Irs Form 2159 PDF Details

The IRS Form 2159, known as the Payroll Deduction Agreement, is a crucial tool for taxpayers who owe taxes and are seeking a manageable way to fulfill their obligations through deductions from their wages or salary. Updated in May 2020, this form facilitates an arrangement between taxpayers and the Internal Revenue Service, allowing for the direct withholding of tax payments by an employer from an employee's paycheck. Crucial to initiating this agreement is the requirement for both employer and employee consent, as outlined in detailed instructions provided on the form itself. The form also sets out various terms of agreement, including the payment schedule, amounts to be deducted, and the specific types of taxes and periods covered. Employers are tasked with forwarding withheld amounts to the IRS at agreed intervals, which could be weekly, bi-weekly, monthly, or as otherwise specified. Importantly, the form contains sections that address potential adjustments to the deduction amounts, criteria under which the agreement might be terminated or modified by the IRS, and information concerning fees associated with the agreement, such as the user fee and possible reinstatement fee. Notably, the agreement allows the IRS to apply federal tax refunds or overpayments towards the tax liability and describes conditions under which a Notice of Federal Tax Lien might be filed, which could impact the taxpayer's credit rating. In essence, Form 2159 is designed to offer a structured and systematic approach to paying down tax debt, ensuring compliance while mitigating the financial burden on taxpayers.

QuestionAnswer
Form NameIrs Form 2159
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesirs form 2159, 2159, form ftc gov complaint, id theft complaint

Form Preview Example

Form 2159

Department of the Treasury — Internal Revenue Service

Payroll Deduction Agreement

(May 2020)

(See Instructions on the back of this page.)

 

TO: (Employer name and address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regarding: (Taxpayer name and address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact person’s name

 

 

 

 

 

 

Telephone (Include area code)

 

 

Social security or employer identification number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Taxpayer)

 

(Spouse, last four digits)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER — See the instructions on the back of Part 2. The taxpayer identified above

 

 

Debit Payments Self-Identifier

on the right named you as an employer. Please read and sign the following statement to

 

 

 

 

 

 

 

 

 

 

 

agree to withhold amount(s) from the taxpayer’s (employee’s) wages or salary to apply to

 

 

If you are unable to make electronic payments through a debit instrument

taxes owed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(debit payments) by entering into a direct debit installment agreement, please

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

check the box below:

 

 

 

I agree to participate in this payroll deduction agreement and will withhold the amount

 

 

 

 

 

 

 

 

 

I am unable to make debit payments

shown below from each wage or salary payment due this employee. I will send the money

 

 

 

 

 

 

 

 

 

 

 

 

 

to the Internal Revenue Service every: (Check one box.)

 

 

Note: Not checking this box indicates that you are able but choosing not to

 

WEEK

 

TWO WEEKS

 

MONTH

 

OTHER (Specify)

 

 

make debit payments. See Instructions to Taxpayer below for more details.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For assistance, call: 1-800-829-0115 (Business) or

Date by which payments will be sent

 

 

 

beginning on

.

 

1-800-829-8374 (Individual – Self-Employed/Business Owners), or

Signed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-800-829-0922 (Individuals – Wage Earners)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Or write:

 

 

 

Campus

Title:

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City, State, and ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kinds of taxes (Form numbers)

 

 

 

 

 

 

Tax periods

 

 

Amount owed as of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

, plus all penalties and interest provided by law.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am paid every (Check one):

I agree to have $

WEEK

TWO WEEKS

MONTH

OTHER (Specify)

 

 

deducted from my wage or salary payments beginning

 

 

and paid by the employer to the IRS until the total

liability is paid in full. I also agree and authorize this deduction to be increased or decreased as follows:

Date of increase (OR DECREASE)

Amount of increase (OR DECREASE)

New installment payment amount

Terms of this agreement—By completing and submitting this agreement, you (the taxpayer) agree to the following terms:

• You will make each payment so that we (IRS) receive it by the due date stated on the

• We will apply all payments on this agreement in the best interests of the United States.

front of this form. If you cannot make a scheduled payment or accrue an additional

Generally, we will apply the payment to the oldest collection statute, which is normally

liability, contact us immediately.

the oldest tax year or tax period.

• This agreement is based on your current financial condition. We may modify or terminate

• We can terminate your installment agreement if: You do not make installment

the agreement if our information shows that your ability to pay has significantly changed.

payments as agreed, you do not pay any other federal tax debt when due, or you do not

You must provide updated financial information when requested.

provide financial information when requested.

• While this agreement is in effect, you must file all federal tax returns and pay any

• If we terminate your agreement, we may collect the entire amount you owe by levy on

(federal) taxes you owe on time.

your income, bank accounts or other assets, or by seizing your property. You will receive

• We will apply your federal tax refunds or overpayments (if any) to the amount you owe

a notice from us prior to termination of your agreement. EXCEPTION: We cannot collect

the individual shared responsibility payment under the Affordable Care Act by levy on

until it is fully paid, including any shared responsibility payment under the Affordable

your income or seizure.

Care Act.

• We may terminate this agreement at any time if we find that collection of the tax is in

 

• You must pay a $225 user fee, which we have authority to deduct from your first payment

jeopardy.

(s). You may be eligible for a reduced user fee of $43 that may be waived or reimbursed

• This agreement may require managerial approval. We'll notify you when we approve or

if certain conditions are met. See Form 13844 for qualifications and instructions.

don’t approve the agreement.

 

• If you default on your installment agreement and we terminate the agreement, you must

• We may file a Notice of Federal Tax lien if one has not been filed previously which may

pay a $89 reinstatement fee if we reinstate the agreement. You may be eligible for a

negatively impact your credit rating, but we will not file a Notice of Federal Tax Lien on an

reduced user fee of $43 that may be waived or reimbursed if certain conditions are met.

individual shared responsibility payment under the Affordable Care Act.

See Form 13844 for qualifications and instructions. We have the authority to deduct this

• By signing and submitting this form, you authorize the IRS to contact third parties and to

fee from your first payment(s) after the agreement is reinstated. If reinstated, you agree

disclose your tax information to third parties in order to process and administer this

to the terms of this agreement as stated herein.

agreement over its duration.

 

 

 

Additional terms (To be completed by IRS)

 

Your signature

Title (If Corporate Officer or Partner)

Date

Spouse’s signature (If a joint liability)

Date

FOR IRS USE ONLY:

AGREEMENT LOCATOR NUMBER: Check the appropriate boxes:

RSI “1” no further review

RSI “5” PPIA IMF 2-year review

RSI “6” PPIA BMF 2-year review Agreement Review Cycle:

Earliest CSED:

AI “0” Not a PPIA

AI “1” Field Asset PPIA AI “2” All other PPIAs

Originator’s ID #:

 

Originator Code:

Name:Title:

A NOTICE OF FEDERAL TAX LIEN (Check one box.)

HAS ALREADY BEEN FILED

WILL BE FILED IMMEDIATELY

WILL BE FILED WHEN TAX IS ASSESSED

Check box if pre-assessed modules included

MAY BE FILED IF THIS AGREEMENT DEFAULTS

 

Agreement examined or approved by (Signature, title, function)

Date

 

 

 

Part 1 — Acknowledgement Copy (RETURN TO IRS)

Catalog Number 21475H

www.irs.gov

Form 2159 (Rev. 5-2020)

 

 

 

 

 

 

 

 

Form 2159

Department of the Treasury — Internal Revenue Service

Payroll Deduction Agreement

(May 2020)

(See Instructions on the back of this page.)

 

TO: (Employer name and address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regarding: (Taxpayer name and address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact person’s name

 

 

 

 

 

 

Telephone (Include area code)

 

 

Social security or employer identification number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Taxpayer)

 

(Spouse, last four digits)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER — See the instructions on the back of Part 2. The taxpayer identified above

 

 

Debit Payments Self-Identifier

on the right named you as an employer. Please read and sign the following statement to

 

 

 

 

 

 

 

 

 

 

 

agree to withhold amount(s) from the taxpayer’s (employee’s) wages or salary to apply to

 

 

If you are unable to make electronic payments through a debit instrument

taxes owed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(debit payments) by entering into a direct debit installment agreement, please

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

check the box below:

 

 

 

I agree to participate in this payroll deduction agreement and will withhold the amount

 

 

 

 

 

 

 

 

 

I am unable to make debit payments

shown below from each wage or salary payment due this employee. I will send the money

 

 

 

 

 

 

 

 

 

 

 

 

 

to the Internal Revenue Service every: (Check one box.)

 

 

Note: Not checking this box indicates that you are able but choosing not to

 

WEEK

 

TWO WEEKS

 

MONTH

 

OTHER (Specify)

 

 

make debit payments. See Instructions to Taxpayer below for more details.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For assistance, call: 1-800-829-0115 (Business) or

Date by which payments will be sent

 

 

 

beginning on

.

 

1-800-829-8374 (Individual – Self-Employed/Business Owners), or

Signed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-800-829-0922 (Individuals – Wage Earners)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Or write:

 

 

 

Campus

Title:

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City, State, and ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kinds of taxes (Form numbers)

 

 

 

 

 

 

Tax periods

 

 

Amount owed as of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

, plus all penalties and interest provided by law.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am paid every (Check one):

I agree to have $

WEEK

TWO WEEKS

MONTH

OTHER (Specify)

 

 

deducted from my wage or salary payments beginning

 

 

and paid by the employer to the IRS until the total

liability is paid in full. I also agree and authorize this deduction to be increased or decreased as follows:

Date of increase (OR DECREASE)

Amount of increase (OR DECREASE)

New installment payment amount

Terms of this agreement—By completing and submitting this agreement, you (the taxpayer) agree to the following terms:

• You will make each payment so that we (IRS) receive it by the due date stated on the

• We will apply all payments on this agreement in the best interests of the United States.

front of this form. If you cannot make a scheduled payment or accrue an additional

Generally, we will apply the payment to the oldest collection statute, which is normally

liability, contact us immediately.

the oldest tax year or tax period.

• This agreement is based on your current financial condition. We may modify or terminate

• We can terminate your installment agreement if: You do not make installment

the agreement if our information shows that your ability to pay has significantly changed.

payments as agreed, you do not pay any other federal tax debt when due, or you do not

You must provide updated financial information when requested.

provide financial information when requested.

• While this agreement is in effect, you must file all federal tax returns and pay any

• If we terminate your agreement, we may collect the entire amount you owe by levy on

(federal) taxes you owe on time.

your income, bank accounts or other assets, or by seizing your property. You will receive

• We will apply your federal tax refunds or overpayments (if any) to the amount you owe

a notice from us prior to termination of your agreement. EXCEPTION: We cannot collect

the individual shared responsibility payment under the Affordable Care Act by levy on

until it is fully paid, including any shared responsibility payment under the Affordable

your income or seizure.

Care Act.

• We may terminate this agreement at any time if we find that collection of the tax is in

 

• You must pay a $225 user fee, which we have authority to deduct from your first payment

jeopardy.

(s). You may be eligible for a reduced user fee of $43 that may be waived or reimbursed

• This agreement may require managerial approval. We'll notify you when we approve or

if certain conditions are met. See Form 13844 for qualifications and instructions.

don’t approve the agreement.

 

• If you default on your installment agreement and we terminate the agreement, you must

• We may file a Notice of Federal Tax lien if one has not been filed previously which may

pay a $89 reinstatement fee if we reinstate the agreement. You may be eligible for a

negatively impact your credit rating, but we will not file a Notice of Federal Tax Lien on an

reduced user fee of $43 that may be waived or reimbursed if certain conditions are met.

individual shared responsibility payment under the Affordable Care Act.

See Form 13844 for qualifications and instructions. We have the authority to deduct this

• By signing and submitting this form, you authorize the IRS to contact third parties and to

fee from your first payment(s) after the agreement is reinstated. If reinstated, you agree

disclose your tax information to third parties in order to process and administer this

to the terms of this agreement as stated herein.

agreement over its duration.

 

 

 

Additional terms (To be completed by IRS)

 

Your signature

Title (If Corporate Officer or Partner)

Date

Spouse’s signature (If a joint liability)

Date

FOR IRS USE ONLY:

AGREEMENT LOCATOR NUMBER: Check the appropriate boxes:

RSI “1” no further review

RSI “5” PPIA IMF 2-year review

RSI “6” PPIA BMF 2-year review Agreement Review Cycle:

Earliest CSED:

AI “0” Not a PPIA

AI “1” Field Asset PPIA AI “2” All other PPIAs

Originator’s ID #:

 

Originator Code:

Name:Title:

A NOTICE OF FEDERAL TAX LIEN (Check one box.)

HAS ALREADY BEEN FILED

WILL BE FILED IMMEDIATELY

WILL BE FILED WHEN TAX IS ASSESSED

Check box if pre-assessed modules included

MAY BE FILED IF THIS AGREEMENT DEFAULTS

 

Agreement examined or approved by (Signature, title, function)

Date

 

 

 

Part 2 — Employer’s Copy

Catalog Number 21475H

www.irs.gov

Form 2159 (Rev. 5-2020)

INSTRUCTIONS TO EMPLOYER

This payroll deduction agreement is subject to your approval. If you agree to participate, please complete the spaces provided under the employer section on the front of this form.

WHAT YOU SHOULD DO

•Enter the name and telephone number of a contact person. (This will allow us to contact you if your employee’s liability is satisfied ahead of time.)

•Indicate when you will forward payments to IRS.

•Sign and date the form.

•After you and your employee have completed and signed all parts of the form, please return the parts of the form which were requested on the letter the employee received with the form. Use the IRS address on the letter the employee received with the form or the address shown on the front of the form.

HOW TO MAKE PAYMENTS

Please deduct the amount your employee agreed to have deducted from each wage or salary payment due the employee.

Make your check payable to the “United States Treasury.” To insure proper credit, please write your employee’s name and social security number on each payment.

Send the money to the IRS mailing address printed on the letter that came with the agreement. Your employee should give you a copy of this letter. If there is no letter, use the IRS address shown on the front of the form.

Note: The amount of the liability shown on the form may not include all penalties and interest provided by law. Please continue to make payments unless IRS notifies you to stop.

If you need assistance, please call the telephone number on the letter that came with the agreement or write to the address shown on the letter. If there’s no letter, please call the appropriate telephone number below or write IRS at the address shown on the front of the form.

For assistance, call: 1-800-829-0115 (Business), or

1-800-829-8374 (Individual – Self-Employed/Business Owners), or 1-800-829-0922 (Individuals – Wage Earners)

THANK YOU FOR YOUR COOPERATION

Catalog Number 21475H

www.irs.gov

Form 2159 (Rev. 5-2020)

Form 2159

Department of the Treasury — Internal Revenue Service

Payroll Deduction Agreement

(May 2020)

(See Instructions on the back of this page.)

 

TO: (Employer name and address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regarding: (Taxpayer name and address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact person’s name

 

 

 

 

 

 

Telephone (Include area code)

 

 

Social security or employer identification number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Taxpayer)

 

(Spouse, last four digits)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER — See the instructions on the back of Part 2. The taxpayer identified above

 

 

Debit Payments Self-Identifier

on the right named you as an employer. Please read and sign the following statement to

 

 

 

 

 

 

 

 

 

 

 

agree to withhold amount(s) from the taxpayer’s (employee’s) wages or salary to apply to

 

 

If you are unable to make electronic payments through a debit instrument

taxes owed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(debit payments) by entering into a direct debit installment agreement, please

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

check the box below:

 

 

 

I agree to participate in this payroll deduction agreement and will withhold the amount

 

 

 

 

 

 

 

 

 

I am unable to make debit payments

shown below from each wage or salary payment due this employee. I will send the money

 

 

 

 

 

 

 

 

 

 

 

 

 

to the Internal Revenue Service every: (Check one box.)

 

 

Note: Not checking this box indicates that you are able but choosing not to

 

WEEK

 

TWO WEEKS

 

MONTH

 

OTHER (Specify)

 

 

make debit payments. See Instructions to Taxpayer below for more details.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For assistance, call: 1-800-829-0115 (Business) or

Date by which payments will be sent

 

 

 

beginning on

.

 

1-800-829-8374 (Individual – Self-Employed/Business Owners), or

Signed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-800-829-0922 (Individuals – Wage Earners)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Or write:

 

 

 

Campus

Title:

 

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City, State, and ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kinds of taxes (Form numbers)

 

 

 

 

 

 

Tax periods

 

 

Amount owed as of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

, plus all penalties and interest provided by law.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am paid every (Check one):

I agree to have $

WEEK

TWO WEEKS

MONTH

OTHER (Specify)

 

 

deducted from my wage or salary payments beginning

 

 

and paid by the employer to the IRS until the total

liability is paid in full. I also agree and authorize this deduction to be increased or decreased as follows:

Date of increase (OR DECREASE)

Amount of increase (OR DECREASE)

New installment payment amount

Terms of this agreement—By completing and submitting this agreement, you (the taxpayer) agree to the following terms:

• You will make each payment so that we (IRS) receive it by the due date stated on the

• We will apply all payments on this agreement in the best interests of the United States.

front of this form. If you cannot make a scheduled payment or accrue an additional

Generally, we will apply the payment to the oldest collection statute, which is normally

liability, contact us immediately.

the oldest tax year or tax period.

• This agreement is based on your current financial condition. We may modify or terminate

• We can terminate your installment agreement if: You do not make installment

the agreement if our information shows that your ability to pay has significantly changed.

payments as agreed, you do not pay any other federal tax debt when due, or you do not

You must provide updated financial information when requested.

provide financial information when requested.

• While this agreement is in effect, you must file all federal tax returns and pay any

• If we terminate your agreement, we may collect the entire amount you owe by levy on

(federal) taxes you owe on time.

your income, bank accounts or other assets, or by seizing your property. You will receive

• We will apply your federal tax refunds or overpayments (if any) to the amount you owe

a notice from us prior to termination of your agreement. EXCEPTION: We cannot collect

the individual shared responsibility payment under the Affordable Care Act by levy on

until it is fully paid, including any shared responsibility payment under the Affordable

your income or seizure.

Care Act.

• We may terminate this agreement at any time if we find that collection of the tax is in

 

• You must pay a $225 user fee, which we have authority to deduct from your first payment

jeopardy.

(s). You may be eligible for a reduced user fee of $43 that may be waived or reimbursed

• This agreement may require managerial approval. We'll notify you when we approve or

if certain conditions are met. See Form 13844 for qualifications and instructions.

don’t approve the agreement.

 

• If you default on your installment agreement and we terminate the agreement, you must

• We may file a Notice of Federal Tax lien if one has not been filed previously which may

pay a $89 reinstatement fee if we reinstate the agreement. You may be eligible for a

negatively impact your credit rating, but we will not file a Notice of Federal Tax Lien on an

reduced user fee of $43 that may be waived or reimbursed if certain conditions are met.

individual shared responsibility payment under the Affordable Care Act.

See Form 13844 for qualifications and instructions. We have the authority to deduct this

• By signing and submitting this form, you authorize the IRS to contact third parties and to

fee from your first payment(s) after the agreement is reinstated. If reinstated, you agree

disclose your tax information to third parties in order to process and administer this

to the terms of this agreement as stated herein.

agreement over its duration.

 

 

 

Additional terms (To be completed by IRS)

 

Your signature

Title (If Corporate Officer or Partner)

Date

Spouse’s signature (If a joint liability)

Date

FOR IRS USE ONLY:

AGREEMENT LOCATOR NUMBER: Check the appropriate boxes:

RSI “1” no further review

RSI “5” PPIA IMF 2-year review

RSI “6” PPIA BMF 2-year review Agreement Review Cycle:

Earliest CSED:

AI “0” Not a PPIA

AI “1” Field Asset PPIA AI “2” All other PPIAs

Originator’s ID #:

 

Originator Code:

Name:Title:

A NOTICE OF FEDERAL TAX LIEN (Check one box.)

HAS ALREADY BEEN FILED

WILL BE FILED IMMEDIATELY

WILL BE FILED WHEN TAX IS ASSESSED

Check box if pre-assessed modules included

MAY BE FILED IF THIS AGREEMENT DEFAULTS

 

Agreement examined or approved by (Signature, title, function)

Date

 

 

 

Part 3 — Taxpayer’s Copy

Catalog Number 21475H

www.irs.gov

Form 2159 (Rev. 5-2020)

INSTRUCTIONS TO TAXPAYER

If not already completed by an IRS employee, please fill in the information in the spaces provided on the front of this form for the following items:

•Your employer’s name and address

•Your name(s) (plus spouse’s name if the amount owed is for a joint return) and current address.

•Your social security number or employer identification number. (Use the number that appears on the notice(s) you received.) Also, enter the last four digits of your spouse’s social security number if this is a joint liability.

•If you are a low-income taxpayer, you would qualify for the waiver of your installment agreement fees if you agreed to make electronic payments through a debit instrument (debit payments) by entering into a direct debit installment agreement. This payroll deduction agreement is not a direct debit installment agreement and you are not making debit payments under this agreement. However, if you indicated in the Debit Payments Self-Identifier section of this agreement that you are unable to make debit payments by entering into a direct debit installment agreement, then your installment agreement fees will be reimbursed upon completion of your agreement. Low-income taxpayers, for installment agreement purposes, are individuals with adjusted gross incomes, as determined for the most recent year for which such information is available, at or below 250% of the criteria established by the poverty guidelines updated annually by the U.S. Department of Health and Human Services.

•The kind of taxes you owe (form numbers) and the tax periods

•The amount you owe as of the date you spoke to IRS

•When you are paid

•The amount you agreed to have deducted from your pay when you spoke to IRS

•The date the deduction is to begin

•The amount of any increase or decrease in the deduction amount, if you agreed to this with IRS; otherwise, leave BLANK

After you complete, sign (along with your spouse if this is a joint liability), and date this agreement form, give it to your participating employer. If you received the form by mail, please give the employer a copy of the letter that came with it.

Your employer should mark the payment frequency on the form and sign it. Then, your employer should return the parts of the form which were requested on your letter or return Part 1 of the form to the address shown in the “For assistance” box on the front of the form.

If you need assistance, please call the appropriate telephone number below or write IRS at the address shown on the form. However, if you received this agreement by mail, please call the telephone number on the letter that came with it or write IRS at the address shown on the letter.

For assistance, call: 1-800-829-0115 (Business), or

1-800-829-8374 (Individual – Self-Employed/Business Owners), or 1-800-829-0922 (Individuals – Wage Earners)

Note: This agreement will not affect your liability (if any) for backup withholding under Public Law 98-67, the Interest and Dividend Compliance Act of 1983.

Catalog Number 21475H

www.irs.gov

Form 2159 (Rev. 5-2020)

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form ftc gov complaint writing process shown (stage 1)

2. The subsequent stage is to fill in all of the following blank fields: Additional terms To be completed, Your signature, Title If Corporate Officer or, Spouses signature If a joint, Date, Date, AGREEMENT LOCATOR NUMBER Check the, Originators ID, Originator Code, Name, Title, S R, R O F, Y L N O E S U, and RSI no further review.

Writing part 2 of form ftc gov complaint

3. Completing TO Employer name and address, See Instructions on the back of, Regarding Taxpayer name and address, Contact persons name, Telephone Include area code, Social security or employer, Spouse last four digits, EMPLOYER See the instructions on, WEEK, TWO WEEKS, MONTH, OTHER Specify, Date by which payments will be sent, beginning on, and Signed Title is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

MONTH, TO Employer name and address, and Signed Title of form ftc gov complaint

Always be very attentive while filling in MONTH and TO Employer name and address, since this is the section where a lot of people make a few mistakes.

4. The form's fourth paragraph arrives with the following blank fields to type in your details in: Additional terms To be completed, Your signature, Title If Corporate Officer or, Spouses signature If a joint, Date, Date, AGREEMENT LOCATOR NUMBER Check the, Originators ID, Originator Code, Name, Title, S R, R O F, Y L N O E S U, and RSI no further review.

Writing section 4 in form ftc gov complaint

5. Because you get close to the finalization of your file, you'll notice a couple extra requirements that have to be satisfied. In particular, HOW TO MAKE PAYMENTS, Please deduct the amount your, Make your check payable to the, Send the money to the IRS mailing, Note The amount of the liability, If you need assistance please call, For assistance call Business or, Individual SelfEmployedBusiness, and THANK YOU FOR YOUR COOPERATION must all be done.

form ftc gov complaint conclusion process detailed (stage 5)

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