Catalog Number 51767Y www.irs.gov
Form
14017 (Rev. 3-2020)
Form 14017
(March 2020)
Department of the Treasury - Internal Revenue Service
Application for Fast Track Settlement
Submitted to IRS Independent Office of Appeals
Date Location
From
LB&I SB/SE TE/GE Other
Type of tax
Taxpayer name
Taxpayer TIN/EIN Tax years
Address
City State Zip code
Telephone number Fax number
Representative name (if applicable)
Name of firm
Address
City State Zip code
Telephone number Fax number
Examination Group/Team Manager
Source (FE/OE, etc.)
City State Zip code Telephone number Fax number
Other Participants (if applicable)
Name Position or Affiliation Telephone Number
Signatures
The undersigned request assistance from the IRS Independent Office of Appeals in the Fast Track Settlement (FTS) process. The issues
for which this assistance is requested are described in the Form(s) 5701, Summary of Issues, or Form 886-A, Explanation of Items, or
similar documents and the taxpayer’s written response, and are attached to this application. By signing this application, taxpayer
consents, pursuant to section 6103(c) of the Code, to the disclosure of the taxpayer’s returns and return information pertaining to the
issues being considered in the FTS process to those persons named on the application as participants in the process. The prohibition
against ex parte communications between Appeals personnel and other Service employees provided by section 1001(a) of the Internal
Revenue Service Restructuring and Reform Act of 1998 does not apply to the communications arising in FTS because Appeals
personnel, in facilitating an agreement between the taxpayer and the other Service Operating Division, are not acting in their traditional
Appeals settlement role. IRS employees, taxpayer and persons invited to participate by the IRS or taxpayer will not voluntarily disclose
information regarding any communication made during the FTS session, except as provided by statute.
Taxpayer signature Date signed
Taxpayer Spouse's signature (if related to a joint return)
Date signed
Taxpayer(s) Representative signature Date signed
IRS Group/Team Manager Signature Date signed
Approving Operating Division Official (signature and title)
Date signed
Accepted by Appeals Official (Appeals Team Manager signature)
Date signed
Accepted by Appeals Official (Appeals Program Manager signature)
Date signed
MFT PBC
Potential Joint Committee Yes No Listed transaction Yes No
LB&I practice area Preferred conference site Fast Track end date
