Taxpayer's Name Enter the Taxpayer's name: TIN Do you wish to enter an SSN or EIN? Do you wish to enter an SSN or EIN? SSNEIN If the taxpayer is an individual, the Taxpayer Identifying Number (TIN) is typically a Social Security Number. If the taxpayer is a corporation, the TIN is generally an Employer Identification Number (EIN). Enter the Taxpayer's SSN: Enter the Taxpayer's EIN: Taxpayer's Address Enter the Taxpayer's street address: What city does the Taxpayer live in? Which state does the Taxpayer live in? Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming Enter the Taxpayer's ZIP code: Spouse's Information Is the Taxpayer married and filing jointly? Is the Taxpayer married and filing jointly? YesNo Enter Spouse's name: Enter Spouse's SSN: Email Address Enter the Taxpayer's email address: Contact Who should the TAS contact about this request? Daytime Phone Enter a daytime number the TAS can call: Is this a cell phone? Is this a cell phone? YesNo Do you want to enter a fax number? Do you want to enter a fax number? YesNo Enter a fax number where the Taxpayer can be reached: Voicemail Is it okay for the TAS representative discuss tax-related information in a voice message? Is it okay for the TAS representative discuss tax-related information in a voice message? YesNo Best Time Select the best time for the TAS to call: 9 a.m.10 a.m.11 a.m.12 p.m.1 p.m.2 p.m.3 p.m.4 p.m.5 p.m.6 p.m.7 p.m.8 p.m.9 p.m. Language Specify any special communication needs: Specify any special communication needs: TTYInterpreterOtherNot Applicable Select a language: SpanishChinese TraditionalChinese SimplifiedKoreanRussianVietnameseHaitian CreoleOther Enter language: Describe other communciation needs: Tax Form Which Tax Form does this request for assistance pertain to? Description of Issue Describe the issue you are experiencing: Description of Request Describe the relief/assistance you are requesting: Tax Year Enter the Tax Year or Period to which the request applies: Authorized Representative Is there an Authorized Representative the TAS can call? Is there an Authorized Representative the TAS can call? YesNo Enter the Authorized Representative's name: Enter the Authorized Representative's Centralized Authorization File (CAF) number: Enter the Authorized Representative's mailing address: Enter the Authorized Representative's phone number: Is this a cell phone? Is this a cell phone? YesNo TAS How did the Taxpayer hear about the TAS? How did the Taxpayer hear about the TAS? IRS FormsMediaEmployeeOther Next Save Save and finish later
