2. Wizard

Form 14039

(Rev. May 2024)

Identity Theft Affidavit

OMB Number 1545-2139

Catalog Number 52525A

Instructions

Important Things You Should Know

  • This affidavit is for victims of identity theft. To avoid delays do not use this form if you have already filed a Form 14039 for this incident.
  • The IRS process for assisting victims selecting Section B, Box 1 below is explained at irs.gov/victimassistance.
  • Get an IP PIN: We encourage everyone to opt-in to the Identity Protection Personal Identification Number (IP PIN) program. If you don’t have an IP PIN, you can get one by going to irs.gov/ippin for information on the three ways to enroll into the program.
  • If you need help verifying your identity or to submit a support ticket, you can visit the ID.me website at https://ID.me IRS help site.
  • Identity thieves may attempt to steal your tax information by either creating an Online Account in your name or by attempting to change an Online Account that you had already established.  If someone used your personal information to access an IRS online service, IRS will alert you by sending Notice CP303 to the address we have on file for you.  

  • If you get a notice that an online account has been created in your name, or that your existing online account has been accessed or disabled without your knowledge, immediately call the number on your notice. Once we verify your identity, we'll disable your online account. See Understanding Your CP303 Notice.

                                                                Privacy Act and Paperwork Reduction Notice

Our legal authority to request the information is 26 U.S.C. 6001. The primary purpose of the form is to provide a method of reporting identity theft issues to the IRS so that the IRS may document situations where individuals are or may be victims of identity theft. Additional purposes include the use in the determination of proper tax liability and to relieve taxpayer burden. The information may be disclosed only as provided by 26 U.S.C. 6103. Providing the information on this form is voluntary. However, if you do not provide the information it may be more difficult to assist you in resolving your identity theft issue. If you are a potential victim of identity theft and do not provide the required substantiation information, we may not be able to place a marker on your account to assist with future protection. If you are a victim of identity theft and do not provide the required information, it may be difficult for IRS to determine your correct tax liability. If you intentionally provide false information, you may be subject to criminal penalties. 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 records 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 section 6103. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send this form to this address. Instead, see the form for filing instructions. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.

All fields marked with an asterisk (*) are reuired.

What is Identity Theft (IDT)

Tax-related identity theft occurs when someone uses your stolen personal information, including your Social Security number, to file a tax return claiming a fraudulent refund. Tax related IDT includes an impact on your federal tax administration, see Taxpayers guide to identity theft. 

If your personal taxes were affected, select Individual taxes. If your business taxes were affected, select business taxes.

Complete Form 14039-B availabe on IRS.gov or visit https://www.irs.gov/newsroom/Report-Identity-Theft-for-a-Business, and follow instructions to resolve your ID Theft with business taxes.

Select one of the options from listed below. If ID theft affects your income taxes then select "income tax related issue". If ID theft is not related to any tax issue, then select "non-tax related issue". If you have received a letter or notice from IRS, then select "letter or notice from the IRS".

Select one of the options listed if you are having any federal income-tax related issue to inform IRS about your potential ID theft.

If you are unable to access your IRS on-line account, then go to www.irs.gov/your-account for guidance.

If you received a tax refund, when you did not file a tax return then see Tax Topic 161, Returning an erroneous refund  - Paper check or direct deposit, available on IRS.gov website.

Explain in narrative section located under General Information section.

STOP. You do not have an income tax related issue. You do not need to file Form 14039. You can request an IP PIN from the IRS.gov website.

Select Next button to continue completing Form 14039.

Select one of the options listed if you are having non income-tax related issue, to show steps you may take to avoid potential ID theft. 

Complete Form 3949-A and submit. Form 14039 is not required to be filed. Please see IRS.gov to request an IP PIN.

Please review your IRS account on IRS.gov or go to Where is my refund to determine if your return was received. You do not need to file Form 14039. You may request an IP PIN at IRS.gov.

Visit IP PIN page on IRS.gov to request an IP PIN. You do not need to file Form 14039.

You can retrieve your IP PIN at IRS.gov. You do not need to file Form 14039.

Contact your state tax authorities. You are not required to file Form 14039. You may request an IP PIN from IRS website.

Report it to local law enforcement. You are not required to file Form 14039. You may request an IP PIN from IRS website.

Contact the agency involved. You are not required to file Form 14039. You may request an IP PIN from IRS website.

Contact credit bureaus. You do not need to file Form 14039. You may request an IP PIN, available on IRS.gov.

STOP. You do not have any non-income tax related issue. You do not need to file Form 14039. If you desire, you can request an IP PIN from the IRS.gov website.

Select one of the options, if you received one of the letters or notices from the IRS.

Complete your steps as listed on the letter.

STOP. You are not required to file Form 14039, however we recommed that you consider requesting an IP PIN to protect you from possible tax related identity theft in the future. Visit IP PIN webpage on the IRS.gov website.

Select Next button to continue completing Form 14039.

All fields marked with an asterisk (*) are required.

Letter number is found in upper right hand corner

Note: If you are a victim of Identity theft but it does not involve your federal tax return, you should request an IP PIN to protect yourself. Get An Identity Protection PIN| Internal Revenue Service (irs.gov).

If needed, attach additional information and/or pages to this form

    All fields marked with an asterisk (*) are required.

    Name and Contact Information of Identity Theft Victim 

    Must be 9 digits without dashes. Ex: 123456789.

    Apartment or suite number and street, or P.O. Box. If deceased, provide last known address

    Must be 5 or 9 digits with a dash. Ex: 12345 or 123451234. 

    Must be 5 or 9 digits with a dash. Ex: 12345 or 123451234. 

    Telephone number with area code. The IRS may call you regarding this affidavit

    Must be 10 digits without dashes. Ex: 1234567890.

    Must be 10 digits without dashes. Ex: 1234567890.

    Include time zone (i.e. EST, CST, MST, or PST)

     

    Last tax return filed (year shown on the tax return) and Returns Impacted

    All fields marked with an asterisk (*) are required.

    If not known, enter ‘Unknown’

    Example: 2020 is input for citing the 2020 tax return though filed the next year(s). (If not known, enter ‘Unknown’ below)

    Enter tax year as YYYY. Accepts year from 2001 to previous tax year. Ex: 2020.

    Enter tax year as YYYY. Accepts year from 2001 to previous tax year. Ex: 2020.

    Enter tax year as YYYY. Accepts year from 2001 to previous tax year. Ex: 2020.

    Enter tax year as YYYY. Accepts year from 2001 to previous tax year. Ex: 2020.

    Enter tax year as YYYY. Accepts year from 2001 to previous tax year. Ex: 2020.

    Enter tax year as YYYY. Accepts year from 2001 to previous tax year. Ex: 2020.

    Enter tax year as YYYY. Accepts year from 2001 to previous tax year. Ex: 2020.

    All fields marked with an asterisk (*) are required.

    Other - Explain

    Explain

    Parent’s/Representative's Name

    Enter Street, Suite, City or Town, State or Province and ZIP or Postal code.

    City, town or post office, state, and ZIP code

    Enter with no dashes or parenthesis. ex '9999999999'

    All fields marked with an asterisk (*) are required.

    Review

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