Form 15118 — Response to Notice CP562A

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f15118.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(December 2024)

Department of the Treasury - Internal Revenue Service

Provide the information requested below. Return this Response form along with any requested documents.

Provide Your Contact Information

First name Middle name Last name

Street address

Provide Adoptive Child’s Information

Adoptive child’s full name (enter in the spaces below the child’s full name as it will appear on your tax return)

First name Middle name Last name

Adoptive child’s date of birth (Month/Day/Year) (enter the child’s date of birth in the space below)

Adoptive child’s place of birth (enter the child’s place of birth in the spaces below)

City State

Adoptive child’s gender (indicate the child’s gender by checking the appropriate box below)

Male Female

Provide Placement Agency’s Information

Placement agency/agent name (enter in the space below the name of the placement agency or agent who placed the child in your home)

Placement agency’s address (enter in the space below the address of the placement agency or agent who placed the child in your home)

Street address

City State ZIP code

Placement date (Month/Day/Year) (enter in the space below the date the adoptive child was placed in your home for the purpose of adoption)

Signature

You didn’t sign your application. Sign in the spaces below. If two people are adopting the child, both must sign.

Under penalties of perjury, I declare that I have examined the application, including accompanying documentation and statements and to the best of my knowledge and belief, it is true, correct, and complete.

Adoptive parent 1

Signature Telephone number Date

Adoptive parent 2

Signature Telephone number Date

Catalog Number 95467T www.irs.gov Form 15118 (12-2024)

Social Security Number (SSN) of Adoptive Parents

The last name or SSN you entered on your Form W-7A for one or both adoptive parents doesn’t match the records given us by Social Security Administration (SSA). This can happen if you used a maiden, married or professional name that SSA doesn’t have on record. Contact SSA to verify or correct the information they have on record. Verifying or correcting this information may avoid additional delays in processing this application and your tax returns.

Enter in the spaces below your SSN, name, and an explanation of your name change, if applicable. If you have changed your name due to marriage, divorce, or other legal action, include a copy of the legal document that supports the name change.

Adoptive parent 1

SSN Full name

Adoptive parent 2

SSN Full name

Explanation of name change (if applicable)

Change In Your Contact Information

If your address has changed, provide your new address in the space below.

Street address

Catalog Number 95467T www.irs.gov Form 15118 (12-2024)