Form 13362 Consent To Disclosure of Return Information

OMB NO. 1545-1856

Consent To Disclosure of Return Information
Note: Prior to completing this Form, please be sure that
you have reviewed the terms of this agreement.

This consent is valid only if the IRS designates me as unsuitable for employment AND the IRS must report its decision to the Office of
Personnel Management (OPM). The IRS must report to OPM the reason for my rejection if the IRS has determined that I am not
suitable for employment in any position with the Service. If the IRS' rejection of my application is based upon my prior compliance with
the tax laws, this consent will permit the IRS to disclose to OPM the return information listed below. Additionally, if I choose to challenge
this rejection before the Merit Systems Protection Board (MSPB), this consent will permit the IRS to disclose the return information
described below to the MSPB for related proceedings.

I. TAXPAYER INFORMATION (Please type or print)
Taxpayer Name

Social Security Number (SSN)

Address

Daytime Phone

Name and address shown on last three (3) returns Indicated an NIR for a non return year (If different from above)
Tax Year

Name

City/State

Tax Year

Name

City/State

Tax Year

Name

City/State

Spouse's name SSN and address as shown on last (3) returns if filed jointly Indicated an N/R for a non return year
Tax Year

Name

Spouse's SSN (if Known)

Tax Year

Name

Spouse's SSN (if Known)

Tax Year

Name

Spouse's SSN (if Known)

II. DESIGNATION OF RECIPIENT
I designate that the IRS may release my personal income tax returns and return information to:

U.S. Office of Personnel Management, Investigation Service
1900 E St., NW Room 5416
Washington, DC 20415-4000

Merit Systems Protection
Board 1615 M St., NW
Washington, DC 20419

III. AUTHORIZATION TO DISCLOSE
I authorize the IRS to release to my designees any returns or return information in IRS possession that provides evidence
on the following:
1. Whether I failed to file a Federal income tax return for any of the last three years for which filing of a return might
have been required. (The ''last three years'' means the three tax years preceding the date on which the IRS receives
this signed consent. If the filing date for the most recent required return has not yet lapsed [i.e., signed consent
submitted between January 1 and April 15], then the ''last three years'' means the three tax years
preceding the year for which returns are currently being processed and filed.)
2. Whether any of the returns identified in #1 above were filed more than 45 days after (10 days after for SES) the filing
due date (determined with regard to any extension(s) of the time for filing).
3. Whether I failed to pay any tax, penalty, or interest liability during the current or last three calendar years within
45 days (within 10 days for SES) of the date of which the IRS gave notice of the amount due and request for payment.
4. Whether I am presently or was previously under investigation by the IRS for a possible criminal tax offense.
Date:

Signature:

(INVALID UNLESS DATED AND SIGNED BY THE TAXPAYER AUTHORIZING DISCLOSURE OF TAX RETURN INFORMATION
AND RECEIVED BY IRS WITHIN 60 DAYS OF THE DATE ABOVE.)
Form 13362 (Rev. 9-2011)

Catalog Number 35306D

www.irs.gov

Department of the Treasury - Internal Revenue Service

OMB NO. 1545-1856

Privacy Act and Paperwork Reduction Act Notices The Service's authority for requesting this information is 5 U.S.C. § 301, and the authority for requesting your social
security number is Executive Order 93-97. While providing this information is voluntary, failure to supply all or part of the
information requested may result in rejection of your employment application. By providing the information herein and by
signing this consent to disclose, authorize the Internal Revenue Service (IRS) to release my return information to the
designated recipients. My returns and return information for the last three years will be reviewed in the evaluation of my
suitability for appointment or employment with the IRS. This consent is made pursuant to 26 U.S.C. § 6103(c), which
permits the release of returns and return information, which would otherwise be confidential, to my designee. This consent
is considered part of my application for employment with the Service and is subject to the Privacy Act of 1974, 5 U.S.C. §
552a.
We ask for the information on this form in order to carry out the mission of the Internal Revenue Service. We need the
information to process your application for employment with the Internal Revenue Service. You are not required to provide
the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB
control number. Generally, tax returns and return information are confidential, as required by I.R.C. § 6103.
The time needed to complete this form will vary depending upon the individual circumstances. The estimated average
time is 10 minutes per response. If you have comments concerning the accuracy of this estimate or suggestions for
making this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service,
Tax Forms and Publications, SE:W:CAR:MP:T, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224.

For IRS Use Only
Has applicant filed and paid their tax returns on a timely
basis for years stated in part 1
Yes

Intelligence Interest

No

Yes

No

Remarks:

Signature of IRS Official

Date

Requesting Office
Location of Office (Be specific)
Full Name
Title

Form 13362 (Rev. 9-2011)

Date

Catalog Number 35306D

www.irs.gov

Department of the Treasury - Internal Revenue Service