Primary fi ler Last name First name Middle initial Last 4 digits of primary fi ler’s Social Security Number (SSN)
__ __ __ __
Secondary fi ler (required for joint accounts) Last name First name Middle initial Last 4 digits of secondary fi ler’s SSN
__ __ __ __
Address Number and street PO Box City or town State ZIP code
Part 1 - Personal Information (joint fi lers, see Instructions for Joint Filers, below)
In order to authenticate your identity, print your name(s) and mailing address exactly as they appear on your last return
already on fi le with DRS for this TSC account. Your request will not be processed if the following information is not accurately
completed and clearly printed.
Part 2 - Verifi cation
Your password reset request will not be processed if the following information is not accurately completed and clearly printed.
1. Enter your email address (as originally entered in the TSC):
2. Enter the tax year of a prior income tax return already on fi le with DRS. 2.
3. Enter the Federal Adjusted Gross Income (AGI) from the income tax return for the
tax year you entered above. Enter amount from Section 2, Line 1. 3.
2 0
__ __
00
Part 3 - Confi rmation Method
Indicate how DRS should send your new temporary password. Select only one method below.
Mail to the same mailing address listed in Part 1 - Personal Information.
Email to the following email address:
Fax to the following FAX number:
Instructions for Joint Filers
You must use the SSN and password created by the primary fi ler to access
the TSC. The primary fi ler is generally the fi rst person listed on the joint return.
If you are not the primary taxpayer, we cannot provide you with a password
to access the joint account unless both the primary and secondary sign and
date TPG-196.
If there has been a change in fi ling status since your last return, you may not
be able to fi le your return using the TSC. For additional information, visit the
DRS website at www.ct.gov/DRS and select FAQs.
How to Submit Request
Submit your completed request using one of
the following:
FAX to: 860-297-4761
MAIL to: Department of Revenue Services
Electronic Commerce Unit
PO Box 2937
Hartford CT 06104-2937
If you are not the primary taxpayer listed above, both primary and secondary fi lers must sign below.
Declaration: I declare under penalty of law that I have examined this document and, to the best of my knowledge and belief, it is true,
complete, and correct. I understand that the penalty for willfully delivering a false return or document to the DRS is subject to a fi ne of not
more than $5,000, or imprisonment for not more than fi ve years, or both.
Primary fi ler’s signature Date Phone
( )
Secondary fi ler’s signature Date Phone
( )
Sign Here
Keep a copy
for your
records.
State of Connecticut
Department of Revenue Services
TPG-196 (Rev. 07/15)
TPG-196
Individual TSC Password Reset Request
Complete this form in blue or black ink only.
Purpose: If you have established an online account with the Department of Revenue Services (DRS), Taxpayer Service
Center (TSC) and cannot remember your password, your answers to the security questions, or you no longer use the most
recent email address on fi le with DRS, you may use TPG-196 to request a temporary password to access your account.
