Whistleblowers submitting claims under Sec. 7623(a) or (b) must complete IRS Form 211, Application for Award for Original Information, in order to qualify for the whistleblower award. If they submit claims without completing the form, they will not be eligible for the reward. 
IRS Form 211 must be completed in its entirety and should include the following information:
- The date the claimant submits the claim;
- Claimant’s name;
- Name of claimant’s spouse (if applicable);
- Claimant’s contact information, including address with zip code and telephone number;
- Claimant’s date of birth;
- Claimant’s Taxpayer Identification Number (e.g., Social Security Number or Individual Taxpayer Identification Number) and Taxpayer Identification Number of claimant’s spouse, if applicable.
- Specific and credible information concerning the person(s) that the claimant believes have failed to comply with tax laws and which will lead to the collection of unpaid taxes. This information should include the following:
► The legal name of the person(s) (e.g., individual or entity), and any related person(s), that committed the violation of tax laws;
► The person’s aliases, if any;
► The person’s address;
► The person’s Taxpayer Identification Number(s);
► A description of the amount(s) and tax year(s) of Federal tax
claimed to be owed, and facts supporting the basis for the amount(s)
claimed to be owed;
► Documentation to substantiate the claim (e.g., financial data; the location of bank accounts, assets, books, and records; transaction documents or analyses relevant to the claim); and
► Any and all other facts and information pertaining to the claim.
- Explanation of how the information that forms the basis of the claim came to the attention of the claimant, including the date(s) on which this information was acquired, and a complete description of the claimant’s present or former relationship (if any) to the person that is the subject of the claim (e.g., family member, acquaintance, client, employee, accountant, lawyer, bookkeeper, customer). If the claimant identifies multiple person(s) as the subject of a claim, describe his or her relationship to each person.
- Information submitted under section 7623 must be accompanied by an original declaration signed under penalty of perjury. The requirement to submit information under penalty of perjury precludes submissions by: (1) a person serving as a representative of the claimant, or (2) an entity other than a natural person. With respect to claims under section 7623(b), the requirement to submit information under penalty of perjury precludes submissions made anonymously or under an alias.
IRS Form 211 submissions should also include a detailed summary of the facts and supporting evidence from the informant, supporting documents, and a list of witnesses or people involved, including their contact information.
If the whistleblower lacks certain documents that will prove the violation, it is important to describe with specificity those documents to the IRS, and as much as possible provide a “road map” for the IRS to follow in its investigation.
For more information on how to file an IRS whistleblower claim please contact Shauna Itri at firstname.lastname@example.org or 215-875-3049.
 The Form 211 should be mailed to: Internal Revenue Service Whistleblower Office | SE: WO 1111 Constitution Ave. NW Washington, DC. 2022 http://www.irs.gov/pub/irs-pdf/f211.pdf
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