IRS 433-A Template Access IRS 433-A Editor Now

IRS 433-A Template

The IRS 433-A form, also known as the Collection Information Statement for Wage Earners and Self-Employed Individuals, is a detailed document used by the Internal Revenue Service to assess an individual's financial situation and determine a feasible payment plan for outstanding taxes. This form requires comprehensive information about one's income, expenses, assets, and liabilities. For those needing to navigate the complexities of settling tax debts, understanding and accurately filling out this form is a crucial step. Click the button below to start the process of filling out your form with confidence.

Access IRS 433-A Editor Now
Table of Contents

Navigating the intricacies of tax resolution often leads individuals to encounter the IRS 433-A form, a critical document for those seeking to establish a payment agreement with the IRS based on their current financial situation. This form delves into the minutiae of an individual's financial life, encompassing assets, liabilities, income, and expenses to paint a comprehensive picture for the IRS. The objective is to provide a transparent overview that aids in determining the most viable payment plan or settlement option, catering to the taxpayer's ability while ensuring compliance with tax laws. Suitable for both individuals and businesses, the IRS 433-A form acts as a cornerstone for negotiations, making it essential for taxpayers to approach this document with diligence and accuracy. By thoroughly documenting one's financial stance, this form paves the way for resolutions that can alleviate the burden of overwhelming tax debts, offering a pathway to financial recovery and stability.

Form Preview

Form 433-A

(May 2020)

Department of the Treasury Internal Revenue Service

Collection Information Statement for Wage

Earners and Self-Employed Individuals

Wage Earners Complete Sections 1, 2, 3, 4, and 5 including the signature line on page 4. Answer all questions or write N/A if the question is not applicable.

Self-Employed Individuals Complete Sections 1, 3, 4, 5, 6 and 7 and the signature line on page 4. Answer all questions or write N/A if the question is not applicable.

For Additional Information, refer to Publication 1854, "How To Prepare a Collection Information Statement."

Include attachments if additional space is needed to respond completely to any question.

Name on Internal Revenue Service (IRS) Account

SSN or ITIN on IRS Account

Employer Identification Number EIN

 

 

 

Section 1: Personal Information

1a

Full Name of Taxpayer and Spouse (if applicable)

1c

Home Phone

1d

Cell Phone

 

 

 

 

 

 

 

(

)

 

(

)

 

1b

Address (Street, City, State, ZIP code) (County of Residence)

1e

Business Phone

1f

Business Cell Phone

 

 

 

 

 

 

 

(

)

 

(

)

 

 

 

 

 

 

 

2b

Name, Age, and Relationship of

persons in household or claimed as a

 

 

 

 

 

 

 

 

dependent(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2a

Marital Status:

Married

Unmarried (Single, Divorced, Widowed)

 

 

 

 

 

 

 

3a

Taxpayer

 

SSN or ITIN

 

Date of Birth (mmddyyyy)

 

 

Driver's License Number and State

 

 

 

 

 

 

 

 

 

 

 

 

3b

Spouse

 

 

 

 

 

 

 

 

 

 

 

Section 2: Employment Information for Wage Earners

If you or your spouse have self-employment income instead of, or in addition to wage income, complete Business Information in Sections 6 and 7.

 

 

 

 

Taxpayer

 

 

 

 

 

 

 

Spouse

 

 

4a

Taxpayer's Employer Name

 

 

 

5a

Spouse's Employer Name

 

 

 

 

 

 

 

 

 

 

4b

Address (Street, City, State, and ZIP code)

 

5b

Address (Street, City, State, and ZIP code)

 

 

 

 

 

 

 

 

 

 

 

4c

Work Telephone Number

4d

Does employer allow contact at work

5c

Work Telephone Number

5d Does employer allow contact at work

 

 

(

)

 

 

 

Yes

No

 

 

(

)

 

 

Yes

No

4e

How long with this employer

4f

Occupation

 

5e

How long with this employer

5f Occupation

 

 

 

 

(years)

 

(months)

 

 

 

 

 

 

(years)

 

(months)

 

 

 

4g

Number of withholding allowances

4h

Pay Period:

 

5g

Number of withholding allowances

5h Pay Period:

 

 

 

claimed on Form W-4

 

 

Weekly

Bi-weekly

 

 

claimed on Form W-4

 

Weekly

Bi-weekly

 

 

 

 

 

 

 

 

 

 

 

 

Monthly

Other

 

 

 

 

 

 

Monthly

Other

Section 3: Other Financial Information (Attach copies of applicable documentation)

6

Are you a party to a lawsuit (If yes, answer the following)

 

 

 

 

 

 

 

Yes

No

 

Plaintiff

Defendant

Location of Filing

Represented by

 

 

Docket/Case No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount of Suit

 

 

Possible Completion Date (mmddyyyy)

Subject of Suit

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

Have you ever filed bankruptcy

(If yes, answer the following)

 

 

 

 

 

 

 

Yes

No

 

Date Filed (mmddyyyy)

Date Dismissed (mmddyyyy)

Date Discharged (mmddyyyy)

Petition No.

 

 

 

Location Filed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

In the past 10 years, have you lived outside of the U.S for 6 months or longer (If yes, answer the following)

 

Yes

No

 

Dates lived abroad: from (mmddyyyy)

To (mmddyyyy)

 

 

 

 

 

 

 

9a

Are you the beneficiary of a trust, estate, or life insurance policy (If yes, answer the following)

 

 

 

 

Yes

No

 

Place where recorded:

 

 

 

 

 

 

 

 

 

 

EIN:

 

 

 

Name of the trust, estate, or policy

Anticipated amount to be received

 

When will the amount be received

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

9b

Are you a trustee, fiduciary, or contributor of a trust

 

 

 

 

 

 

 

Yes

No

 

Name of the trust:

 

 

 

 

 

 

 

 

 

 

 

EIN:

 

 

10

Do you have a safe deposit box (business or personal) (If yes, answer the following)

 

 

 

 

Yes

No

 

Location (Name, address and box number(s))

 

 

Contents

 

 

 

 

Value

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

11

In the past 10 years, have you transferred any assets for less than their full value (If yes, answer the following)

 

 

 

 

Yes

No

 

List Asset(s)

 

 

 

Value at Time of Transfer

Date Transferred (mmddyyyy)

To Whom or Where was it Transferred

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Catalog Number 20312N

 

 

 

 

www.irs.gov

 

 

 

 

 

 

Form 433-A (Rev. 5-2020)

 

Form 433-A (Rev. 2-2019)

Page 2

Section 4: Personal Asset Information for all Individuals (Foreign and Domestic)

12 CASH ON HAND Include cash that is not in a bank

Total Cash on Hand

$

PERSONAL BANK ACCOUNTS Include all checking, online and mobile (e.g., PayPal etc.) accounts, money market accounts, savings accounts, and stored value cards (e.g., payroll cards, government benefit cards, etc.).

 

Type of Account

Full Name & Address (Street, City, State, ZIP code) of Bank,

Account Number

Account Balance

 

As of

 

 

 

Savings & Loan, Credit Union, or Financial Institution

 

 

 

mmddyyyy

 

 

 

 

 

13a

 

 

 

$

 

 

13b

 

 

 

$

 

 

13c

Total Cash (Add lines 13a, 13b, and amounts from any attachments)

 

$

 

 

INVESTMENTS Include stocks, bonds, mutual funds, stock options, certificates of deposit, and retirement assets such as IRAs, Keogh, 401(k) plans and commodities (e.g., gold, silver, copper, etc.). Include all corporations, partnerships, limited liability companies, or other business entities in which you are an officer, director, owner, member, or otherwise have a financial interest. Include attachment(s) if additional space is needed to respond.

Type of Investment

Full Name & Address

Current Value

Loan Balance (if applicable)

Equity

As of

or Financial Interest

(Street, City, State, ZIP code) of Company

Value minus Loan

 

 

 

 

mmddyyyy

 

 

14a

 

 

 

 

 

 

 

Phone

$

$

 

 

$

14b

 

 

 

 

 

 

Phone

$

$

$

VIRTUAL CURRENCY (CRYPTOCURRENCY) List all virtual currency you own or in which you have a financial interest. (e.g., Bitcoin, Ethereum, Litecoin, Ripple, etc.) If applicable, attach a statement with each virtual currency’s public key.

 

 

 

 

Name of Virtual Currency Wallet,

Email Address Used to Set-up

Location(s) of Virtual Currency

Virtual Currency

Type of Virtual Currency

 

Amount and Value in

 

Exchange or Digital Currency

With the Virtual Currency

(Mobile Wallet, Online, and/or

US dollars as of

 

 

 

 

 

Exchange (DCE)

Exchange or DCE

 

External Hardware storage)

today (e.g., 10 Bitcoins

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$64,600.00 USD)

14c

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14d

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14e

Total Equity (Add lines 14a through 14d and amounts from any attachments)

 

 

 

 

 

 

$

 

 

AVAILABLE CREDIT Include all lines of credit and bank issued credit cards.

 

 

 

 

 

 

 

 

 

 

Full Name & Address (Street, City, State, ZIP code) of Credit Institution

 

Credit Limit

 

Amount Owed

Available Credit

 

 

 

As of

As of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mmddyyyy

 

 

mmddyyyy

 

15a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct. No

 

 

 

 

 

 

 

 

$

 

 

$

 

 

$

 

 

15b

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acct. No

 

 

 

 

 

 

 

 

$

 

 

$

 

 

$

 

 

15c

Total Available Credit (Add lines 15a, 15b and amounts from any attachments)

 

 

 

 

 

 

$

 

 

16a

LIFE INSURANCE Do you own or have any interest in any life insurance policies with cash value (Term Life insurance does

not have a cash value)

 

Yes

No

 

If yes, complete blocks 16b through 16f for each policy.

 

 

 

 

 

 

 

 

16b

Name and Address of Insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company(ies):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16c

Policy Number(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16d

Owner of Policy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16e

Current Cash Value

 

 

 

 

$

 

$

 

 

 

 

 

$

 

 

 

 

16f

Outstanding Loan Balance

 

$

 

$

 

 

 

 

 

$

 

 

 

 

16g

Total Available Cash (Subtract amounts on line 16f from line 16e and include amounts from any attachments)

$

 

 

Catalog Number 20312N

www.irs.gov

Form 433-A (Rev. 5-2020)

Form 433-A (Rev. 2-2019)

 

 

 

 

 

 

 

 

 

Page 3

REAL PROPERTY Include all real property owned or being purchased

 

 

 

 

 

 

 

 

 

Purchase Date

 

Current Fair

Current Loan

Amount of

Date of Final

Equity

 

 

 

 

(mmddyyyy)

 

Market Value

Balance

Monthly Payment

Payment

FMV Minus Loan

 

 

 

 

 

(FMV)

(mmddyyyy)

17a

Property Description

 

$

 

 

$

$

 

 

$

 

 

 

 

 

 

 

 

 

 

Location (Street, City, State, ZIP code) and County

 

Lender/Contract Holder Name, Address (Street, City, State, ZIP code), and Phone

 

 

 

 

 

 

 

 

 

Phone

 

 

 

17b

Property Description

 

$

 

 

$

$

 

 

$

 

 

 

 

 

 

 

 

 

 

Location (Street, City, State, ZIP code) and County

 

Lender/Contract Holder Name, Address (Street, City, State, ZIP code), and Phone

 

 

 

 

 

 

 

 

 

Phone

 

 

 

17c Total Equity (Add lines 17a, 17b and amounts from any attachments)

 

 

 

$

 

PERSONAL VEHICLES LEASED AND PURCHASED Include boats, RVs, motorcycles, all-terrain and off-road vehicles, trailers, etc.

Description (Year, Mileage, Make/Model,

Purchase/

 

Current Fair

Current Loan

Amount of

Date of Final

Equity

Lease Date

 

Market Value

Payment

Tag Number, Vehicle Identification Number)

(mmddyyyy)

 

(FMV)

Balance

Monthly Payment

(mmddyyyy)

FMV Minus Loan

18a Year

 

Make/Model

 

$

 

 

$

$

 

 

$

 

 

 

 

 

 

 

 

 

 

Mileage

 

License/Tag Number

Lender/Lessor

Name, Address

(Street, City, State,

ZIP code), and Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Identification Number

 

 

 

 

 

Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18b Year

 

Make/Model

 

$

 

 

$

$

 

 

$

 

 

 

 

 

 

 

 

 

 

Mileage

 

License/Tag Number

Lender/Lessor

Name, Address

(Street, City, State,

ZIP code), and Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Identification Number

 

 

 

 

 

Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18c Total Equity (Add lines 18a, 18b and amounts from any attachments)

$

PERSONAL ASSETS Include all furniture, personal effects, artwork, jewelry, collections (coins, guns, etc.), antiques or other assets. Include intangible assets such as licenses, domain names, patents, copyrights, mining claims, etc.

 

Purchase/

 

Current Fair

Current Loan

Amount of

Date of Final

Equity

 

Lease Date

 

Market Value

Payment

 

(mmddyyyy)

 

(FMV)

Balance

Monthly Payment

(mmddyyyy)

FMV Minus Loan

19a Property Description

 

 

$

 

 

$

$

 

 

$

 

 

 

 

 

 

 

Location (Street, City, State, ZIP code) and County

 

Lender/Lessor Name, Address (Street, City, State, ZIP code), and Phone

 

 

 

 

 

 

 

Phone

 

 

 

19b Property Description

 

 

$

 

 

$

$

 

 

$

 

 

 

 

 

 

 

Location (Street, City, State, ZIP code) and County

 

Lender/Lessor Name, Address (Street, City, State, ZIP code), and Phone

 

 

 

 

 

 

 

Phone

 

 

 

19c Total Equity (Add lines 19a, 19b and amounts from any attachments)

 

 

 

$

 

Catalog Number 20312N

www.irs.gov

Form 433-A (Rev. 5-2020)

Form 433-A (Rev. 2-2019)

Page 4

 

If you are self-employed, sections 6 and 7 must be completed before continuing.

Section 5: Monthly Income and Expenses

Monthly Income/Expense Statement (For additional information, refer to Publication 1854.)

 

Total Income

 

 

 

Total Living Expenses

 

IRS USE ONLY

 

Source

 

Gross Monthly

 

Expense Items 6

Actual Monthly

Allowable Expenses

20

Wages (Taxpayer) 1

$

 

35

Food, Clothing and Misc. 7

$

 

21

Wages (Spouse) 1

$

 

36

Housing and Utilities 8

$

 

22

Interest - Dividends

$

 

37

Vehicle Ownership Costs 9

$

 

23

Net Business Income 2

$

 

38

Vehicle Operating Costs 10

$

 

24

Net Rental Income 3

$

 

39

Public Transportation 11

$

 

25

Distributions (K-1, IRA, etc.) 4

$

 

40

Health Insurance

$

 

26

Pension (Taxpayer)

$

 

41

Out of Pocket Health Care Costs 12

$

 

27

Pension (Spouse)

$

 

42

Court Ordered Payments

$

 

28

Social Security (Taxpayer)

$

 

43

Child/Dependent Care

$

 

29

Social Security (Spouse)

$

 

44

Life Insurance

$

 

30

Child Support

$

 

45

Current year taxes (Income/FICA) 13

$

 

31

Alimony

$

 

46

Secured Debts (Attach list)

$

 

 

Other Income (Specify below) 5

 

 

47

Delinquent State or Local Taxes

$

 

32

 

$

 

48

Other Expenses (Attach list)

$

 

33

 

$

 

49

Total Living Expenses (add lines 35-48)

$

 

34

Total Income (add lines 20-33)

$

 

50

Net difference (Line 34 minus 49)

$

 

1Wages, salaries, pensions, and social security: Enter gross monthly wages and/or salaries. Do not deduct tax withholding or allotments taken out of pay, such as insurance payments, credit union deductions, car payments, etc. To calculate the gross monthly wages and/or salaries:

If paid weekly - multiply weekly gross wages by 4.3. Example: $425.89 x 4.3 = $1,831.33

If paid biweekly (every 2 weeks) - multiply biweekly gross wages by 2.17. Example: $972.45 x 2.17 = $2,110.22

If paid semimonthly (twice each month) - multiply semimonthly gross wages by 2. Example: $856.23 x 2 = $1,712.46

2Net Income from Business: Enter monthly net business income. This is the amount earned after ordinary and necessary monthly business expenses are paid. This figure is the amount from page 6, line 89. If the net business income is a loss, enter “0”. Do not enter a negative number. If this amount is more or less than previous years, attach an explanation.

3Net Rental Income: Enter monthly net rental income. This is the amount earned after ordinary and necessary monthly rental expenses are paid. Do not include deductions for depreciation or depletion. If the net rental income is a loss, enter “0.” Do not enter a negative number.

4Distributions: Enter the total distributions from partnerships and subchapter S corporations reported on Schedule K-1, and from limited liability companies reported on Form 1040, Schedule C, D or E. Enter total distributions from IRAs if not included under pension income.

5Other Income: Include agricultural subsidies, unemployment compensation, gambling income, oil credits, rent subsidies, sharing economy income from providing on-demand work, services or goods (e.g., Uber, Lyft, AirBnB, VRBO) and income through digital platforms like an app or website, etc.

6Expenses not generally allowed: We generally do not allow tuition for private schools, public or private college expenses, charitable contributions, voluntary retirement contributions or payments on unsecured debts. However, we may allow the expenses if proven that they are necessary for the health and welfare of the individual or family or the production of income. See Publication 1854 for exceptions.

7Food, Clothing and Miscellaneous: Total of food, clothing, housekeeping supplies, and personal care products for one month. The miscellaneous allowance is for expenses incurred that are not included in any other allowable living expense items. Examples are credit card payments, bank fees and charges, reading material, and school supplies.

8Housing and Utilities: For principal residence: Total of rent or mortgage payment. Add the average monthly expenses for the following: property taxes, homeowner’s or renter’s insurance, maintenance, dues, fees, and utilities. Utilities include gas, electricity, water, fuel, oil, other fuels, trash collection, telephone, cell phone, cable television and internet services.

9Vehicle Ownership Costs: Total of monthly lease or purchase/loan payments.

10Vehicle Operating Costs: Total of maintenance, repairs, insurance, fuel, registrations, licenses, inspections, parking, and tolls for one month.

11Public Transportation: Total of monthly fares for mass transit (e.g., bus, train, ferry, taxi, etc.)

12Out of Pocket Health Care Costs: Monthly total of medical services, prescription drugs and medical supplies (e.g., eyeglasses, hearing aids, etc.)

13Current Year Taxes: Include state and Federal taxes withheld from salary or wages, or paid as estimated taxes.

Certification: Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities, and other information is true, correct, and complete.

Taxpayer's Signature

Spouse's signature

Date

After we review the completed Form 433-A, you may be asked to provide verification for the assets, encumbrances, income and expenses reported. Documentation may include previously filed income tax returns, pay statements, self-employment records, bank and investment statements, loan statements, bills or statements for recurring expenses, etc.

IRS USE ONLY (Notes)

Catalog Number 20312N

www.irs.gov

Form 433-A (Rev. 5-2020)

Form 433-A (Rev. 2-2019)

 

Page 5

Sections 6 and 7 must be completed only if you are SELF-EMPLOYED.

Section 6: Business Information

 

 

51 Is the business a sole proprietorship (filing Schedule C)

Yes, Continue with Sections 6 and 7.

No, Complete Form 433-B.

All other business entities, including limited liability companies, partnerships or corporations, must complete Form 433-B.

52Business Name & Address (if different than 1b)

53

Employer Identification Number

54 Type of Business

 

 

55

Is the business a

Yes

No

 

 

 

 

 

 

Federal Contractor

56

Business Website (web address)

57

Total Number of Employees

58

Average Gross Monthly Payroll

 

 

 

 

 

 

 

 

59

Frequency of Tax Deposits

60

Does the business engage in e-Commerce

Yes

No

 

 

 

 

(Internet sales) If yes, complete lines 61a and 61b

PAYMENT PROCESSOR (e.g., PayPal, Authorize.net, Google Checkout, etc.) Include virtual currency wallet, exchange or digital currency exchange.

Name & Address (Street, City, State, ZIP code). Name & Address (Street, City, State, ZIP code)

Payment Processor Account Number

61a

61b

CREDIT CARDS ACCEPTED BY THE BUSINESS

Credit Card

Merchant Account Number

Issuing Bank Name & Address (Street, City, State, ZIP code)

62a

62b

62c

63 BUSINESS CASH ON HAND Include cash that is not in a bank.

Total Cash on Hand

$

BUSINESS BANK ACCOUNTS Include checking accounts, online and mobile (e.g., PayPal) accounts, money market accounts, savings accounts, and stored value cards (e.g., payroll cards, government benefit cards, etc.). Report Personal Accounts in Section 4.

 

Type of Account

Full name & Address (Street, City, State, ZIP code)

Account Number

Account Balance

 

As of

 

 

 

of Bank,Savings & Loan, Credit Union or Financial Institution.

 

 

 

mmddyyyy

 

 

 

 

 

64a

 

 

 

$

 

 

64b

 

 

 

$

 

 

64c

Total Cash in Banks (Add lines 64a, 64b and amounts from any attachments)

 

$

 

 

ACCOUNTS/NOTES RECEIVABLE Include e-payment accounts receivable and factoring companies, and any bartering or online auction accounts. (List all contracts separately, including contracts awarded, but not started.) Include Federal, state and local government grants and contracts.

Accounts/Notes Receivable & Address (Street, City, State, ZIP code)

Status (e.g., age,

Date Due

Invoice Number or Government

Amount Due

factored, other)

(mmddyyyy)

Grant or Contract Number

65a

 

 

 

$

65b

 

 

 

$

65c

 

 

 

$

65d

 

 

 

$

65e

 

 

 

$

65f Total Outstanding Balance (Add lines 65a through 65e and amounts from any attachments)

 

$

Catalog Number 20312N

www.irs.gov

Form 433-A (Rev. 5-2020)

Form 433-A (Rev. 2-2019)

Page 6

BUSINESS ASSETS Include all tools, books, machinery, equipment, inventory or other assets used in trade or business. Include a list and show the value of all intangible assets such as licenses, patents, domain names, copyrights, trademarks, mining claims, etc.

 

 

Purchase/

 

Current Fair

Current Loan

Amount of

Date of Final

Equity

 

 

Lease Date

 

Market Value

Payment

 

 

(mmddyyyy)

 

(FMV)

Balance

Monthly Payment

(mmddyyyy)

FMV Minus Loan

66a

Property Description

 

$

 

 

$

$

 

$

 

 

 

 

 

 

 

Location (Street, City, State, ZIP code) and Country

 

 

Lender/Lessor/Landlord

Name, Address (Street,

City, State, ZIP code), and Phone

 

 

 

 

 

 

 

Phone

 

 

66b

Property Description

 

$

 

 

$

$

 

$

 

 

 

 

 

 

Location (Street, City, State, ZIP code) and Country

Lender/Lessor/Landlord Name, Address (Street, City, State, ZIP code), and Phone

Phone

66c Total Equity (Add lines 66a, 66b and amounts from any attachments)

$

Section 7 should be completed only if you are SELF-EMPLOYED

Section 7: Sole Proprietorship Information (lines 67 through 87 should reconcile with business Profit and Loss Statement)

Accounting Method Used:

Cash

Accrual

Use the prior 3, 6, 9 or 12 month period to determine your typical business income and expenses.

Income and Expenses during the period (mmddyyyy)

 

 

to (mmddyyyy)

 

Provide a breakdown below of your average monthly income and expenses, based on the period

of time used above.

 

 

Total Monthly Business Income

 

Total Monthly Business Expenses (Use attachments as needed)

 

Source

Gross Monthly

 

Expense Items

Actual Monthly

67

Gross Receipts

$

77

Materials Purchased 1

$

68

Gross Rental Income

$

78

Inventory Purchased 2

$

69

Interest

$

79

Gross Wages & Salaries

$

70

Dividends

$

80

Rent

$

71

Cash Receipts not included in lines 67-70

$

81

Supplies 3

$

 

Other Income (Specify below)

 

82

Utilities/Telephone 4

$

72

 

$

83

Vehicle Gasoline/Oil

$

73

 

$

84

Repairs & Maintenance

$

74

 

$

85

Insurance

$

75

 

$

86

Current Taxes 5

$

76

Total Income (Add lines 67 through 75)

$

87

Other Expenses, including installment payments

$

 

(Specify)

 

 

 

88

Total Expenses (Add lines 77 through 87)

$

 

 

 

89

Net Business Income (Line 76 minus 88) 6

$

Enter the monthly net income amount from line 89 on line 23, section 5. If line 89 is a loss, enter "0" on line 23, section 5.

Self-employed taxpayers must return to page 4 to sign the certification.

1Materials Purchased: Materials are items directly related to the production of a product or service.

2Inventory Purchased: Goods bought for resale.

3Supplies: Supplies are items used in the business that are consumed or used up within one year. This could be the cost of books, office supplies, professional equipment, etc.

4Utilities/Telephone: Utilities include gas, electricity, water, oil, other fuels, trash collection, telephone, cell phone and business internet.

5Current Taxes: Real estate, excise, franchise, occupational, personal property, sales and employer’s portion of employment taxes.

6Net Business Income: Net profit from Form 1040, Schedule C may be used if duplicated deductions are eliminated (e.g., expenses for business use of home already included in housing and utility expenses on page 4). Deductions for depreciation and depletion on Schedule C are not cash expenses and must be added back to the net income figure. In addition, interest cannot be deducted if it is already included in any other installment payments allowed.

IRS USE ONLY (Notes)

Privacy Act: The information requested on this Form is covered under Privacy Acts and Paperwork Reduction Notices which have already been provided to the taxpayer.

Catalog Number 20312N

www.irs.gov

Form 433-A (Rev. 5-2020)

Form Breakdown

Fact Name Description
Purpose of Form 433-A The Form 433-A, or Collection Information Statement for Wage Earners and Self-Employed Individuals, is designed to provide the Internal Revenue Service (IRS) with detailed information about an individual's financial situation. This allows the IRS to assess the individual's ability to pay outstanding tax debt.
Eligibility Criteria Form 433-A is specifically intended for use by individuals who are either wage earners or self-employed. It is not designed for businesses, which are required to complete Form 433-B, a similar document for entities.
Components of Form 433-A The form covers extensive financial details, including but not limited to, employment information, account balances, investments, real estate, and other personal asset information, along with monthly income and living expenses.
Resulting Actions from Submission Once the IRS reviews the completed Form 433-A, they may propose a payment plan that aligns with the individual's financial capacity. This could lead to an offer in compromise, installment agreements, or temporary delays in collection actions.
Governing Law While Form 433-A is a federal form issued by the IRS and is thus governed by federal law, state tax authorities may have similar forms or requirements for assessing state tax liabilities. The information provided may also affect individuals’ state tax obligations.

Guidelines on Filling in IRS 433-A

Filling out the IRS Form 433-A is a necessary step for individuals who need to provide the Internal Revenue Service (IRS) with detailed information about their financial situation. This form is often used to set up payment plans or to settle tax debt. It’s important to approach this task with careful attention to detail, as accurately representing your financial status is crucial. To ensure that you complete the form correctly, follow the step-by-step instructions outlined below.

  1. Gather all necessary documents, including pay stubs, bank statements, investment accounts, and information on assets such as vehicles and properties.
  2. Begin by filling out your personal information in Section 1. This includes your name, social security number, address, and contact details.
  3. In Section 2, provide detailed employment information for both yourself and, if applicable, your spouse. This covers employers' names, addresses, and the length of employment.
  4. Section 3 requires information on other financial aspects, such as self-employment or business ownership. Be prepared to outline business expenses and revenues.
  5. List all types of income in Section 4, including wages, business income, rental income, and any other sources.
  6. Describe your assets in Section 5. This part includes bank accounts, credit cards, real estate, vehicles, and personal assets. Be specific about the location, account numbers, balances, and values.
  7. Section 6 is dedicated to monthly living expenses. Detail your expenditures on food, clothing, housing, utilities, transportation, insurance, taxes, and other regular expenses.
  8. Section 7 and 8 require details about any business assets and monthly business expenses if you own a business.
  9. Review the form carefully to ensure all the information provided is accurate and complete. Inaccuracies may lead to delays or complications with the IRS.
  10. Sign and date the form. Your signature certifies that the information provided is truthful and accurate to the best of your knowledge.
  11. Finally, submit the form to the IRS, using the submission instructions provided. It may be advisable to keep a copy for your records.

Once the IRS Form 433-A has been submitted, the IRS will review the information to understand your financial situation better. They may use this data to determine eligibility for payment plans or offer in compromise settlements. Expect communication from the IRS regarding the next steps, which may include requests for additional information or clarification. Remember, prompt and truthful responses will facilitate the process of finding a manageable resolution to your tax situation.

Learn More on IRS 433-A

What is Form 433-A and who needs to fill it out?

Form 433-A, known as the Collection Information Statement for Wage Earners and Self-Employed Individuals, is a detailed form used by the IRS to gather financial information. This form is necessary for individuals who owe federal taxes and are seeking to set up a payment plan or settle their tax debt for less than the full amount owed. Specifically, it's used by:

  • Individual wage earners,
  • Self-employed individuals,
  • Those who are involved in a sole proprietorship business.
The form helps the IRS to understand the taxpayer's financial situation better and decide on the most suitable payment arrangement.

What information do I need to provide on Form 433-A?

Form 433-A requires comprehensive information about your financial situation. The main categories of information you need to provide include:

  1. Personal information, such as your full name, social security number, and contact details.
  2. Employment details for both you and, if applicable, your spouse.
  3. Information about all forms of income, including wages, self-employment income, and any other sources.
  4. Detailed information on your living expenses, such as housing, utilities, food, transportation, and healthcare.
  5. Information on your assets, including bank accounts, investments, property, and vehicles.
  6. Details on any liabilities and debts, including credit cards, loans, and other outstanding debts.
This information allows the IRS to accurately assess your ability to pay your tax debt.

How does the IRS use the information provided in Form 433-A?

The IRS uses the information you provide on Form 433-A to evaluate your financial situation and determine your ability to pay the tax debt. The analysis includes:

  • Calculating your monthly disposable income by subtracting your total monthly living expenses from your total monthly income. This helps the IRS to establish how much you can afford to pay each month towards your tax debt.
  • Reviewing your asset information to understand if you have any non-essential assets that could be liquidated to pay down the debt.
  • Developing a comprehensive picture of your financial status to decide if you qualify for an installment agreement, an offer in compromise, or other payment arrangements that would allow you to settle your tax debt over time or for less than the full amount owed.
The goal is to find a realistic and sustainable solution for both you and the IRS.

What happens if I don't fill out Form 433-A or if I provide incomplete information?

Failing to fill out Form 433-A, or submitting it with incomplete or inaccurate information, can have serious consequences. These include:

  • The IRS may not be able to process your request for a payment agreement or offer in compromise, leaving your full tax debt due immediately.
  • Penalties and interest will continue to accrue on your unpaid tax balance.
  • The IRS may take enforcement actions, such as filing a federal tax lien against your property or initiating a levy on your wages and bank accounts.
To avoid these outcomes, it’s crucial to provide complete and accurate information on Form 433-A. If you're unsure about how to fill out the form or need assistance, consider consulting a tax professional or an attorney who specializes in tax law.

Common mistakes

Filling out the IRS 433-A form, a document necessary for individuals to provide their financial information to the Internal Revenue Service (IRS), is a task that demands meticulous attention to detail. Unfortunately, mistakes can easily be made. These errors not only potentially delay the resolution of a taxpayer’s case but also increase the risk of an unfavorable outcome. Here are six common mistakes individuals make when completing this form:

  1. Omitting or Providing Incomplete Information: One of the fundamental mistakes is the failure to provide all necessary details or leaving sections blank. This form is designed to give the IRS a full picture of an individual's financial situation. Any gaps can lead to incorrect assessments or extended processing times.

  2. Underreporting Income: Intentionally or unintentionally reporting less income than actually earned is a serious error. This not only skews the financial analysis but also flags the submission for potential audit and penalties due to misrepresentation.

  3. Overestimating Expenses: While it might seem beneficial in the short term to overstate expenses in hopes of reducing apparent financial capacity, such actions can lead to complications. Verifiability of information is crucial, and discrepancies can attract unfavorable attention from the IRS.

  4. Misclassifying Assets and Liabilities: Incorrectly defining what constitutes an asset or a liability can significantly affect the outcome. It's vital to accurately categorize property and debts to ensure an accurate determination of one's financial standing.

  5. Not Attaching Required Documentation: The IRS often requires documentation to support the figures reported on the form. Failing to attach these documents, such as pay stubs, bank statements, and bills, can stall the process.

  6. Ignoring Tax Debt Information: Lastly, overlooking the inclusion of precise tax debt details can be detrimental. This information aids the IRS in understanding the full scope of one’s financial obligations and is pivotal in negotiating terms that might include installment plans or offers in compromise.

To navigate the complex process of submitting IRS forms accurately, individuals may find it beneficial to seek guidance from a professional. This approach ensures not only that all relevant information is correctly presented but also significantly reduces the likelihood of errors that could complicate one’s financial dealings with the IRS.

Documents used along the form

The IRS Form 433-A is a crucial document for individuals looking to set up a payment plan or negotiate other terms for their tax liability based on their financial situation. However, navigating through the tax resolution process often entails more than just this one form. To get a comprehensive understanding and successfully navigate through this process, several other forms and documents are typically utilized alongside Form 433-A. Knowing what these documents are and their purpose can greatly streamline the process.

  • IRS Form 1040: This is the standard federal income tax form people use to report their income to the IRS, claim deductions, and calculate the amount of tax they owe or the refund they are due. It serves as a foundational document that provides the IRS with a snapshot of the taxpayer's financial situation for the year.
  • IRS Form 9465: Individuals who cannot immediately pay the tax they owe may use Form 9465 to request a monthly installment plan. This form is often submitted in conjunction with Form 433-A when the taxpayer’s debt is substantial, and they need to demonstrate their financial situation to negotiate the terms of their installment agreement.
  • Proof of Income: This can include recent pay stubs, business income statements, or any other documents that verify the income amount listed on Form 433-A. Proof of income helps the IRS assess the taxpayer's ability to pay their tax liability.
  • Bank Statements: Recent bank statements are often required to provide a clearer picture of the taxpayer's financial health. These statements can showcase monthly income deposits and expenses, helping the IRS understand the taxpayer’s financial commitments.
  • Proof of Expenses: Receipts, bills, or other documentation for expenses claimed on Form 433-A. These documents are vital for verifying the necessary living expenses the taxpayer has, allowing the IRS to gauge the reasonable amount the taxpayer can afford to pay toward their tax debt each month.

Collectively, these documents and forms paint a detailed picture of the taxpayer's financial situation for the IRS. They play a pivotal role in establishing a fair and manageable resolution to outstanding tax liabilities. Familiarizing oneself with these documents and understanding their significance in the context of the IRS Form 433-A can make the tax resolution process more navigable and less daunting for taxpayers facing financial hardship.

Similar forms

  • IRS 433-B:

    This form is designed for businesses, as opposed to IRS 433-A, which is meant for individual taxpayers. Both forms serve a similar purpose: they are used to collect financial information from the taxpayer to help the IRS determine how the individual can settle their outstanding tax debts. The structure of the questions and the type of financial details requested are comparable, tailored to the entity—business or individual—providing the information.

  • IRS Form 1040:

    IRS Form 1040 and IRS 433-A may seem different at first glance—one is a tax return, and the other is a collection information statement. However, both require detailed financial information from the taxpayer. Form 1040 focuses on income, deductions, and credits to calculate taxes owed or refunds due for a specific tax year, while IRS 433-A assesses the taxpayer's ability to pay back taxes. The similarity lies in the necessity for thorough financial disclosure.

  • IRS Form 9465:

    This form is used to request an installment agreement for paying back taxes. While IRS 433-A collects comprehensive financial information to evaluate a taxpayer's ability to pay, Form 9465 is the formal request to make payments over time. They are similar in that they both play pivotal roles in the process of resolving unpaid taxes, often being used together to negotiate payment terms with the IRS.

  • IRS Form 656:

    IRS Form 656 pertains to an Offer in Compromise, allowing taxpayers to settle their tax debt for less than the full amount they owe. Like the IRS 433-A, it's part of the negotiation process with the IRS for taxpayers seeking relief from financial burdens. Financial disclosure is critical in both documents, though IRS 433-A is broader in scope, while Form 656 is specifically for proposing a compromise settlement.

  • Financial Statement (Personal):

    Although not an IRS form, personal financial statements serve a similar purpose to IRS 433-A in that they provide a comprehensive overview of an individual's financial status, including assets, liabilities, income, and expenses. The IRS 433-A can be considered a specialized form of a personal financial statement, tailored for the specific context of resolving tax debt.

  • Bankruptcy Schedules:

    When filing for bankruptcy, debtors must complete schedules that detail their financial situation, akin to the information requested on IRS 433-A. These schedules are necessary for the court to understand the debtor's ability to pay creditors. Similarly, IRS 433-A is used by the IRS to assess a taxpayer's financial ability to settle outstanding tax obligations.

  • Application for Mortgage:

    Mortgage applications require detailed financial information from the applicant to determine their eligibility for a loan, much like the IRS 433-A is used to evaluate a person's financial capability to settle tax debts. Though serving different purposes—one for securing a loan and the other for resolving tax liabilities—both demand thorough financial disclosure from the individual.

Dos and Don'ts

Filling out the IRS 433-A form, which is used to collect financial information necessary for tax resolution options, requires accuracy and honesty. Below are key dos and don'ts to help guide you through the process.

  • Do gather all necessary documentation before starting the form. This includes recent statements for all bank accounts, income sources, living expenses, and debts.
  • Do review the instructions for each section carefully. Understanding the requirements can help prevent mistakes.
  • Do provide accurate information about your financial situation. The IRS uses this form to assess your ability to pay taxes owed, so honesty is crucial.
  • Do double-check your math. Errors in calculation can lead to inaccuracies in the assessment of your financial situation.
  • Do consider consulting with a tax professional. They can provide guidance and ensure that the form is completed correctly.
  • Don't leave any sections blank. If a section does not apply to you, write “N/A” to indicate this. Omitting information can result in processing delays.
  • Don't underreport income or overstate expenses. This can be considered fraudulent and lead to penalties or legal action.

Misconceptions

Many people have misconceptions about the IRS Form 433-A, which can lead to confusion and mistakes when trying to resolve tax debts. Here are four common misunderstandings and the facts to set them straight:

  • Only businesses need to file IRS Form 433-A. This is not the case. While businesses might use a similar form, Form 433-B, the IRS Form 433-A is designed for individual taxpayers. It is used to collect financial information from individuals to determine their ability to pay a tax debt.

  • Filling out Form 433-A will automatically reduce your tax debt. Unfortunately, this is a misconception. Completing and submitting Form 433-A provides the IRS with your financial information so they can assess your payment capability. It is the basis for negotiating payment terms or an offer in compromise, but it does not guarantee debt reduction.

  • You only need to include your income information. Form 433-A requires much more than just income information. Taxpayers must also provide detailed data about their expenses, assets, and liabilities. This comprehensive financial profile helps the IRS understand your financial situation fully.

  • Submitting Form 433-A means the IRS will immediately seize your assets. This is a worry for many, but it’s not accurate. While the IRS does ask for detailed asset information on Form 433-A, its primary goal is to work with taxpayers to find reasonable payment solutions. Asset seizure is a last resort, not a first step, after you submit Form 433-A.

Key takeaways

The IRS 433-A form, officially named the Collection Information Statement for Wage Earners and Self-Employed Individuals, is a detailed form used by the IRS to gather financial information from individuals to determine their ability to pay outstanding taxes. Here are ten key takeaways regarding filling out and using the 433-A form:

  1. Ensure accuracy: All information provided on the form must be accurate and complete. Inaccuracies can lead to further investigation or complications with the IRS.
  2. Document income sources: You need to document all sources of income, including wages, self-employment income, and any other sources, to give the IRS a clear picture of your financial situation.
  3. List all assets: Assets such as bank accounts, real estate, vehicles, and life insurance with cash value should be thoroughly documented.
  4. Outline living expenses: Accurately record monthly living expenses including rent or mortgage, utilities, food, transportation, and health care.
  5. Debt and payment obligations: Include all monthly payment obligations, such as credit card payments, loan payments, and any other debts.
  6. Business owners: If you are self-employed or own a business, additional information regarding the business’s financial condition will be required, such as accounts receivable, business bank accounts, and assets.
  7. Proof of compliance: Ensure you are current with all tax filing obligations before submitting the form, as the IRS requires compliance for consideration of any payment plans or settlements.
  8. Use official instructions: Refer to the official IRS instructions for the 433-A form to guide you through each section and ensure all required information is provided.
  9. Consider professional help: Given the complexity of the form and the potential consequences of errors, consider consulting with a tax professional or attorney to assist in completing the form accurately.
  10. Follow-up and updates: After submission, be prepared to provide additional information if the IRS requests it and to update the IRS on any significant changes to your financial situation.

Completing the IRS 433-A form accurately is crucial for individuals working to resolve tax debts. It provides the IRS with the necessary information to make informed decisions regarding payment plans or other tax relief options. Taking the process seriously and seeking professional advice if needed can help to navigate this step more effectively.

Please rate IRS 433-A Template Form
5
(Exceptional)
2 Votes

Create More Documents