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Federal Free Printable Form 3911 (Rev. 1-2018) for 2021 Federal Taxpayer Statement Regarding Refund

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Taxpayer Statement Regarding Refund
Form 3911 (Rev. 1-2018)

Form 3911 Department of the Treasury - Internal Revenue Service OMB Number 1545-1384 Taxpayer Statement Regarding Refund (January 2018) The box checked below is in reply to your inquiry on We sent you the following refund(s) $ ,$ Check Direct Deposit about your Federal tax return for ,$ on . The U.S. Postal Service returned your check because they could not deliver it.   Your check was not cashed within one year of the issue date as the law requires and it can no longer be cashed. If we indicated above that your check was returned by the Post Office or not cashed within one year of the issue date, please complete Sections I and III of this form and send it back to us in the enclosed envelope or facsimile form to . We will send you a new check within six weeks of the date we receive this form. If you did not receive the refund check, or if you received it and it was lost, stolen or destroyed, please complete Sections I, II and III. Send this form back to us in the enclosed envelope or facsimile form to . If you don’t hear from us by six weeks from the date you send the form back to us, please contact us at If you prefer, you may write to us at the service center where you filed your return. . Print your current name(s), taxpayer identification number (for individuals, this is your social security number, for businesses, it is your employer identification number) and address, including ZIP code. If you filed a joint return, show the names of both spouses on lines 1 and 2 below. Section I 1. Your name Taxpayer Identification Number 2. Spouse’s name (if a name is entered here, spouse must sign on line 14) Taxpayer Identification Number 3. Street Apt. No. City State ZIP code  Please give us a phone number where you can be reached between 8 a.m. and 4 p.m. Include area code.   If any of the above has changed since you filed your tax return, please enter the information below exactly as shown on your return. Area code Telephone number 4. Name(s) Taxpayer Identification Number(s) Street  Apt. No. City State ZIP code If you have filed a power of attorney authorizing a representative to receive your refund check, please enter his or her name and mailing address below. 6. Address (include ZIP code) 5. Name of representative Individual 7. Type of return Type of refund requested Business, Form Check Tax period Other Amount Direct Deposit $ Date filed Refund Information Section II (Please check all boxes that apply to you.) 8. I didn’t receive a refund. I received a refund check, but it was lost, stolen or destroyed. 9. I received the refund check and signed it. NOTE: The law doesn’t allow us to issue a replacement check if you endorsed it and someone other than you cashed the check, since that person didn’t forge your signature. 10. I have received correspondence about the tax return. (Please attach a copy if possible.) (Please give us the following information if possible.) 11. Name of bank and account number where you normally cash or deposit your checks Bank Account number 12. a. If the refund was a direct deposit, did you receive a “Refund Anticipation Loan”? b. Enter the Routing Transit Number(s) , Catalog Number 41167W , , , Yes No , and account number(s) , shown on your return for the refund you did not receive. www.irs.gov (Continued on back) Form 3911 (Rev. 1-2018) Page 2 Section III  Certification Please sign below, exactly as you signed the return. If this refund was from a joint return, we need the signatures of both spouses before we can trace it. Under penalties of perjury, I declare that I have examined this form, and to the best of my knowledge and belief, the information is true, correct, and complete. I request that you send a replacement refund, and if I receive two refunds I will return one. 13. Signature (For business returns, signature of person authorized to sign the check) Date 14. Spouse’s signature, if required (For businesses, enter the title of the person who signed above.) Date Description of Check Section IV (For Internal Revenue Service use only) Schedule number Refund Date Amount Other (DLN, Check/Symbol, etc.) Schedule number Refund Date Amount Other (DLN, Check/Symbol, etc.) Schedule number Refund Date Amount Other (DLN, Check/Symbol, etc.) Privacy Act and Paperwork Reduction Act Notice We ask for the information on this form to carry out the Internal Revenue laws of the United States. You aren’t required to give us the information since the refund you claimed has already been issued. However, without the information we won’t be able to trace your refund, and may be unable to replace it. You may give us the information we need in a letter. We need the information to ensure that you are complying with these laws and to allow us to determine the correctness of your refund or the right amount of payment. Your Social Security Number and the other information are being requested in order that the Department of the Treasury can process your refund. The authority of requesting your social security number is 26 United States Code, section 6109. If you cannot or will not furnish the information, the tracing of your refund may be delayed. 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 record 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 Internal Revenue Code section 6103. The time needed to compete and file this form will vary depending on individual circumstances. The estimated average time is less than 5 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Attention: Tax Products Coordinating Committee, Western Area Distribution Center, Rancho Cordova, CA 95743-0001. Do not send this form to this office. Instead, please use the envelope provided or mail the form to the Internal Revenue Service center where you would normally file a paper tax return. Catalog Number 41167W www.irs.gov Form 3911 (Rev. 1-2018)
Extracted from PDF file 2020-federal-form-3911.pdf, last modified May 2020

More about the Federal Form 3911 Individual Income Tax TY 2020

We last updated the Taxpayer Statement Regarding Refund in January 2021, so this is the latest version of Form 3911, fully updated for tax year 2020. You can download or print current or past-year PDFs of Form 3911 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 3911 from the Internal Revenue Service in January 2021.

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About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Federal Form 3911

We have a total of eight past-year versions of Form 3911 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2020 Form 3911

Form 3911 (Rev. 1-2018)

2019 Form 3911

Form 3911 (Rev. 4-2009)

2018 Form 3911

Form 3911 (Rev. 4-2009)

2017 Form 3911

Form 3911 (Rev. 4-2009)

2016 Form 3911

Form 3911 (Rev. 4-2009)

Taxpayer Statement Regarding Refund 2015 Form 3911

Form 3911 (Rev. 4-2009)

Taxpayer Statement Regarding Refund 2012 Form 3911

Form 3911 (Rev. 4-2009)

Taxpayer Statement Regarding Refund 2011 Form 3911

Form 3911 (Rev. 4-2009)


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