Information Update

You may now file a petition for redetermination (appeal) using CDTFA’s online services at onlineservices.cdtfa.ca.gov. 
To submit a petition for redetermination, simply log in using your username and password and click on the account 
for which you want to submit a petition. The petition for redetermination is located under the I Want To section, More 
subsection. Simply select the Submit a Petition for Redetermination link and follow the prompts.

CDTFA-416 REV. 11 (3-21)                                                                                         STATE OF CALIFORNIA
PETITION FOR REDETERMINATION                                    CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION

BUSINESS NAME                                                                            ACCOUNT NUMBER

TAXPAYER NAME                                                                            TYPE OF TAX OR FEE

                                            PETITION FOR REDETERMINATION
                                                    Administrative Appeal

Generally, if you have received a notice of amount due from the California Department of Tax and Fee Administration (CDTFA), you 
may file an administrative appeal of that notice using this Petition for Redetermination. There are two important deadlines:

1.  If you received a Notice of Determination, a Notice of Deficiency Assessment, or a Notice of Successor Liability, you have 
     30 days from the date on the notice to appeal.

2.  If you received a Jeopardy Notice of Determination, you only have 10 days from the date listed on that document to appeal 
     and pay the amount due or a deposit security considered acceptable by the CDTFA.

Please look carefully at the notice you received to find the specific conditions and requirements for filing this petition. You should 
be prepared, upon request, to provide documentation that supports the specific grounds upon which your petition is founded.

I am filing a petition of the notice dated          for the period                              in the amount of $                                        .

Please indicate below the specific grounds upon which the petition is founded (required):

        In addition, I have new documentation ready to present for review and consideration (please attach or provide a list and 
     detailed description of the new documentation to be provided):

You have the right to, and may request, an appeals conference. During the review of your petition, we may ask you to reaffirm 
your request for an appeals conference.You  must respond timely to that request for affirmation. If your case is accepted into the 
administrative appeals process, you may request that your case be considered under the CDTFA’s Settlement Program.  
Review under the Settlement Program is confidential and will not affect your appeal rights.

If appealing, please indicate your request(s) below:

        I request an appeals conference with an Appeals Bureau attorney or auditor at CDTFA’s nearest office or in the  
     CDTFA’s Headquarters office in Sacramento.

        I request my appeal be considered under the Settlement Program.

SIGNATURE                   DATE SIGNED                                             DAYTIME TELEPHONE NUMBER

PRINTED NAME                TITLE/CAPACITY                                          EMAIL ADDRESS

If there is a conflict between this form or the notice you received and the law, the law is controlling. The filing of this form does not protect your right to 
a refund of tax, fee, interest, or penalty amounts paid in excess of amounts legally due. You must file a timely claim for refund if you believe you have 
overpaid tax, fee, interest, or penalty amounts. Filing a Petition for Redetermination will not prevent interest from accruing on any unpaid tax/fee due.

                                                    CLEAR          PRINT