IRS Form 5646 – Claim for Damage, Injury, or Death

IRS Form 5646 – Claim for Damage, Injury, or Death – If you’ve experienced property damage, personal injury, or even death due to the negligence or wrongful actions of an IRS employee, you may be eligible to file a claim under the Federal Tort Claims Act (FTCA). IRS Form 5646, officially titled “Claim for Damage, Injury, or Death,” is the key document for pursuing compensation. This form allows individuals to seek monetary damages for incidents caused by federal employees acting within their scope of employment.

In this comprehensive guide, we’ll break down everything you need to know about IRS Form 5646, including its purpose, eligibility requirements, step-by-step filing instructions, and important deadlines. Whether you’re dealing with vehicle accidents involving IRS personnel, property damage during audits, or other related incidents, understanding how to use this form can help protect your rights. Always consult official IRS resources for the most up-to-date information.

What Is IRS Form 5646 and When Should You Use It?

IRS Form 5646 is a specialized version of the Standard Form 95 (SF-95) used across federal agencies for FTCA claims. It enables claimants to request compensation for:

  • Property damage: Such as vehicle repairs or loss of personal belongings.
  • Personal injury: Including medical expenses, lost wages, and pain and suffering.
  • Wrongful death: For claims related to fatalities caused by IRS employee actions.

This form is typically used when an IRS employee’s negligence or wrongful act—occurring within the scope of their federal duties—leads to harm. Examples include accidents involving IRS vehicles or injuries during official IRS operations. Note that Form 5646 is not for tax disputes or refunds; those are handled through different IRS processes.

The form was last revised in January 2017 and is available as a mobile-friendly PDF on the IRS website. You can download it directly from https://www.irs.gov/pub/irs-pdf/f5646.pdf.

Who Can File IRS Form 5646?

Any individual, business, or estate representative affected by an IRS employee’s actions can file Form 5646. Key eligibility criteria include:

  • The incident must involve an IRS employee acting in their official capacity.
  • Claims must be for a “sum certain” (a specific dollar amount) in damages.
  • You cannot file if the claim involves intentional misconduct, as FTCA covers only negligence.

If the claimant is a minor or deceased, a legal guardian, executor, or authorized representative must file on their behalf. Businesses can file for property damage, but personal injury claims are limited to individuals.

Key Deadlines for Filing IRS Form 5646

Time is critical when filing a claim:

  • Statute of limitations: You must submit the form to the IRS within two years from the date the claim accrues (typically the incident date).
  • If denied, you have six months to file a lawsuit in federal court.
  • For vehicle-related incidents, report immediately to preserve evidence.

Missing these deadlines could result in forfeiture of your rights, so act promptly.

Step-by-Step Guide: How to Fill Out IRS Form 5646

Filling out Form 5646 requires detailed information about the incident. The form mirrors the SF-95 structure and includes sections for claimant details, incident description, and damage amounts. Here’s a breakdown:

  1. Claimant Information (Sections 1-5): Provide your full name, address, date of birth, marital status, and contact details. If filing for someone else, include their information.
  2. Incident Details (Sections 6-8): Specify the date, time, and location of the accident. Describe the facts in detail, including involved parties, property, and cause. Use additional pages if needed.
  3. Property Damage (Section 9): List the owner (if not you), describe the damage, and note where the property can be inspected.
  4. Personal Injury or Wrongful Death (Section 10): Detail injuries, medical treatments, or cause of death. Include the injured/deceased person’s name if different from the claimant.
  5. Witnesses (Section 11): Provide names and addresses of any witnesses.
  6. Claim Amount (Section 12): Enter specific amounts for property damage, personal injury, wrongful death, and total. Failure to specify exact figures may invalidate your claim.
  7. Signature and Certification (Section 13): Sign and date the form, certifying that the claim covers only incident-related damages. Include your phone number.

Tips for Completing the Form:

  • Be factual and concise; avoid speculation.
  • Attach supporting documents like police reports, medical bills, photos, and estimates.
  • If you have insurance, disclose the carrier’s details.
  • Review for accuracy—false statements can lead to civil penalties (up to $10,000 plus triple damages) or criminal charges.

The IRS offers a mobile-friendly version that requires an IRS Online Account for electronic signatures and submissions. You can fill it out online, attach scans of supporting documents, and submit digitally or print for mailing.

Where and How to Submit IRS Form 5646?

Submit the completed form to the IRS office responsible for the incident or the agency’s designated claims handler. For general tort claims:

  • Contact the IRS Claims Manager at 202-317-6999 for guidance on the appropriate address.
  • Mail to: Internal Revenue Service, Attn: Claims Manager, 1111 Constitution Ave NW, Washington, DC 20224 (confirm via phone as addresses may vary by location).

If the incident involves a specific IRS field office or employee, submit directly there. Electronic submission is available through the mobile-friendly portal if you have an online account.

What Happens After Filing IRS Form 5646?

Once submitted, the IRS will review your claim:

  • They may investigate, request more information, or negotiate a settlement.
  • You’ll receive a written decision (approval, denial, or partial approval).
  • If denied, you can appeal or file a lawsuit.

Processing times vary but can take several months. Track your claim by contacting the IRS Claims Manager.

Common Mistakes to Avoid When Filing IRS Form 5646

  • Vague descriptions: Provide specific details to strengthen your case.
  • Missing deadlines: File within two years to avoid rejection.
  • Incomplete amounts: Always specify a “sum certain.”
  • Lack of evidence: Attach all relevant documents to support your claim.
  • Not consulting professionals: Consider legal advice for complex cases, as FTCA rules are strict.

Additional Resources for IRS Form 5646

  • Download the form: IRS Form 5646 PDF
  • IRS Forms and Publications: Search for updates on IRS.gov/forms-instructions-and-publications.
  • For tort claim details: Review the Department of Justice’s FTCA guidelines.
  • IRS Internal Manuals: IRM 9.11.3 and IRM 1.14.5 provide internal procedures for handling claims.

Filing IRS Form 5646 can be a crucial step toward recovery, but it’s essential to use accurate, current information from trusted sources like IRS.gov. If your situation involves serious injury or death, seek professional legal counsel immediately. This guide is for informational purposes only and not a substitute for official advice.