Response

Prefix

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Primary Phone

Secondary Phone

Date of Birth

Social Security Number

Case Details

Please select an agency you need help with:

Tax Year(s)

Tax Form(s)

Is this for a Joint Return? Yes
No

Spouse's First Name

Spouse's Last Name

Spouse's Social Security Number

Attention!! For assistance with individual joint returns, please download, fill out, and sign with your spouse the Privacy Release Authorization Form here (https://www.kim.senate.gov/wp-content/uploads/2026/03/PRF-IRS-Senator-Kim.pdf, then return to this form and upload it in the attachment section provided below.

Is this for a Business? Yes
No

Business Name

Your Job Title

Federal Tax ID Number

Please complete if your request is for someone other that yourself:

Decedent's First Name

Decedent's Last Name

Decedent's Social Security Number

Decedent's Executor or Administrator's Name

Do we have permission to discuss your case with anyone else?Yes
No

First Name

Last Name

Phone Number and/or Email Address

Relationship

RequiredHave you contacted any other elected official regarding this matter?

Yes
No

RequiredWhich Office?

Date of Contact

Your Request

Please briefly explain the nature of your complaint or concern:

What would you consider to be a fair outcome?

Attach copies of any relevant documentation here. ***Allowed file types: .doc, .docx, .pdf, or .txt***

You may upload multiple attachments, however there is a cumulative maximum file size limit = 15MB. You may send additional documentation directly to your caseworker after they have made contact with you.

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RequiredBy checking this check, I confirm who I say I am

Today's Date

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