Form Pps 5928 PDF Details

Pursuant to the requirements of the Paperwork Reduction Act, the IRS has proposed a new form to be used by taxpayers who have received an erroneous refund. The proposed Form Pps 5928 would be used by taxpayers to request that the IRS not process the refund and return it to the taxpayer. The proposed form is 8½ inches wide and 11 inches long with one-half inch margins on all sides. It is designed to be used by taxpayers who have received an erroneous refund or a refund in excess of what they were owed. The form would require taxpayers to provide their name, address, social security number, daytime telephone number, reason for requesting that the refund not be processed, and signature. In addition, the form would require taxpayers to identify the tax year for which they received the erroneous refund and the amount of the erroneous refund. The IRS is seeking comments from stakeholders on this proposed form. Comments may be submitted on or before November 3, 2014. Stakeholders are enco

QuestionAnswer
Form NameForm Pps 5928
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesstudent dcf bengali meaning, student dcf, dcf full form in bengali, dcf full form

Form Preview Example

State of Kansas

Department for Children and FamiliesDCF GSO Reporting Form Prevention and Protection Services

Attn:

DCF eData Reporting Form

PPS 5928 Aug 2012

 

 

Claimant’s Name:

 

Date of Report:

 

 

 

 

 

 

Reporter’s Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

Position:

 

 

 

Social Security Number:

 

 

 

 

 

 

 

 

 

 

 

Location:

 

 

Parent’s SSA Claim Number:

 

 

 

 

 

 

 

 

 

Phone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAX Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payee Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to: Choose One

Date of Change:

 

 

 

 

 

 

Payee’s Phone:

 

 

 

Name of New Payee:

 

 

 

 

 

 

 

 

 

 

Address of New Payee:

 

 

 

 

 

 

 

 

Best Time to Call:

 

 

 

Reason for Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Placement Change:

Date of Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Old Placement Name:

 

 

 

 

 

 

 

 

Old Type:

Choose One

 

 

Old Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New Placement Name:

 

 

 

 

 

 

 

 

New Type: Choose One

 

 

New Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cost of Care:

 

 

 

 

 

 

Unit:

Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSI Funding Source: Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income Change:

Date of Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type:

 

 

Choose One

 

 

Choose One

 

 

 

 

 

Monthly Amnt:

 

 

 

 

 

 

 

Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resource Change:

Date of Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reason:

 

 

Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Change:

Attending?

 

 

Choose One

 

Effective Date:

 

Name & Address of School:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comment:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DCF: For clients 17-1/2 complete and mail back the Student Report when received.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Changes:

Type:

 

 

Choose One

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Change:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Multi-Month Distribution

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Request:

Date of Deposit:

 

 

 

 

Amount:

 

 

 

 

 

 

 

 

Requested Dates:

From:

 

 

 

 

 

 

To:

 

 

 

 

 

 

Expenses Incurred: (see attached) DCF: Ask for an expense report from SCRIPTS Average Monthly cost of care:

Is client nearing age 18?

Yes

 

If yes, has the need to conserve these

No

funds for IL been considered?

Yes

No

Additional Comments: