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DOSES 114AR Rev. 07/2013State of Utah Department of Workforce Services AUTHORIZATION TO DISCLOSE MEDICAL ELIGIBILITY INFORMATION Customer Asocial Security # / / Case #Date of BirthD02714001800101I
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114ddoc is a form used to report information on certain foreign financial accounts to the Internal Revenue Service (IRS) in the United States.
Any U.S. person who has a financial interest in or signature authority over foreign financial accounts with an aggregate value exceeding $10,000 at any time during the calendar year is required to file 114ddoc.
114ddoc can be filled out electronically through the Financial Crimes Enforcement Network's (FinCEN) BSA E-Filing System.
The purpose of 114ddoc is to help combat tax evasion by providing the IRS with information about foreign financial accounts held by U.S. persons.
114ddoc requires information such as the name and address of the account holder, the account number, the name and address of the financial institution, and the maximum value of the account during the reporting period.
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