Nebraska ID as It Appears on Your Return Social Security Number (for individual income tax)
Tax Period for Which Interest Was Assessed (For income tax,
complete a separate request for each tax year.)
Name Doing Business As (dba)
Street Address
City
Email Address Phone Number
State
Zip Code
Name
Street or Other Mailing Address
City State
Zip Code
FORM
21A
Complete a separate application for each interest assessment.
Request for Abatement of Interest
Amount of Interest Assessed
Name and Mailing Address
A Request for Abatement of Interest Will Not be Processed Until the Tax Has Been Paid.
Check the Tax Program for Which Interest Was Assessed:
Interest was assessed due to an error or unreasonable delay by the Nebraska Department of Revenue (DOR). (Provide a written explanation below.)
Interest was assessed due to erroneous written advice by DOR. This advice was given as a direct response to a request from the taxpayer and the
taxpayer reasonably relied upon the advice. (Attach a copy of the request and the written advice.)
Interest was attributable to an amount that was previously refunded without payment of interest. Interest can be abated up to the date the previous
refund was issued. (This reason does not apply to Motor Fuels taxes.)
Interest was assessed because of an amount erroneously refunded to the taxpayer, provided the taxpayer did not request the refund and it was not caused by
information supplied by the taxpayer. Interest may be abated for the first 90 days after the refund was issued.
Interest that was abated by the IRS on a related federal amount. (Attach a copy of the federal document showing abatement. This reason does not apply
to Motor Fuels taxes.)
Interest was assessed for taxes when the taxpayer complied with the tax laws by filing delinquent tax returns for prior periods after signing a Voluntary
Disclosure Agreement. (This reason does not apply to Motor Fuels taxes.)
Interest was assessed for taxes when the taxpayer was unable to file timely returns because of family illness or death. This could include the discovery
of unfiled returns for a deceased taxpayer. Attach a copy of the death certificate.
Interest was assessed on taxes which were filed after the taxpayer’s records were destroyed due to a natural disaster.
(Attach a written explanation.)
Explanation:
Interest Assessed
Amount Abated
Amount Denied
Unable to Process
sign
here
For Nebraska Department of Revenue Use Only
Comments:
Date
Under penalties of law, I declare that, as taxpayer or preparer, I have examined this application, and to the best of my knowledge and belief, it is
correct and complete.
$
$
$
Authorized Signature
Please Do Not Write in This Space
7-201-1991 Rev. 8-2020 Supersedes 7-201-1991 Rev. 2-2018
$
Transaction Code Amount
Interest
Line # ___
Line # ___
c Sales or Use Tax
c Income Tax Withholding
c Individual Income Tax
c Corporation Income Tax
c Fiduciary Income Tax
c Motor Fuels Tax
c Litter Fee
c Lodging Tax
c Tire Fee
c Cigarette Tax
c Tobacco Products Tax
c Waste Reduction and Recycling Fee
c Other ____________________________________
Interest abatements may only be considered for the following reasons. Please check the boxes that apply to you.
Name and Location Address
$______________________
Legal Name
Signature of Owner, Partner, Member, Corporate Officer, Title Date Daytime Phone
or Person Authorized by Attached Power of Attorney
Signature of Preparer Other Than Taxpayer Title Date Daytime Phone
Email Address
You may fax this request to 402-471-5927, or mail it to: Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903.
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
Retain a copy for your records.
Email Address Phone Number
RESET
PRINT
Instructions
Who May File. Any taxpayer may request an abatement of interest when the taxpayer has been assessed interest
and one of the specic reasons listed on this Form 21A applies. A separate request must be completed for each
interest amount assessed. This form may not be used to request an abatement of penalty except for the penalty for
underpayment of estimated tax. Use the Request for Abatement of Penalty, Form21, to request abatement of any
other penalty.
Email Address. By entering an email address, the taxpayer acknowledges that DOR may contact the taxpayer by
email. The taxpayer accepts any risk to condentiality associated with this method of communication. DOR will
send all condential information by secure email or the State of Nebraska’s le share system. If you do not wish to be
contacted by email, write “Opt Out” on the line labeled “email address.”
Where to File. This Request for Abatement of Interest must be mailed to the Nebraska Department of Revenue, PO
Box 98903, Lincoln, NE 68509‑8903, or faxed to 402‑471‑5927.
Processing Procedure. The Nebraska Department of Revenue (DOR) will not process any Form 21A that does not
meet the following criteria: the Form 21A is lled out completely and the tax associated with the abatement request has
been paid. DOR will review all documentation supporting the Form 21A prior to making a determination of whether
a request for abatement is approved, partially approved, denied, or cannot be processed.
Appeal Procedure. The denial of a Request for Abatement of Interest in its entirety, or in part, is considered a nal
determination of DOR and may be appealed. The requesting party must le its appeal with the District Court of
Lancaster County within 30 days after the mailing of DOR’s nal determination in order to contest the determination.
Amount Denied. If the entire interest is not abated, DOR will send a copy of this Form 21A with an explanation.
If the Form 21A has been denied in whole or in part, and there is an amount shown on the Amount Denied line, you
must remit this amount along with a copy of the Form 21A or appeal DOR’s nal determination by following the
appeal procedures described above.
Unable to Process. If DOR was unable to process the Form 21A, DOR will return a copy to you and you may submit
a corrected Form 21A to DOR or remit to DOR the amount of interest on the Unable to Process line.
Payment. If you are a business and the interest is related to a monthly or quarterly return, please pay the remaining
interest with your next tax return. If you are mandated to make payments by electronic funds transfer (EFT), the interest
payment must also be made by EFT. If you are not mandated to make payments electronically and do not le business
tax returns on a monthly or quarterly basis, the remaining interest should be remitted with a copy of the Form 21A.
Information. Questions may be directed to DOR at 800-742-7474 (NE and IA) or 402-471-5729.
