Instructions for Form 843

Instructions for Form 843

(Rev. December 2024)

(For use with Form 843 (Rev. December 2024))

Claim for Refund and Request for Abatement

Section references are to the Internal Revenue Code unless

otherwise noted.

Contents

Page

Future Developments . . . . . . . . . . . . . . . . . . . . . . . . 1

What’s New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

General Instructions . . . . . . . . . . . . . . . . . . . . . . . . . 1

Purpose of Form . . . . . . . . . . . . . . . . . . . . . . . . . 1

Who Can File . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Where To File . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Separate Form Required . . . . . . . . . . . . . . . . . . . 3

Specific Instructions . . . . . . . . . . . . . . . . . . . . . . . . . 3

Checkboxes, Name, Taxpayer Identification

Number (TIN), and Address . . . . . . . . . . . . . . . 3

Line Instructions: Lines 1 through 8 . . . . . . . . . . . 3

Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Paid Tax Return Preparer . . . . . . . . . . . . . . . . . . . 4

Special Situations . . . . . . . . . . . . . . . . . . . . . . . . 4

Taxpayers With Visual Impairments and

Disabilities . . . . . . . . . . . . . . . . . . . . . . . . 4

Refund of Excess Social Security,

Medicare, or RRTA Tax . . . . . . . . . . . . . . . 4

Excess Tier 2 RRTA Tax . . . . . . . . . . . . . . . . 4

Refund of Social Security or Medicare

Tax Withheld in Error . . . . . . . . . . . . . . . . . 4

Requesting Abatement or Refund of a

Penalty or Addition to Tax as a Result

of Written Advice . . . . . . . . . . . . . . . . . . . 4

Requesting Abatement or Refund of

Interest Due to IRS Error or Delay

Under Section 6404(e)(1) . . . . . . . . . . . . . 5

Requesting Net Interest Rate of Zero on

Overlapping Tax Underpayments and

Overpayments . . . . . . . . . . . . . . . . . . . . . 5

Branded Prescription Drug Fee . . . . . . . . . . . 5

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

Redesigned. We have redesigned Form 843 and these

instructions.

General Instructions

Purpose of Form

Do not use Form 843 to request an abatement of

income, estate, or gift tax. 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 an

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.

!

Checkboxes at the top of Form 843. Check the box at the top

of your Form 843 that provides your reason for filing the form.

Those reasons are listed below.

• An abatement or refund 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.

• An abatement or 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, later.)

• 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 Refund of

Excess Social Security, Medicare, or RRTA Tax, later.

• A refund to an employee of excess tier 2 RRTA tax when, for

the year, you had more than one railroad employer and your total

tier 2 RRTA tax withheld or paid for the year was more than the

tier 2 limit. See Excess Tier 2 RRTA Tax, later.

• A refund to an employee of social security, Medicare, or RRTA

tax that was withheld in error but only if your employer will not

adjust the overcollection. See Refund of Social Security and

Medicare Tax Withheld in Error, later. If you are a nonresident

alien, see Pub. 519, U.S. Tax Guide for Aliens, for specific

instructions.

• An abatement or refund of tier 1 RRTA tax for an employee

representative.

• An abatement or refund of a penalty or addition to tax due to

reasonable cause or other reason allowed under the law. (This

includes a request for a refund or an abatement of the section

6676 penalty for an erroneous claim for refund, where the claim

was due to reasonable cause. The penalty is assessed at 20% of

the amount determined to be excessive.)

• An abatement or refund of the penalty imposed under section

6672 for failure to collect and pay over tax, or attempt to evade or

defeat tax (Trust Fund Recovery Penalty).

• A refund of the penalty imposed under section 6695A for

misstatements due to incorrect appraisals.

• A refund of the penalty imposed under section 6715 for

misuse of dyed fuel.

• An abatement or refund under section 6404(f) of a penalty or

an addition to tax caused by certain erroneous written advice

from the IRS. See Requesting Abatement or Refund of a Penalty

or Addition to Tax as a Result of Written Advice, later.

• An abatement or refund of interest due to IRS error or delay

under section 6404(e)(1). See Requesting Abatement or Refund

of Interest Due to IRS Error or Delay Under Section 6404(e)(1),

later.

Use Form 843 to claim a refund or request an abatement of

certain taxes, penalties, additions to tax, interest, and fees.

Dec 17, 2024

Instructions for Form 843 (Rev. 12-2024) Catalog Number 11200I

Department of the Treasury Internal Revenue Service www.irs.gov

• A request for net interest rate of zero under Rev. Proc.

2000-26. See Requesting Net Interest Rate of Zero on

Overlapping Tax Underpayments and Overpayments, later.

• An abatement or refund of assessed penalties, interest, or

additions to tax because you were unable to read and timely

respond to a standard print notice from the IRS. See Taxpayers

With Visual Impairments and Disabilities, later.

• A refund of a branded prescription drug fee. See Branded

Prescription Drug Fee, later.

• A refund of the annual fee on health insurance providers.

If you received an IRS notice notifying you of a change to

TIP 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.

Other (specify). If your reason for filing Form 843 is not in the

above bullet list, check “Other (specify)” under “Other” and enter

your reason for filing the form. If you are required to use a tax

form other than Form 843 to request your refund or abatement,

do not check the “Other (specify)” box but see Do not use Form

843 when you must use a different tax form next.

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).

• Employers must use the tax form that corresponds to the tax

return previously filed to make an adjustment or claim a refund or

an abatement of FICA tax, RRTA tax, or income tax withholding.

IF you filed...

CORRECT using...

Form 941 or 941-SS

Form 941-X.

Form 943

Form 943-X.

Form 944 or 944-SS

Form 944-X.

Form 945

Form 945-X.

Form CT-1

Form CT-1 X.

Formulario 941 (sp)

Formulario 941-X (sp).

Formulario 943 (sp)

Formulario 943-X (sp).

Formulario 944 (sp)

Formulario 944-X (sp).

If you filed Schedule H (Form 1040 ) or Anexo H (sp) (Formulario 1040 (sp)),

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 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 to claim a refund of excise taxes other than

those resulting from adjustments to your reported liabilities. For

example, use Form 8849 to claim a refund for an overpayment of

excise taxes reported on Form(s) 11-C or 2290. See Pub. 510,

Excise Taxes, for the appropriate forms to use to claim excise tax

refunds.

• 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),

2

except for the section 4051(d) tire credit and section 6426 fuel

credits. For a refund of excise taxes, use Form 8849.

• 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 6118, Claim for Refund of Income Tax Return

Preparer and Promoter Penalties, to claim a refund of tax return

preparer or promoter penalties you paid but believe were

incorrectly charged.

• 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 a 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 a 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.

• 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).

• 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, a net capital loss, or an unused general business

credit.

• Use Form 4720 to request a refund of an overpayment

computed on Form 4720, Part III, line 4. But, use Form 843 to

request an abatement of the tax reported on Form 4720.

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.

Also, see Paid Tax Return Preparer, later.

Instructions for Form 843 (Rev. December 2024)

Where To File

IF you are filing Form 843...

THEN mail the form to...

in response to an IRS notice

regarding a tax or fee related to

certain taxes such as income,

employment, gift, estate, excise,

etc.

the return address from which the

notice was sent.

to request a claim for refund in a

Internal Revenue Service

Form 706 (United States Estate

Attn: E&G, Stop 824G

(and Generation-Skipping

7940 Kentucky Drive

Transfer) Tax Return) or 709

Florence, KY 41042-2915

(United States Gift (and

Generation-Skipping Transfer) Tax

Return) tax matter

in response to Letter 4658 (notice Internal Revenue Service

of branded prescription drug fee) Mail Stop 4921 BPDF

1973 N. Rulon White Blvd.

Ogden, UT 84201-0051

in response to Letter 5067C

(Annual Fee on Health Insurance

Providers Final Fee)

Internal Revenue Service

Mail Stop 4921 IPF

1973 N. Rulon White Blvd.

Ogden, UT 84201

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.

for requests related to Form 8300

(Report of Cash Payments Over

$10,000 Received in a Trade or

Business)

Internal Revenue Service

Rosa Parks Federal Building

P.O. Box 32621

Detroit, MI 48232

for penalties, or for any other

the service center where you

reason except those described would be required to file a current

above

year tax return for the tax to which

your claim or request relates. See

the instructions for the return you

are filing.

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

form will be forwarded.

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 Special Situations, later, specifically How to request

a net interest rate of zero under Requesting Net Interest Rate of

Zero on Overlapping Tax Underpayments and Overpayments

and Multiple tax years or types of tax under Requesting

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

Section 6404(e)(1).

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.

Instructions for Form 843 (Rev. December 2024)

Specific Instructions

Checkboxes, Name, Taxpayer

Identification Number (TIN), and

Address

Checkboxes. You must check one box above the name block at

the top of the form to indicate your reason for filing Form 843. Do

not check more than one box.

Name. Enter your name as the person requesting the refund or

abatement. If your Form 843 relates to a joint return, enter the

name of your spouse from the related joint return.

Taxpayer Identification Number (TIN). Enter your TIN. If you

are filing Form 843 relating to a joint return, enter the SSNs for

both you and your spouse from the related joint return. If you

have an individual taxpayer identification number (ITIN) rather

than an SSN, enter your ITIN (and, if this relates to a joint return,

the ITIN of your spouse from the related joint return) whenever

an SSN is requested. An entity, such as a partnership or

corporation, filing this form will include the entity’s Employer

Identification Number (EIN) instead of an SSN or ITIN.

Address change. If you move after filing your Form 843, use

Form 8822 to notify the IRS of your new address. If you are a

business or other entity, use Form 8822-B to notify the IRS of a

change in your business mailing address or your business

location.

P.O. box. Enter your box number only if your post office doesn't

deliver mail to your home.

Foreign address. If you have a foreign address, enter the city

name on the appropriate line. Don't enter any other information

on that line, but also complete the spaces below that line. Don't

abbreviate the country name. Follow the country's practice for

entering the postal code and the name of the province, county, or

state.

Line Instructions

Line 1. 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 “Beginning date (MM/DD/YYYY)” line.

Line 2. Enter the dollar amount for which you are requesting a

refund or an abatement.

Line 3. If you are requesting a refund of payments you have

already made, enter the date of each payment. If you need more

space, attach additional sheets.

Line 4. 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 an addition to tax,

check the box indicating the type of tax or fee to which the claim

or request relates.

!

Do not use Form 843 when another tax form must be

used. See Purpose of Form, earlier.

CAUTION

Line 5. Check the appropriate box to show the type of fee or

return, if any, to which your claim or request relates. Check box i

labeled “1040” to indicate other individual income tax returns

(such as Form 1040-SR, 1040-NR, or 1040 (sp)).

Line 6. If you are requesting a refund or an 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.

3

Line 7. Check the box that indicates your reason for the request

for refund or abatement. If a, b, and c do not apply, check box d.

Line 8. Explain in detail your reasons for filing this claim or

request. 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. 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.

Signature

If you are filing Form 843 to request a refund or an abatement

relating to a joint return, both you and your spouse from the

related joint return must sign the Form 843. Forms 843 filed by

corporations must be signed by a corporate officer authorized to

sign, and the officer's title must be included with the signature.

Forms 843 filed by an estate or a trust must be signed by the

fiduciary.

Paid Tax Return Preparer

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.

Special Situations

Your Form 843 may deal with situations that have special

qualifications or special rules. The items that follow give you

specialized information so your Form 843 can be filed and

processed correctly.

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 an

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 8 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.

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.

4

If you cannot obtain a statement from the employer, you

should attach a statement with the same information to the best

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.

Excess Tier 2 RRTA Tax

Complete lines 1 and 2. Skip line 3. On line 4, check box a for

“Employment” tax. Skip lines 5, 6, and 7. On line 8, 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.

Refund of Social Security or Medicare Tax

Withheld in Error

The same supporting evidence described in Refund of Excess

Social Security, Medicare, or RRTA Tax above must be provided.

If you are a nonresident alien, see Pub. 519 for additional

information.

Requesting Abatement or Refund of a Trust

Fund Recovery Penalty (TFRP) Assessment

In order to file a claim for refund of a TFRP assessment for each

applicable tax period, the taxpayer must pay the portion of the

penalty attributable to either:

• One employee if the TFRP is based on employment taxes, or

• One transaction if the claim relates to a TFRP for excise taxes.

Requesting Abatement or Refund of a Penalty or

Addition to Tax as a Result of Written Advice

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 their official capacity.

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.

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. Complete lines

1 through 4. On line 3, enter the date of payment if the penalty or

addition to tax has been paid. On line 6, enter the applicable

Internal Revenue Code section for the assessed penalty. Check

box b on line 7.

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.

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

Instructions for Form 843 (Rev. December 2024)

• 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.

Requesting Abatement or Refund of Interest

Due to IRS Error or Delay Under Section 6404(e)

(1)

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 later). 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.

How to request abatement of interest on a tax. Complete

lines 1 through 4. On line 3, show the dates of any payment of

interest or tax liability for the period involved. Check box a on

line 7.

On line 8, 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.

Managerial act. The term “managerial act” means an

administrative act that occurs during the processing of your case

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.

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 4 and provide a detailed explanation

on line 8.

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 must provide

documentation to substantiate that you are the taxpayer entitled

to receive the interest due on the overpayment.

Leave line 1 blank. You can enter a dollar amount on line 2 or

leave it blank. Complete line 4 to indicate the type of tax.

Instructions for Form 843 (Rev. December 2024)

Complete line 5 to indicate the type of return filed. More than one

box can be checked on lines 4 and 5. Do not complete lines 3, 6,

and 7.

On line 8, 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.

Branded Prescription Drug Fee

On line 1, enter the fee year on the “Beginning date (MM/DD/

YYYY)” line. Complete line 2. Skip line 3. On line 4, check the

box for “Fee.” On line 5, check box m for “Branded Prescription

Drug (BPD) Fee.” Skip lines 6 and 7. On line 8, 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.

Note. Interest related to the branded prescription drug fee

cannot be abated.

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 territories 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

5

claim or request; providing false or fraudulent information may

subject you to civil or criminal penalties.

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 . . . . . . . . . . . . . . . . . . . . .

Learning about the law or the form . . . . . .

Preparing the form . . . . . . . . . . . . . . . . . .

Copying, assembling, and sending the form

to the IRS . . . . . . . . . . . . . . . . . . . . . . . . .

6

26 min.

20 min.

28 min.

If you have comments concerning the accuracy of these time

estimates or suggestions for making Form 843 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.

20 min.

Instructions for Form 843 (Rev. December 2024)