IRS 14039 Template

IRS 14039 Template

The IRS Form 14039 is a document used to report identity theft related to tax issues. This form allows individuals to alert the Internal Revenue Service that their personal information may have been compromised, enabling the agency to take necessary precautions. If you believe you are a victim of identity theft, consider filling out the form by clicking the button below.

Table of Contents

The IRS Form 14039, also known as the Identity Theft Affidavit, serves as a crucial tool for individuals who suspect that their personal information has been misused for fraudulent purposes, particularly in relation to tax filings. This form allows taxpayers to report identity theft incidents to the IRS, ensuring that their tax records are protected and that any fraudulent returns filed in their name are addressed. By submitting Form 14039, individuals can initiate the process of rectifying their tax accounts and safeguarding their identities. It is important to note that this form is not just a means of reporting; it also helps the IRS take necessary actions to prevent further misuse of the taxpayer’s information. Completing the form requires specific details, including personal identification information and a description of the suspected identity theft. Additionally, the form can be submitted alongside a tax return or on its own, depending on the circumstances. Understanding the significance of Form 14039 is vital for anyone who may find themselves a victim of identity theft, as it plays a key role in reclaiming control over one’s financial identity.

IRS 14039 Sample

Form 14039

(May 2024)

Department of the Treasury - Internal Revenue Service

Identity Theft Affidavit

OMB Number

1545-2139

This affidavit is for victims of identity theft. To avoid delays do not use this form if you have already filed a Form 14039 for this incident.

Form 14039 can also be completed online at https://www.irs.gov/dmaf/form/f14039.

The IRS process for assisting victims selecting Section B, Box 1 below is explained at irs.gov/victimassistance.

Get an IP PIN: We encourage everyone to opt-in to the Identity Protection Personal Identification Number (IP PIN) program. If you don’t have an IP PIN, you can get one by going to irs.gov/ippin. If unable to do so online, you may schedule an appointment at your closest Taxpayer Assistance Center by calling (844-545-5640). Or, if eligible, you may use IRS Form 15227 to apply for an IP PIN by mail or FAX, also available by going to irs.gov/ippin.

Section A - Check the following boxes in this section that apply to the specific situation you are reporting (required for all filers)

1. I am submitting this Form 14039 for myself

2. I am submitting this Form 14039 in response to an IRS Notice or Letter received

Provide ‘Notice’ or ‘Letter’ number(s) on the line to the right

Check box 1 in Section B and see special mailing and faxing instructions on reverse side of this form.

3. I am submitting this Form 14039 on behalf of my dependent child or dependent relative (include that person’s information below in Section C and D)

Complete Sections A-F of this form. Do not use this form If dependent’s identity was misused by a parent or guardian in filing taxes, this is not identity theft.

4. I am submitting this Form 14039 on behalf of another person living or deceased (other than my dependent child or dependent relative)

• Complete Sections A- F of this form.

Section B – How I Am Impacted (required when reporting misuse of Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN))

Check all boxes that apply to the person listed in Section C below. If the person in Section C has previously submitted a Form 14039 for the same incident, there’s no need to submit another Form 14039.

1. I know or suspect that someone used my information to fraudulently file a federal tax return

I/My dependent was fraudulently/incorrectly claimed as a dependent (use that person’s information for Section C & D)

My SSN or ITIN was fraudulently used for employment purposes

Note: If you are a victim of Identity theft but it does not involve your federal tax return, you should request an IP PIN to protect yourself. Get An Identity Protection PIN | Internal Revenue Service (irs.gov)

Provide an explanation of the identity theft issue, how it impacts your tax account, when you became aware of it and provide relevant dates. If needed, attach additional information and/or pages to this form

Section C – Name and Contact Information of Identity Theft Victim (required)

Victim’s last name

First name

 

 

 

Middle

Taxpayer Identification Number

 

 

 

 

 

 

 

initial

(provide 9-digit SSN or ITIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

Current mailing address (apartment or suite

number and street, or P.O. Box)

Current city

 

 

 

 

State

ZIP code

If deceased, provide last known address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

Address used on last filed tax return (if different than ‘Current’)

 

City (on last tax return filed)

 

 

State

ZIP code

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

Telephone number with area code. The IRS may call you regarding this affidavit

 

 

 

Best time(s) to call

 

Home phone number

 

 

Cell phone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Language in which you would like to be contacted

English

 

Spanish

 

Other

 

 

 

Section D – Tax Account Information: Last tax return filed (year shown on the tax return) and Returns Impacted

 

 

 

 

 

 

 

I was not required to file a return or filed a return with no income information

 

 

 

 

 

 

 

 

 

 

 

Names used on last filed tax return

 

 

 

The last tax return filed (year shown on the tax return)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What Tax Year(s) you believe were impacted by tax-related identity theft (example: 2020 is input for citing the 2020 tax return though filed the next year(s). (if not known, enter ‘Unknown’ below))

Submit this completed form to either the mailing address or the FAX number provided on the reverse side of this form.

Catalog Number 52525A

www.irs.gov

Form 14039 (Rev. 5-2024)

Section E – Penalty of Perjury Statement and Signature (required)

Under penalty of perjury, I declare that, to the best of my knowledge and belief, the information entered on this Form 14039 is true, correct, complete, and made in good faith.

Signature of taxpayer, or representative, conservator, parent or guardian

Date signed

Section F – Representative, Conservator, Parent or Guardian Information (required if completing Form 14039 on someone else’s behalf)

Check only ONE of the following five boxes next to the reason you are submitting this form

1.The taxpayer is deceased, and I am the surviving spouse

No attachments are required, including death certificate.

2.The taxpayer is deceased, and I am the court-appointed or certified personal representative

Attach a copy of the court certificate showing your appointment.

3.The taxpayer is deceased, and a court-appointed or certified personal representative has not been appointed

Attach copy of death certificate or formal notification from a government office informing next of kin of the decedent’s death.

• Indicate your relationship to decedent:

Child

Parent/Legal Guardian

Other

4. The taxpayer is unable to complete this form and I am the appointed conservator, or I have been authorized to act on behalf of the taxpayer per Form 2848, Power of Attorney and Declaration of Representative

Attach a copy of documentation showing your appointment as conservator or Power of Attorney authorization.

If you have an IRS issued Centralized Authorization File (CAF) number, enter the nine-digit number:

5. The person listed above is my dependent child or my dependent relative

By checking this box and signing below you are indicating that you are an authorized representative, as parent, guardian or legal guardian, to file a legal document on the dependent’s behalf.

• Indicate your relationship to person

Parent/Legal Guardian

Power of Attorney

Fiduciary per IRS Form 56, Notice of Fiduciary Relationship

Other

 

 

 

 

Parent’s/Representative's name

 

 

 

Last name

First name

 

Middle initial

Parent’s/Representative’s current mailing address (city, town or post office, state, and ZIP code)

Parent’s/Representative’s telephone number

Instructions for Submitting this Form

Submit this completed and signed form to the IRS via Online, Mail or FAX to specialized IRS processing areas dedicated to assist you. In Section C of this form, be sure to include the Social Security Number in the ‘Taxpayer Identification Number’ field.

Help us avoid delays:

Do not use this form if you have already filed a Form 14039 for this incident.

Choose one method of submitting this form either Online (preferred method), by Mail, or by FAX, not all methods.

Provide clear and readable photocopies/images of any additional information you may choose to provide.

Submit the original tax return to the IRS location where you normally file your tax return. Do not use the following address or fax number to file an original tax return.

 

Online (Preferred Method)

 

Submitting by Mail

https://www.irs.gov/dmaf/form/f14039

If you checked Box 2 in Section A in response to a notice or letter

 

 

 

received from the IRS, return this form and if possible, a copy of the

 

Submitting by FAX

 

 

 

notice or letter to the address contained in the notice or letter.

• Always include a cover sheet marked "Confidential”.

If you checked Box 1 or 2 in Section B of Form 14039 and are unable

• If you checked Box 2 in Section A of Form 14039 and are submitting

 

to file your tax return electronically because the SSN/ITIN of you,

 

this form in response to a notice or letter received from the IRS. If it

 

your spouse, or dependent was misused, attach this Form 14039 to

 

provides a FAX number, you should send there.

 

the back of your paper tax return and submit to the IRS location where

If no FAX number is shown on the notice or letter, follow the mailing

 

you normally file your tax return.

All others should mail this form to:

 

instructions on the notice or letter.

For all others, FAX this form toll-free to:

 

Department of the Treasury

 

Internal Revenue Service

 

855-807-5720

 

 

 

Fresno, CA 93888-0025

 

 

 

 

 

 

 

Privacy Act and Paperwork Reduction Notice

Our legal authority to request the information is 26 U.S.C. 6001. The primary purpose of the form is to provide a method of reporting identity theft issues to the IRS so that the IRS may document situations where individuals are or may be victims of identity theft. Additional purposes include the use in the determination of proper tax liability and to relieve taxpayer burden. The information may be disclosed only as provided by 26 U.S.C. 6103. Providing the information on this form is voluntary. However, if you do not provide the information it may be more difficult to assist you in resolving your identity theft issue. If you are a potential victim of identity theft and do not provide the required substantiation information, we may not be able to place a marker on your account to assist with future protection. If you are a victim of identity theft and do not provide the required information, it may be difficult for IRS to determine your correct tax liability. If you intentionally provide false information, you may be subject to 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. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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 write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send this form to this address. Instead, see the form for filing instructions. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.

Catalog Number 52525A

www.irs.gov

Form 14039 (Rev. 5-2024)

Document Attributes

Fact Name Description
Purpose The IRS Form 14039 is used to report suspected identity theft related to tax returns.
Eligibility Anyone who believes their identity has been stolen for tax purposes can file this form.
Submission Method This form can be submitted online or mailed to the IRS.
Supporting Documents Taxpayers may need to provide supporting documentation to verify their identity.
State-Specific Forms Some states have their own forms for reporting identity theft, governed by state laws.
Processing Time Processing of Form 14039 can take several weeks, depending on the case.
Follow-Up Taxpayers should follow up with the IRS if they do not receive confirmation after filing.

IRS 14039: Usage Instruction

After receiving the IRS 14039 form, you will need to complete it accurately to address your tax-related concerns. Follow these steps to ensure you fill it out correctly.

  1. Begin by downloading the IRS 14039 form from the IRS website or obtain a physical copy from a local IRS office.
  2. At the top of the form, enter your name as it appears on your tax return.
  3. Provide your Social Security Number (SSN) in the designated box.
  4. Fill in your address, including city, state, and ZIP code.
  5. Indicate your phone number where you can be reached.
  6. In the next section, check the appropriate box that describes the reason you are filing this form.
  7. Complete the section regarding any previous attempts to resolve the issue, including any relevant details.
  8. Sign and date the form at the bottom to confirm that the information you provided is accurate.
  9. Make a copy of the completed form for your records.
  10. Submit the form according to the instructions provided, either by mail or electronically, if applicable.

Once you have submitted the form, you may need to wait for a response from the IRS. Be sure to keep track of any correspondence related to your submission.

Frequently Asked Questions

  1. What is the IRS Form 14039?

    The IRS Form 14039, also known as the Identity Theft Affidavit, is a document used by individuals who believe they are victims of identity theft. This form allows you to report the misuse of your personal information, particularly in relation to tax-related fraud. By submitting this form, you inform the IRS about the unauthorized use of your Social Security number or other personal information in connection with tax filings.

  2. When should I use Form 14039?

    You should use Form 14039 if you suspect that your personal information has been compromised and used to file a fraudulent tax return. Signs of identity theft may include receiving a notice from the IRS about a tax return filed in your name that you did not submit, or discovering that your Social Security number has been used for employment purposes without your knowledge. If you encounter these situations, it is crucial to act promptly and file this form.

  3. How do I submit Form 14039?

    To submit Form 14039, you can complete it online or print it out and fill it in manually. Once completed, you should send the form to the appropriate address listed in the instructions. Typically, you will need to send it to the IRS office that corresponds to your state. Ensure that you keep a copy of the completed form for your records. If you are filing this form due to a fraudulent tax return, you should also consider filing a police report and notifying your financial institutions.

  4. What happens after I submit Form 14039?

    After submitting Form 14039, the IRS will review your case. They may contact you for additional information or clarification. The process may take some time, so it is important to remain patient. You will receive a confirmation from the IRS once your case is processed. If your identity theft claim is verified, the IRS will take steps to secure your account and may assist you in resolving any tax issues that arise from the fraudulent activity.

Common mistakes

Filling out the IRS Form 14039, also known as the Identity Theft Affidavit, can be a daunting task. Many individuals encounter common mistakes that can lead to delays or complications in processing. One frequent error is incomplete information. When sections of the form are left blank, it can hinder the IRS's ability to address the issue effectively. Ensure that all required fields are filled out accurately.

Another common mistake is incorrect personal information. Providing the wrong Social Security number, address, or name can create confusion and may result in the form being rejected. Double-checking this information before submission is crucial for a smooth process.

Additionally, some people fail to sign the form. A signature is necessary to validate the affidavit. Without it, the IRS cannot process the claim, which can lead to further complications. Always remember to sign and date the form before sending it in.

Some individuals also neglect to include supporting documentation. The IRS may require additional proof of identity theft, such as police reports or other relevant documents. Failing to attach these can result in a delay in resolving the issue.

Another mistake is submitting the form to the wrong address. The IRS has specific mailing addresses for Form 14039, depending on the situation. Check the IRS website for the correct address to ensure that your form reaches the appropriate department.

People sometimes forget to keep copies of their submissions. Having a record of what was sent can be invaluable for follow-up communications. It is wise to keep copies of the completed form and any supporting documents for your records.

Lastly, a lack of timely follow-up can lead to unresolved issues. After submitting the form, it is important to monitor the situation and check in with the IRS if no response is received within a reasonable timeframe. Staying proactive can help in resolving identity theft cases more efficiently.

Documents used along the form

The IRS Form 14039, also known as the Identity Theft Affidavit, is a crucial document for individuals who suspect their personal information has been misused for tax purposes. When dealing with identity theft, several other forms and documents may be necessary to ensure proper reporting and resolution. Below is a list of common forms and documents that often accompany the IRS 14039.

  • Form 1040: This is the standard individual income tax return form. It may need to be amended or corrected if identity theft has affected the taxpayer's reported income or deductions.
  • Form 14039-A: This is an additional affidavit used specifically for victims of identity theft who need to report the misuse of their Social Security number. It provides more detailed information about the theft.
  • Form 4506-T: This form allows individuals to request a transcript of their tax return. It can help verify what the IRS has on file and identify any discrepancies caused by identity theft.
  • Form 8821: This is a tax information authorization form that allows a designated person to access the taxpayer's information. It can be useful if someone is helping the victim resolve identity theft issues.
  • Form 8862: If a taxpayer's refund was denied due to identity theft, this form can be used to claim the Earned Income Tax Credit (EITC) after the issue has been resolved.
  • Form 941: Employers who suspect identity theft involving their employees may need to file this quarterly payroll tax form to report wages and taxes withheld.
  • Identity Theft Report: This document is created when a victim reports identity theft to law enforcement. It serves as official proof of the crime and can be used to dispute fraudulent transactions.
  • Credit Reports: Victims should obtain copies of their credit reports to check for unauthorized accounts or inquiries. This is essential for monitoring ongoing identity theft issues.

In conclusion, when navigating the complexities of identity theft, the IRS Form 14039 is just one piece of the puzzle. Each of these documents plays a vital role in addressing the situation effectively. Being thorough and organized can help victims reclaim their identities and protect their financial futures.

Similar forms

The IRS Form 14039, also known as the Identity Theft Affidavit, is a critical document for individuals who suspect they have been victims of identity theft. Several other forms and documents share similarities with Form 14039 in terms of their purpose, function, or context. Here are eight documents that are comparable to the IRS 14039 form:

  • Form 14095: Identity Theft Affidavit for Victims of Tax Fraud - This form is specifically designed for individuals who have had their tax information misused, allowing them to report the fraudulent activity to the IRS.
  • Form 8821: Tax Information Authorization - This document permits a third party to receive information from the IRS about a taxpayer's account, which can be crucial when addressing identity theft issues.
  • Form 4506-T: Request for Transcript of Tax Return - Individuals can use this form to obtain a transcript of their tax return, which can help verify if their information has been compromised.
  • Form 1040: U.S. Individual Income Tax Return - This standard tax form is essential for filing taxes and can be impacted by identity theft, making it relevant for victims to monitor closely.
  • Form 1040-X: Amended U.S. Individual Income Tax Return - If identity theft has resulted in incorrect tax filings, this form allows individuals to amend their returns and correct any errors.
  • Form 8962: Premium Tax Credit - This form is used to claim the premium tax credit and may be affected if someone uses a victim's identity to obtain health insurance.
  • Form 8862: Information to Claim Earned Income Credit After Disallowance - Victims of identity theft may need to submit this form if their eligibility for the Earned Income Credit was denied due to fraudulent claims.
  • FTC Identity Theft Report - This report is filed with the Federal Trade Commission and serves as a formal declaration of identity theft, which can be useful in conjunction with the IRS 14039.

Each of these documents plays a role in addressing issues related to identity theft, whether through reporting, amending tax filings, or granting access to information. Understanding these forms can empower individuals to take the necessary steps to protect their financial identity.

Dos and Don'ts

When filling out the IRS Form 14039, which is used to report identity theft, it’s crucial to follow certain guidelines to ensure your submission is accurate and effective. Below is a list of things you should and shouldn't do while completing this form.

  • Do provide accurate personal information.
  • Don't leave any required fields blank.
  • Do sign and date the form before submission.
  • Don't submit the form electronically; it must be mailed.
  • Do keep a copy of the completed form for your records.
  • Don't use a pencil; always use black or blue ink.
  • Do include any supporting documentation that verifies your identity theft claim.
  • Don't forget to check the mailing address for submissions, as it may vary.
  • Do follow up with the IRS if you don’t receive a confirmation.
  • Don't hesitate to seek help if you have questions about the form.

By adhering to these guidelines, you can help ensure that your form is processed smoothly, allowing you to address the issues related to identity theft more effectively.

Misconceptions

The IRS Form 14039, also known as the Identity Theft Affidavit, is often misunderstood. Here are ten common misconceptions about this form:

  1. It is only for tax fraud cases.

    Many believe the form is solely for tax-related fraud. In reality, it addresses any identity theft issue affecting your tax records.

  2. Filing the form guarantees a resolution.

    Submitting the form does not automatically resolve identity theft issues. It initiates a process that may take time.

  3. You must file the form every year.

    This is not true. You only need to file it if you suspect identity theft has impacted your tax return.

  4. Only individuals can file this form.

    Businesses can also file Form 14039 if they experience identity theft issues affecting their tax accounts.

  5. The form is only for recent identity theft.

    It can be filed for any past incidents of identity theft that have affected your tax records, not just recent ones.

  6. Filing the form is a lengthy process.

    While it may take time to resolve issues, the actual filing of the form is straightforward and quick.

  7. You need to provide extensive documentation.

    While some documentation is necessary, the form itself is designed to be filled out with minimal required information.

  8. Once filed, you cannot track the status.

    You can contact the IRS for updates on your case after filing the form.

  9. Form 14039 is only for those who have lost money.

    Even if you haven't lost money, you should file if you suspect your identity has been compromised.

  10. It is not necessary to report to the police.

    While not mandatory, reporting identity theft to law enforcement is highly recommended and can support your claims.

Key takeaways

When dealing with the IRS 14039 form, it is essential to understand its purpose and how to complete it correctly. Here are some key takeaways to keep in mind:

  1. Purpose of the Form: The IRS 14039 form is used to report suspected identity theft. If you believe your personal information has been compromised, this form is your first step in addressing the issue.
  2. Filling Out the Form: Be thorough when completing the form. Provide all requested information accurately to help the IRS process your claim efficiently.
  3. Supporting Documentation: Attach any relevant documents that support your claim. This may include police reports or other evidence of identity theft.
  4. Submitting the Form: Once completed, submit the form to the IRS according to the instructions provided. Ensure that you keep a copy for your records.
  5. Follow-Up: After submission, be prepared to follow up with the IRS. They may contact you for additional information or clarification.
  6. Protection Measures: While the form addresses identity theft, consider additional steps to protect your identity, such as credit monitoring or placing a fraud alert on your accounts.
  7. Seek Assistance: If you feel overwhelmed, don’t hesitate to seek help. Professional advice can guide you through the process and ensure that your rights are protected.

Taking these steps seriously can help you navigate the complexities of identity theft and safeguard your personal information effectively.