Complete your protest and mail it to the IRS address on the letter that explains your appeal rights. This form is to be used to request an Appeals review upon completion of an examination (audit) if you do not agree with our proposed changes from the audit.Purpose of this form: You can use this form to appeal a Letter 4890 Notice of Denial or a Letter 5015 Notice of Revocation of your IRS-approved. Navigate an IRS Notice of Deficiency with Dallo Law Group. Learn to respond, appeal, or request a waiver with our expert attorneys. A PDF example of an IRS Form 9297 can be found here. What Do I Fill Out on IRS Form 9297? If you recieve Medicaid through NY State of Health, you may fill out form DOH-5085 and submit to NY State of Health.