IRS Form 13287 "Bank Payment Problem Identification"

What Is IRS Form 13287?

This is a tax form that was released by the Internal Revenue Service (IRS) - a subdivision of the U.S. Department of the Treasury on December 1, 2009. As of today, no separate filing guidelines for the form are provided by the IRS.

Form Details:

  • A 2-page form available for download in PDF;
  • Actual and valid for filing 2020 taxes;
  • Additional instructions and information can be found on page 2 of the document;
  • Editable, printable, and free;

Download a fillable version of IRS Form 13287 through the link below or browse more documents in our library of IRS Forms.

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Download IRS Form 13287 "Bank Payment Problem Identification"

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Department of the Treasury – Internal Revenue Service
13287
Form
Bank Payment Problem Identification
(December 2009)
Section I.
Information Supplied by Bank
Part 1: Taxpayer Information
(For completion by bank)
1. Taxpayer Identification Number
2. Multiple TINs
3. Form(s) Payment Intended For
4. Tax Period(s) Payment Intended For
(TIN)
(if known)
(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
6. Federal Employer Identification Number
(Enter complete legal name of responsible bank)
of Bank
(FEIN)
7. Bank Branch Street Address
8. Branch Number of Bank Where Problem
Occurred
9. City, State, ZIP Code
10. American Banking Association
Number
(ABA)
12. Telephone Number
11. Bank Contact Name and Title
(Please print)
(
)
13. FAX Number
(
)
14. Number of Payments Delayed 15. Payment / Combined Payments Amount
16. Method of Payment
(“x” proper box)
ACH debit
ACH credit
Coupon
Fed wire
$
17. Date T/P Requested
18. Date Payment
19. Number of Days
20. Date IRS was
21. Mode of Contact
(“x” proper box)
Payment
Payment Late
(explain in item 26)
Transmitted
Contacted
Phone
FAX
Letter
22. Problem Involved Multiple Payments
23. Deposit Made More than 48 Hours After
24. IRS Contacted within 48 Hours of Problem
Problem Discovered
Discovery
Yes
No
No
Yes
Yes
No
(See attached list.)
(Explain in Item 25.)
(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
delay.
(s)
27. Name
28. Title
(Please print)
Signature
Authorization of
Bank Official
29. Signature
30. Date
INFORMATION SUPPLIED BY INTERNAL REVENUE SERVICE
Section II.
Part 3: IRS Information
(For completion by IRS)
31. History
32. Resolution
33. Name of Taxpayer
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
37. TC 971
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
43. IRS Contact Phone Number
Number
(
)
44. IDRS Input Date
45. Master File Projected 23C
46. Date Information FAXd to Federal
(mm/dd/yyyy)
Posting Date
Reserve Board
(FRB)
13287
Catalog No. 34294M
Form
(Rev. 12-2009)
www.irs.gov
Department of the Treasury – Internal Revenue Service
13287
Form
Bank Payment Problem Identification
(December 2009)
Section I.
Information Supplied by Bank
Part 1: Taxpayer Information
(For completion by bank)
1. Taxpayer Identification Number
2. Multiple TINs
3. Form(s) Payment Intended For
4. Tax Period(s) Payment Intended For
(TIN)
(if known)
(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
6. Federal Employer Identification Number
(Enter complete legal name of responsible bank)
of Bank
(FEIN)
7. Bank Branch Street Address
8. Branch Number of Bank Where Problem
Occurred
9. City, State, ZIP Code
10. American Banking Association
Number
(ABA)
12. Telephone Number
11. Bank Contact Name and Title
(Please print)
(
)
13. FAX Number
(
)
14. Number of Payments Delayed 15. Payment / Combined Payments Amount
16. Method of Payment
(“x” proper box)
ACH debit
ACH credit
Coupon
Fed wire
$
17. Date T/P Requested
18. Date Payment
19. Number of Days
20. Date IRS was
21. Mode of Contact
(“x” proper box)
Payment
Payment Late
(explain in item 26)
Transmitted
Contacted
Phone
FAX
Letter
22. Problem Involved Multiple Payments
23. Deposit Made More than 48 Hours After
24. IRS Contacted within 48 Hours of Problem
Problem Discovered
Discovery
Yes
No
No
Yes
Yes
No
(See attached list.)
(Explain in Item 25.)
(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
delay.
(s)
27. Name
28. Title
(Please print)
Signature
Authorization of
Bank Official
29. Signature
30. Date
INFORMATION SUPPLIED BY INTERNAL REVENUE SERVICE
Section II.
Part 3: IRS Information
(For completion by IRS)
31. History
32. Resolution
33. Name of Taxpayer
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
37. TC 971
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
43. IRS Contact Phone Number
Number
(
)
44. IDRS Input Date
45. Master File Projected 23C
46. Date Information FAXd to Federal
(mm/dd/yyyy)
Posting Date
Reserve Board
(FRB)
13287
Catalog No. 34294M
Form
(Rev. 12-2009)
www.irs.gov
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) —
Item 31: History —
Enter the Employer Identification Number (EIN) or Social
Enter a brief history of any actions, contacts, etc.
Security Number (SSN) of the taxpayer. (DO NOT enter the
EIN of the taxpayer's bank.)
Item 32: Resolution —
Enter a brief history of actions taken to resolve this issue.
Item 2: Multiple TIN(s) —
If multiple TINs (clients) are involved in this issue, please
Item 33: Name of Taxpayer —
indicate this and attach a list to this document.  The list should
If the case only involves one TIN, list the name of the
include the clients’ TIN(s), the deposit date(s), the deposit
taxpayer(s) or business.
amount(s), and the form(s) and tax period(s) where the deposit
was intended.
Item 34: Taxpayer correspondence date (mmddyyyy) —
Enter the date the taxpayer first contacted IRS about this
Item 3: Form(s) —
issue.
Enter the Form number of the account where the deposit was
intended (if known). If the payment was submitted for an
Item 36: Method of Taxpayer Contact (mm/dd/yyyy) —
incorrect form number, please notate that form in Item # 26.
Enter the mode the taxpayer used to contact the IRS about
this issue.
Item 4: Tax Period(s) —
Enter the Tax Period of the account where the deposit was
Item 37: TC 971 —
intended (if known). If the payment was submitted for an
For TC971 input, enter “1 – 9” for action codes 301-309. If
incorrect tax period, please notate that tax period in Item # 26.
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 ) —
Part 2: Bank Information
Enter the date the payment was posted to the taxpayer's
(Items 5 thru 30 for completion by bank)
account.
Item 10: American Banking Association (ABA) Number —
Item 39: Intended Payment Date (mm/dd/yyyy ) —
Enter the ABA number of the responsible bank for assessment
Enter the date the payment should have posted to the
of the cost of funds (loss of interest).
taxpayer's account.
Item 11: Bank Contact Name and Title —
Item 40: Additional Action(s) for Adjustment(s) to
Enter the name and title of the bank contact person who can
Account (TC 181, ADX 48/24/34) —
discuss this issue.
Enter any other actions taken in addition to the TC 971 (or in
place of).
Item 14: Number of Payments Delayed —
If only one payment was delayed, enter “1” in this block. If
Item 41: IRS contact name —
more than one, enter the total and attach a separate
Enter the name of the person who worked the case.
spreadsheet which shows the breakdown by TIN of the
individual payment amounts (see Item # 2).
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.
13287
Catalog No. 34294M
Form
(Rev. 12-2009)
www.irs.gov
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