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Form 5646 is the rare IRS form that has nothing to do with your taxes. It is the administrative claim you file under the Federal Tort Claims Act when a negligent IRS employee causes property damage, personal injury, or death, and it cannot be used to fight a tax bill, a levy, or a denied refund. The Act bars anything arising from assessing or collecting a tax, so a dispute about money the IRS says you owe belongs in a different process entirely.
Two details sink most of these claims, and both are unforgiving. You have to present the claim within two years of the date it accrued, and the clock stops when the IRS actually receives it, not when you mail it. Block 11d has to state one fixed sum-certain dollar amount, the property, injury, and death figures added together, and a range or a to-be-determined makes the claim invalid. Standard Form 95 is an accepted substitute if you do not have Form 5646 in front of you.
Key Takeaways
- Form 5646, Claim for Damage, Injury, or Death, is the administrative claim used to seek recovery under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671-2680) for property damage, personal injury, or death caused by the negligent acts of an IRS employee. The current revision is January 2017 (Catalog Number 42720D).
- You must present the claim within 2 years from the date it accrued. A claim is deemed presented when the IRS receives it, not when it is mailed, and an untimely claim is forever barred under 28 U.S.C. 2401(b).
- Block 11d must carry a single fixed sum-certain dollar amount, the total of property damage (11a), personal injury (11b), and wrongful death (11c). A range, an open estimate, or to be determined renders the claim invalid.
- The FTCA bars claims arising from the assessment or collection of any tax under 28 U.S.C. 2680(c), so Form 5646 cannot be used to dispute a tax bill, levy, or refund. Those disputes go through Tax Court, refund claims, CDP hearings, or a wrongful-collection action under 26 U.S.C. 7433.
- Mail the completed form to IRS Claims Management, 1111 Constitution Avenue, N.W., Room 6404 (CC:GLS), Washington, D.C. 20224. Standard Form 95 is an accepted alternative to Form 5646.
What Is Form 5646?
Form 5646, Claim for Damage, Injury, or Death, is the IRS form you use to file an administrative claim under the Federal Tort Claims Act for property and personal injury damages or death arising specifically from the negligent acts of IRS employees. It is issued by the Department of the Treasury, Internal Revenue Service, and the routing office on the form is CC:GLS. The current revision is January 2017, Catalog Number 42720D, and that revision is still in use for 2025; the form is not reissued each tax year.
Why it exists is simple. The United States is shielded by sovereign immunity, and the FTCA is the narrow waiver that lets a private party seek money damages for a federal employee's negligence. Before anyone can sue in federal court, they must first present an administrative claim to the agency, and Form 5646 is the vehicle the IRS provides for that. The principal purpose of the information collected is to evaluate damage claims filed against the United States under the FTCA.
One boundary matters from the start. The FTCA specifically bars claims arising from the assessment or collection of any tax (28 U.S.C. 2680(c)). Any such claim filed on Form 5646 will be denied. This form is for tort harm, a vehicle damaged in an accident with an IRS vehicle, an injury during an enforcement action gone wrong, not a fight over what you owe.
Who Can File, and Who Cannot
The rule on standing is tight. The claimant must be the owner of the damaged property, the injured person, or their duly authorized agent or legal representative. A bystander or unrelated witness cannot file for someone else.
- If property was damaged, the owner files. Block 8a captures the owner's name and address when the owner is someone other than the claimant.
- If a person was injured, the injured person files, or their authorized representative does on their behalf.
- For a wrongful-death claim, the duly authorized legal representative of the decedent files. IRS Publication 559, Survivors, Executors, and Administrators, is a useful companion where a death claim overlaps with estate filings.
One Claimant Per Form, One Form Per Incident
If an accident involves more than one claimant, each claimant submits a separate Form 5646. You cannot combine family members or co-owners onto one form.
The flip side also matters. If a single claimant has both property damage and personal injury from the same incident, both amounts go on one form, property in Block 11a and injury in Block 11b, with the total in Block 11d. Filing two separate forms for one incident, one for property and one for injury, is not allowed; one claim for both types of damage must be presented at the same time.
Two Quick Scenarios
- An IRS vehicle rear-ends your car and you are hurt. You file one Form 5646 with your repair costs in 11a, your injury claim in 11b, and the combined total in 11d.
- You and a passenger are both injured in the same accident. You each file your own Form 5646, because each claimant needs a separate form.
Where To Get Form 5646 and Where To Send It
Download the current form from the IRS using the button above, or from the official IRS PDF library. The fillable PDF caps each dollar field at 13 characters and enforces a 10-digit format on phone-number fields, so save it locally and open it in a current PDF reader rather than filling it inside a browser preview.
When the form is complete, submit it to the office pre-printed in Block 1:
- Mail to: IRS Claims Management, 1111 Constitution Avenue, N.W., Room 6404 (CC:GLS), Washington, D.C. 20224.
- Telephone for questions: 202-317-6999.
- Fax: 877-487-4695.
Questions about completing Form 5646 should go to that office using the contact information in Block 1 on the front of the form, not to a local IRS office, the Taxpayer Advocate, or a general toll-free line. If you prefer, Standard Form 95 (the cross-agency federal tort claim form) is accepted in place of Form 5646.
How Form 5646 Is Organized, Block by Block
Read all the instructions on both sides of the form, then answer every question. Where a question does not apply, enter the word None rather than leaving it blank. The numbered blocks walk through the incident in order.
The Incident, Blocks 1 Through 7
- Block 1 is the pre-printed Submit to address for IRS Claims Management.
- Block 2 is the name, address, and phone number of the claimant.
- Block 3 is the place of accident, with city or town and state.
- Blocks 4a and 4b are the date the accident occurred and the day of the week.
- Block 5 is the time, AM or PM.
- Block 6 asks for all known facts and circumstances attending the damage, injury, or death, identifying the persons and property involved and the cause.
- Block 7 names the IRS employee involved in the accident.
Damages, Witnesses, and Amounts, Blocks 8 Through 16
- Blocks 8a and 8b cover property damage: the owner's name and address if other than the claimant, and a description of the property and the nature and extent of damage.
- Block 9 covers personal injury or wrongful death, stating the nature and extent of the injury.
- Blocks 10a through 10f capture witness information, with telephone as 10 digits and ZIP as 5 or 9 digits.
- Blocks 11a, 11b, and 11c are the dollar amounts for property damage, personal injury, and wrongful death, and Block 11d is the total, the sum certain.
- Blocks 12a through 12c are the claimant's signature, date signed, and a 10-digit phone number, with no separators.
- Blocks 13 through 16 disclose accident insurance and any claim filed with the insurer, including full coverage or deductible and what action the insurer has taken.
By signing Block 12a, you certify that the amount claimed covers only damages and injuries actually caused by the accident, and you agree to accept the Block 11d amount in full satisfaction and final settlement of the claim.
Step-By-Step, From Accrual to Presentment
- Fix the accrual date. The 2-year clock under 28 U.S.C. 2401(b) runs from when the claim accrued, usually the date of the accident or, for latent harm, when the injury reasonably should have been discovered, not from any later agency decision.
- Gather substantiation early: repair estimates, valuations, the attending physician's report, and itemized bills, all of which take time to assemble.
- Complete every block, entering None where a question does not apply, and total 11a, 11b, and 11c into the sum certain in Block 11d.
- Sign and date Blocks 12a through 12c, and disclose insurance in Blocks 13 through 16.
- Send the executed form to IRS Claims Management with delivery confirmation, well ahead of the 2-year date.
A claim is deemed presented when the IRS receives it, not when it is mailed, so build in margin. After a final agency denial, a separate 6-month window applies before you may sue in federal district court, but that does not extend the 2-year presentment deadline.
Substantiation That Holds Up
The form is short; the proof behind it is the real work. Match the substantiation to the type of loss.
- Repairable property: submit at least two repair estimates from reliable, disinterested concerns. If the work is already done, provide the paid receipt instead.
- Lost, destroyed, or non-repairable property: provide statements of the original cost, the date of purchase, and the value both before and after the accident, from disinterested competent persons (preferably reputable dealers or officials) or from two or more competitive bidders, certified as just and correct.
- Personal injury or death: submit the attending physician's written report covering the nature and extent of the injury, treatment, the degree of permanent disability if any, the prognosis, and the period of hospitalization or incapacitation, plus itemized bills for medical, hospital, or burial expenses actually incurred.
Quick Example, Substantiating a Damaged Vehicle
Say an IRS vehicle dents your car. Get two written repair estimates from independent shops and enter the figure they support in Block 11a. If you have already paid for the repair, the paid receipt replaces the estimates. Keep estimates of future or hypothetical costs out of the file; the IRS wants actual, substantiated charges tied to the amounts you entered.
The Sum-Certain Rule in Block 11d
Block 11d is the single most common reason a claim is rejected on a technicality. It must state a sum certain, a specific fixed dollar amount, equal to the total of property damage (11a), personal injury (11b), and wrongful death (11c). The fillable form auto-calculates that total, and the block text itself warns that failure to specify may cause forfeiture of your rights.
Why it is jurisdictional: a claim is only deemed presented when the IRS receives an executed Form 5646 (or SF-95 or other written notification) accompanied by a demand for money, the sum certain in Block 11d. No exact dollar figure means no valid claim.
What Will Get the Block Rejected
- Leaving Block 11d blank, or writing to be determined.
- Entering a range instead of one number.
- Asking the IRS to determine the value for you.
Each dollar field on the form is capped at 13 characters, so very large figures must still fit the field's format. Total the components, enter the exact figure, and reconcile it back to your substantiation before the form leaves your desk.
Insurance Disclosure and Subrogation
Insurance information is not optional. The IRS adjusts a tort claim based on any insurance recovery, and it needs the details so an insurer's subrogation claims can be adjudicated. Blocks 13 through 16 capture that picture.
Block 13, Do You Carry Accident Insurance
If yes, provide the carrier name, address, ZIP, and policy number. If no, say so. Do not leave it blank.
Blocks 14 Through 16, Claims Already Filed
Block 14 asks whether you have already filed a claim with your insurance carrier for this incident, and if so whether it is full coverage or deductible. If you checked deductible, Block 15 asks for the deductible amount. Block 16 asks what action your insurer has taken or proposes to take, and the instructions note it is your job to ascertain those facts.
Why It Matters
- Omitting insurance details can stall adjudication, because the IRS cannot reconcile your claimed amount against what an insurer already paid or will pay.
- Reconcile Blocks 13 through 16 against your Block 11d total so the figures line up and the claim holds together.
Penalties for a Fraudulent Claim
The form carries two warning notices, and they are not boilerplate. Overstating damages or fabricating a claim has real consequences.
- Civil: a claimant who presents a fraudulent claim is liable to the United States for a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages sustained by the Government, under 31 U.S.C. 3729.
- Criminal: a fine, federal imprisonment, or both may be imposed for presenting a fraudulent claim or making false statements, under 18 U.S.C. 287 and 1001.
One caveat on the dollar figures. The $5,000 to $10,000 range printed on the January 2017 form is the statutory base. The per-violation amount under the False Claims Act is adjusted annually for inflation (28 U.S.C. 2461 note), so the current operative minimum and maximum are higher than the form text shows. The practical takeaway is simpler: certify only damages and injuries the accident actually caused, and let the substantiation prove every dollar.
Common Mistakes That Delay Approvals
Form 5646 fails on technicalities far more often than on the merits. From my side of the desk, the same avoidable errors show up on tort claims against the IRS, and most of them forfeit the claim before anyone weighs what actually happened.
Quick Scenario Table
| Situation | Is Form 5646 the right form? | What to attach |
| An IRS vehicle damages your car in an accident | Yes, a property-damage tort claim | Two repair estimates from disinterested shops, or the paid receipt |
| You are injured during a negligent IRS action | Yes, a personal-injury tort claim | Attending physician's report and itemized medical bills actually incurred |
| A family member dies due to an IRS employee's negligence | Yes, filed by the legal representative | Physician's report and itemized medical, hospital, or burial bills |
| You disagree with a tax assessment, levy, or refund | No, barred by 28 U.S.C. 2680(c) | Use Tax Court, a refund claim, a CDP hearing, or 26 U.S.C. 7433 |
If the loss is genuinely a tort caused by an IRS employee's negligence, keep your substantiation organized and present the claim within the 2-year window.
Troubleshooting And Integrity Checks
If the fillable form rejects an entry
- Phone fields in Blocks 10b and 12c require exactly 10 digits with no parentheses, dashes, or spaces, for example 2025551515. The form clears anything else.
- Witness ZIP in Block 10f must be 5 or 9 digits, and each dollar field is capped at 13 characters.
If you are unsure the claim is complete
- Confirm every block is answered, with None written where a question does not apply.
- Confirm Block 11d carries a single sum-certain figure that equals 11a plus 11b plus 11c.
Version and timing checks that take 30 seconds
- Confirm you are using the January 2017 revision (Catalog Number 42720D); it remains current for 2025 and is not reissued annually.
- Calendar the accrual date and the 2-year deadline, and send with delivery confirmation so the IRS receives the claim, not just a postmark, before it closes.
Privacy, Security, And Record Keeping
The form carries a Privacy Act notice under 5 U.S.C. 552a(e)(3). Disclosure of the requested information is described as voluntary, but the same notice warns that failure to supply it or to complete the form may render the claim null and void. In practice, treat every field as required and write None where a question does not apply.
Treat your file like any sensitive legal record. Store the signed claim and its substantiation in a secure folder, back it up, and limit who can access it. Keep originals in case the IRS asks to verify them during adjudication.
From my side of the desk, a short checklist prevents the three most common errors on a tort claim: a missing sum certain in Block 11d, thin substantiation behind the dollar amounts, and a claim presented after the 2-year window has closed.
Where Accountably Fits
This article lives on Accountably.com, and our day job is keeping books, asset schedules, and supporting documentation in the shape that makes a claim provable. When a business is the claimant on Form 5646, the Block 11a property figure only moves as fast as its records, original cost, purchase dates, repair receipts, and current fixed-asset schedules.
We keep that documentation review-ready all year, so when an accrual date starts the 2-year clock, the numbers and their proof are already in place. No hard sell, just a nudge to systematize the records that a time-sensitive claim depends on.
Conclusion
You now have the why, the who, and the how for Form 5646. Confirm the loss is a tort caused by an IRS employee's negligence and not a tax dispute, complete every block, substantiate each dollar, and total the figures into a single sum certain in Block 11d. Then present the executed form to IRS Claims Management within 2 years of the date the claim accrued, with delivery confirmation, so the IRS receives it before the deadline. Standard Form 95 works if you prefer it.
For final accuracy, always confirm thresholds, deadlines, and procedures against the current Form 5646 instructions for your facts before you file.
Reusable Checklists
These checklists are copy-paste ready for an SOP or a claim file. Drop them into your workflow so a Form 5646 leaves the desk complete, substantiated, and inside the statute.
Form 5646 presentment packet
- Confirm the claimant is the property owner, the injured person, or a duly authorized agent or legal representative.
- Complete Blocks 1 through 16, and enter ‘None’ in any field that does not apply.
- Name the IRS employee involved in Block 7 and describe all known facts of the accident in Block 6.
- Enter property damage in 11a, personal injury in 11b, and wrongful death in 11c.
- State an exact sum-certain total in Block 11d, with no range and no ‘to be determined.’
- Sign and date Blocks 12a through 12c, using a 10-digit phone number with no separators.
- Disclose accident insurance in Block 13 and any insurer claim in Blocks 14 through 16.
- Mail to IRS Claims Management, 1111 Constitution Avenue, N.W., Room 6404 (CC:GLS), Washington, D.C. 20224, with delivery confirmation.
Substantiation pack
- For repairable property, attach at least two repair estimates from disinterested concerns, or the paid receipt if the work is done.
- For lost or destroyed property, document original cost, purchase date, and before-and-after value.
- Source those valuations from disinterested competent persons or two or more competitive bidders, certified as just and correct.
- For personal injury or death, obtain the attending physician’s written report on nature, extent, treatment, prognosis, and permanent disability.
- Attach itemized medical, hospital, or burial bills actually incurred.
- Keep estimates of future expenses out of the file, since the IRS wants actual charges.
- Reconcile every substantiated total back to the amounts entered in 11a, 11b, and 11c.
Statute and eligibility scan
- Identify the accrual date, the date of the accident or, for latent harm, the discovery date.
- Calendar the 2-year presentment deadline under 28 U.S.C. § 2401(b) from that accrual date.
- Confirm the claim is a tort for property, injury, or death, and not a tax assessment or collection dispute barred by 28 U.S.C. § 2680(c).
- Split co-claimants onto separate Form 5646 filings, and keep one claimant’s property and injury on a single form.
- Verify the claim is physically received by the IRS before the deadline, not merely postmarked.
- Note the 6-month agency window after a final denial before any district-court FTCA suit.
- File Standard Form 95 as an accepted alternative to Form 5646, or any other written notification that identifies the incident and states a sum-certain demand for money.
Keep 5646 Season From Stalling
Form 5646 has no annual season, but it runs on a hard clock. The IRS estimates about 6 hours to complete the form (per the Paperwork Reduction Act notice on Form 5646), and the real work sits in the substantiation behind it: original cost, repair estimates, asset values, and itemized bills that all have to support the sum-certain figure in Block 11d before the 2-year window under 28 U.S.C. § 2401(b) closes.
When a business is the claimant, that math only moves as fast as its books. Missing purchase dates, stale fixed-asset schedules, or unreconciled repair receipts turn a straightforward property claim into a scramble, and a claim that arrives incomplete or late is forever barred, not merely delayed.
- Tie the Block 11a property figure to a current fixed-asset schedule that already carries original cost and purchase dates.
- File the two required independent estimates, or the paid receipt, with the asset they support.
- Reconcile insurance recovery from Blocks 13 through 16 against the claimed amount so the 11d total holds up.
- Hold before-and-after valuations from disinterested sources for any lost or destroyed property.
- Track the accrual date and the 2-year deadline the way you would a filing deadline, with a named owner and a review step.
That is records discipline, not heroics, and it is what a structured back office protects. Accountably keeps the books, asset schedules, and supporting documentation in the shape that makes a claim like this provable, so when the clock starts the numbers are already there. See how our tax and accounting delivery keeps documentation review-ready all year.
FAQs
What is Form 5646 used for?
Form 5646, Claim for Damage, Injury, or Death, is used to present an administrative claim under the Federal Tort Claims Act for property damage, personal injury, or death caused by the negligent acts of an IRS employee. It cannot be used to dispute a tax assessment, levy, or refund; the FTCA bars claims arising from the assessment or collection of any tax under 28 U.S.C. 2680(c).
Who can file Form 5646?
The claimant must be the owner of the damaged property, the injured person, or their duly authorized agent or legal representative. If an accident involves more than one claimant, each claimant submits a separate Form 5646.
What is the deadline to file Form 5646?
You must present the claim within 2 years from the date the claim accrued, usually the date of the accident or when the injury should reasonably have been discovered. A claim is deemed presented when the IRS receives it, not when it is mailed, and an untimely claim is forever barred under 28 U.S.C. 2401(b).
Why does Block 11d ask for a sum certain?
Block 11d must state a single fixed dollar amount, the sum of property damage (11a), personal injury (11b), and wrongful death (11c). A range, an open estimate, or to be determined renders the claim invalid and may forfeit your right to recover.
Can I use Standard Form 95 instead of Form 5646?
Yes. A claim is deemed presented when the IRS receives an executed Form 5646, Standard Form 95, or other written notification of the incident accompanied by a demand for money (a sum certain). SF-95 is accepted alongside Form 5646.
Where do I send the completed Form 5646?
Submit the completed form to IRS Claims Management, 1111 Constitution Avenue, N.W., Room 6404 (CC:GLS), Washington, D.C. 20224. Questions about completing the form go to that office at the contact information shown in Block 1 on the front of the form.