Penalty Waiver Request, 78-629

Penalty Waiver Request

tax.iowa.gov

78-629a (12/21/2023)

For expedited processing, you may submit a penalty waiver request online at GovConnectIowa (GCI). You can find a

link and additional information about GCI at tax.iowa.gov

. Otherwise, check appropriate box for type of account/tax.

Other tax types include but are not limited to Cigarette and Tobacco, Fiduciary, Franchise, Fuel, and Inheritance:

Sales ☐ Individual Income ☐ Corporation Income ☐

Use ☐ Withholding ☐ Other ☐: _________________________________

Taxpayer name: _________________________________________________________________________________

Address: ______________________________________________________________________________________

City: _______________________________________________________ State: __________ ZIP: ______________

Contact name (See instructions): ___________________________________________________________________

Phone: ___________________________________ Email:_______________________________________________

Social Security Number (SSN): _____________________________________________________________________

or Individual Taxpayer Identification Number (ITIN): _____________________________________________________

Federal Employer Identification Number (FEIN): ________________________________________________________

Collections account number (if billed): ________________________________________________________________

Tax period(s): ___________________________________________________________________________________

1. Reason(s) for Waiver. Enter the code for the applicable reason(s) for waiver from the list in the instructions:

# ________________

If you think you should be granted relief from penalty for a reason other than those listed in the instructions, you

should review the Abatement Application to determine if you are eligible for relief through the abatement program.

2. Documentation. Attach documentation to support your waiver request. Supporting documentation must be included

for reason codes 3 through 15. Your request will be DENIED if supporting documentation is not provided.

3. Explanation. Describe below why the penalty waiver reason(s) you selected applies. If you need more space, include

additional pages.

I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this request, and, to the

best of my knowledge and belief, it is true, correct, and complete.

Signature: _________________________________________________ Date: ______________________________

Submit Waiver Request

Email: idrsalestax

@iowa.gov

Fax: 515-281-3756

Mail to: Iowa Department of Revenue Penalty Waiver

Box 10465

Des Moines, IA 50306-0465

The integrity and security of sending personal information via fax or email cannot be guaranteed. By submitting this form

via fax or email, you agree to hold the Department harmless if a fax or an email results in third party access to the

information.

Instructions for Penalty Waiver Request, page 2

78-629b (12/21/2023)

Permit number/SSN/FEIN: Enter the permit number, Social Security Number, or Federal Employer Identification

Number for which penalty waiver is requested. You must submit a separate Penalty Waiver Request form for each

penalty requested to be waived.

Account number: If you have been billed, enter the account number shown on the billing notice.

Penalty Types:

Penalty Type A – 5% Penalty for Failure to Timely File a Return

Penalty Type B – 5% Penalty for Failure to Timely Pay the Tax Due

Penalty Type C – 5% Penalty for Audit Deficiencies

NOTE: The 75% Penalty for Willful Failure to File a Return cannot be waived.

Reason(s) for Waiver: From the list of 15 penalty waiver reasons shown below, enter the code(s) of the waiver

reason(s) applicable to your situation. Reasons 3 through 15 require supporting documentation. See Iowa Administrative

Code chapter 701—10 for additional information. If you think you are eligible for relief for a reason other than those

listed below, you should review the Abatement Application to see if you are eligible for one of the reasons provided on

that form.

Taxpayer timely pays at least 90% of the correct tax due (Not applicable to the penalty for failure to timely file by a

specified business under Iowa Admin. Code r. 10.6(2)): A, B, C

Taxpayer has timely filed returns and timely paid all tax due for at least 36 months immediately prior to the tax period

for which taxpayer is applying (not available for income tax, corporate tax, or franchise tax, or annual sales tax or

withholding filers): A, B

Taxpayer, immediate family member, or responsible party dies: A, B

Taxpayer, immediate family member, or responsible party becomes seriously ill or hospitalized: A, B

Taxpayer’s records are destroyed by fire, flood, or other act of God: A, B

Taxpayer relied on case-specific written advice from the Iowa Department of Revenue (Department), Department of

Transportation, county treasurer, or Internal Revenue Service: A, B, C

Taxpayer relied on results of a previous audit: A, B, C

Taxpayer provides documented proof of substantial authority to support position and that all facts and circumstances

were disclosed on the return: A, B, C

Taxpayer provides proof that the return, deposit form, or payment was mailed on time and with proper postage but

that it was incorrectly mailed to the IRS or other state or local governmental agency: A, B

10.

Taxpayer proves before being contacted by the Department that the wrong permit holder paid the tax timely: A, B

11.

Taxpayer discovers through the Department’s self-audit program* that taxpayer failed to file: A

12.

Taxpayer voluntarily files an amended return and pays all tax due before being contacted by the Department except

under a Department self-audit program*: B

13.

Taxpayer voluntarily provides a copy of the final disposition of a federal audit and files an amended return with

payment within 180 days of final disposition of the federal audit or, in the case of a federal centralized partnership

audit, the audited partnership or a direct or indirect partner voluntarily and timely complies with its reporting and

payment requirements under section 422.25A, subsection 4 or 5: B

14.

Taxpayer is required to pay the tax by electronic funds transfer, and the availability of funds is delayed due to reasons

beyond the control of the taxpayer: A, B

15.

The sole reason for the taxpayer’s failure to timely file or pay an Iowa inheritance tax return is due to a beneficiary’s

decision to disclaim property or disclaim an interest in property from the estate and the Iowa inheritance return is

filed and all Iowa inheritance tax is paid to the Department within the later of nine months from the date of death or

60 days from the delivery or filing date of the disclaimer: A, B.

A taxpayer involved with a self-audit program will receive a letter from the Department that will identify the audit as a

self-audit program. The specific years will be identified. Any returns voluntarily filed that are not part of the self-audit

program do not qualify for a waiver of penalty for this reason.