Department of Taxation and Finance

                               Request for Assistance from the                                                       DTF-911(8/22)
                               Office of the Taxpayer Rights Advocate

Read the instructions on page 2 before completing this form.

Taxpayer information
 Taxpayer’s name or business’s name                                                       Social Security number or taxpayer identification number

 Spouse’s name (if applicable)                                                                          Spouse’s Social Security number

 Name of POA, third-party designee, or business contact person (if applicable)                           

 Current street address (number, street, and apartment number)

 City                                                                                     State (or foreign country) ZIP code

 Telephone number              Email address
 (    )

 Indicate if you have any special communications needs (Mark an  Xin the box.)

 TTY/TTD line                  Other (specify) : 

 Describe the tax problem you are experiencing, how you previously tried to resolve the problem, and the Tax Department office(s) you 
 contacted previously (see instructions for required information; attach additional sheets if necessary)

 Describe the relief/assistance you are requesting (attach additional sheets if necessary)

 Signature of taxpayer or POA (if applicable)                                                                        Date

 Signature of spouse (if applicable)                                                                                 Date

 Print name                                                                     Title 

Page 2 of 2  DTF-911 (8/22)

                                                           Instructions

General information                                                 Describe the tax problem you are experiencing
The Office of the Taxpayer Rights Advocate (OTRA) is an             Enter any detailed information necessary to describe the tax 
independent organization within the New York State Department       problem you are experiencing. If you have been involved with 
of Taxation and Finance. OTRA was created to safeguard              a Bureau of Conciliation and Mediation Services (BCMS) 
taxpayer rights and to assist taxpayers who are experiencing        conference, a small claims hearing, the Tax Appeals Tribunal, 
problems with the Tax Department.                                   a courtesy conference, the Division of Tax Appeals, an Offer in 
                                                                    Compromise, a driver’s license suspension, or an audit or other 
                                                                    collection action, include the dates of such activity, as well as the 
When to use this form                                               following information (if applicable):
Use this form if you are experiencing any of the following 
problems:                                                           •  BCMS number
•  You are facing a threat of immediate adverse action (such        •  Division of Tax Appeals number
as seizure of an asset) for a debt you believe is not owed          •  audit case number
or where the action is, in your view, unwarranted, unfair, or       •  assessment or collection case number
illegal.
•  You are experiencing undue economic harm or are about to         Where to file
suffer undue economic harm because of your tax problem.             Do not staple any items to this form. Send your completed 
•  You believe there has been an undue delay by the Tax             Form DTF-911 and any required attachments by:
Department in providing a response or resolution to your 
problem or inquiry.                                                 Mail: NYS TAX DEPARTMENT
                                                                          OTRA
•  You believe the tax laws, regulations, or policies are being           W A HARRIMAN CAMPUS
administered unfairly or have impaired (or will impair) your              ALBANY NY 12227-0912
rights.
•  You believe a Tax Department system or procedure has failed      Fax: (518) 435-8532
to operate as intended, or has failed to resolve your problem       Private delivery services – If you choose, you may use a 
or dispute.                                                         private delivery service, instead of the U.S. Postal Service, to 
•  You believe that the unique facts of your case or compelling     mail in your form and tax payment. However, if, at a later date, 
public policy reasons warrant assistance.                           you need to establish the date you filed or paid your tax, you 
                                                                    cannot use the date recorded by a private delivery service 
When not to use this form                                           unless you used a delivery service that has been designated 
•  If you have not exhausted all reasonable efforts to obtain       by the U.S. Secretary of the Treasury or the Commissioner of 
timely relief through normal Tax Department channels.               Taxation and Finance. (Currently designated delivery services 
                                                                    are listed in Publication 55, Designated Private Delivery 
•  To seek legal or tax return preparation advice.                  Services. See Need help? for information on obtaining forms 
•  To seek review of an unfavorable administrative law judge, Tax   and publications.) If you have used a designated private 
Appeals Tribunal, or judicial determination.                        delivery service and need to establish the date you filed your 
                                                                    form, contact that private delivery service for instructions on 
Specific instructions                                               how to obtain written proof of the date your form was given 
                                                                    to the delivery service for delivery. If you use any private 
Taxpayer information                                                delivery service, whether it is a designated service or not, 
Email address – We may contact you by email if we’re unable         send the form(s) covered by these instructions to: NYS TAX 
to reach you by telephone.                                          DEPARTMENT, OTRA, 90 COHOES AVE, GREEN ISLAND NY 
                                                                    12183
Social Security number or taxpayer identification number – 
Enter your Social Security number, or taxpayer identification       Privacy notification
number if this request involves a business or non-individual        New York State Law requires all government agencies that maintain a 
                                                                    system of records to provide notification of the legal authority for any 
entity (such as a partnership, corporation, trust, or self-employed request for personal information, the principal purpose(s) for which 
individual).                                                        the information is to be collected, and where it will be maintained. To 
                                                                    view this information, visit our website, or, if you do not have Internet 
Business contact person – If a business entity is filing this       access, call and request Publication 54, Privacy Notification. See 
form, enter the name of the person to contact about the request.    Need help? for the Web address and telephone number.
This may be the corporate officer signing the request, or another 
person authorized to discuss the matter.
                                                                     Need help?
Power of attorney 
If you choose to have a representative act on your behalf, you                Visit our website at www.tax.ny.gov
must complete a power of attorney form.                                       •  get information and manage your taxes online
Businesses and individuals: use Form POA-1, Power of                          •  check for new online services and features
Attorney
                                                                     Telephone assistance
Estates: use Form ET-14, Estate Tax Power of Attorney
                                                                     Miscellaneous Tax Information Center:               518-457-5735
You can get these forms from our website at www.tax.ny.gov.
                                                                     To order forms and publications:                    518-457-5431
Include the power of attorney form when you submit this form.        Text Telephone (TTY) or TDD                     Dial 7-1-1 for the  
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