Government of the
District of Columbia
2022
STAPLE OTHER REQUESTED DOCUMENTS IN UPPER LEFT BEHIND THIS FORM
STAPLE W-2s AND OTHER WITHHOLDING STATEMENTS HERE
Revised 08/2022
D-40B Nonresident
Request for Refund
*220401110000*
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Important: Print in CAPITAL letters using black ink. Leave lines blank that do not apply.
1 $ .00
2 $ .00
3 $ .00
Round cents to nearest dollar. If amount is zero, leave line blank.
Refund request
1. DC income tax withheld Attach copies of your withholding statements.
2. 2022 DC estimated income tax payments
3. Refund request Add Lines 1 and 2.
Will the refund go to an account outside the US? Yes No See instructions.
Refund Options: For information on the tax refund card and program limitations, see instructions or visit our website MyTax.DC.gov
Mark one refund choice: Direct Deposit or ReliaCard (see instructions) or Paper Check
Direct Deposit If you want your refund deposited in your bank account, fill in type of account checking savings and enter the routing number and account
number below.
Routing Number Account Number
Fill in if you agree to receive your 1099-G Income Tax Refund Statement electronically (see instructions).
Third party designee To authorize another person to discuss this return with OTR, fill in here and enter the name and phone number of that person. See instructions.
Designee’s name Phone number
Signature Under penalties of law, I declare that I have examined this request and any attached statements and, to the best of my knowledge, they are correct.
Personal information
Your first name M.I. Last name
Your Taxpayer Identification Number (TIN) Your date of birth (MMDDYYYY) Daytime phone number
Current mailing address (number, street and suite/apartment number if applicable)
City State Zip Code + 4
Country or U.S. commonwealth/U.S. territory
Review categories A - B below and attach your withholding statements and/or DD Form 2058, JAN 2018. Indicate the state in the boxes
below.
A. Commuter/Domiciliary State Exemption: I declare that during the taxable year shown above I either commuted on a daily basis
from my place of residence to work in the District of Columbia (DC) or I was a domiciliary or legal resident of the state listed
and my only income from sources within DC was from wages and salaries, which are subject to taxation by (enter the 2 letter
state abbreviation for your domiciliary or legal state of residency). I did not maintain a place of abode in DC for a total of more
than 183 days. (see instructions). DC tax was erroneously withheld from salary and wages paid to me by my employer.
B. Military spouse exemption: If your non-resident military spouse was in the armed services during 2022, and you are not a DC
resident or elected to use the same residence as your non-resident military spouse, enter the state of domicile declared on DD
Form 2058. You must complete and attach a copy of DD Form 2058, JAN 2018 with the D-40B.
C. List the type and location of any DC real property you own. Type of property
Address #1 (number, street and suite/apartment number if applicable)
Address #2 (number, street and suite/apartment number if applicable)
Your signature Date Preparer’s signature
Preparer’s Tax Identification Number (PTIN)
OFFICIAL USE ONLY
Vendor ID#0000
Email Address
Who must le a Form D-40B?
Any non-resident of DC claiming a refund of DC income tax with-
held or paid by estimated tax payments must file a D-40B. A
non-resident is anyone whose permanent home was outside
DC during all of 2022 and who did not maintain a place of
abode in DC for a total of 183 days or more during 2022.
• A joint request for refund is not permitted.
• Attach all W2/1099 showing DC withholding to the front of
this form. Schedule K-1's are not a substitute for W2/1099.
• Attach your DD Form 2058, JAN 2018 if completing
Category B.
• Be sure to include your date of birth on the front page.
NOTE: If you moved into DC with the intent of becoming a domi-
ciliary, you are considered a DC resident and the 183 days does
not apply.
NOTE: If you are claiming a military spouse exemption, a copy
of DD Form 2058, JAN 2018 must be completed and attached
to your D-40B request.
Taxpayer Identication Number (TIN)
You must have a TIN, whether it is a Federal Employer Iden-
tification Number (FEIN), Social Security Number (SSN),
Individual Taxpayer Identification Number (ITIN) or Preparer Tax
Identification Number (PTIN).
• An SSN is a valid number issued by the Social Security
Administration (SSA) of the United States Government. To
apply for an SSN, get form SS-5, Application for a Social
Se
curity Card,
from your local SSA office or get this form
on
line at www.ssa.gov. You may also get this form by calling
1-800-772-1213.
• An ITIN, Individual Taxpayer Identification Number is a valid
number issued by the IRS. The IRS issues ITINs to individu-
als who are required to have a U.S. taxpayer identification
number but who do not have, and are not eligible to obtain,
a Social Security number (SSN) from the Social Security Ad-
ministration (SSA). ITINs do not serve any purpose other than
federal tax reporting
• An PTIN, Preparer Tax Identification Number is a valid
identification number issued by the IRS that all paid tax
preparers must use on tax returns or claims for refund.
Where to send a Form D-40B?
You must mail the completed Form D-40B and attachments to:
Office of Tax and Revenue
PO Box 96147
Washington, DC 20090-6147
How will we respond to your request?
• We will send you a refund for the amount you request if we
determine you were not a resident of DC during 2022; or
• Based on the information you provide, we may determine that you
qualify as a DC resident. If so, we will require that you file a
DC Form D-40 tax return.
• Missing attachments or supporting documentation or if your form is
incomplete, will cause delays in processing.
Notice: In order to comply with banking rules, we will not issue a
refund to or through a foreign financial institution. Instead, we
will issue a paper check. In the event of a rejection of direct deposit,
refunds will be re-issued on a paper check.
Reminders
U.S. Bank ReliaCard™
If you want your refund on a ReliaCard, select “ReliaCard” under the
Refund Options on the D-40B form. Refunds under $2 or greater than
$4,000 do not qualify for the ReliaCard. Non-qualified refunds will re-
ceive a paper check if direct deposit is not selected.
Pre-Acquisition Disclosures
The Consumer Financial Protection Board (CFPB) has published its fi-
nal Prepaid Account Rule, creating detailed consumer protections for
prepaid accounts. For tax year 2022, if you elect to receive a
refund using the U.S. Bank ReliaCard™ or use a pre-paid card to
make payments, you are required to review and acknowledge the Pre-
Acquisition Disclosures (Short and Long Forms) prior to selecting
the ReliaCard option as method for receiving a refund or using a
prepaid card when making a payment.
Electronic 1099-G
The Office of Tax and Revenue (OTR is offering a paperless option
for receiving the Form 1099-G income tax refund statement. You
will receive a paper statement unless you choose the paperless
option.
Revised 08/2022
• An FEIN is a number issued by the Internal Revenue Service
(IRS) To apply for an FEIN, get Form SS-4, Application for
Employer Identification Number, or get this form online at
www.irs.gov/businesses and click on Employer Identification
Number (EIN) under Starting a Business. You may also get
this form by calling 1-800-TAX-FORM (1-800-829-3676);