Question	Answer
Form Name	Form 4180 Pdf
Form Length	4 pages
Fillable?	Yes
Fillable fields	146
Avg. time to fill out	30 min 16 sec
Other names	form fund recovery, 4180 form irs, form 4180, form 4180 pdf

1.	Name	2.	Social Security Number (SSN)

3.	Address (street, city, state, ZIP code)	4.	Home telephone number
			(	)

		5.	Work telephone number
			(	)

Did you...		Yes	No		Dates
Did you...		Yes	No	From		To
				From		To
a. Determine financial policy for the business?

b. Direct or authorize payments of bills/creditors?

c. Prepare, review, sign, or authorize transmit payroll tax returns?

d. Have knowledge withheld taxes were not paid?

e. Authorize payroll?

f. Authorize or make Federal Tax Deposits?

g. Authorize the assignment of any EFTPS or electronic banking PINS/passwords?

h. Could other individuals do any of the above? (Complete Section IV and V)
Name	Contact Number
Name	Contact Number

i. Have signature authority or PIN assignment on business bank accounts?
Bank Name(s)	Account Number(s)
Bank Name(s)	Account Number(s)

2. Did/does the business use the Electronic Federal Tax Payment	3. Other than the EFTPS, does the business do any other banking
System (EFTPS) to make Federal Tax Deposits (FTD's) or	electronically?
payments?	No

No	Yes Where
Yes If yes, to whom are the PINS or passwords assigned
	To whom are the PINs/passwords assigned

No	Who is authorized to sign Form 941
Yes	Who files the returns electronically

6. Were discussions ever held by stockholders, officers, or other	7. Who handled IRS contacts such as phone calls,
interested parties regarding nonpayment of the taxes?	correspondence, or visits by IRS personnel?
No
Yes
Identify who attended, dates, any decisions reached, and	When did these contacts take place, and what were the results
whether any documentation is available.	of these contacts?

1.	Who signed the service contract or entered into the agreement	2. Who in the business handled the contacts with the third-party
	for services with the third-party payer?		payer?

3.	Who was your contact at the third-party payer?	4. How were funds to be made available for the third-party payer to
		pay the taxes?

			Name of Bank(s) and Account number(s) from which funds
			were to be transferred.

5.	What actions did you take to verify the third-party payer was	6. Were funds available for the third-party payer to use for
	filing returns, or making required payments?		payment of the taxes?
			Yes	No
			If yes, explain in detail how and when the money was
			transferred to the third-party.

7. Were you aware that the third-party payer was not making the		8. Did you receive IRS notices indicating that the employment tax
required payments?		returns were not filed, or that the employment taxes were not
		paid?
Yes	No	Yes	No

1.	Who in your organization handled the contacts with the client?	2.	Who was your contact at the client business?

3.	Who at the client business signed the service contract or	4.	Who had control over the payments of the client's employment
	entered into the agreement for services?		taxes?

1.	Are you aware of any required excise tax returns which have not		2. With respect to excise taxes, were the patrons or customers
	been filed?		informed that the tax was included in the sales price?
	No	Yes (list periods)	No	Yes

3.	If the liability is one of the ''collected'' taxes (transportation of		4. Were you aware, during the period tax accrued, that the law
	persons or property and communications), was the tax		required collection of the tax?
	collected?
	No	Yes	No	Yes

Position (e.g. president, director)	Name	Address	Dates

Signature of person interviewed		Date

Signature of Interviewer		Date

Date copy of completed interview form given to person interviewed	►

Form 4180 Pdf – Fill Out and Use This PDF

Form 4180 Pdf PDF Details