Information Referral

• Legal Form Number: 3949-A
• Year: 2020
• Issuer: Treasury Department
• Section: Treasury Department

Catalog Number 47872E www.irs.gov Form 3949-A (Rev. 10-2020)

Form 3949-A

(October 2020)

Department of the Treasury - Internal Revenue Service

Information Referral

(See instructions on reverse)

OMB Number

1545-1960

Use this form to report suspected tax law violations by a person or a business.

CAUTION: READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM. There may be other more appropriate forms specific to your complaint.

(For example, if you suspect your identity was stolen, use Form 14039.)

Section A – Information About the Person or Business You Are Reporting

Complete 1, if you are reporting an Individual. Complete 2, if you are reporting a business only. Complete 1 and 2 if you are reporting a business and its owner.

(Leave blank any lines you do not know.)

1a. Name of individual b. Social Security Number/TIN c. Date of birth

d. Street address e. City f. State g. ZIP code

h. Occupation i. Email address

j. Marital status (check one, if known)

Married Single Head of Household Divorced Separated

k. Name of spouse

2a. Name of business b. Employer Tax ID number (EIN) c. Telephone number

d. Street address e. City f. State g. ZIP code

h. Email address i. Website

Section B – Describe the Alleged Violation of Income Tax Law

3. Alleged violation of income tax law. (Check all that apply.)

False Exemption

False Deductions

Multiple Filings

Organized Crime

Unsubstantiated Income

Earned Income Credit

Public/Political Corruption

False/Altered Documents

Unreported Income

Narcotics Income

Kickback

Wagering/Gambling

Failure to Withhold Tax

Failure to File Return

Failure to Pay Tax

Other (describe in 5)

4. Unreported income and tax years

Fill in Tax Years and dollar amounts, if known (e.g., TY 2010- $10,000)

TY $ TY $ TY $ TY $ TY $ TY $

5. Comments (Briefly describe the facts of the alleged violation-Who/What/Where/When/How you learned about and obtained the information in this report. Attach

another sheet, if needed.)

6. Additional information. Answer these questions, if possible. Otherwise, leave blank.

a. Are book/records available? (If available, do not send now. We will contact you, if they are needed for an investigation.) Yes No

b. Do you consider the taxpayer dangerous Yes No

c. Banks, Financial Institutions used by the taxpayer

Name

Street address

City State ZIP code

Name

Street address

City State ZIP code

Section C – Information About Yourself

(We never share this information with the person or business you are reporting.)

This information is not required to process your report, but would be helpful if we need to contact you for any additional information.

7a. Your name b. Telephone number c. Best time to call

d. Street address e. City f. State g. ZIP code

Print and send your completed form to: Internal Revenue Service

PO Box 3801

Ogden, UT 84409