New Jersey Division of Taxation                                                                       NJ-OTA-911

Request for Assistance from the  

 Office of the Taxpayer Advocate (OTA) 

 Read instructions on back (Page 2) before completing this form. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 
 Taxpayer information
  Name (as shown on tax return)                                                Social Security Number (SSN) 

  Spouse’s/Civil Union Partner’s name (if applicable)                          Spouse’s/Civil Union Partner’s SSN 

  Current street address (number, street, and apartment number) 

  City                                                                 State (or foreign country)                 Zip Code 

  Daytime Telephone Number                            E-mail address
   (            ) 
  NJ Taxpayer identification number (if applicable)   Tax type  *                          Tax form(s)       Tax period(s) 

  Fax number                                           Business contact (if not on power of attorney) 
   (           ) 

 Describe the tax problem you are experiencing, how you previously tried to resolve the problem, and the Division office(s) you contacted previously (see 
 instructions for required information; attach additional sheets if necessary) 

 _________________________________________________________________________________________________________________________
 Describe the relief/assistance you are requesting (attach additional sheets if necessary) 

  Signature of taxpayer, executor or corporate officer (as applicable)                                 Date 

 Power of Attorney 
 The taxpayer shown on this form appoints the following individual(s) as attorney(s)-in-fact to represent the taxpayer(s) before the NJ Division of 
 Taxation’s OTA for the above-named tax matter(s) and any subsequent periods for the same types of tax as of the date below.  The attorney-in-fact is 
 authorized, subject to limitations set forth on this form, to receive confidential information and to perform any and all acts that the principal(s) can perform 
 with respect to the above-specified tax matters, excluding the power to endorse a refund check.  This appointment is void if not signed and dated.  
  Signature of taxpayer or executor (if applicable)                                                    Date 

  Signature of spouse (if applicable)                                                                  Date 

  Signature of attorney-in-fact indicating acceptance of appointment as representative                 Title 

  Name of firm                                         EIN or SSN                                      Date 

  Mailing address                                      City/Town               State       Zip         Daytime Telephone Number 

  E-mail address

                                    Form NJ-OTA-911 Instructions                              

The Office of the Taxpayer Advocate (OTA) is an independent          Tax Period(s) —Enter the quarterly, annual or other tax 
office within the New Jersey Division of Taxation. The OTA           period(s) that relates to this request. For example, if this 
was created to ensure that all taxpayers are accorded fair and       request involves an income tax issue, enter the calendar or 
equitable treatment under the tax law of this State and to           fiscal year; if an employment (e.g., GIT-ER) tax issue, enter the 
ensure that no taxpayer should suffer undue hardship as a            calendar quarter. 
result of action or inaction by the Division. 
                                                                     Business contact person — If a business entity is filing this 
When to use this form                                                form, enter the name of the person to contact about the 
Use this form if you are experiencing any of the following:          request. This may be the corporate officer signing the request, 
                                                                     or another person authorized to discuss the matter. 
→ You have been unable to resolve a State tax issue through 
  normal channels.  You must have exhausted all 
  administrative remedies provided by the Division before            Describe the tax problem you are experiencing 
  contacting the OTA.                                                Enter any detailed information necessary to describe the tax 
                                                                     problem you are experiencing. If you have been involved with a 
→ You are facing a documented hardship as a result of the            Conference & Appeals conference, a Tax Court appeal, an 
  Division’s action or inaction. Personal or economic                administrative law judge, a Deferred (Installment) Payment 
  inconvenience is  not considered undue hardship and is not         Plan, or an audit or other collection action, include the dates of 
  sufficient to trigger assistance from the OTA.                     such activity (as applicable). 
→ You have experienced a delay of more than 120 days to 
  resolve a tax account problem or in receiving a response to        Describe the relief/assistance you are requesting 
  an inquiry to the Division.  At this time, the OTA is not          Be specific and include any documentation which supports 
  considering inquiries involving New Jersey Earned Income           your request.  If applicable, you may describe what action you 
  Tax Credit (NJ EITC). All NJ EITC inquiries should be              would like the OTA to take.  Please note that personal or 
  referred to the address shown on the notice that was               economic inconvenience, which is not considered “undue 
  mailed to you or you can contact the Division’s Customer           hardship”, is not sufficient to trigger the assistance of the OTA. 
  Service Center at (609) 292-6400 for assistance.
→ You believe the tax laws, regulations, or policies are being       Power of Attorney 
  administered unfairly or have impaired (or will impair) your       Complete the Power of Attorney (POA) section of this form if 
  rights.                                                            you choose to designate a representative to act on your behalf 
→ You believe a Division system or procedure has failed to           for the tax type(s) and period(s) indicated. Please be aware 
  operate or resolve your problem as intended.                       that authorizing someone to represent you before the OTA by 
                                                                     appointment of a POA does not relieve you of your tax 
When not to use this form                                            responsibilities or obligations. 
Do not use this form if any of the following apply: 
→ You have not exhausted all reasonable efforts or                   Contacting third parties 
  established administrative remedies to obtain timely relief        You should understand that by making your request for 
  through normal Division channels.                                  assistance you are authorizing the OTA to contact third parties 
                                                                     as necessary in order to resolve your problem. 
→ You are seeking legal or tax return preparation advice, a
  reversal of a legal or technical tax determination or a review     Signature 
  of an unfavorable Conference & Appeals decision, Tax               If you filed a joint return it is not necessary for both you and 
  Court decision, or other judicial determination.                   your spouse to sign this application for your account to be 
                                                                     reviewed. 
Specific Instructions 
Taxpayer Information                                                 Where to file 
Daytime Telephone Number—Enter a telephone number                    Send your completed Form NJ-OTA-911 and any required 
where you can be contacted during normal business hours.             attachments to: 
E-mail address — We may contact you by e-mail during                 By mail —  State of New Jersey 
normal business hours if we’re unable to reach you by                            NJ Division of Taxation 
telephone. We won’t use your e-mail address to discuss the                       Office of the Taxpayer Advocate (OTA) 
specifics of your case unless you authorize us to do so.                         PO Box 240 
NJ Taxpayer identification — Enter your NJ taxpayer                              Trenton, NJ  08695-0240 
identification number if this request involves a business or non-    By fax —    (609) 984-5491 
individual entity (e.g., a partnership, corporation, trust, or self- 
employed individual).                                                Privacy notification 
                                                                     The Division of Taxation is required by N.J.S.A. 54:50-8 to 
Tax type — Enter the tax type (for example, personal income 
                                                                     treat all records and files as confidential information. Any 
tax, corporation tax, sales tax, etc.) that relates to this request 
                                                                     information acquired by the Division, including information 
Tax Form(s) — Enter the form number(s) that relates to this          collected electronically on our website, is subject to the 
request. For example, an individual taxpayer with an income          provisions of N.J.S.A. 54:50-8. The Division does not share or 
tax issue might enter Form NJ-1040.                                  disclose information with any other agency except as required 
                                                                     under N.J.S.A. 54:50-9. 

NJOTA11 09/29