Free IRS 14039 Template in PDF

Free IRS 14039 Template in PDF

The IRS Form 14039 is a document used by individuals to report suspected identity theft related to their tax records. This form helps the IRS take action to protect taxpayers and their sensitive information. By filing Form 14039, you can alert the IRS to potential fraud and seek assistance in resolving any issues that may arise from identity theft.

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The IRS 14039 form, also known as the Identity Theft Affidavit, serves a critical function for individuals who suspect that their personal information has been compromised and misused for tax-related purposes. This form provides a structured way for taxpayers to report identity theft, enabling the Internal Revenue Service to take appropriate action to protect the taxpayer's account and rectify any fraudulent activities that may have occurred. By submitting the form, individuals can alert the IRS to potential discrepancies in their tax filings, such as unrecognized income or erroneous claims for refunds. The process of completing the form requires detailed personal information, including the taxpayer's name, Social Security number, and a description of the identity theft incident. Additionally, the IRS 14039 form helps to initiate a review of the taxpayer's account, which may lead to the issuance of an Identity Protection Personal Identification Number (IP PIN) to further safeguard against future fraud. Understanding the significance of this form is essential for anyone who finds themselves in a situation where their identity has been compromised, as it is a vital step in reclaiming control over their financial and tax-related matters.

IRS 14039 Preview

Form 14039

(May 2024)

Department of the Treasury - Internal Revenue Service

Identity Theft Affidavit

OMB Number

1545-2139

This affidavit is for victims of identity theft. To avoid delays do not use this form if you have already filed a Form 14039 for this incident.

Form 14039 can also be completed online at https://www.irs.gov/dmaf/form/f14039.

The IRS process for assisting victims selecting Section B, Box 1 below is explained at irs.gov/victimassistance.

Get an IP PIN: We encourage everyone to opt-in to the Identity Protection Personal Identification Number (IP PIN) program. If you don’t have an IP PIN, you can get one by going to irs.gov/ippin. If unable to do so online, you may schedule an appointment at your closest Taxpayer Assistance Center by calling (844-545-5640). Or, if eligible, you may use IRS Form 15227 to apply for an IP PIN by mail or FAX, also available by going to irs.gov/ippin.

Section A - Check the following boxes in this section that apply to the specific situation you are reporting (required for all filers)

1. I am submitting this Form 14039 for myself

2. I am submitting this Form 14039 in response to an IRS Notice or Letter received

Provide ‘Notice’ or ‘Letter’ number(s) on the line to the right

Check box 1 in Section B and see special mailing and faxing instructions on reverse side of this form.

3. I am submitting this Form 14039 on behalf of my dependent child or dependent relative (include that person’s information below in Section C and D)

Complete Sections A-F of this form. Do not use this form If dependent’s identity was misused by a parent or guardian in filing taxes, this is not identity theft.

4. I am submitting this Form 14039 on behalf of another person living or deceased (other than my dependent child or dependent relative)

• Complete Sections A- F of this form.

Section B – How I Am Impacted (required when reporting misuse of Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN))

Check all boxes that apply to the person listed in Section C below. If the person in Section C has previously submitted a Form 14039 for the same incident, there’s no need to submit another Form 14039.

1. I know or suspect that someone used my information to fraudulently file a federal tax return

I/My dependent was fraudulently/incorrectly claimed as a dependent (use that person’s information for Section C & D)

My SSN or ITIN was fraudulently used for employment purposes

Note: If you are a victim of Identity theft but it does not involve your federal tax return, you should request an IP PIN to protect yourself. Get An Identity Protection PIN | Internal Revenue Service (irs.gov)

Provide an explanation of the identity theft issue, how it impacts your tax account, when you became aware of it and provide relevant dates. If needed, attach additional information and/or pages to this form

Section C – Name and Contact Information of Identity Theft Victim (required)

Victim’s last name

First name

 

 

 

Middle

Taxpayer Identification Number

 

 

 

 

 

 

 

initial

(provide 9-digit SSN or ITIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

Current mailing address (apartment or suite

number and street, or P.O. Box)

Current city

 

 

 

 

State

ZIP code

If deceased, provide last known address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

Address used on last filed tax return (if different than ‘Current’)

 

City (on last tax return filed)

 

 

State

ZIP code

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

Telephone number with area code. The IRS may call you regarding this affidavit

 

 

 

Best time(s) to call

 

Home phone number

 

 

Cell phone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Language in which you would like to be contacted

English

 

Spanish

 

Other

 

 

 

Section D – Tax Account Information: Last tax return filed (year shown on the tax return) and Returns Impacted

 

 

 

 

 

 

 

I was not required to file a return or filed a return with no income information

 

 

 

 

 

 

 

 

 

 

 

Names used on last filed tax return

 

 

 

The last tax return filed (year shown on the tax return)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What Tax Year(s) you believe were impacted by tax-related identity theft (example: 2020 is input for citing the 2020 tax return though filed the next year(s). (if not known, enter ‘Unknown’ below))

Submit this completed form to either the mailing address or the FAX number provided on the reverse side of this form.

Catalog Number 52525A

www.irs.gov

Form 14039 (Rev. 5-2024)

Section E – Penalty of Perjury Statement and Signature (required)

Under penalty of perjury, I declare that, to the best of my knowledge and belief, the information entered on this Form 14039 is true, correct, complete, and made in good faith.

Signature of taxpayer, or representative, conservator, parent or guardian

Date signed

Section F – Representative, Conservator, Parent or Guardian Information (required if completing Form 14039 on someone else’s behalf)

Check only ONE of the following five boxes next to the reason you are submitting this form

1.The taxpayer is deceased, and I am the surviving spouse

No attachments are required, including death certificate.

2.The taxpayer is deceased, and I am the court-appointed or certified personal representative

Attach a copy of the court certificate showing your appointment.

3.The taxpayer is deceased, and a court-appointed or certified personal representative has not been appointed

Attach copy of death certificate or formal notification from a government office informing next of kin of the decedent’s death.

• Indicate your relationship to decedent:

Child

Parent/Legal Guardian

Other

4. The taxpayer is unable to complete this form and I am the appointed conservator, or I have been authorized to act on behalf of the taxpayer per Form 2848, Power of Attorney and Declaration of Representative

Attach a copy of documentation showing your appointment as conservator or Power of Attorney authorization.

If you have an IRS issued Centralized Authorization File (CAF) number, enter the nine-digit number:

5. The person listed above is my dependent child or my dependent relative

By checking this box and signing below you are indicating that you are an authorized representative, as parent, guardian or legal guardian, to file a legal document on the dependent’s behalf.

• Indicate your relationship to person

Parent/Legal Guardian

Power of Attorney

Fiduciary per IRS Form 56, Notice of Fiduciary Relationship

Other

 

 

 

 

Parent’s/Representative's name

 

 

 

Last name

First name

 

Middle initial

Parent’s/Representative’s current mailing address (city, town or post office, state, and ZIP code)

Parent’s/Representative’s telephone number

Instructions for Submitting this Form

Submit this completed and signed form to the IRS via Online, Mail or FAX to specialized IRS processing areas dedicated to assist you. In Section C of this form, be sure to include the Social Security Number in the ‘Taxpayer Identification Number’ field.

Help us avoid delays:

Do not use this form if you have already filed a Form 14039 for this incident.

Choose one method of submitting this form either Online (preferred method), by Mail, or by FAX, not all methods.

Provide clear and readable photocopies/images of any additional information you may choose to provide.

Submit the original tax return to the IRS location where you normally file your tax return. Do not use the following address or fax number to file an original tax return.

 

Online (Preferred Method)

 

Submitting by Mail

https://www.irs.gov/dmaf/form/f14039

If you checked Box 2 in Section A in response to a notice or letter

 

 

 

received from the IRS, return this form and if possible, a copy of the

 

Submitting by FAX

 

 

 

notice or letter to the address contained in the notice or letter.

• Always include a cover sheet marked "Confidential”.

If you checked Box 1 or 2 in Section B of Form 14039 and are unable

• If you checked Box 2 in Section A of Form 14039 and are submitting

 

to file your tax return electronically because the SSN/ITIN of you,

 

this form in response to a notice or letter received from the IRS. If it

 

your spouse, or dependent was misused, attach this Form 14039 to

 

provides a FAX number, you should send there.

 

the back of your paper tax return and submit to the IRS location where

If no FAX number is shown on the notice or letter, follow the mailing

 

you normally file your tax return.

All others should mail this form to:

 

instructions on the notice or letter.

For all others, FAX this form toll-free to:

 

Department of the Treasury

 

Internal Revenue Service

 

855-807-5720

 

 

 

Fresno, CA 93888-0025

 

 

 

 

 

 

 

Privacy Act and Paperwork Reduction Notice

Our legal authority to request the information is 26 U.S.C. 6001. The primary purpose of the form is to provide a method of reporting identity theft issues to the IRS so that the IRS may document situations where individuals are or may be victims of identity theft. Additional purposes include the use in the determination of proper tax liability and to relieve taxpayer burden. The information may be disclosed only as provided by 26 U.S.C. 6103. Providing the information on this form is voluntary. However, if you do not provide the information it may be more difficult to assist you in resolving your identity theft issue. If you are a potential victim of identity theft and do not provide the required substantiation information, we may not be able to place a marker on your account to assist with future protection. If you are a victim of identity theft and do not provide the required information, it may be difficult for IRS to determine your correct tax liability. If you intentionally provide false information, you may be subject to criminal penalties. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send this form to this address. Instead, see the form for filing instructions. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.

Catalog Number 52525A

www.irs.gov

Form 14039 (Rev. 5-2024)

Document Specs

Fact Name Description
Purpose The IRS Form 14039 is used to report suspected identity theft related to a taxpayer's account.
Eligibility This form is available to individuals who believe their tax information has been compromised.
Submission Taxpayers can submit Form 14039 online or by mailing it to the appropriate IRS address.
Processing Time The IRS typically takes 4 to 6 weeks to process Form 14039 after submission.
State-Specific Forms Some states have their own identity theft reporting forms, governed by state laws such as California's Civil Code § 1798.92.
Additional Resources The IRS provides resources and guidance on identity theft on its official website.

Detailed Instructions for Using IRS 14039

The IRS Form 14039 is a tool used to report identity theft related to tax issues. Completing this form is essential for addressing any fraudulent activities associated with your tax records. Once you fill it out, you'll need to submit it to the IRS along with any required documentation to support your claim.

  1. Begin by downloading the IRS Form 14039 from the official IRS website or obtain a physical copy from a local IRS office.
  2. Fill in your personal information at the top of the form. This includes your name, address, and Social Security number.
  3. Provide details about the identity theft incident. Describe how you became aware of the identity theft and any actions you have taken.
  4. Indicate the tax year(s) affected by the identity theft. Be specific about which years you believe were impacted.
  5. Sign and date the form at the bottom. This confirms that the information you provided is accurate to the best of your knowledge.
  6. Gather any additional documentation that supports your claim, such as police reports or correspondence with the IRS.
  7. Mail the completed form and any supporting documents to the address specified in the instructions on the form.

FAQ

  1. What is the IRS Form 14039?

    The IRS Form 14039, also known as the Identity Theft Affidavit, is a document that individuals can use to report identity theft related to their tax records. If you believe your personal information has been misused to file a fraudulent tax return or to gain tax benefits, this form helps you notify the IRS of the situation.

  2. When should I use Form 14039?

    You should consider using Form 14039 if you have received a notice from the IRS indicating that more than one tax return was filed using your Social Security number, or if you believe someone else has used your personal information to file a tax return. Additionally, if you notice unusual activity on your financial accounts that suggests identity theft, completing this form can be a crucial step in addressing the issue.

  3. How do I complete Form 14039?

    To complete Form 14039, you will need to provide your personal information, including your name, address, and Social Security number. You will also need to describe the circumstances of the identity theft. The form requires you to indicate how you became aware of the theft and to provide any relevant details that can assist the IRS in investigating your claim. Be sure to sign and date the form before submitting it.

  4. Where do I send Form 14039?

    Once you have completed Form 14039, you should send it to the address provided in the instructions on the form. Typically, this will be the IRS office that corresponds to your location. If you are unsure, you can check the IRS website or contact them directly for guidance on where to send your completed form.

  5. What happens after I submit Form 14039?

    After you submit Form 14039, the IRS will review the information you provided. They may contact you for additional details or clarification. The IRS will also take steps to secure your tax account, which may include placing a flag on your account to prevent further fraudulent activity. It’s important to monitor your financial accounts and credit reports during this time.

  6. Can I file Form 14039 electronically?

    Currently, Form 14039 must be submitted in paper form and cannot be filed electronically. It is advisable to keep a copy of the completed form for your records. Additionally, consider sending it via certified mail to ensure that you have proof of submission.

Common mistakes

Filling out the IRS Form 14039 can be a crucial step in addressing identity theft issues. However, many individuals make common mistakes that can delay the process or lead to further complications. One frequent error is providing incorrect personal information. This includes misspellings of names, wrong Social Security numbers, or incorrect addresses. Such mistakes can hinder the IRS's ability to verify the identity of the individual filing the form.

Another mistake involves not signing the form. The IRS requires a signature to process the claim. If the form is submitted without a signature, it may be returned or ignored, causing unnecessary delays. Additionally, some people forget to include all necessary documentation. Supporting documents are essential for the IRS to investigate claims of identity theft effectively. Missing these can result in a lack of follow-up from the IRS.

Inaccurate descriptions of the identity theft incident also pose a problem. When detailing the circumstances, clarity and accuracy are vital. Vague or misleading descriptions can confuse the IRS and may lead to further inquiries. Furthermore, individuals sometimes fail to keep copies of their submitted forms. Without a record, it becomes challenging to track the status of the claim or provide additional information if requested.

Lastly, some individuals overlook the importance of timely submission. The IRS has specific deadlines for reporting identity theft. Delaying the filing of Form 14039 can lead to complications in resolving the issue. Being aware of these timelines is essential for effective resolution.

Documents used along the form

The IRS Form 14039, also known as the Identity Theft Affidavit, is a crucial document for individuals who suspect their personal information has been used fraudulently. When filing this form, it is often necessary to include additional documents to support the claim and streamline the resolution process. Below is a list of other forms and documents that are commonly used alongside the IRS 14039.

  • Form 1040: This is the standard individual income tax return form. It provides the IRS with information about your income, deductions, and credits for the tax year in question.
  • Form 14039-A: This is an additional affidavit that can be used to report identity theft specifically related to a tax return. It helps to clarify the circumstances surrounding the theft.
  • Form 8821: This form authorizes a third party to receive confidential tax information on your behalf. It can be helpful if you are working with a tax professional to resolve your identity theft issue.
  • Form 4506-T: This form allows you to request a transcript of your tax return. It can be useful to verify the information the IRS has on file, especially if you suspect fraudulent activity.
  • Identity Theft Report: If you have filed a police report regarding identity theft, attaching a copy can strengthen your case and provide additional evidence to the IRS.
  • Credit Reports: Obtaining your credit reports from the major credit bureaus can help identify any unauthorized accounts or inquiries made in your name, providing further proof of identity theft.
  • Form 8862: If your identity theft has affected your ability to claim certain tax credits, this form can be used to reapply for those credits after resolving the issue.

Including these documents when submitting Form 14039 can enhance your case and facilitate a quicker resolution. Always ensure that you keep copies of everything you send to the IRS for your records.

Similar forms

The IRS Form 14039, also known as the Identity Theft Affidavit, is specifically designed for individuals who believe they have been victims of identity theft related to their tax information. It serves as a formal declaration to the IRS, allowing victims to report the misuse of their personal information for fraudulent tax purposes. This form is crucial for initiating the process of resolving tax-related identity theft issues.

Form 4506-T, the Request for Transcript of Tax Return, is similar in that it allows taxpayers to request copies of their tax documents. While Form 14039 is focused on reporting identity theft, Form 4506-T helps individuals obtain the necessary information to verify their tax history, which can be essential in cases of identity theft. Both forms require personal information and are used to address issues concerning the accuracy of tax filings.

The IRS Form 1040 is the standard individual income tax return form. While it serves a different primary purpose—reporting income and calculating tax liability—both the 1040 and Form 14039 can be interconnected. If someone has filed a fraudulent return using a victim's identity, the victim will need to file Form 14039 to address the identity theft while also potentially needing to file a 1040 to report their actual income.

Form 8821, Tax Information Authorization, allows individuals to authorize a third party to receive their tax information. This document is similar to Form 14039 in that it involves the protection and management of personal tax data. If someone has been a victim of identity theft, they may wish to use Form 8821 to grant access to trusted individuals who can help them navigate the aftermath of identity theft.

Form 14095, the Identity Theft Affidavit for Tax Exempt Organizations, parallels Form 14039 as it addresses identity theft but is tailored for non-profit entities. Both forms allow for the reporting of identity theft incidents, but Form 14095 is specifically designed to help organizations that may have experienced similar fraudulent activities related to their tax-exempt status.

Form 8862, the Information to Claim Certain Refundable Credits After Disallowance, is another document that can relate to identity theft. If an individual’s credits were improperly disallowed due to fraudulent returns filed in their name, they would need to submit Form 8862 to reclaim those credits. Both forms serve as mechanisms for individuals to correct issues arising from identity theft.

Form 1040-X, the Amended U.S. Individual Income Tax Return, is used to correct errors on a previously filed 1040. If a victim of identity theft discovers that a fraudulent return was filed in their name, they may need to file Form 1040-X to amend their records. This form, like Form 14039, is part of the process of rectifying the consequences of identity theft.

Form 9465, the Installment Agreement Request, allows taxpayers to set up a payment plan for tax owed. While it doesn’t directly relate to identity theft, individuals who have been victims may find themselves with unexpected tax liabilities due to fraudulent activity. In such cases, Form 9465 can be a helpful tool for managing the financial aftermath of identity theft.

Form 1099 is used to report various types of income other than wages, salaries, or tips. If someone’s identity is stolen and fraudulent income is reported under their name, they might receive a 1099 form showing income they never earned. This document, while different in purpose, can create complications that necessitate the filing of Form 14039 to report the identity theft.

Lastly, Form 14157, the Complaint About a Return Preparer, can be relevant in cases where a tax professional has mishandled a client’s information leading to identity theft. If a taxpayer believes their preparer has acted irresponsibly, they can use Form 14157 to file a complaint. Both forms address issues of trust and integrity in handling personal tax information, albeit from different angles.

Dos and Don'ts

When filling out the IRS 14039 form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are six important do's and don'ts to consider:

  • Do provide accurate personal information, including your name, address, and Social Security number.
  • Do clearly indicate the reason for filing the form, such as suspected identity theft.
  • Do sign and date the form before submission to validate your request.
  • Do keep a copy of the completed form for your records.
  • Don't leave any required fields blank; incomplete forms may delay processing.
  • Don't submit the form without reviewing it for errors or inconsistencies.

By adhering to these guidelines, individuals can facilitate a smoother process when addressing potential identity theft concerns with the IRS.

Misconceptions

The IRS Form 14039, also known as the Identity Theft Affidavit, is often misunderstood. Here are four common misconceptions about this form, along with clarifications to help you better understand its purpose and use.

  • Misconception 1: The form is only for individuals who have already been victims of identity theft.
  • While many people associate Form 14039 with having experienced identity theft, it can also be used proactively. If you suspect that your personal information has been compromised, you can file this form to alert the IRS and help protect yourself from potential tax-related fraud.

  • Misconception 2: Submitting the form guarantees that the IRS will resolve your identity theft issues immediately.
  • Filing Form 14039 does not guarantee a quick resolution. Once submitted, the IRS will review the information provided, which can take time. It is important to remain patient and monitor any updates regarding your case.

  • Misconception 3: You can only submit this form once.
  • This form can be submitted multiple times if necessary. If new incidents of identity theft occur or if you continue to experience issues, you may need to file the form again to ensure that the IRS is aware of your ongoing situation.

  • Misconception 4: The form is only relevant for tax-related identity theft.
  • Although primarily associated with tax identity theft, Form 14039 can also be relevant in broader contexts. It serves as a tool to report any misuse of your personal information related to tax matters, which can include fraudulent tax returns or claims.

Key takeaways

When dealing with identity theft and tax-related issues, the IRS 14039 form is an essential tool. Here are some key takeaways to keep in mind when filling out and using this form:

  • The IRS 14039 form is specifically designed for individuals who believe they are victims of identity theft.
  • It is crucial to complete the form accurately to ensure your case is processed efficiently.
  • Gather all necessary documentation before filling out the form, including any notices from the IRS regarding suspicious activity.
  • Be sure to sign and date the form. An unsigned form may delay processing.
  • Submit the form to the appropriate address provided in the instructions to ensure it reaches the right department.
  • Keep a copy of the completed form for your records, as it may be needed for future reference.
  • Monitor your tax account after submission to track any updates or requests from the IRS.
  • Consider following up with the IRS if you do not receive confirmation of your submission within a reasonable time frame.

Using the IRS 14039 form can help protect your financial identity and resolve issues stemming from identity theft. Take the time to fill it out correctly and follow up as needed.

Free IRS 14039 Template in PDF

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