Form 8038-R Request for Recovery of Overpayments Under Arbitrage Reb

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 8038-R, PAGE 1 of 2
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20.
FLAT SIZE: 216mm x 279mm (8.5" x 11")
PERFORATE: (NONE)

Action

8038-R

Revised proofs
requested

Request for Recovery of Overpayments
Under Arbitrage Rebate Provisions

(Rev. January 2006)
Department of the Treasury
Internal Revenue Service

Part I

䊳

File a separate form for each issue.

䊳

Signature

O.K. to print

PRINTS: HEAD TO HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form

Date

OMB No. 1545-1750

See instructions on back.

Reporting Authority

1

Issuer’s name

2

Issuer’s employer identification number

3

Number and street (or P.O. box if mail is not delivered to street address)

4

Report number

5

City, town, or post office, state, and ZIP code

6

Date of issue

7

Name of issue

8

CUSIP number

9

Name and title of officer or legal representative whom the IRS may call for more information

Room/suite

10

Telephone number of officer or legal representative

(

Part II

)

Request for Refund of Amounts Paid Under Rebate Provisions (see instructions)

11

If the issue is outstanding on June 30, 1993, and the issuer elects not to apply the 1992 regulations, check here (see
䊳
instructions)

12

Total amount paid under rebate provisions

13

Rebate amount as of the most recent computation date

13

14

Amounts (not included in line 12) required to be paid under section
148 as of the date the recovery is requested

14

12

15

Add lines 13 and 14

16
17

Amount of overpayment. Subtract line 15 from line 12
16
Computations and relevant facts that led to overpayment (see instructions). Attach additional sheets if necessary.

18

Schedule of payments (see instructions). Attach additional sheets if necessary.

Part III

Other Information (see instructions)

15

Check the “Yes” or “No” box for each question below.

19

Was the overpayment paid as penalty in lieu of rebate under section 148(f)(4)(C)(vii)?

䊳

19

20

Has the final computation date for the issue occurred?

䊳

20

21

Is the issue comprised of qualified redevelopment, qualified small issue, or exempt facilities bonds? If “Yes,”
provide name and EIN of the primary private user.
Name 䊳
EIN 䊳

21

Yes

No

Under penalties of perjury, I declare that I have examined this request for recovery of overpayment, including accompanying schedules and
statements, and to the best of my knowledge and belief, the facts represented in support of the request are true, correct, and complete.

Sign
Here

䊳

Signature of issuer’s authorized representative

For Paperwork Reduction Act Notice, see back of form.

Date
Cat. No. 57334H

䊳

Type or print name and title
Form

8038-R

(Rev. 1-2006)

3
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 8038-R, PAGE 2 of 2
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD to HEAD
PAPER: WHITE, WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm X 279mm (8.5" x 11")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 8038-R (Rev. 1-2006)

What’s New
You must attach all copies of Form 8038-T, Arbitrage Rebate, Yield
Reduction, and Penalty in Lieu of Arbitrage Rebate, which are related
to the request for refund.

General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Note. Use a separate Form 8038-R for each issue.

Purpose of Form
Form 8038-R is used by issuers of state and local bonds to request
a refund of amounts paid with Form 8038-T.
Payments made with Form 8038-T that may be recoverable
include:
1. Yield reduction payments,
2. The arbitrage rebate to the United States,
3. A penalty in lieu of rebating arbitrage to the United States, or
4. A penalty to terminate the election to pay a penalty in lieu of
rebating arbitrage.

Recovery of Overpayment
In general, an issuer may recover an overpayment of rebate for an
issue of tax-exempt bonds by establishing to the Internal Revenue
Service that the overpayment occurred. An overpayment is the
excess of the amount paid to the United States for an issue under
section 148 over the sum of the rebate amount for the issue as of
the most recent computation date and all amounts that are
otherwise required to be paid under section 148 as of the date the
recovery is requested.
An overpayment may be recovered only to the extent that a
recovery on the date that it is first requested would not result in an
additional rebate amount if that date were treated as a computation
date.
Except for overpayments of penalty in lieu of rebate under section
148(f)(4)(C)(vii) and Regulations section 1.148-7(k), an overpayment of
less than $5,000 may not be recovered before the final computation
date. See Regulations section 1.148-3(i).

Processing the Request
When filing Form 8038-R, you must provide:
● All copies of Form(s) 8038-T related to the request for refund, and
● The computations of the overpayment and interest (if any) on
line 17. Provide any additional attachments if needed.
Generally, this information will be sufficient to determine whether a
refund is appropriate. However, if additional information is necessary,
the IRS will contact the issuer or its representative. Processing of the
request will then be suspended and the issuer will have 30 calendar
days to submit the requested information. If all the requested
information is not timely received, a letter will be sent explaining that
the request for recovery is deficient and that its processing is
terminated. This letter may also be sent instead of a request for
additional information if the initial request for recovery is severely
deficient.
Any proposed adverse determination may be appealed. See Rev.
Proc. 99-35, 1999-2 C.B. 501, for details.

Where To File
File Form 8038-R, and attachments, with the Internal Revenue
Service, Ogden Submission Processing Center, Ogden, UT 84201.

Signature
Form 8038-R must be signed by an authorized representative of the
issuer. Also type or print the name and title of the person signing
Form 8038-R.

Specific Instructions
Part I. Reporting Authority
Line 1. Enter the name of the governmental entity that issued the
bonds, not the name of the entity receiving the benefit of the
financing.

Page

2

Line 6. Enter the date of issue. This is generally the first date on
which there is a physical exchange of the bonds for the purchase
price.
Line 7. Enter the name of the issue. If there is no name, please
provide other identification of the issue.
Line 8. Enter the CUSIP (Committee on Uniform Securities
Identification Procedures) number of the bond with the latest
maturity. Enter “None” if the issue does not have a CUSIP number.

Part II. Request for Refund
Line 11. Current Regulations sections 1.148-1 through 1.148-11
apply to issues outstanding after June 30, 1993. If the issue was
outstanding prior to July 1, 1993, the 1992 regulations apply (that is,
Regulations sections 1.148-1 through 1.148-12 effective May 18,
1992 (T.D. 8418, 1992-1 C.B. 29)). However, check the box if the
issue was outstanding prior to July 1, 1993, and the issuer has
elected not to apply the 1992 regulations; the current Regulations
sections 1.148-1 through 1.148-11 apply.
Line 17. Provide the computations of the overpayment paid as part
of a rebate payment, penalty in lieu of rebate, or to terminate the
penalty in lieu of rebate. Also, include the computations for interest
(if any). If relevant, a description of the facts that led to the
overpayment may also be included.
Line 18. Provide a schedule showing amounts and dates that
payments were made to the United States for the issue. Attach
copies of Form(s) 8038-T that accompanied payments to the United
States.

Part III. Other Information
Line 20. The final computation date is the date the issue is
discharged. For details, see Regulations section 1.148-3(e)(2).
Line 21. Check the “Yes” box if:
The issue is comprised of...

As described in section...

Qualified redevelopment bonds

144(c)

Qualified small issue bonds

144(a)

Exempt facilities bonds

142(a)(4) through 142(a)(11)
and 142(a)(13) through 142(a)(15)

If one of the above applies, then enter the name and employer
identification number (EIN) of the primary private user. A “private
user” is the nongovernmental entity that meets the private business
tests of section 141(b) or private loan financing test of section 141(c).
Paperwork Reduction Act Notice. We ask for the information on
this form to carry out the Internal Revenue laws of the United States.
You are required to give us the information. We need it to ensure
that you are complying with these laws.
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 OMB control number. Books or records relating to a
form or its instructions must be retained as long as their contents
may become material in the administration of any Internal Revenue
law. Generally, tax returns and return information are confidential, as
required by section 6103.
The time needed to complete and file this form will vary depending
on individual circumstances. The estimated average time is:
Recordkeeping, 5 hr., 44 min.; Learning about the law or the
form, 3 hr., 10 min.; Preparing, copying, assembling, and sending
the form to the IRS, 3 hr., 24 min.
If you have comments concerning the accuracy of these time
estimates or suggestions for making this form simpler, we would be
happy to hear from you. You can write to the Internal Revenue
Service, Tax Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6406,
Washington, DC 20224. Do not send the form to this address.
Instead, see Where To File above.