Response Form

1. Review the Explanation Section to decide whether you agree or do not agree with IRS's proposed changes.
2. Complete and return the Response Form by {due date}.
3. If you need additional time, call us at {toll-free #}.

If you agree with the changes IRS is proposing, return this form with your FULL or PARTIAL payment along with the completed Installment Agreement Request for the remaining balance (if applicable).

[  ] OPTION 1 |  I Agree with All Changes

I agree with the changes to my {tax year} tax return.
I understand that I owe {$ amount} in additional tax, penalties, and interest.
I understand that the law requires IRS to charge interest on taxes that are not paid in full by {due date}.  In addition, I understand that the IRS will charge interest until I have paid the tax in full.  Certain penalties may also apply.
I understand that I can challenge these changes in the U.S. Tax Court only if IRS determines after the date I sign this form that I owe additional taxes for {tax year}.
I understand that I can file for a refund at a later date.

_____________________________________

Signature                                       Date

If you do not agree with the changes IRS is proposing, return this form.  When you return this form, include a signed statement that explains what you do not agree with.  Also include copies of any documents, such as a corrected W-2, 1099, or missing forms, that support your statement.

[  ] OPTION 2 |  I Do Not Agree with Some of the Changes
I've enclosed documentation to support the entries on my original return.

[  ] OPTION 3 |  I Do Not Agree with Any of the Changes
I've enclosed documentation to support the entries on my original return.

Tip!  Pay as much as you can now to keep penalty and interest charges low. Make your check or money order payable to "United States Treasury."  Write "Tax Year {tax year} CP2000," this  Social Security Number {SSN #} and your phone number on your check or money order.

[  ] OPTION 1 |  I'm paying the proposed balance due of {$ amount}
Balance may not include all applicable penalties - refer to the Explanation Section..

[  ] OPTION 2 |  I'm making a payment of $_______ because either:

       [  ] I'm paying the amount I agree with or
       [  ] I'm making a partial payment at this time

[  ] OPTION 3 |  I'd like to request a payment plan to pay the tax I owe.
Complete the Installment Agreement Request (Form 9465) and mail it along with this form.  Please refer to Form 9465 instructions for applicable fees.