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Department of the Treasury
Internal Revenue Service
Instructions for Form 843

(Rev. December 2021)

(For use with Form 843 (Rev. August 2011))
Claim for Refund and Request for Abatement

Section references are to the Internal Revenue Code unless • A refund or abatement of a penalty or addition to tax due to
otherwise noted. reasonable cause or other reason (other than erroneous written
advice provided by the IRS) allowed under the law. (This
includes a request for an abatement or refund of the section
General Instructions 6676 penalty for an erroneous claim for refund, where the claim
was due to a reasonable cause. The penalty is assessed at 20%
Future Developments of the amount determined to be excessive.)
For the latest information about developments related to Form • A refund of the penalty imposed under section 6715 for
843 and its instructions, such as legislation enacted after they misuse of dyed fuel.
were published, go to IRS.gov/Form843. • A refund or abatement of tier 1 RRTA tax for an employee
representative.
What’s New • A refund of a branded prescription drug fee.
Penalty for erroneous claim for refund. The information If you received an IRS notice notifying you of a change
under what had been Penalty for Erroneous Claim for Refund TIP to an item on your tax return, or that you owe interest, a
has been moved to a parenthetical in a bullet under Use Form penalty, or addition to tax, follow the instructions on the
843 to claim or request the following. notice. You may not have to file Form 843.
Purpose of Form Do not use Form 843 when you must use a different tax
Use Form 843 to claim a refund or request an abatement of form.
certain taxes, interest, penalties, fees, and additions to tax. • Use Form 1040-X, Amended U.S. Individual Income Tax
Return, to change any amounts reported on Form 1040,
Note. If you are filing Form 843 to claim a refund of the branded 1040-SR, 1040A, 1040EZ, 1040-NR, or 1040-NR-EZ, to change
prescription drug fee, please write “Branded Prescription Drug amounts previously adjusted by the IRS, or to make certain
Fee” across the top of Form 843. elections after the prescribed deadline (see Regulations
sections 301.9100-1 through -3).
Do not use Form 843 to request an abatement of Use Form 1040-X and attach a corrected Form 8959,
•
! income, estate, or gift taxes. Do not use Form 843 to Additional Medicare Tax, to correct your liability for Additional
CAUTION request a refund of income tax or Additional Medicare
Medicare Tax. If your Medicare wages, RRTA compensation, or
Tax. Employers cannot use Form 843 to request a refund or self-employment income is adjusted, you may need to correct
abatement of Federal Insurance Contributions Act (FICA) tax, your liability, if any, for Additional Medicare Tax.
Railroad Retirement Tax Act (RRTA) tax, or income tax Use Form 8379, Injured Spouse Allocation, to claim your
withholding. Also, do not use Form 843 to amend a previously •
portion of a joint refund used to offset your spouse's past due
filed income or employment tax return. Do not use Form 843 to obligations.
claim a refund of agreement fees, offer-in-compromise fees, or Individuals, estates, and trusts, filing within 1 year after the
lien fees. •
end of the year in which a claim of right adjustment under
Use Form 843 to claim or request the following. section 1341(b)(1), a net operating loss (NOL), a general
• A refund of tax, other than a tax for which a different form business credit, or net section 1256 contracts loss arose, can
use Form 1045, Application for Tentative Refund, to apply for a
must be used. (See Do not use Form 843 when you must use a
“quick refund” resulting from any overpayment of tax due to the
different tax form next.)
claim of right adjustment or the carryback of the loss or unused
• An abatement of tax, other than income, estate, or gift tax.
credit. Individuals can also get a refund by filing Form 1040-X
Employers cannot use Form 843 to request an abatement of
instead of Form 1045. An estate or trust can file an amended
FICA tax, RRTA tax, or income tax withholding.
Form 1041, U.S. Income Tax Return for Estates and Trusts.
• A refund to an employee of excess social security, Medicare,
or RRTA tax withheld by any one employer, but only if your • Use Form 940, Employer's Annual Federal Unemployment
employer will not adjust the overcollection. See the instructions (FUTA) Tax Return, for the tax year being amended to amend a
for line 7. previously filed Form 940. See the Instructions for Form 940.
• A refund to an employee of social security or Medicare taxes • Employers must use the tax form that corresponds to the tax
return previously filed to make an adjustment or claim a refund or
that were withheld in error, but only if your employer will not
abatement of FICA tax, RRTA tax, or income tax withholding.
adjust the overcollection. See the instructions for line 7. If you
are a nonresident alien, see Pub. 519, U.S. Tax Guide for Aliens,
for specific instructions.
• A refund of excess tier 2 RRTA tax when you had more than
one railroad employer for the year and your total tier 2 RRTA tax
withheld or paid for the year was more than the tier 2 limit. See
the instructions for line 3.
• 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.

Dec 17, 2021 Cat. No. 11200I

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IF you filed... CORRECT using... Who Can File
Form 941 or Form 941-SS Form 941-X You can file Form 843 or your authorized representative can file
it for you. If your authorized representative files Form 843, the
Form 943 Form 943-X original or copy of Form 2848, Power of Attorney and
Form 944 or Form 944-SS Form 944-X Declaration of Representative, must be attached. You must sign
Form 945 Form 945-X Form 2848 and authorize the representative to act on your
behalf for the purposes of the request. See the Instructions for
Form CT-1 Form CT-1 X Form 2848 for more information.
Formulario 941-PR Formulario 941-X (PR)
If you are filing as a legal representative for a decedent
Formulario 943-PR Formulario 943-X (PR) whose return you filed, attach to Form 843 a statement that you
Formulario 944-PR Formulario 944-X (PR) filed the return and you are still acting as the decedent's
representative. If you did not file the decedent's return, attach
Formulario 944 (SP) Formulario 944-X (SP) certified copies of letters testamentary, letters of administration,
If you filed Schedule H (Form 1040 ) or Anexo H-PR (Formulario 1040-PR), see Pub. or similar evidence to show your authority. File Form 1310,
926, Household Employer's Tax Guide, for how to correct that form. Statement of Person Claiming Refund Due a Deceased
Taxpayer, with Form 843 if you are the legal representative of a
decedent. See the instructions for Form 1310 for full details.
For more information, see Treasury Decision 9405 at
IRS.gov/irb/2008-32_IRB#TD-9405. Taxpayers With Visual Impairments and
• Use Form 1120-X, Amended U.S. Corporation Income Tax
Return, to correct Form 1120 or 1120-A as originally filed, or as Disabilities
later adjusted by an amended return, a claim for refund, or an If you were unable to read and timely respond to a standard print
examination, or to make certain elections after the prescribed notice from the IRS, you may be able to request a refund or
deadline (see Regulations sections 301.9100-1 through -3). abatement of assessed penalties, interest, or additions to tax.
• Use Form 720-X, Amended Quarterly Federal Excise Tax The following list illustrates the types of items you may want to
Return, to make adjustments to liability reported on Forms 720 include in your explanation on line 7 when completing Form 843
you have filed for previous quarters. Do not use Form 720-X to for this purpose.
make changes to claims made on Schedule C (Form 720), • The nature of the disability that prevents you from reading and
except for the section 4051(d) tire credit and section 6426 fuel timely responding to notices in a standard print format.
credits. • The date you received the standard print notice from the IRS
• Use Form 730, Monthly Tax Return for Wagers, to claim a and a description of the notice.
credit or refund of wagering tax. You may also use Schedule 6 • The date you learned of the issue described in the standard
(Form 8849). print notice.
• Use Form 4136, Credit for Federal Tax Paid on Fuels, to claim • Whether you requested that the IRS provide the notice (or
a credit against your income tax for certain nontaxable uses (or previous notices) in an alternative format and, if so, the date of
sales) of fuel during the income tax year. Also, use Form 4136 if the request and the format requested.
you are a producer claiming a credit for alcohol fuel mixtures or
biodiesel mixtures. However, you can use Form 8849, Claim for
Refund of Excise Taxes, to claim a periodic refund instead of
waiting to claim an annual credit on Form 4136.
• Use Form 8849, Claim for Refund of Excise Taxes, to claim a
refund of excise taxes other than those resulting from
adjustments to your reported liabilities. See Pub. 510, Excise
Taxes, for the appropriate forms to use to claim excise tax
refunds.
• Corporations (other than S corporations) can use Form 1139,
Corporation Application for Tentative Refund, to apply for a
“quick refund” of taxes from an overpayment of tax due to a
claim of right adjustment under section 1341(b)(1); or the
carryback of any NOL, the carryback of a net capital loss, or the
carryback of an unused general business credit.

Separate Form Required
Generally, you must file a separate Form 843 for each tax period
or fee year or type of tax or fee. There are exceptions for certain
claims. See the instructions for line 5.
Generally, you must file a claim for a credit or refund within 3
years from the date you filed your original return or 2 years from
the date you paid the tax, whichever is later. If you do not file a
claim within this period, you may no longer be entitled to a credit
or refund. See Pub. 556, Examination of Returns, Appeal Rights,
and Claims for Refund, for more information. But see
Requesting Abatement or Refund of a Penalty or Addition to Tax
as a Result of Written Advice, later, for when to file a request for
abatement or refund of a penalty or an addition to tax as a result
of erroneous written advice.

-2- Instructions for Form 843 (Rev. December 2021)

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your ITIN (and your spouse's ITIN if this relates to a joint return)
Where To File whenever an SSN is requested.

IF you are filing Form 843... THEN mail the form to... Line 1
in response to an IRS notice the address shown in the notice. Enter the tax period for which you are making the claim for
regarding a tax or fee related to refund or request for abatement. If you are requesting a refund of
certain taxes such as income, a branded prescription drug fee, enter the fee year on the “From”
employment, gift, estate, line.
excise, etc.
to request a claim for refund in Internal Revenue Service Line 3
an estate tax matter Attn: E&G Check the appropriate box to show the type of tax or fee for
Mail Stop 824G which you are claiming a refund or requesting an abatement. If
7940 Kentucky Drive the claim relates to interest, a penalty, or addition to tax, check
Florence, KY 41042-2915 the box to indicate the type of tax to which the claim or request
for penalties, or for any other the service center where you would be relates.
reason other than an IRS notice required to a file a current year tax return for Do not use Form 843 when another tax form must be
or estate tax claim (described the tax to which your claim or request
above) or Letter 4658, Letter relates. See the instructions for the return ! used. See Purpose of Form, earlier.
CAUTION
5067C, net interest rate of zero you are filing.
request, or a nonresident Excess tier 2 RRTA tax. Complete lines 1 and 2. On line 3,
alien’s claim for refund of social check the box for “Employment” tax. Skip lines 4, 5, and 6. On
security or Medicare taxes
withheld in error (see below) line 7, identify the claim as “Excess tier 2 RRTA” and show your
computation of the refund. You must also attach copies of your
in response to Letter 4658 Internal Revenue Service Forms W-2 for the year to Form 843. See the worksheet in Pub.
(notice of branded prescription Mail Stop 4921 BPDF 505, Tax Withholding and Estimated Tax, to help you figure the
drug fee) 1973 N. Rulon White Blvd. excess amount.
Ogden, UT 84201
Note. To ensure proper Branded prescription drug fee. Write "Branded Prescription
processing, write “Branded Drug Fee" across the top of Form 843. On line 1, enter the fee
Prescription Drug Fee” across ! year on the “From” line. Complete line 2. On line 3, check the
the top of Form 843. CAUTION box for “Fee.” Skip lines 4 and 5. On line 6, check the “Other”
Use this address only if you
are claiming a refund of the branded box and enter “BPD Fee” in the space provided. On line 7,
prescription drug fee. identify the claim as “branded prescription drug fee” and explain
in response to Letter 5067C Internal Revenue Service why you are claiming a refund.
(Annual Fee on Health Mail Stop 4921 IPF Attach a copy of the Form 8947, Report of Branded
Insurance Providers Final Fee) 1973 N. Rulon White Blvd. Prescription Drug Information, that provided the basis for the fee
Ogden, UT 84201 as calculated by the IRS, as well as any additional information
Note. To ensure proper on the amount to be refunded. You must tell us whether you or
processing, write "Annual Fee anyone else has filed a previous claim for any amount covered
on Health Insurance Providers ! by this claim. Fee claims should not be combined with any other
Final Fee" across the top of CAUTION
Form 843. Use this address only if you claims.
are claiming a refund of the health
insurance providers fee. Note. Interest related to the branded prescription drug fee
for requests of a net interest the service center where you filed your most cannot be abated.
rate of zero recent return.
Line 4
as a nonresident alien the address in Pub. 519 for nonresident
requesting a refund of social aliens requesting such refunds and follow If you are requesting a refund or abatement of an assessed
security or Medicare taxes the specific instructions in Pub. 519 penalty, enter the applicable Internal Revenue Code section.
withheld in error from pay that regarding the documents to be filed and the Generally, you can find the Code section on the Notice of
is not subject to these taxes conditions under which the form can be filed. Assessment you received from the IRS.
Note. If you have mailed the form to an address that has changed, the form
will be forwarded. Line 5

Requesting Abatement or Refund of Interest
Due to IRS Error or Delay
Paid Tax Return Preparer
The IRS can abate interest if the interest is caused by IRS errors
A paid tax return preparer who files Form 843 for you must sign or delays.The IRS will abate the interest only if there was an
the form and fill in the identifying information at the bottom of the unreasonable error or delay in performing a managerial or
form. The tax preparer must give you a copy of the completed ministerial act (defined next). The taxpayer cannot have caused
Form 843 for your records. Someone who prepares your Form any significant aspect of the error or delay. In addition, the
843 but does not charge you should not sign it. interest can be abated only if it relates to taxes for which a notice
of deficiency is required. This includes income taxes,
generation-skipping transfer taxes, estate and gift taxes, and
Specific Instructions certain excise taxes. Interest related to employment taxes or
Social security number. Enter your social security number other excise taxes cannot be abated. See Pub. 556 for more
(SSN). If you are filing Form 843 relating to a joint return, enter information.
the SSNs for both you and your spouse. If you have an individual Managerial act. The term “managerial act” means an
taxpayer identification number (ITIN) rather than an SSN, enter administrative act that occurs during the processing of your case

Instructions for Form 843 (Rev. December 2021) -3-

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involving the temporary or permanent loss of records or the You must attach copies of the following information to Form
exercise of judgment or discretion relating to management of 843.
personnel. A decision regarding the proper application of federal 1. Your written request for advice.
tax law (or other federal or state law) is not a managerial act.
See Regulations section 301.6404-2 for more information. 2. The erroneous written advice you relied on that was
furnished to you by the IRS.
Ministerial act. The term “ministerial act” means a procedural 3. The report, if any, of tax adjustments identifying the
or mechanical act that does not involve the exercise of judgment penalty or addition to tax and the item(s) relating to the
or discretion and that occurs during the processing of your case erroneous advice.
after all prerequisites of the act, such as conferences and review
by supervisors, have taken place. A decision regarding the When to file. An abatement of any penalty or addition to tax
proper application of federal tax law (or other federal or state as a result of written advice will be allowed only if:
law) is not a ministerial act. See Regulations section 301.6404-2 • You submit the request for abatement within the period
for more information. allowed for collection of the penalty or addition to tax, or
• You paid the penalty or addition to tax within the period
How To Request an Abatement of Interest allowed for claiming a credit or refund of such penalty or addition
to tax.
Abatement of interest on a tax. Request an abatement of
interest on a tax by writing “Request for Abatement of Interest Line 6
Under Section 6404(e)” at the top of Form 843. Check the appropriate box to show the type of fee or return, if
Complete lines 1 through 3. Check the first box on line 5a. On any, to which your claim or request relates. Check the box
line 5b, show the dates of any payment of interest or tax liability labeled “1040” to indicate other individual income tax returns
for the tax period involved. (such as Form 1040-SR, Form 1040A, or Form 1040EZ). You
must use Form 843 to request an abatement of the tax reported
On line 7, state: on the Form 4720. You cannot use Form 843 and you must use
• The type of tax involved, Form 4720 to request a refund of an overpayment computed on
• When you were first notified by the IRS in writing about the Form 4720, Part III, line 4.
deficiency or payment,
• The specific period for which you are requesting abatement of You can use Form 843 to request a refund or an
interest, ! abatement of interest, penalties, and additions to tax
• The circumstances of your case, and CAUTION that relate to your income tax return. However, you
• The reasons why you believe that failure to abate the interest cannot use Form 843 to request a refund or an abatement of
would result in grossly unfair treatment. income tax. If you are an employer, you cannot use it to request
Multiple tax years or types of tax. File only one Form 843 if abatement of FICA tax, RRTA tax, or income tax withholding.
the interest assessment resulted from the IRS's error or delay in
performing a single managerial or ministerial act affecting a tax Check the box labeled “Other (specify)” if your claim relates
assessment for multiple tax years or types of tax (for example, to any of the following.
where 2 or more tax years were under examination). Check the • Form 944, Employer's ANNUAL Federal Tax Return. Enter
applicable box(es) on line 3 and provide a detailed explanation “944” (or “944-SS”) in the space provided.
on line 7. • Form CT-2, Employee Representative's Quarterly Railroad
Tax Return. Enter “CT-2” in the space provided.
Requesting Abatement or Refund of a Penalty or • The branded prescription drug fee. Enter “BPD Fee” in the
Addition to Tax as a Result of Written Advice space provided.

The IRS can abate or refund any portion of a penalty or addition Line 7
to tax caused by erroneous advice furnished to you in writing by
an officer or employee of the IRS acting in his or her official Explain in detail your reasons for filing this claim and show your
capacity. computation for the credit, refund, or abatement. If you attach an
additional sheet(s), include your name and SSN, ITIN, or
The IRS will abate the penalty or addition to tax only if: employer identification number (EIN) on it. Also attach
1. You reasonably relied on the written advice, appropriate supporting evidence. Include a statement that to the
extent of equivalent amounts of underpayment and overpayment
2. The written advice was in response to a specific written for the period(s) identified and established, the period(s) has
request for advice made by you (or your representative who is (have) been used only once in a request to obtain the net
allowed to practice before the IRS), and interest rate of zero under section 6621(d). See Requesting Net
3. The penalty or addition to tax did not result from your Interest Rate of Zero on Overlapping Tax Underpayments and
failure to provide the IRS with adequate or accurate information. Overpayments, later, for more information.
See Regulations section 301.6404-3 for more information. Refund of excess social security, Medicare, or RRTA tax. If
you are claiming a refund of excess social security, Medicare, or
How To Request an Abatement or Refund of a RRTA tax withheld by one employer, you must, if possible,
attach a statement from the employer. The statement should
Penalty or an Addition to Tax as a Result of indicate the following.
Written Advice • The amount, if any, the employer has repaid or reimbursed
Request an abatement or refund of a penalty or addition to tax you for excess taxes withheld.
because of erroneous written advice by writing “Request for • The amount, if any, of credit or refund claimed by the
Abatement of Penalty or Addition to Tax Under Section 6404(f)” employer or authorized by you to be claimed by the employer.
at the top of Form 843. The employer should include in the statement the fact that it is
made in support of your claim for refund of employee tax paid by
Complete lines 1 through 4. Check the second box on line 5a. the employer to the IRS.
On line 5b, enter the date of payment if the penalty or addition to If you cannot obtain a statement from the employer, you
tax has been paid. should attach a statement with the same information to the best

-4- Instructions for Form 843 (Rev. December 2021)

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of your knowledge and belief and include in the statement an
explanation of why you could not obtain a statement from the Privacy Act and Paperwork Reduction Act Notice. We ask
employer. Attach a copy of your Form W-2 to prove the amount for the information on this form to carry out the Internal Revenue
of social security, Medicare, or RRTA tax withheld. laws of the United States. Sections 6402 and 6404 state the
conditions under which you may file a claim for refund and
Refund of social security and Medicare tax withheld in er- request for abatement of certain taxes, penalties, and interest.
ror. The same supporting evidence described above must be Form 843 may be used to file your claim or request. Section
provided. If you are a nonresident alien, see Pub. 519 for 6109 requires that you disclose your taxpayer identification
additional information. number (TIN). Routine uses of this information include giving it to
the Department of Justice for civil or criminal litigation and to
Requesting Net Interest Rate of Zero on cities, states, the District of Columbia, and U.S. commonwealths
Overlapping Tax Underpayments and and possessions for use in administering their tax laws. We may
Overpayments also give this information to federal and state agencies to
enforce federal nontax criminal laws and to combat terrorism.
If you have paid or are liable for interest on a tax underpayment You are not required to claim a refund or request an abatement;
and have received or are due interest on a tax overpayment for however, if you choose to do so, you are required to provide the
the same period of time, you can request that the IRS compute information requested on this form. Failure to provide all of the
the interest using the net interest rate of zero. requested information may delay or prevent processing your
claim or request; providing false or fraudulent information may
How To Request a Net Interest Rate of Zero subject you to civil or criminal penalties.
You can request a net interest rate of zero by writing on top of You are not required to provide the information requested on
Form 843 “Request for Net Interest Rate of Zero under Rev. a form that is subject to the Paperwork Reduction Act unless the
Proc. 2000-26.” You must provide documentation to substantiate form displays a valid OMB control number. Books or records
that you are the taxpayer entitled to receive the interest due on relating to a form or its instructions must be retained as long as
the overpayment. their contents may become material in the administration of any
Internal Revenue law. Generally, tax returns and return
Leave line 1 blank. You can enter a dollar amount on line 2 or information are confidential, as required by section 6103.
leave it blank. Complete line 3 to indicate the type of tax. More
than one box can be checked. Do not complete lines 4 and 5. The time needed to complete and file this form will vary
Complete line 6 to indicate the type of return filed. More than one depending on individual circumstances. The estimated average
box can be checked. time is:

On line 7, provide all of the following information. Recordkeeping . . . . . . . . . . . . . . . . . . . . . 26 min.
1. The tax periods for which you overpaid and underpaid Learning about the law or the form . . . . . . 20 min.
your tax liability. A separate Form 843 is not required for each
separate tax period involved in the request. Preparing the form . . . . . . . . . . . . . . . . . . 28 min.
Copying, assembling, and sending the form
2. When you paid the tax if the underpayment is no longer
outstanding. to the IRS . . . . . . . . . . . . . . . . . . . . . . . . . 20 min.
3. When you received your tax refund if the overpayment is
no longer outstanding.
If you have comments concerning the accuracy of these time
4. The period(s) that your overpayment and underpayment
estimates or suggestions for making this form simpler, we would
overlapped and the overlapping amount. You should provide any
be happy to hear from you. You can send us comments through
background material (such as copies of examination reports,
IRS.gov/FormComments. Or you can send your comments to:
notices, or prior interest computations provided by the IRS)
relating to the overpayment and underpayment. Internal Revenue Service
5. A computation, to the extent possible, of the amount of Tax Forms and Publications Division
interest to be credited, refunded, or abated. If you are unable to 1111 Constitution Ave. NW, IR-6526
provide a computation, provide an explanation of why you are Washington, DC 20224
unable to provide the computation. The computation should
generally be made by applying section 6621(d) to reduce your Do not send the form to this address. Instead, see Where To
underpayment interest payable to the IRS. However, if only the File, earlier.
period of limitation for claiming additional overpayment interest
is open on the date you file Form 843, you should make the Although we can't respond individually to each comment
computation by applying section 6621(d) to increase your received, we do appreciate your feedback and will consider your
overpayment interest payable by the IRS. comments as we revise our tax forms and instructions.
6. Section 6621(d) provides for a net interest rate of zero to
the extent of the overlapping underpayment and overpayment of
the same taxpayer. If your claim involves more than one
taxpayer identification number (TIN), explain why the different
TINs can be treated as the same taxpayer.

Instructions for Form 843 (Rev. December 2021) -5-

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