CDTFA-393 REV. 7 (8-19)                                                                           STATE OF CALIFORNIA
SETTLEMENT REVIEW REQUEST FOR                                                                     CALIFORNIA DEPARTMENT OF 
SALES AND USE TAX AND SPECIAL TAXES AND FEE CASES                                        TAX AND FEE ADMINISTRATION

                                        SETTLEMENT REVIEW REQUEST
BUSINESS NAME                                          ACCOUNT NUMBER(S)

TAXPAYER/FEEPAYER                                      CASE NUMBER(S)

Generally, while you are pursuing an appeal before the California Department of Tax and Fee Administration (CDTFA), 
you may request consideration of your case under the Settlement Program. Examples of appeals are a petition for 
redetermination, an administrative protest, or a claim for refund.  

As long as your case remains under appeal, you may submit a Settlement Request. You should submit your request at 
least 15 days prior to your oral hearing. The Settlement Program considers all Settlement Requests and subsequent 
communications confidential and does not share this information with other CDTFA departments, sections, or units.

I request that the tax or fee amount in question for the above account(s) established on 
                                                                                         (DATE OF NOTICE, BILLING OR REFUND CLAIM) 

for the period(s)                                       through 
 (MONTH/DAY/YEAR)                                                       (MONTH/DAY/YEAR)

  receive settlement consideration for the reason(s) previously set forth in my appeal
  and/or for the reasons detailed below (optional):

I understand settlement is discretionary, that offers are subject to review, and only those considered reasonable by the 
CDTFA’s Settlement Section staff will be forwarded to CDTFA management for approval.
SIGNATURE                               DATE                            TELEPHONE NUMBER

PRINTED NAME                            TITLE/CAPACITY                  EMAIL ADDRESS

NOTE:
The Settlement Program does not currently apply to disputes involving the jet fuel tax, motor vehicle fuel tax, fire prevention fee, 
or to insurance tax disputes. Also, with the exception of disputes pertaining to the Childhood Lead Poisoning Prevention Fee 
and the Occupational Lead Poisoning Prevention Fee, disputes involving Hazardous Substances Tax Law are administered by the 
Department of Toxic Substances Control. 
You may email your proposal to settlement@cdtfa.ca.gov, fax it to 1-916-323-3387, or mail it to:  
Assistant Chief Counsel, Settlement & Taxpayer Services Division MIC:87, California Department of Tax and Fee Administration,  
P.O. Box 942879, Sacramento, CA 94279-0087.
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