Taxpayer Delinquent Account (TDA) Confirmation Letter

DEPARTMENT OF THE TREASURY

WASHINGTON, D.C. 20220

Inspector general

for tax

administration

Confirmation Letter OMB NO. XXXX Expires MM/DD/YY

Month Day, Year

Person to Contact: xx xxxx xxxxxxxx

Telephone Number (Not Toll Free):

(xxx) xxx-xxxx

Taxpayer Identifying Name: John Q. Public

Taxpayer Identifying Number: 012-34-5678

Taxpayer

1234 Main Avenue

Metropolis, USA 01234

Dear Taxpayer,

The Treasury Department is conducting an independent review of the Internal Revenue Service’s (IRS) records to determine whether the IRS is complying with certain provisions contained in the Internal Revenue Code. The Treasury Inspector General for Tax Administration (TIGTA), which is part of the Department of Treasury but independent of the IRS, is charged with conducting these independent reviews of the IRS.

We would appreciate your help in verifying the accuracy of the IRS records by answering the questions listed below. Your response is voluntary and there are no penalties for not replying. This letter is NOT a review of your tax records or a request for payment.

The information that you provide may be furnished to the IRS. However, the law prohibits us from providing information concerning your tax account to third parties (other than the IRS) without your written permission.

We are currently reviewing procedures related to the balance due on accounts. Please provide the following information.

Balance Due Amount. Show the related tax return and tax period ending date.

Type of Return Period Ending Balance Due

_______________ ________________ ________________

_______________ ________________ ________________

If the balance due amount is not correct, please provide the date and amount of any payment. Please show the IRS receipt number, if you were given one; the name of the IRS employee receiving payment, if available; and, the address of the IRS office where paid.

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

If you paid with a personal check or money order, please show the IRS endorsement on back of personal check and 13 digit number on front. If you paid by money order, please provide the date and place of purchase, and serial number.

__________________________________________________________________

__________________________________________________________________

Name and identifying number: Show the name and number used if your payment was not made under the name or taxpayer identifying number shown above.

__________________________________________________________________

__________________________________________________________________

To help assure our independent review of the IRS, please reply only to the Department of Treasury (or TIGTA) using the enclosed postage-paid envelope. Please do not forward this letter to the IRS. If you have any questions, please call the individual shown at the top of this letter. We would appreciate your reply within 20 days. Thank you for your cooperation.

Sincerely,

Michael R. Phillips

Deputy Inspector General for Audit

Enclosures: Postage-paid Envelope

Privacy Act and Paperwork Reduction Act Notice

The Budget and Accounting Procedures Act of 1950 authorizes the Department of Treasury to request this information for the purposes stated in the letter. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid Office of Management and Budget control number. The estimated average time to comply with this letter is fifteen minutes. If you have any comments concerning the accuracy of this time estimate or suggestions for making this letter simpler, please write to either the:

Treasury Inspector General for Tax Administration

Office of Audit

1125 15^th Street, N.W., Suite 700A

Washington, D.C. 20005

Or

Office of Management and Budget

Paperwork Reduction Project (1591-XXXX)

Washington, D.C. 20503

Do not send your reply to this letter to either of these addresses.