i843--2021-12-00

Instructions for Form 843

Department of the Treasury
Internal Revenue Service

(Rev. December 2021)

(For use with Form 843 (Rev. August 2011))
Claim for Refund and Request for Abatement
Section references are to the Internal Revenue Code unless
otherwise noted.

General Instructions
Future Developments

For the latest information about developments related to Form
843 and its instructions, such as legislation enacted after they
were published, go to IRS.gov/Form843.

What’s New
Penalty for erroneous claim for refund. The information
under what had been Penalty for Erroneous Claim for Refund
has been moved to a parenthetical in a bullet under Use Form
843 to claim or request the following.

Purpose of Form

Use Form 843 to claim a refund or request an abatement of
certain taxes, interest, penalties, fees, and additions to tax.
Note. If you are filing Form 843 to claim a refund of the branded
prescription drug fee, please write “Branded Prescription Drug
Fee” across the top of Form 843.
Do not use Form 843 to request an abatement of
income, estate, or gift taxes. Do not use Form 843 to
CAUTION request a refund of income tax or Additional Medicare
Tax. Employers cannot use Form 843 to request a refund or
abatement of Federal Insurance Contributions Act (FICA) tax,
Railroad Retirement Tax Act (RRTA) tax, or income tax
withholding. Also, do not use Form 843 to amend a previously
filed income or employment tax return. Do not use Form 843 to
claim a refund of agreement fees, offer-in-compromise fees, or
lien fees.

!

Use Form 843 to claim or request the following.
• A refund of tax, other than a tax for which a different form
must be used. (See Do not use Form 843 when you must use a
different tax form next.)
• An abatement of tax, other than income, estate, or gift tax.
Employers cannot use Form 843 to request an abatement of
FICA tax, RRTA tax, or income tax withholding.
• A refund to an employee of excess social security, Medicare,
or RRTA tax withheld by any one employer, but only if your
employer will not adjust the overcollection. See the instructions
for line 7.
• A refund to an employee of social security or Medicare taxes
that were withheld in error, but only if your employer will not
adjust the overcollection. See the instructions for line 7. If you
are a nonresident alien, see Pub. 519, U.S. Tax Guide for Aliens,
for specific instructions.
• A refund of excess tier 2 RRTA tax when you had more than
one railroad employer for the year and your total tier 2 RRTA tax
withheld or paid for the year was more than the tier 2 limit. See
the instructions for line 3.
• A refund or abatement of interest, penalties, or additions to
tax, caused by certain IRS errors or delays, or certain erroneous
written advice from the IRS.

Dec 17, 2021

• A refund or abatement of a penalty or addition to tax due to
reasonable cause or other reason (other than erroneous written
advice provided by the IRS) allowed under the law. (This
includes a request for an abatement or refund of the section
6676 penalty for an erroneous claim for refund, where the claim
was due to a reasonable cause. The penalty is assessed at 20%
of the amount determined to be excessive.)
• A refund of the penalty imposed under section 6715 for
misuse of dyed fuel.
• A refund or abatement of tier 1 RRTA tax for an employee
representative.
• A refund of a branded prescription drug fee.
If you received an IRS notice notifying you of a change

TIP to an item on your tax return, or that you owe interest, a

penalty, or addition to tax, follow the instructions on the
notice. You may not have to file Form 843.

Do not use Form 843 when you must use a different tax
form.
• Use Form 1040-X, Amended U.S. Individual Income Tax
Return, to change any amounts reported on Form 1040,
1040-SR, 1040A, 1040EZ, 1040-NR, or 1040-NR-EZ, to change
amounts previously adjusted by the IRS, or to make certain
elections after the prescribed deadline (see Regulations
sections 301.9100-1 through -3).
• Use Form 1040-X and attach a corrected Form 8959,
Additional Medicare Tax, to correct your liability for Additional
Medicare Tax. If your Medicare wages, RRTA compensation, or
self-employment income is adjusted, you may need to correct
your liability, if any, for Additional Medicare Tax.
• Use Form 8379, Injured Spouse Allocation, to claim your
portion of a joint refund used to offset your spouse's past due
obligations.
• Individuals, estates, and trusts, filing within 1 year after the
end of the year in which a claim of right adjustment under
section 1341(b)(1), a net operating loss (NOL), a general
business credit, or net section 1256 contracts loss arose, can
use Form 1045, Application for Tentative Refund, to apply for a
“quick refund” resulting from any overpayment of tax due to the
claim of right adjustment or the carryback of the loss or unused
credit. Individuals can also get a refund by filing Form 1040-X
instead of Form 1045. An estate or trust can file an amended
Form 1041, U.S. Income Tax Return for Estates and Trusts.
• Use Form 940, Employer's Annual Federal Unemployment
(FUTA) Tax Return, for the tax year being amended to amend a
previously filed Form 940. See the Instructions for Form 940.
• Employers must use the tax form that corresponds to the tax
return previously filed to make an adjustment or claim a refund or
abatement of FICA tax, RRTA tax, or income tax withholding.

Cat. No. 11200I

IF you filed...

CORRECT using...

Form 941 or Form 941-SS

Form 941-X

Form 943

Form 943-X

Form 944 or Form 944-SS

Form 944-X

Form 945

Form 945-X

Form CT-1

Form CT-1 X

Formulario 941-PR

Formulario 941-X (PR)

Formulario 943-PR

Formulario 943-X (PR)

Formulario 944-PR

Formulario 944-X (PR)

Formulario 944 (SP)

Formulario 944-X (SP)

Who Can File

You can file Form 843 or your authorized representative can file
it for you. If your authorized representative files Form 843, the
original or copy of Form 2848, Power of Attorney and
Declaration of Representative, must be attached. You must sign
Form 2848 and authorize the representative to act on your
behalf for the purposes of the request. See the Instructions for
Form 2848 for more information.
If you are filing as a legal representative for a decedent
whose return you filed, attach to Form 843 a statement that you
filed the return and you are still acting as the decedent's
representative. If you did not file the decedent's return, attach
certified copies of letters testamentary, letters of administration,
or similar evidence to show your authority. File Form 1310,
Statement of Person Claiming Refund Due a Deceased
Taxpayer, with Form 843 if you are the legal representative of a
decedent. See the instructions for Form 1310 for full details.

If you filed Schedule H (Form 1040 ) or Anexo H-PR (Formulario 1040-PR), see Pub.
926, Household Employer's Tax Guide, for how to correct that form.

For more information, see Treasury Decision 9405 at
IRS.gov/irb/2008-32_IRB#TD-9405.
• Use Form 1120-X, Amended U.S. Corporation Income Tax
Return, to correct Form 1120 or 1120-A as originally filed, or as
later adjusted by an amended return, a claim for refund, or an
examination, or to make certain elections after the prescribed
deadline (see Regulations sections 301.9100-1 through -3).
• Use Form 720-X, Amended Quarterly Federal Excise Tax
Return, to make adjustments to liability reported on Forms 720
you have filed for previous quarters. Do not use Form 720-X to
make changes to claims made on Schedule C (Form 720),
except for the section 4051(d) tire credit and section 6426 fuel
credits.
• Use Form 730, Monthly Tax Return for Wagers, to claim a
credit or refund of wagering tax. You may also use Schedule 6
(Form 8849).
• Use Form 4136, Credit for Federal Tax Paid on Fuels, to claim
a credit against your income tax for certain nontaxable uses (or
sales) of fuel during the income tax year. Also, use Form 4136 if
you are a producer claiming a credit for alcohol fuel mixtures or
biodiesel mixtures. However, you can use Form 8849, Claim for
Refund of Excise Taxes, to claim a periodic refund instead of
waiting to claim an annual credit on Form 4136.
• Use Form 8849, Claim for Refund of Excise Taxes, to claim a
refund of excise taxes other than those resulting from
adjustments to your reported liabilities. See Pub. 510, Excise
Taxes, for the appropriate forms to use to claim excise tax
refunds.
• Corporations (other than S corporations) can use Form 1139,
Corporation Application for Tentative Refund, to apply for a
“quick refund” of taxes from an overpayment of tax due to a
claim of right adjustment under section 1341(b)(1); or the
carryback of any NOL, the carryback of a net capital loss, or the
carryback of an unused general business credit.

Taxpayers With Visual Impairments and
Disabilities

If you were unable to read and timely respond to a standard print
notice from the IRS, you may be able to request a refund or
abatement of assessed penalties, interest, or additions to tax.
The following list illustrates the types of items you may want to
include in your explanation on line 7 when completing Form 843
for this purpose.
• The nature of the disability that prevents you from reading and
timely responding to notices in a standard print format.
• The date you received the standard print notice from the IRS
and a description of the notice.
• The date you learned of the issue described in the standard
print notice.
• Whether you requested that the IRS provide the notice (or
previous notices) in an alternative format and, if so, the date of
the request and the format requested.

Separate Form Required

Generally, you must file a separate Form 843 for each tax period
or fee year or type of tax or fee. There are exceptions for certain
claims. See the instructions for line 5.
Generally, you must file a claim for a credit or refund within 3
years from the date you filed your original return or 2 years from
the date you paid the tax, whichever is later. If you do not file a
claim within this period, you may no longer be entitled to a credit
or refund. See Pub. 556, Examination of Returns, Appeal Rights,
and Claims for Refund, for more information. But see
Requesting Abatement or Refund of a Penalty or Addition to Tax
as a Result of Written Advice, later, for when to file a request for
abatement or refund of a penalty or an addition to tax as a result
of erroneous written advice.

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Instructions for Form 843 (Rev. December 2021)

Where To File
IF you are filing Form 843...

your ITIN (and your spouse's ITIN if this relates to a joint return)
whenever an SSN is requested.

Line 1

THEN mail the form to...

Enter the tax period for which you are making the claim for
refund or request for abatement. If you are requesting a refund of
a branded prescription drug fee, enter the fee year on the “From”
line.

in response to an IRS notice
the address shown in the notice.
regarding a tax or fee related to
certain taxes such as income,
employment, gift, estate,
excise, etc.
to request a claim for refund in
an estate tax matter

Internal Revenue Service
Attn: E&G
Mail Stop 824G
7940 Kentucky Drive
Florence, KY 41042-2915

for penalties, or for any other
reason other than an IRS notice
or estate tax claim (described
above) or Letter 4658, Letter
5067C, net interest rate of zero
request, or a nonresident
alien’s claim for refund of social
security or Medicare taxes
withheld in error (see below)

the service center where you would be
required to a file a current year tax return for
the tax to which your claim or request
relates. See the instructions for the return
you are filing.

in response to Letter 4658
(notice of branded prescription
drug fee)

Internal Revenue Service
Mail Stop 4921 BPDF
1973 N. Rulon White Blvd.
Ogden, UT 84201

Note. To ensure proper
processing, write “Branded
Prescription Drug Fee” across
the top of Form 843.

in response to Letter 5067C
(Annual Fee on Health
Insurance Providers Final Fee)
Note. To ensure proper
processing, write "Annual Fee
on Health Insurance Providers
Final Fee" across the top of
Form 843.

Line 3

Check the appropriate box to show the type of tax or fee for
which you are claiming a refund or requesting an abatement. If
the claim relates to interest, a penalty, or addition to tax, check
the box to indicate the type of tax to which the claim or request
relates.

!

CAUTION

Excess tier 2 RRTA tax. Complete lines 1 and 2. On line 3,
check the box for “Employment” tax. Skip lines 4, 5, and 6. On
line 7, identify the claim as “Excess tier 2 RRTA” and show your
computation of the refund. You must also attach copies of your
Forms W-2 for the year to Form 843. See the worksheet in Pub.
505, Tax Withholding and Estimated Tax, to help you figure the
excess amount.
Branded prescription drug fee. Write "Branded Prescription
Drug Fee" across the top of Form 843. On line 1, enter the fee
year on the “From” line. Complete line 2. On line 3, check the
box for “Fee.” Skip lines 4 and 5. On line 6, check the “Other”
box and enter “BPD Fee” in the space provided. On line 7,
identify the claim as “branded prescription drug fee” and explain
why you are claiming a refund.
Attach a copy of the Form 8947, Report of Branded
Prescription Drug Information, that provided the basis for the fee
as calculated by the IRS, as well as any additional information
on the amount to be refunded. You must tell us whether you or
anyone else has filed a previous claim for any amount covered
by this claim. Fee claims should not be combined with any other
claims.

!

CAUTION

Use this address only if you
are claiming a refund of the branded
prescription drug fee.
Internal Revenue Service
Mail Stop 4921 IPF
1973 N. Rulon White Blvd.
Ogden, UT 84201

!

CAUTION

Use this address only if you
are claiming a refund of the health
insurance providers fee.

for requests of a net interest
rate of zero

the service center where you filed your most
recent return.

as a nonresident alien
requesting a refund of social
security or Medicare taxes
withheld in error from pay that
is not subject to these taxes

the address in Pub. 519 for nonresident
aliens requesting such refunds and follow
the specific instructions in Pub. 519
regarding the documents to be filed and the
conditions under which the form can be filed.

Note. Interest related to the branded prescription drug fee
cannot be abated.

Line 4

If you are requesting a refund or abatement of an assessed
penalty, enter the applicable Internal Revenue Code section.
Generally, you can find the Code section on the Notice of
Assessment you received from the IRS.

Line 5

Note. If you have mailed the form to an address that has changed, the form
will be forwarded.

Requesting Abatement or Refund of Interest
Due to IRS Error or Delay

Paid Tax Return Preparer

The IRS can abate interest if the interest is caused by IRS errors
or delays.The IRS will abate the interest only if there was an
unreasonable error or delay in performing a managerial or
ministerial act (defined next). The taxpayer cannot have caused
any significant aspect of the error or delay. In addition, the
interest can be abated only if it relates to taxes for which a notice
of deficiency is required. This includes income taxes,
generation-skipping transfer taxes, estate and gift taxes, and
certain excise taxes. Interest related to employment taxes or
other excise taxes cannot be abated. See Pub. 556 for more
information.

A paid tax return preparer who files Form 843 for you must sign
the form and fill in the identifying information at the bottom of the
form. The tax preparer must give you a copy of the completed
Form 843 for your records. Someone who prepares your Form
843 but does not charge you should not sign it.

Specific Instructions
Social security number. Enter your social security number
(SSN). If you are filing Form 843 relating to a joint return, enter
the SSNs for both you and your spouse. If you have an individual
taxpayer identification number (ITIN) rather than an SSN, enter
Instructions for Form 843 (Rev. December 2021)

Do not use Form 843 when another tax form must be
used. See Purpose of Form, earlier.

Managerial act. The term “managerial act” means an
administrative act that occurs during the processing of your case
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You must attach copies of the following information to Form
843.
1. Your written request for advice.
2. The erroneous written advice you relied on that was
furnished to you by the IRS.
3. The report, if any, of tax adjustments identifying the
penalty or addition to tax and the item(s) relating to the
erroneous advice.

involving the temporary or permanent loss of records or the
exercise of judgment or discretion relating to management of
personnel. A decision regarding the proper application of federal
tax law (or other federal or state law) is not a managerial act.
See Regulations section 301.6404-2 for more information.
Ministerial act. The term “ministerial act” means a procedural
or mechanical act that does not involve the exercise of judgment
or discretion and that occurs during the processing of your case
after all prerequisites of the act, such as conferences and review
by supervisors, have taken place. A decision regarding the
proper application of federal tax law (or other federal or state
law) is not a ministerial act. See Regulations section 301.6404-2
for more information.

When to file. An abatement of any penalty or addition to tax
as a result of written advice will be allowed only if:
• You submit the request for abatement within the period
allowed for collection of the penalty or addition to tax, or
• You paid the penalty or addition to tax within the period
allowed for claiming a credit or refund of such penalty or addition
to tax.

How To Request an Abatement of Interest
Abatement of interest on a tax. Request an abatement of
interest on a tax by writing “Request for Abatement of Interest
Under Section 6404(e)” at the top of Form 843.
Complete lines 1 through 3. Check the first box on line 5a. On
line 5b, show the dates of any payment of interest or tax liability
for the tax period involved.
On line 7, state:
• The type of tax involved,
• When you were first notified by the IRS in writing about the
deficiency or payment,
• The specific period for which you are requesting abatement of
interest,
• The circumstances of your case, and
• The reasons why you believe that failure to abate the interest
would result in grossly unfair treatment.
Multiple tax years or types of tax. File only one Form 843 if
the interest assessment resulted from the IRS's error or delay in
performing a single managerial or ministerial act affecting a tax
assessment for multiple tax years or types of tax (for example,
where 2 or more tax years were under examination). Check the
applicable box(es) on line 3 and provide a detailed explanation
on line 7.

Line 6

Check the appropriate box to show the type of fee or return, if
any, to which your claim or request relates. Check the box
labeled “1040” to indicate other individual income tax returns
(such as Form 1040-SR, Form 1040A, or Form 1040EZ). You
must use Form 843 to request an abatement of the tax reported
on the Form 4720. You cannot use Form 843 and you must use
Form 4720 to request a refund of an overpayment computed on
Form 4720, Part III, line 4.
You can use Form 843 to request a refund or an
abatement of interest, penalties, and additions to tax
CAUTION that relate to your income tax return. However, you
cannot use Form 843 to request a refund or an abatement of
income tax. If you are an employer, you cannot use it to request
abatement of FICA tax, RRTA tax, or income tax withholding.

!

Check the box labeled “Other (specify)” if your claim relates
to any of the following.
• Form 944, Employer's ANNUAL Federal Tax Return. Enter
“944” (or “944-SS”) in the space provided.
• Form CT-2, Employee Representative's Quarterly Railroad
Tax Return. Enter “CT-2” in the space provided.
• The branded prescription drug fee. Enter “BPD Fee” in the
space provided.

Requesting Abatement or Refund of a Penalty or
Addition to Tax as a Result of Written Advice

Line 7

The IRS can abate or refund any portion of a penalty or addition
to tax caused by erroneous advice furnished to you in writing by
an officer or employee of the IRS acting in his or her official
capacity.

Explain in detail your reasons for filing this claim and show your
computation for the credit, refund, or abatement. If you attach an
additional sheet(s), include your name and SSN, ITIN, or
employer identification number (EIN) on it. Also attach
appropriate supporting evidence. Include a statement that to the
extent of equivalent amounts of underpayment and overpayment
for the period(s) identified and established, the period(s) has
(have) been used only once in a request to obtain the net
interest rate of zero under section 6621(d). See Requesting Net
Interest Rate of Zero on Overlapping Tax Underpayments and
Overpayments, later, for more information.

The IRS will abate the penalty or addition to tax only if:
1. You reasonably relied on the written advice,
2. The written advice was in response to a specific written
request for advice made by you (or your representative who is
allowed to practice before the IRS), and
3. The penalty or addition to tax did not result from your
failure to provide the IRS with adequate or accurate information.

Refund of excess social security, Medicare, or RRTA tax. If
you are claiming a refund of excess social security, Medicare, or
RRTA tax withheld by one employer, you must, if possible,
attach a statement from the employer. The statement should
indicate the following.
• The amount, if any, the employer has repaid or reimbursed
you for excess taxes withheld.
• The amount, if any, of credit or refund claimed by the
employer or authorized by you to be claimed by the employer.
The employer should include in the statement the fact that it is
made in support of your claim for refund of employee tax paid by
the employer to the IRS.
If you cannot obtain a statement from the employer, you
should attach a statement with the same information to the best

See Regulations section 301.6404-3 for more information.

How To Request an Abatement or Refund of a
Penalty or an Addition to Tax as a Result of
Written Advice
Request an abatement or refund of a penalty or addition to tax
because of erroneous written advice by writing “Request for
Abatement of Penalty or Addition to Tax Under Section 6404(f)”
at the top of Form 843.
Complete lines 1 through 4. Check the second box on line 5a.
On line 5b, enter the date of payment if the penalty or addition to
tax has been paid.
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Instructions for Form 843 (Rev. December 2021)

of your knowledge and belief and include in the statement an
explanation of why you could not obtain a statement from the
employer. Attach a copy of your Form W-2 to prove the amount
of social security, Medicare, or RRTA tax withheld.

Privacy Act and Paperwork Reduction Act Notice. We ask
for the information on this form to carry out the Internal Revenue
laws of the United States. Sections 6402 and 6404 state the
conditions under which you may file a claim for refund and
request for abatement of certain taxes, penalties, and interest.
Form 843 may be used to file your claim or request. Section
6109 requires that you disclose your taxpayer identification
number (TIN). Routine uses of this information include giving it to
the Department of Justice for civil or criminal litigation and to
cities, states, the District of Columbia, and U.S. commonwealths
and possessions for use in administering their tax laws. We may
also give this information to federal and state agencies to
enforce federal nontax criminal laws and to combat terrorism.
You are not required to claim a refund or request an abatement;
however, if you choose to do so, you are required to provide the
information requested on this form. Failure to provide all of the
requested information may delay or prevent processing your
claim or request; providing false or fraudulent information may
subject you to civil or criminal penalties.

Refund of social security and Medicare tax withheld in error. The same supporting evidence described above must be
provided. If you are a nonresident alien, see Pub. 519 for
additional information.

Requesting Net Interest Rate of Zero on
Overlapping Tax Underpayments and
Overpayments

If you have paid or are liable for interest on a tax underpayment
and have received or are due interest on a tax overpayment for
the same period of time, you can request that the IRS compute
the interest using the net interest rate of zero.

How To Request a Net Interest Rate of Zero
You can request a net interest rate of zero by writing on top of
Form 843 “Request for Net Interest Rate of Zero under Rev.
Proc. 2000-26.” You must provide documentation to substantiate
that you are the taxpayer entitled to receive the interest due on
the overpayment.

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.

Leave line 1 blank. You can enter a dollar amount on line 2 or
leave it blank. Complete line 3 to indicate the type of tax. More
than one box can be checked. Do not complete lines 4 and 5.
Complete line 6 to indicate the type of return filed. More than one
box can be checked.

The time needed to complete and file this form will vary
depending on individual circumstances. The estimated average
time is:

On line 7, provide all of the following information.
1. The tax periods for which you overpaid and underpaid
your tax liability. A separate Form 843 is not required for each
separate tax period involved in the request.
2. When you paid the tax if the underpayment is no longer
outstanding.
3. When you received your tax refund if the overpayment is
no longer outstanding.
4. The period(s) that your overpayment and underpayment
overlapped and the overlapping amount. You should provide any
background material (such as copies of examination reports,
notices, or prior interest computations provided by the IRS)
relating to the overpayment and underpayment.
5. A computation, to the extent possible, of the amount of
interest to be credited, refunded, or abated. If you are unable to
provide a computation, provide an explanation of why you are
unable to provide the computation. The computation should
generally be made by applying section 6621(d) to reduce your
underpayment interest payable to the IRS. However, if only the
period of limitation for claiming additional overpayment interest
is open on the date you file Form 843, you should make the
computation by applying section 6621(d) to increase your
overpayment interest payable by the IRS.
6. Section 6621(d) provides for a net interest rate of zero to
the extent of the overlapping underpayment and overpayment of
the same taxpayer. If your claim involves more than one
taxpayer identification number (TIN), explain why the different
TINs can be treated as the same taxpayer.

Instructions for Form 843 (Rev. December 2021)

Recordkeeping . . . . . . . . . . . . . . . . . . . . .
Learning about the law or the form . . . . . .
Preparing the form . . . . . . . . . . . . . . . . . .
Copying, assembling, and sending the form
to the IRS . . . . . . . . . . . . . . . . . . . . . . . . .

26 min.
20 min.
28 min.
20 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 send us comments through
IRS.gov/FormComments. Or you can send your comments to:
Internal Revenue Service
Tax Forms and Publications Division
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224
Do not send the form to this address. Instead, see Where To
File, earlier.
Although we can't respond individually to each comment
received, we do appreciate your feedback and will consider your
comments as we revise our tax forms and instructions.

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