IRS Form 3911 "Taxpayer Statement Regarding Refund"

What Is IRS Form 3911?

IRS Form 3911, Taxpayer Statement Regarding Refund, is a legal document completed by individuals who want to inquire about the status of an expected refund. Once the Internal Revenue Service (IRS) receives this document from you, they start the replacement process by the information you provided to look into the matter and to confirm you have not received the refund in question. When you file Form IRS 3911, you provide the IRS with an opportunity to trace your refund and replace it if needed.

This form was released by the IRS. The latest version of the form was issued in April 2009 with all previous editions obsolete. You can download a fillable Form 3911 through the link below.

If you prefer to complete a Spanish version of the document, download IRS Form 3911 (SP), Declaración del Conribuyente Sobre el Reembolso on our website using this link.

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How to Fill Out IRS Form 3911?

IRS Form 3911 instructions are as follows:

  1. Write down your full name and taxpayer identification number. If you are married and filing jointly, your spouse's name and taxpayer identification number are also required;
  2. Indicate your address and daytime telephone number;
  3. If the representative fills out the document, it is necessary to state the representative's name and address;
  4. Write down the type of your return and the type of refund you requested. Record its amount, tax period, and the date of filing the initial request;
  5. Describe what happened to your refund - you did not receive it, it was lost, stolen, or destroyed, you received the check and signed it, or you have received correspondence about the tax return. Write down the name of the bank where you normally receive your checks and your account number. Indicate whether you have received a refund anticipation loan and enter the routing transit number and account number from your return for the refund you did not receive. Only provide this information if you did not receive the check or it was lost, stolen, or destroyed;
  6. Certify the statements in the form are true and correct. Sign and date the form. If you file for a business, enter the title of the person who signs the papers.

Where to Mail Form 3911?

Usually, the IRS sends Form IRS 3911 to taxpayers who have contacted the IRS because they have not received their refunds. The IRS will enclose an envelope with the correct return address for the applicant to use to send the form back to the IRS. However, if you have not received these instructions from the IRS, you may direct the form to the IRS center where you normally submit a paper tax return. Some individuals prefer to fax their tax returns and statements, but you can only receive a fax number from the IRS representative who specifically requests information from you. So, unless the IRS provides you with an IRS Form 3911 fax number, you cannot fax it.

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Download IRS Form 3911 "Taxpayer Statement Regarding Refund"

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Department of the Treasury – Internal Revenue Service
3911
Form
OMB NO. 1545-1384
Taxpayer Statement Regarding Refund
(Rev. A
pril 2009)
The box checked below is in reply to your inquiry on
about your Federal tax return for
, $
on
We sent you the following refund(s) $
, $
.
Check
Direct Deposit
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
.
Ill. 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
Section I
businesses, it is your employer identification number) and address, including ZIP code. If you filed a joint return,
show the names of both husband and wife on lines 1 and 2 below.
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
Area code
Number
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.
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.
5. Name of representative
6. Address (include ZIP code)
Tax period:
7. Type of return:
Individual
Business, Form
Other
Type of refund requested:
Check
Direct Deposit
Amount: $
Date filed:
Refund Information
Section II
(Please check all boxes that apply to you.)
8.
I received a refund check, but it was lost, stolen or destroyed.
I didn’t receive a refund.
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:
YES
NO
12. a. If the refund was a direct deposit, did you receive a “Refund Anticipation Loan”?
b. Enter the Routing Transit Number(s)
,
,
, and account number(s)
,
,
shown on your return for the refund you did not receive.
3911
Catalog Number 41167W
(Continued on back)
Form
(Rev. 4-2009)
Department of the Treasury – Internal Revenue Service
3911
Form
OMB NO. 1545-1384
Taxpayer Statement Regarding Refund
(Rev. A
pril 2009)
The box checked below is in reply to your inquiry on
about your Federal tax return for
, $
on
We sent you the following refund(s) $
, $
.
Check
Direct Deposit
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
.
Ill. 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
Section I
businesses, it is your employer identification number) and address, including ZIP code. If you filed a joint return,
show the names of both husband and wife on lines 1 and 2 below.
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
Area code
Number
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.
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.
5. Name of representative
6. Address (include ZIP code)
Tax period:
7. Type of return:
Individual
Business, Form
Other
Type of refund requested:
Check
Direct Deposit
Amount: $
Date filed:
Refund Information
Section II
(Please check all boxes that apply to you.)
8.
I received a refund check, but it was lost, stolen or destroyed.
I didn’t receive a refund.
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:
YES
NO
12. a. If the refund was a direct deposit, did you receive a “Refund Anticipation Loan”?
b. Enter the Routing Transit Number(s)
,
,
, and account number(s)
,
,
shown on your return for the refund you did not receive.
3911
Catalog Number 41167W
(Continued on back)
Form
(Rev. 4-2009)
Certification
Section III
Please sign below, exactly as you signed the return. If this refund was from a joint return, we need the signatures of both
husband and wife 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.)
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.
The time needed to complete 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
more simple, 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, use the envelope provided, or mail it to the Internal
Revenue Service center where you would normally file a paper tax return.
3911
Form
(Rev. 4-2009)
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