Form 843 - Rev. August 2011 - Claim for Refund and Request for Abatement

Sep 19, 2026

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Form 843 is used to claim a refund or request abatement for specific federal taxes and fees, excluding claims related to income taxes or certain employment tax categories. The form guides filers on when to use it, what types of taxes or fees qualify, and how to select reasons for interest, penalties, and additions to tax. It collects taxpayer and spouse identifying information, payment dates, related return references, and requires an explanation with computations and signatures under penalties of perjury.

LanguageEnglish

CategoryForms

FormatPDF

Pages1

AccessFree to download

Form 843 Overview

When to Use / When Not to Use

Tax or Fee and Penalty Information

Interest, Penalties, and Additions to Tax Reasons

Original Return Reference

Explanation and Signature

| Department of the Treasury Internal Revenue Service | Claim for Refund and Request for Abatement
▶ See separate instructions. | OMB No. 1545-0024 | | --- | --- | --- | Form 843 (Rev. August 2011) Use Form 843 if your claim or request involves: (a) a refund of one of the taxes (other than income taxes or an employer’s claim for FICA tax, RRTA tax, or income tax withholding) or a fee, shown on line 3, (b) an abatement of FUTA tax or certain excise taxes, or (c) a refund or abatement of interest, penalties, or additions to tax for one of the reasons shown on line 5a. Do not use Form 843 if your claim or request involves: (a) an overpayment of income taxes or an employer’s claim for FICA tax, RRTA tax, or income tax withholding (use the appropriate amended tax return), (b) a refund of excise taxes based on the nontaxable use or sale of fuels, or (c) an overpayment of excise taxes reported on Form(s) 11-C, 720, 730, or 2290. | Name(s)
Your name as it appears on your W-2 form | Your social security number
your SSN | | --- | --- | | Address (number, street, and room or suite no.)
Your local street address in the US | Spouse’s social security number | | City or town, state, and ZIP code
Your local city, state and zip code in the US | Employer identification number (EIN)
Box B -W2 | | Name and address shown on return if different from above | Daytime telephone number | | If your name and address on your tax return is different, put it here. Otherwise, leave this area blank. | local number | | 1 Period. Prepare a separate Form 843 for each tax period or fee year.
From 01/01/2011 to 12/31/2011 | 2 Amount to be refunded or abated:$ amount | 3 Type of tax or fee. Indicate the type of tax or fee to be refunded or abated or to which the interest, penalty, or addition to taxis related. ✔ Employment Estate Gift Excise Income Fee | 4 Type of penalty. If the claim or request involves a penalty, enter the Internal Revenue Code section on which the penalty is based (see instructions) . IRC section: | | | --- | --- | | 5a Interest, penalties, and additions to tax. Check the box that indicates your reason for the request for refund or abatement. (If none apply, go to line 6.) | | | Interest was assessed as a result of IRS errors or delays. | | | | A penalty or addition to tax was the result of erroneous written advice from the IRS.
Reasonable cause or other reason allowed under the law (other than erroneous written advice) can be shown for not assessing a penalty or addition to tax. | | b | Date(s) of payment(s)▶ | | 6 | Original return. Indicate the type of fee or return, if any, filed to which the tax, interest, penalty, or addition to tax relates. | | | 706 709 940 941 943 945 | | | 990-PF 1040 1120 4720 Other (specify) ▶ | | 7 Explanation. Explain why you believe this claim or request should be allowed and show the computation of the amount shown on line 2. If you need more space, attach additional sheets.
EXAMPLE: I am an Non-resident for tax purposes (I have been here for less than 5 calendar years) and am in (F-1 or J-1) student status. I worked with (CPT/OPT/Academic Training) authorization at XX company and while I worked there, they withheld Social Security taxes in the amount of $xx.xx and Medicare taxes in the amount of $xx.xx. According to IRS Pub. 519, I am not subject to Social Security and Medicare taxes. I have attached a letter from my company stating that they would not refund the taxes to me. I have attached my visa status and work documentation to provide my eligibility to work in the United States. I request a total refund of $xx.xx | | | Signature. If you are filing Form 843 to request a refund or abatement relating to a joint return, both you and your spouse must sign the claim. Claims filed by corporations must be signed by a corporate officer authorized to sign, and the officer’s title must be shown. | | Under penalties of perjury, I declare

FAQs

When should Form 843 be used?

Use Form 843 when the claim involves a refund of certain non-income taxes or fees, an abatement of FUTA or certain excise taxes, or a refund/abatement of interest, penalties, or additions to tax for specified reasons.

When should Form 843 NOT be used?

Do not use it for overpayments of income taxes or certain employment tax claims (FICA/RRTA/income tax withholding), for refunds of excise taxes based on non-taxable use or sale of fuels, or for overpayment of excise taxes reported on specified forms.

What information must be provided to explain the claim?

Explain why the claim should be allowed and show the computation for the amount on line 2. If additional space is needed, attach extra sheets.

Sep 19, 2026

Upload by Violet