CDTFA-324-OIC (FRONT) REV. 3 (11-18)                                                              STATE OF CALIFORNIA  
                                                            CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION 

                                       Annual Privacy Notice 

                                     Information Provided to the  
                California Department of Tax and Fee Administration 

We will use the information you provide to determine        You may contact the Offer in Compromise Section at 
whether you are eligible for relief from liability as       1-916-322-7931 or by writing to: 
an innocent spouse or whether you are eligible for          OFFER IN COMPROMISE SECTION, MIC:52  
an offer in compromise. To process your request for         SETTLEMENT AND TAXPAYER SERVICES BUREAU 
relief from liability as an innocent spouse or your offer   CALIFORNIA DEPARTMENT OF TAX  
in compromise request, you must provide all of the          AND FEE ADMINISTRATION  
information we request, including your social security      PO BOX 942879 
number (used for identifcation purposes [see Title 42       SACRAMENTO, CA 94279-0052 
Code section 405(c)2(C)(i)]). 
                                                            We must collect information in order to administer 
What happens if I don’t provide the information?            the state laws listed below. 
If you fail to provide the requested information, we will   Code sections are from the California Revenue and 
be unable to determine the outcome of your request for      Taxation Code unless otherwise noted. 
relief from liability as an innocent spouse or your request 
                                                            • Alcoholic Beverage Tax (sections 32001-32557) 
for an offer in compromise. 
Can anyone else see my information?                         • California Tire Fee (sections 55001-55381, Public 
                                                               Resources Code sections 42860-42895) 
Your records are covered by state laws that protect your 
privacy. However, we may share information regarding        • Cannabis Tax (sections 34010-34021.5, 55001-55381) 
your account with certain government agencies (see list     •  Childhood Lead Poisoning Prevention Fee (sections 
on reverse). We may also share certain information with        43001-43651, Health and Safety Code section 105310) 
companies authorized to represent local governments. 
                                                            • Cigarette and Tobacco Products Tax (sections 
With your written permission, we can release information       30001-30483, Health and Safety Code sections 
regarding your account to anyone you designate.                104555-104558) 
Can I review my records?                                    • Cigarette and Tobacco Products Licensing Act of 
Yes. Please contact the Offer in Compromise                    2003 (Business and Professions Code sections 
Section at 1-916-322-7931. If you need more                    22970-22991, Government Code section 15618.5, 
information, you may contact our Disclosure                    Penal Code section 830.11) 
Officer in Sacramento by calling 1-916-445-2918.            • Covered Electronic Waste Recycling Fee (sections 
You may also want to review publication 58A, How               55001-55381, Health and Safety Code sections 
to Inspect and Correct Your Records, online at                 25214.10.1-25214.10.2, Public Resources Code 
www.cdtfa.ca.gov/formspubs/pub58a.pdf or order a               sections 42463-42486) 
copy from our Customer Service Center at 1-800-400-
                                                            • Diesel Fuel Tax (sections 60001-60708) 
7115 (TTY:711). 
                                                            • Emergency Telephone Users Surcharge (sections 
Who is responsible for maintaining my records? 
                                                               41001-41176) 
The manager of the Offer in Compromise Section is 
                                                            • Energy Resources Surcharge (sections 40001-40216) 
responsible for maintaining your records. 
                                                            • Fee Collection Procedures (sections 55001-55381) 
                                                            • Fire Prevention Fee (Public Resources Code 
                                                               sections 4210-4228) 

CDTFA-324-OIC (BACK) REV. 3 (11-18) 

• Hazardous Substances Tax (sections 43001-43651,         We may disclose information to the proper officials 
Health and Safety Code sections 25174-25174.11,           of the following agencies, among others: 
25205.1-25205.23)                                         • United States government agencies: U.S.  Attorney’s 
• Integrated Waste Management Fee (sections               Office; Bureau of Alcohol, Tobacco, Firearms and 
45001-45984, Public Resources Code sections               Explosives; Departments of Agriculture, Defense, 
48000-48008)                                              and Justice; Federal Bureau of Investigation; General 
                                                          Accounting Office; Internal Revenue Service 
• International Fuel Tax Agreement (sections 9401-
9433)                                                     • State of California government agencies and 
                                                          officials:  Air Resources Board; Department of 
• Lead-Acid Battery Recycling Fees (Health and Safety 
                                                          Alcoholic Beverage Control; Department of Child 
Code section 25215-25215.75) 
                                                          Support Services; Department of Consumer Affairs; 
• Lumber Products Assessment Fee (sections                State Controller’s Office; Employment Development 
55001-55381, Public Resources Code sections               Department; Energy Commission; Department 
4629-4629.13)                                             of Fish and Wildlife; Department of Food and 
• Marine Invasive Species (Ballast Water) Fee             Agriculture; Forest Products Commission; Board of 
(sections 44000-44008, 55001-55381, Public                Forestry and Fire Protection; Franchise Tax Board; 
Resources Code sections 71200-71271)                      Department of Public Health; California Highway 
                                                          Patrol; Department of Housing and Community 
• Motor Vehicle Fuel Tax, including Aircraft Jet Fuel Tax 
                                                          Development; Integrated Waste Management Board; 
(sections 7301-8526) 
                                                          State Lands Commission; Department of Motor 
• Natural Gas Surcharge (sections 55001-55381,            Vehicles; California Public Utilities Commission; 
Public Utilities Code sections 890-900)                   Department of Toxic Substances Control; State 
• Occupational Lead Poisoning Prevention Fee              Water Resources Control Board 
(sections 43001-43651, Health and Safety Code             • State agencies outside of California for tax 
sections 105190, 105195)                                  enforcement purposes 
• Oil Spill Response, Prevention, and Administrative      • City attorneys and prosecutors; county district 
Fees (sections 46001-46751, Government Code               attorneys, police and sheriff departments 
sections 8670.40, 8670.48) 
                                                          • Any agency authorized to enforce local tobacco 
• Prepaid Mobile Telephony Services Surcharge             control ordinances 
(sections 55001-55381, sections 42001-42024, 
sections 42100-42111) 
• Regional Railroad Accident Preparedness and 
Immediate Response Fee (sections 55001-55381, 
Government Code sections 8574.30-8574.48) 
• Sales and Use Tax (sections 6001-7176, 7200-7226, 
7251-7279.6, 7285-7288.6) 
• Tax on Insurers (sections 12001-13170) 
• Timber Yield Tax (sections 38101-38908) 
• Underground Storage Tank Maintenance Fee 
(sections 50101-50162, Health and Safety Code 
sections 25299.10-25299.51) 
• Use Fuel Tax (sections 8601-9355) 
• Water Rights Fee (sections 55001-55381, Water 
Code sections 1525-1560)