Form 15116

(Rev. 4-2022)

Information Sheet

Catalog Number 69810S

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Instructions
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General Information
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Review
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Instructions

Important Things You Should Know

Please enter all information as accurately as possible.

General Information

All fields marked with an asterisk (*) are required.

Reference number

On the top right of the letter 112c that you received. The line ‘in reply refer to:’ contains a 10 digit number. Enter that number here.

Full name at birth

First name

Middle initial

Last name

Date of birth

Any other name used on your returns

Mother's full name at birth

Mother's first name at birth

Mother's MI name at birth

Mother's last name at birth

Father's full name

Father's first name

Father's MI

Father's last name

SSNYes

SSNNo

Have you ever applied for or had a Social Security number?

Yes

Name of State

Date received

Enter the Social Security number you received

Enter without dashes ie 999999999

Street

City

State

ZIP code

Must be 5 or 9 digit ZIP code; include dash if providing full ZIP code. All zeros are not accepted. Ex: 12345-1234.

Work

Enter including spaces and symbols. ex: +01 999-999-9999

Home

Enter including spaces and symbols. ex: +01 999-999-9999

Convenient hours for us to call you

Review your information below. Form is for review purposes only. If changes are needed please use web form.

Review

Review your information below. If you need to make changes, you can use the Edit links to go back to previous sections to ensure your information is accurate.

You can choose to submit form electronically or download the PDF to submit by fax or mail. You can still download PDF after submitting electronically for your records.

Submit Electronically

Download PDF

Your Form Has Been Submitted

Click here to download a pdf for your records