CDTFA-393 REV. 6 (7-17)                                                                                         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 before the Board Members. 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 appea
       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 Fe                 
and the Occupational Lead Poisoning Prevention Fee, disputes involving Hazardous Substances Tax Law are administered by th                  
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,               
PO Box 942879, Sacramento, CA 94279-0087
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