CT-3911 Form – Fill Out and Use This PDF

CT-3911 Form PDF Details

Connecticut taxpayers who are missing a state income tax refund, or believe a refund check was lost or stolen, can file this taxpayer statement to begin an investigation with the Department of Revenue Services (DRS). This document applies to both individual and business tax filers who expected a direct deposit refund or a paper check. It does not apply to debit card refunds. Before submitting, check with your bank to verify the direct deposit was not received.

When to File the CT-3911 Taxpayer Statement

Allow at least six weeks from the date you filed your Connecticut tax return before submitting this form. Common reasons to file include a direct deposit that never posted to your bank account, a paper refund check that was lost in the mail, or a refund check that was stolen before it could be cashed. The DRS recommends reviewing any prior correspondence about your refund before completing the form. Both individual and business taxpayers are eligible to file.

• Direct deposit refund not received after six or more weeks
• Paper refund check was never delivered or is missing
• Refund check was lost, stolen, or cashed by someone else
• Refund check was issued but never cashed by the recipient

What You Need to Complete the Form

Use blue or black ink when completing the paper version of this taxpayer statement. Required information includes your full name, Social Security number or Federal Employer Identification Number (for business returns), the tax year and filing status, and the amount of the expected refund. Attach any prior DRS correspondence about the refund. If filing a joint return, both spouses must sign the declaration. Business taxpayers must also include their title in the signature section.

How to Submit and What to Expect

Mail or fax the completed statement to the Department of Revenue Services at the address or fax number printed on the form. After receiving the form, the DRS will provide written updates on the status of the investigation. If the original refund check was never cashed, the DRS will issue a replacement check. If you receive no response within six weeks of filing, contact the DRS directly by phone or mail to follow up. Connecticut takes refund investigations seriously and works to resolve each case in writing.

Taxpayers who are also missing a federal income tax refund should file the IRS Form 3911 separately with the Internal Revenue Service. In some cases where a refund check was fraudulently cashed, a replacement check request form from your bank may be needed as supporting documentation.