and pay over tax,or attempt to evade or defeattax(Trust Fund Recovery Penalty)  \n□Refund of penalty imposed under section 6695A for misstatements due to incorect appraisals  \n□ Refund of penalty imposed under section 6715 for misuse of dyed fuel  \n□ Abatement or refund under section 6404(f)of a penalty or addition to tax attributable to erroneous written advice by the IRS  \n# Interest\n\n□ Abatement or refund of interest due to IRS error or delay under section 6404(e)(1)  \n□ Request for net interest rate of zero under Rev.Proc.2000-26  \nOther  \n□ Abatement or refund of assessed penalties,interest,or aditions to tax because you were unable to read and timely respond to astandard print notice from the IRS  \n□ Refund of branded prescription drug fee  \n□ Refund of annual fee on health insurance providers  \n□ Other(specify)                                            \nCAUTION:Do not use Form 843when you must use a different tax form.For example,do not use Form 843 to claim a refund orabatement of an overpayment of income taxes or an employer's claim for FICA tax,RRTA tax,or income tax witholding;a refund ofexcise taxes based on the nontaxable use or sale of fuels;or an overpayment of excise taxes reported on Form(s)11-C,720,730,or  \n2290.Aso,do not use Form 843 to claim a refund of tax return preparer or promoter penalties.Se instructions for the forms to use.  \n\n| Name of person requesting the refund or abatement (see instructions)   |  |  |  | Social security number (SSN)   |  |\n| --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |\n| Name of spouse if filing Form 843 relating to a joint return(see instructions)   |  |  |  | Spouse's social security number(SSN)   |  |\n|  |  |  |  |  |  |\n| Address (number and street or P.O.box if mail is not delivered to street address)   |  |  |  |  | Apt.,room,or suite no.   |\n|  |  |  |  |  |  |\n| City,town,or post office.If you have a foreign address,also complete spaces below.   |  | State   | ZIP code   |  | Employer ID number(EIN)   |\n|  |  |  |  |  |  |\n| Foreign country name   | Foreign province/state/county   |  |  |  | Foreign postal code   |\n|  |  |  |  |  |  |\n| Name and address shown on return if different from above   |  |  |  |  | Daytime telephone number   |\n|  |  |  |  |  |  |\n\n1 Enter the tax period or fee year.Prepare a separate Form 843 for each tax period or fee year.  \nBeginning date(MM/DD/YYYY)         Ending date(MM/DD/YYYY)           \n2 Amount to be refunded or abated.$                    \n3 Date(s)of payment(s)for which you are requesting a refund(MM/DD/YYYY).If you need more space,attach additional sheets.  \nd_          \ne_            \nh         \n4 Check the box(es)with the type of tax or fee for which you are asking a refund or abatement.Or check the box(es)with ","cbCaidHIVcGBzMc3","https://ap.wps.com/l/cbCaidHIVcGBzMc3","pdf",112273,"English","# Tax\n## Penalty\n## Interest\n# Request details\n## Tax period and amounts\n## Reason for refund/abatement\n## Explanation and computation","[{\"question\":\"When can you use IRS Form 843 for a refund or abatement?\",\"answer\":\"Use Form 843 to request an abatement or refund of specific taxes other than income, estate, or gift tax, as well as certain penalties, additions to tax, and interest that fit the form’s listed categories. The instructions warn against using Form 843 for items that must be claimed on other specific forms.\"},{\"question\":\"What information does Form 843 require from the claimant?\",\"answer\":\"The form collects the person requesting the refund/abatement, including SSN, spouse information if applicable, address, city/state/ZIP, employer EIN, foreign address fields if needed, and daytime telephone number. It also requires tax period or fee year dates and the refund or abatement amount.\"},{\"question\":\"What must you provide in the explanation section?\",\"answer\":\"You must explain why the claim or request should be allowed and show how the amount on line 2 was computed. If more space is needed, additional sheets should be attached.\"}]","Claim for Refund and Request for Abatement - Form 843 | PDF",1789804283]