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25.2.2.3
(12-30-2008)
Submission of Information for Award under Sections 7623(a) or (b)
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Individuals submitting information under section 7623(a) or (b) must complete IRS Form 211, Application for Award for Original Information, which is available on http://www.irs.gov and send the completed Form 211 to:
Internal Revenue Service
Whistleblower Office
SE: WO
1111 Constitution Ave., NW
Washington, D.C. 20224
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Information submitted under section 7623 must be accompanied by an original signed declaration under penalty of perjury, as
follows:
I declare, under penalty of perjury, that I have examined this application and my accompanying statement and supporting documentation
and aver that such application is true, correct and complete, to the best of my knowledge.
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The requirement to submit information under penalty of perjury precludes submissions by:
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a person serving as a representative of the claimant, or
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an entity other than a natural person.
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The requirement to submit information under penalty of perjury also precludes submissions made anonymously or under an alias.
Until further guidance is issued, claims for awards may not be submitted electronically or by fax.
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Joint claims must be signed by each claimant and each claimant must sign the claim under penalty of perjury.
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Some whistleblower submissions present legal and policy issues that can preclude the use of some or all of the information
offered by the whistleblower. Whistleblowers may also mistakenly submit claims for award directly to Service field personnel,
despite instructions to send all Forms 211 to the Whistleblower Office. In such cases, to protect the integrity of any taxpayer
investigation or examination, Service personnel should not act on the underlying tax noncompliance issue presented by the
whistleblower prior to forwarding the claim to the Whistleblower Office. Any and all information should be forwarded to the
Whistleblower Office.
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A whistleblower may be represented by counsel during any proceeding by filing a properly executed Form 2848, Power of Attorney and Declaration of Representative.
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If available information is not provided by the claimant, the claimant bears the risk that such information may not be considered
by the Whistleblower Office in making any award decision or determination. If documents or supporting evidence are known to
the claimant but are not in his or her possession or control, the claimant should describe these documents and identify their
location to the best of his or her ability.
25.2.2.3.1
(12-30-2008)
Information to be included with IRS Form 211
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The Form 211 must be completed in its entirety and should include the following information:
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The date the claimant submits the claim;
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Claimant’s name;
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Name of claimant’s spouse (if applicable);
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Claimant’s contact information, including address with zip code and telephone number;
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Claimant’s date of birth;
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Claimant’s Taxpayer Identification Number (e.g., Social Security Number or Individual Taxpayer Identification Number) and
Taxpayer Identification Number of claimant’s spouse, if applicable.
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In addition to the information shown above, the Form 211 must include specific and credible information concerning the person(s)
that the claimant believes will lead to the collection of unpaid taxes. This information should include the following:
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The legal name of the person(s) (e.g., individual or entity), and any related person(s), that failed to pay taxes;
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The person’s aliases, if any;
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The person’s address;
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The person’s Taxpayer Identification Number(s);
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A description of the amount(s) and tax year(s) of Federal tax claimed to be owed, and facts supporting the basis for the amount(s)
claimed to be owed;
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Documentation to substantiate the claim (e.g., financial data; the location of bank accounts, assets, books, and records;
transaction documents or analyses relevant to the claim); and
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Any and all other facts and information pertaining to the claim.
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Finally, the Form 211 must include an explanation of how the information that forms the basis of the claim came to the attention
of the claimant, including the date(s) on which this information was acquired, and a complete description of the claimant’s
present or former relationship (if any) to the person that is the subject of the claim (e.g., family member, acquaintance,
client, employee, accountant, lawyer, bookkeeper, customer). If the claimant identifies multiple person(s) as the subject
of a claim, describe his or her relationship to each person.
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