Mailing Instructions Place the Form 14157-A on top of all other required documentation. If submitting this information in response to a notice or letter received from the IRS Send the completed Form 14157-A Form 14157 and other documents with a copy of the notice or letter to the address contained in that notice or letter. Important Read the instructions for additional required documentation to submit with Form 14157-A. Incomplete complaints will delay the processing of your claim. Your name Last First MI Spouse name if applicable Last First MI Last four digits of your SSN or ITIN Name of Tax Return Preparer Your mailing address street city state ZIP code I am a victim of preparer fraud or misconduct check all that apply. Provide an explanation on the back of this form. the refund List the tax year s impacted for each box checked above If you used the tax return preparer named above for any other tax year s filings or returns list the tax year s Do you have a relationship with the preparer other than a business relationship Yes No If Yes define the relationship friend neighbor relative co-worker etc. How did you find out this person prepared income tax returns Did you receive a refund If Yes enter refund amount Enter refund amount expected if different from the refund amount you received If No did you contact your preparer or financial institution to inquire about your refund Preparer or financial institution response regarding your refund Note If you did not receive a refund or received a refund for a different amount than what was expected you may contact the IRS at 1-800-829-1040 to determine if a refund trace is needed. The refund trace will assist with the processing of your claim. Did you pay a fee to your preparer If Yes enter fee amount How did you pay the fee For example deducted from refund personal payment Do you authorize the IRS to disclose your identity your name mailing address taxpayer identifying number or any combination thereof and each bank routing and account number listed on your tax return to the corresponding bank in order to determine if the refund was directed to your account Catalog Number 59567Y www.irs.gov Page 2 Briefly describe what happened and the resulting tax issue if applicable. Provide an explanation on the back of this form. the refund List the tax year s impacted for each box checked above If you used the tax return preparer named above for any other tax year s filings or returns list the tax year s Do you have a relationship with the preparer other than a business relationship Yes No If Yes define the relationship friend neighbor relative co-worker etc. How did you find out this person prepared income tax returns Did you receive a refund If Yes enter refund amount Enter refund amount expected if different from the refund amount you received If No did you contact your preparer or financial institution to inquire about your refund Preparer or financial institution response regarding your refund Note If you did not receive a refund or received a refund for a different amount than what was expected you may contact the IRS at 1-800-829-1040 to determine if a refund trace is needed. The refund trace will assist with the processing of your claim. Did you pay a fee to your preparer If Yes enter fee amount How did you pay the fee For example deducted from refund personal payment Do you authorize the IRS to disclose your identity your name mailing address taxpayer identifying number or any combination thereof and each bank routing and account number listed on your tax return to the corresponding bank in order to determine if the refund was directed to your account Catalog Number 59567Y www.irs.gov Page 2 Briefly describe what happened and the resulting tax issue if applicable. If additional space is needed attach your explanation. Under penalties of perjury I declare that to the best of my knowledge and belief the information entered on this form is true correct complete and made in good faith Taxpayer signature Date signed Spouse s signature if applicable Telephone number include area code Page 3 Instructions for Form 14157-A Tax Return Preparer Fraud or Misconduct Affidavit Purpose of Form information without your knowledge or consent AND 2 you are seeking a change to your tax account.
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