Pictured is an example of a completed Form 8546 which is sent to the taxpayer to complete when there is a claim for $1000 or less for reimbursement of bank charges due to erroneous service levy or misplaced payment check. Block 1 contains the name and address, block 2 contains the telephone number, block 3 contains best time to call, block 4 contains amount of claim, block 5 contains social security or employee identification number, block 6 contains name on bank account, block 7 contains ABA number, block 8 contains bank name and address, block 9 contains bank account number, block 10 contains type of account - checking or savings, block 11 contains description of claim, block 12 contains the signature of claimant, and block 13 contains the date of claim.