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CP 91 Sample Contents Page 1

Contents of This Notice - Page 1 of 2

Levy On Social Security Benefits

You have not paid the federal taxes you owe even though we previously asked you to pay them and advised you of your appeal rights. Internal Revenue Code section 6331(h) allows the IRS to take (levy) up to 15% of your Social Security benefits to pay your overdue taxes. We have identified the following Social Security account from which we can take your benefits:

Social Security Claim Account Number: {SS claim # prints here on notice}

Beneficiary's Own Account Number: {Beneficiary's own account # prints here on notice}

To Avoid Levy Action 30 Days From The Date Of This Notice:

If You Can Pay The Amount You Owe In Full:

  • Make your check or money order payable to the United States Treasury.
  • Write your Social Security Number, the form number(s), and tax period(s) on your payment.
  • Send your payment and the attached Payment Voucher to us in the enclosed envelope.

The amount you owe (including tax, penalties, and interest) is listed on the next page. Penalty and interest charges, known as statutory additions, continue to increase until you pay the amount in full.


Call Us Immediately At The Telephone Number Shown Above
Please be prepared to tell us your monthly Income and expenses so we can help you resolve this tax matter. We may be able to set up a payment arrangement. Or, if we determine that you cannot pay any of your tax debt due to a financial hardship, we may temporarily delay collection until your financial condition improves.

You may also request a hearing with us; however, this may not stop the levy on your Social Security benefits.

Do Not Contact The Social Security Administration

If you have any questions, please call us at the telephone number shown above or write to us at the address on the payment voucher found on the second page of this notice. We want to help you resolve this matter, so please call us if you need assistance.

Declaration of Representative And Low Income Taxpayer Clinics

If you wish to have someone else contact us to resolve this tax matter, complete Power of Attorney and Declaration of Representative">Form 2848, Power of Attorney and Declaration of Representative, and send it to us in the enclosed envelope. You can get this form at your local IRS office, by calling {toll-free #}, or from our website at Also, we have enclosed Publication 4134, Low Income Taxpayer Clinic List. These Clinics assist low-income taxpayers for free or a nominal charge.

Publication 4134
Copy of this notice

Page Last Reviewed or Updated: 31-Mar-2014