Manager s name and mailing address Signature Date signed Part F OPR Acknowledgement of Report We received your report on To check the status of your report call Form 8484 Rev. 1-2004 Catalog Number 63110D at www.irs.gov Department of the Treasury Internal Revenue Service Instructions to Form 8484 Report of Suspected Practitioner Misconduct Use of Form All IRS organizations may use this form to make A written report of suspected practitioner misconduct Use of this form is optional. A written report may be made in any other format but it must contain all the information required by this form and these instructions. Report of Suspected Practitioner Misconduct and Report of Appraiser Penalty to the Office of Professional Responsibility OPR Read all instructions on back of form before completing this form* Part A Practitioner Information Check each box as applicable Practitioner s name and mailing address The Practitioner is An attorney A certified public accountant Telephone number An enrolled agent Fax number An enrolled actuary Social Security Number CAF number This report concerns an appraiser penalty. Part B Evidence of Practice Before the IRS Power of attorney in case file and a copy is attached* a CAF printout is attached* Personal knowledge of practice and an explanation is attached* Part C Explanation of Suspected Misconduct Explain stating facts and reasons the suspected misconduct. Include the explanation below or attach it to this form* Attach supporting documents as necessary. Check as applicable Explanation of suspected misconduct is attached and consists of Supporting documents are attached and consist of pages. Part D Contact Person OPR will direct questions concerning this report to the contact person* Contact person s name and mailing address Title IRS organization Office code Part E Management Approval Your signature indicates your approval of this report. Authority to Make Reports Any IRS employee who believes a practitioner has violated the regulations governing practice before the IRS should make a 10 and are published in pamphlet form as Treasury Department Circular No* 230 IRS Catalog Number 16586R revised 7-2002 which is available on the Multimedia Publishing intranet site publish. no. irs. gov* In January 2003 the OPR replaced the former Office of Director of Practice and assumed responsibility for receiving practitioner misconduct reports and instituting disciplinary proceedings. Mail or Fax Forms to the OPR as follows IRS/Office of Professional Responsibility SE OPR Attn Misconduct Reports Desk 1111 Constitution Avenue NW Washington DC 20224 Fax 202-622-2207 Disciplinary Hearings Submission of a misconduct report may result in an evidentiary hearing before an administrative law judge. The OPR may request an IRS employee having information supporting allegations of misconduct to appear as a witness at a hearing or to submit an affidavit under penalty of perjury. Misconduct reports generally may be disclosed to practitioners under the Freedom of Information Act.
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