Form H1864, Federal Tax Information Fax Transmittal
Effective Date: 1/2011
Use Form H1864 when staff transmit Federal Tax Information via fax.
When to Prepare
Form H1864 must accompany all faxed documents that contain IRS data (such as fraud referrals) whenever they are transmitted from one office to another, or from an office to a banking institution for verification purposes. Complete all information on the form. The sender should ensure that the receiver acknowledges the receipt of the information.
Retain Form H1864 for five years.
Enter the date.
Enter the recipient's name, fax number and telephone number in the appropriate spaces.
Enter the sender's name, fax number and telephone number in the appropriate spaces.
Enter the number of pages, including the cover page, in the appropriate space.
The following statement must appear on the bottom of the fax transmission cover sheet: "This communication is intended for the sole use of the individual to whom it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this communication is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is prohibited. If you have received this communication in error, please notify the sender immediately by telephone and destroy the information via shredding."
The sender should call the fax recipient prior to faxing the Federal Tax Information and make the recipient aware that IRS data will be arriving. The sender should ask the recipient to wait for the faxed information to arrive.