Requesting a Collection Due Process hearing: Form 12153 companion letter

Who it is for

An owner who received a notice of intent to levy (LT11 or L-1058) or a notice of federal tax lien filing (Letter 3172) and wants an independent Appeals officer to review the collection action or consider a payment alternative.

When to use it

Use it only as a cover letter. The request itself is IRS Form 12153, which is linked below and is not reproduced here. The letter lists what is enclosed and states the reason for the hearing in your own words, because the form requires a reason.

The deadline and form it relates to

• A Collection Due Process hearing on a levy notice must be requested within 30 days of receiving the LT11 or L-1058 (IRS — Collection due process (CDP) FAQs).
• Letter 3172, the lien-filing notice, also gives 30 days to request a hearing (IRS — Collection due process (CDP) FAQs).
• A timely request prohibits levy action in most cases (IRS — Form 12153, Request for a Collection Due Process or Equivalent Hearing (Rev. 7-2022)).
• After the 30 days, an equivalent hearing can still be requested within one year of the levy notice date, or one year plus five business days from the lien filing date (IRS — Form 12153, Request for a Collection Due Process or Equivalent Hearing (Rev. 7-2022)).
• Form 12153 warns that a request without a reason for the dispute will not be honored (IRS — Form 12153, Request for a Collection Due Process or Equivalent Hearing (Rev. 7-2022)).

The template

Replace every [BRACKETED] field and delete any line that does not apply. Keep a copy of everything you send.

[DATE]

[IRS ADDRESS — copy it exactly from your notice]

Re: Request for a Collection Due Process hearing — Form 12153 enclosed
Taxpayer name: [BUSINESS OR INDIVIDUAL NAME, exactly as on the return]
Taxpayer identification number: [EIN or last four digits of SSN, as the notice shows it]
Tax form: [e.g. Form 1120-S, Form 1065, Form 941, Form 1040]
Tax period(s): [e.g. tax year 2024, or quarter ending 03/31/2025]
Notice or letter number: [e.g. CP14, CP2000, LT11 — top or bottom right corner] dated [NOTICE DATE]

To the IRS Independent Office of Appeals:

Enclosed is a signed Form 12153, Request for a Collection Due Process or Equivalent Hearing, and a copy of the notice listed above.

I am requesting a hearing about the [proposed levy / filed notice of federal tax lien / both] for [TAX FORM AND PERIODS].

The reason for this request: [Choose what applies and explain in plain words. Examples: "I cannot pay the balance in full and ask Appeals to consider an installment agreement of $[AMOUNT] per month." / "I ask Appeals to consider placing the account in currently-not-collectible status because of financial hardship." / "I ask for withdrawal of the lien because [REASON]." / "I did not receive a deficiency notice for this liability and dispute the amount because [REASON]."]

[IF PROPOSING A PAYMENT ALTERNATIVE: A completed Form 433-A (individual) and/or Form 433-B (business) with supporting documents is enclosed.]

Please send hearing correspondence to the address above. I have kept a copy of this request and proof of the date it was sent.

Sincerely,

[SIGNATURE]
[PRINTED NAME], [TITLE — e.g. Owner, Managing Member, President]
[BUSINESS NAME]
[DAYTIME PHONE]

Enclosures: Form 12153; copy of the CDP notice; [Form 433-A / Form 433-B and supporting documents]

What to attach

• Form 12153, completed and signed (download it from the IRS link below).
• A copy of the CDP notice (LT11, L-1058 or Letter 3172).
• Form 433-A (individual) and/or Form 433-B (business) with supporting documents, if you want Appeals to consider a payment plan, hardship status or another alternative.

Where to send it

• Form 12153 says to send it to the address for requesting a hearing shown on the CDP notice, not the payment address (IRS — Form 12153, Request for a Collection Due Process or Equivalent Hearing (Rev. 7-2022)).
• Include a copy of the CDP notice so the request is handled properly (IRS — Form 12153, Request for a Collection Due Process or Equivalent Hearing (Rev. 7-2022)).
• To discuss a collection alternative, the form asks for Form 433-A (individual) and/or Form 433-B (business) with the request (IRS — Form 12153, Request for a Collection Due Process or Equivalent Hearing (Rev. 7-2022)).
• Keep a copy of the request and proof of the date you sent it (IRS — Form 12153, Request for a Collection Due Process or Equivalent Hearing (Rev. 7-2022)).

Official forms and pages

• Form 12153 (PDF, IRS)