Federal Free Printable Form 13287 (Rev. 12-2009) for 2017 Federal Bank Payment Problem Identification

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Bank Payment Problem Identification
Form 13287 (Rev. 12-2009)

Department of the Treasury – Internal Revenue Service Form 13287 (December 2009) Bank Payment Problem Identification Information Supplied by Bank Section I. Part 1: Taxpayer Information (For completion by bank) 1. Taxpayer Identification Number (TIN) 3. Form(s) Payment Intended For (if known) 4. Tax Period(s) Payment Intended For 2. Multiple TINs (DO NOT enter the EIN of the taxpayer's bank.) (if known) Yes (See attached list) Part 2: Bank Information (For completion by bank) 5. Name of Bank (Enter complete legal name of responsible bank) 6. Federal Employer Identification Number (FEIN) of Bank 7. Bank Branch Street Address 8. Branch Number of Bank Where Problem Occurred 9. City, State, ZIP Code 10. American Banking Association (ABA) Number 11. Bank Contact Name and Title (Please print) 12. Telephone Number ( ) 13. FAX Number ( ) 14. Number of Payments Delayed 15. Payment / Combined Payments Amount 16. Method of Payment (“x” proper box) ACH debit $ 17. Date T/P Requested Payment (explain in item 26) 18. Date Payment Transmitted 19. Number of Days Payment Late 20. Date IRS was Contacted ACH credit Coupon 21. Mode of Contact (“x” proper box) Phone FAX Letter 23. Deposit Made More than 48 Hours After 24. IRS Contacted within 48 Hours of Problem Discovery Problem Discovered 22. Problem Involved Multiple Payments Yes (See attached list.) Fed wire No No Yes (Explain in Item 25.) Yes No (Explain in Item 25.) 25. Explanation (Items 23 and 24) 26. Brief explanation why payment could not be processed as taxpayer requested By signing below, I understand that the financial institution listed above will accept responsibility for the payment(s) delay. 27. Name (Please print) 28. Title Signature Authorization of Bank Official 29. Signature Section II. 30. Date INFORMATION SUPPLIED BY INTERNAL REVENUE SERVICE Part 3: IRS Information (For completion by IRS) 31. History 33. Name of Taxpayer 37. TC 971 32. Resolution 34. Taxpayer 35. Date Bank's Completed Form 36. Method of Taxpayer Contact Correspondence Date 13287 received at IRS (“x” proper box) Phone FAX Letter 38. Payment Date 39. Intended Payment Date 40. Additional Action(s) for Adjustment(s) to Account (TC 181, ADX 48/24/34) Action Code 30 ___ 41. IRS Contact Name (Please print) 42. IRS Contact Employee Number 43. IRS Contact Phone Number ( 44. IDRS Input Date (mm/dd/yyyy) Catalog No. 34294M 45. Master File Projected 23C Posting Date www.irs.gov ) 46. Date Information FAXd to Federal Reserve Board (FRB) Form 13287 (Rev. 12-2009) Instructions for Completing Form 13287, Bank Problem Identification Worksheet GENERAL— When a bank delays forwarding a taxpayer's “timely received with proper instructions” Federal Tax Deposit (FTD) to the U.S. Treasury, the taxpayer may be relieved of the portion of the FTD penalty pertaining to that payment, if the bank accepts responsibility for the delay. For each delayed FTD payment or issue, FAX a separate Form 13287 and Instructions to the responsible bank for completion and a bank official's signature. The signed form then becomes the authorization for the Federal Reserve Board (FRB) to charge the bank for the loss of funds to the U.S. Treasury. SECTION I. INFORMATION SUPPLIED BY BANK SECTION II. INFORMATION SUPPLIED BY IRS Part 1: Taxpayer Information Part 3: IRS Information (Items 1 thru 4 for completion by bank) (Items 31 thru 46 for completion by IRS) Item 1: Taxpayer Identification Number (TIN) — Enter the Employer Identification Number (EIN) or Social Security Number (SSN) of the taxpayer. (DO NOT enter the EIN of the taxpayer's bank.) Item 31: History — Enter a brief history of any actions, contacts, etc. Item 2: Multiple TIN(s) — If multiple TINs (clients) are involved in this issue, please indicate this and attach a list to this document.  The list should include the clients’ TIN(s), the deposit date(s), the deposit amount(s), and the form(s) and tax period(s) where the deposit was intended. Item 3: Form(s) — Enter the Form number of the account where the deposit was intended (if known). If the payment was submitted for an incorrect form number, please notate that form in Item # 26. Item 4: Tax Period(s) — Enter the Tax Period of the account where the deposit was intended (if known). If the payment was submitted for an incorrect tax period, please notate that tax period in Item # 26. Part 2: Bank Information (Items 5 thru 30 for completion by bank) Item 10: American Banking Association (ABA) Number — Enter the ABA number of the responsible bank for assessment of the cost of funds (loss of interest). Item 11: Bank Contact Name and Title — Enter the name and title of the bank contact person who can discuss this issue. Item 14: Number of Payments Delayed — If only one payment was delayed, enter “1” in this block. If more than one, enter the total and attach a separate spreadsheet which shows the breakdown by TIN of the individual payment amounts (see Item # 2). Item 32: Resolution — Enter a brief history of actions taken to resolve this issue. Item 33: Name of Taxpayer — If the case only involves one TIN, list the name of the taxpayer(s) or business. Item 34: Taxpayer correspondence date (mmddyyyy) — Enter the date the taxpayer first contacted IRS about this issue. Item 36: Method of Taxpayer Contact (mm/dd/yyyy) — Enter the mode the taxpayer used to contact the IRS about this issue. Item 37: TC 971 — For TC971 input, enter “1 – 9” for action codes 301-309. If TC971 cannot be input, prepare a Form 8646, Checklist to Identify Delays in Processing Federal Tax Deposits (FTDs). Item 38: Payment Date (mm/dd/yyyy ) — Enter the date the payment was posted to the taxpayer's account. Item 39: Intended Payment Date (mm/dd/yyyy ) — Enter the date the payment should have posted to the taxpayer's account. Item 40: Additional Action(s) for Adjustment(s) to Account (TC 181, ADX 48/24/34) — Enter any other actions taken in addition to the TC 971 (or in place of). Item 41: IRS contact name — Enter the name of the person who worked the case. Item 15: Payment / Combined Payments Amount — Enter the single payment amount or, if multiple payments are involved, enter the total of all delayed payments. Item 17: Date T/P Requested Payment (mm/dd/yyyy) — Enter the date the taxpayer requested the payment to post to their IRS account. (This usually is the due date.) Item 19: Number of Days Payment Late — Enter the number of days elapsed between the date the payment should have been posted to the taxpayer's IRS account and the date it actually posted (settlement date and the intended settlement date). Item 20: Date IRS was contacted (mmddyyyy) — Enter the date the IRS was first contacted about the issue. Catalog No. 34294M www.irs.gov Form 13287 (Rev. 12-2009)
Extracted from PDF file 2016-federal-form-13287.pdf, last modified December 2009

More about the Federal Form 13287 Other Voucher TY 2016

We last updated the Bank Payment Problem Identification in May 2017, so this is the latest version of Form 13287, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 13287 directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 13287 from the Internal Revenue Service in May 2017.

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Form 13287 is a Federal Other form. Payment vouchers are provided to accompany checks mailed to pay off tax liabilities, and are used by the revenue department to record the purpose of the check and the SSN/EIN of the taxpayer who sent it. Many states recommend that taxpayers also write their social security number and the purpose of the payment on the check itself, in case the accompanying payment voucher is misplaced or destroyed.

Historical Past-Year Versions of Federal Form 13287

We have a total of four past-year versions of Form 13287 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

2016 Form 13287

Form 13287 (Rev. 12-2009)

Bank Payment Problem Identification 2015 Form 13287

Form 13287 (Rev. 12-2009)

Bank Payment Problem Identification 2012 Form 13287

Form 13287 (Rev. 12-2009)

Bank Payment Problem Identification 2011 Form 13287

Form 13287 (Rev. 12-2009)

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