Free IRS 433-A Form in PDF

Free IRS 433-A Form in PDF

The IRS 433-A form is an essential document for individuals seeking to set up a payment plan or negotiate an offer in compromise with the IRS. It provides a detailed account of one's financial situation, allowing the IRS to make informed decisions on repayment strategies. To securely navigate through the process of filling out this form, click the button below.

Get Form

Facing financial difficulties can be challenging, especially when it comes to settling debts with the Internal Revenue Service (IRS). During such times, the IRS 433-A form becomes a critical document for individuals. This comprehensive form is designed to provide the IRS with a detailed picture of a taxpayer's financial situation, allowing for the arrangement of a manageable payment plan or an offer in compromise. By meticulously detailing income, expenses, assets, and liabilities, individuals demonstrate their financial condition, paving the way for negotiations regarding tax debt resolution. Understanding and accurately completing this form is paramount. It's not just about filling in the blanks; it's about presenting one's financial reality in a way that can lead to a feasible agreement, alleviating the burden of overwhelming tax debts. The process, while it might seem daunting at first, is an essential step towards regaining financial stability and peace of mind.

Preview - IRS 433-A Form

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)

Document Specs

Fact Name Description
Purpose of IRS 433-A Form This form is used by individuals to provide the Internal Revenue Service (IRS) with detailed information about their financial situation. It helps in setting up payment plans or settling tax liabilities in other ways.
Required Respondents Individuals who are unable to pay their taxes in full and are seeking any form of tax relief or payment plan with the IRS are required to complete this form.
Components of the Form The form collects comprehensive information about the filer’s income, expenses, assets, and liabilities to assess their ability to pay.
Governing Regulations Although the form is federally mandated, its acceptance and scrutiny fall under the purview of the IRS, guided by the Internal Revenue Code (IRC) and relevant IRS regulations and guidelines.

Instructions on Writing IRS 433-A

Filling out IRS Form 433-A is a crucial step for individuals who need to set up a payment plan or settle a debt with the IRS based on their current financial situation. This form collects detailed information about one's earnings, assets, and monthly living expenses to determine how one can resolve their tax liabilities. Completing this form accurately is essential for ensuring a smooth process. Below are simplified steps to help guide you through the process of filling out the IRS 433-A form.

  1. Gather your financial documents, including recent pay stubs, bank statements, bills, and any documentation of assets and debts. This will prepare you for the detailed information the form requires.
  2. Begin with Section 1, where you'll provide personal information. This includes your name, Social Security Number, address, and employment details. For those self-employed, additional business-related information will be required.
  3. In Section 2, list all forms of your income, such as wages, business income, and any other sources. Accurate reporting is crucial here to provide a clear picture of your finances.
  4. Proceed to Section 3 to report your living expenses. Include rent or mortgage payments, food, clothing, utilities, and other monthly expenses. Make sure these figures are current and accurately reflect your monthly spending.
  5. Section 4 asks for information about your assets. This includes checking and savings accounts, investments, life insurance, and property owned, among others. Detailed and accurate reporting will help establish a thorough understanding of your financial situation.
  6. In Section 5, you will disclose all personal liabilities and debts, such as car loans, credit card debt, and other outstanding obligations. Providing a complete list is essential for an accurate assessment.
  7. Review the form thoroughly once you've entered all necessary information. This step cannot be overstated, as accuracy is critical to avoid delays or issues with your submission.
  8. After reviewing, sign and date the form. This step is crucial as it verifies the accuracy of the information provided and your understanding of the legal implications.
  9. Finally, submit the completed form to the IRS following their submission guidelines. It’s advisable to keep a copy of the form for your records.

Once the IRS receives your Form 433-A, they will review the provided information to determine your eligibility for payment plans or other tax relief options. The outcome will be communicated to you, which may include further instructions or requests for additional information. Remember, the key to a favorable resolution is providing complete and accurate information on the form.

Understanding IRS 433-A

What is a Form 433-A?

Form 433-A, also known as the Collection Information Statement for Wage Earners and Self-Employed Individuals, is a detailed document used by the IRS to gather financial information from individuals. This form assists the IRS in understanding an individual's financial situation to determine how they can fulfill their tax obligations, potentially through a payment plan or by qualifying for a compromise.

Who needs to fill out Form 433-A?

Individuals who are unable to pay their tax debt in full and are seeking an installment agreement or offer in compromise with the IRS are required to complete Form 433-A. This form is especially directed towards wage earners and self-employed individuals, providing the IRS with a comprehensive view of their financial standing.

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

Form 433-A requires a wide range of financial details, including but not limited to personal information, employment details, information about bank accounts and assets, ongoing monthly income and expenses, and information regarding any business owned by the individual.

How will the IRS use the information on Form 433-A?

The IRS utilizes the information provided on Form 433-A to evaluate your ability to pay your tax debt. By analyzing your income, expenses, and assets, the IRS can establish a suitable payment plan, or determine if you qualify for other tax relief options like an offer in compromise or currently not collectible status.

Is there a deadline for submitting Form 433-A?

Typically, Form 433-A should be submitted in response to a request from the IRS, often as part of negotiations for a payment plan or a tax relief proposal. The IRS will provide a specific deadline in such cases. Failing to meet this deadline might result in collection actions, so promptly attending to the request is crucial.

Can I fill out Form 433-A online?

While Form 433-A is available for download and can be filled out digitally for your records, the IRS currently does not offer an online submission process for this form. You must print and mail the completed form to the address provided by the IRS. Always verify the correct mailing address for your situation, as it can vary.

What happens after I submit Form 433-A?

After submitting Form 433-A, the IRS will review your financial information to determine your tax resolution eligibility. This process may involve further verification steps, including requests for additional documentation or clarification regarding the information provided on the form. It is essential to respond promptly to any IRS request to ensure the smooth processing of your case.

Can I seek help to complete Form 433-A?

Yes, completing Form 433-A can be complex and seeking assistance ensures accuracy and completeness. You can seek help from a tax professional familiar with IRS procedures and forms. Their expertise can provide invaluable guidance through the process and potentially improve the outcome of your tax situation.

What should I do if my financial situation changes after submitting Form 433-A?

If your financial situation changes significantly after you have submitted Form 433-A, it's important to inform the IRS as soon as possible. Such changes might affect your payment plan or eligibility for tax relief programs. Keeping the IRS informed helps manage your tax obligations effectively and may prevent future complications.

Common mistakes

Filling out the IRS Form 433-A, which is required to set up payment plans or settle tax debts, can be daunting. One common mistake is not including all sources of income. This oversight can lead to the IRS questioning the accuracy of the form, potentially resulting in a rejected agreement. It's crucial to list all income sources, including wages, self-employment income, dividends, and any other earnings, to provide a clear financial picture.

Another error often made is underestimating or forgetting to list monthly expenses. The IRS uses national and local standards to determine reasonable living expenses. If expenses are significantly underreported, it may appear that there's more disposable income available for debt payment than there actually is. Conversely, overestimating expenses without proper documentation can also cause issues. It's key to accurately report monthly living expenses, with evidence to back up the figures provided.

A frequent oversight involves misunderstanding asset valuation. When listing assets such as vehicles or real estate, the market value should be given, not the purchase price or the amount owed. This mistake can lead to incorrect assessment of an individual's ability to pay. It's important to research current market values to ensure the form reflects an accurate financial situation.

Many also fail to include information on all debts and liabilities, which can present an incomplete financial status to the IRS. The form requires details about credit card debts, loans, and other obligations. Leaving out such information might result in the IRS questioning the credibility of the submitted information or deciding that the taxpayer has more funds available than they do.

Incorrectly calculating or not claiming allowable living expenses can affect one's monthly disposable income calculation. Taxpayers should ensure they thoroughly understand which expenses are considered allowable by the IRS to avoid this mistake.

Some individuals mistakenly believe they don’t need to provide details about business assets if they own a business. However, Form 433-A requires information about business assets, liabilities, income, and expenses for those who are self-employed or own a business. Omitting this information can lead to incomplete or inaccurate submissions.

Not updating the form with current information is another common pitfall. Financial situations can change, and the IRS needs the most current data to make a determination. Submitting outdated information can delay the process or lead to a decision based on no longer relevant information.

Lastly, not signing and dating the form is a simple but critical error. An unsigned or undated form is not valid and will be returned, causing delays in resolving tax issues. Double-checking that the form is properly signed and dated before submission can save time and frustration.

By avoiding these mistakes, individuals can ensure their Form 433-A accurately reflects their financial situation, leading to a smoother process in setting up payment plans or resolving tax debts with the IRS.

Documents used along the form

The IRS 433-A form, used for individuals to provide financial information necessary for setting up payment plans or determining tax resolution strategies, often requires additional documentation for complete assessment and verification by the IRS. These documents can range from personal identification to proof of financial status. Knowing which documents are commonly required in conjunction with the IRS 433-A form can help individuals prepare more effectively for the process of negotiating with the IRS.

  • Proof of Identity: Documentation such as a driver's license, passport, or other government-issued photo ID is essential to confirm the identity of the individual submitting the IRS 433-A form.
  • Pay Stubs: Recent pay stubs, generally for the last two months, are needed to verify current income. This helps the IRS understand the individual’s ability to pay.
  • Bank Statements: Bank statements from the last three months are typically required to provide a snapshot of the individual's financial situation, including savings, checking accounts, and investments.
  • Tax Returns: Copies of recent tax returns, usually for the last two years, aid the IRS in cross-referencing self-reported financial information with previously submitted data.
  • Proof of Expenses: Documentation of current expenses, such as bills for utilities, rent or mortgage payments, insurance premiums, and any other regular expenses, illustrates the person's cost of living and financial obligations.
  • Statements for All Debts: Statements concerning credit cards, loans, and other liabilities offer insight into the individual’s debt situation, contributing to a complete assessment of their financial capacity.
  • Asset Documentation: Documents relating to any significant assets owned, including real estate, vehicles, or valuable personal property, help establish the person's net worth and potential ability to satisfy tax liabilities.

While the IRS 433-A form is crucial for individuals looking to address tax debts or negotiate payment arrangements, it's only part of the documentation needed. Properly compiling and submitting these associated forms and documents can significantly impact the effectiveness and outcome of discussions with the IRS. Individuals should consider consulting a tax professional to ensure all necessary documentation is accurate and thoroughly prepared.

Similar forms

The IRS Form 433-F, Collection Information Statement, is similar to the IRS Form 433-A, as both forms are used by individuals to provide financial information to the IRS. This information is critical for determining how taxpayers can resolve outstanding tax liabilities. While the Form 433-A is typically used by self-employed individuals or sole proprietors, Form 433-F can be used by a broader range of taxpayers. Both forms assess the taxpayer's ability to pay by collecting detailed financial information, including income, expenses, and assets.

The IRS Form 9465, Installment Agreement Request, shares similarities with IRS Form 433-A because they are both used in the process of addressing unpaid taxes. Taxpayers who cannot pay their tax bill in full may use Form 9465 to request a monthly payment plan. However, the detailed financial information provided in Form 433-A may be required to support the installment agreement request, helping the IRS to determine the taxpayer's ability to make monthly payments.

The IRS Form 656, Offer in Compromise, is another document related to Form 433-A. This form is used by taxpayers who wish to settle their tax debt for less than the full amount owed. The financial information detailed in Form 433-A helps the IRS evaluate whether to accept an Offer in Compromise by providing a comprehensive picture of the taxpayer's financial situation, making it a critical component of the negotiation process.

IRS Form 1040, U.S. Individual Income Tax Return, while primarily a vehicle for yearly tax reporting, is connected to Form 433-A in the context of tax compliance and resolution strategies. Information from Form 1040 can provide a baseline for the financial data required on Form 433-A, especially regarding income. Additionally, discrepancies between these forms can raise questions about a taxpayer's financial situation, so accuracy and consistency are essential.

The Statement of Financial Condition for Individuals, not a specific IRS form but often equivalent to Form 433-A, is used in various financial settings, including loan applications and credit evaluations. Like Form 433-A, this statement requires detailed disclosure of an individual's financial status, including assets, liabilities, income, and expenses. Both serve to assess the individual's financial stability and ability to meet financial obligations, albeit for different purposes. While one is for tax resolution, the other may influence creditworthiness decisions.

Dos and Don'ts

Filling out the IRS Form 433-A, a detailed form that captures your financial situation for the Internal Revenue Service, requires careful attention to detail and thoroughness. Here are ten guidelines to ensure the process is both accurate and beneficial to your tax situation.

Do:
  • Provide Accurate Information: Make sure all the information you provide is accurate and truthful to the best of your knowledge. Misreporting, whether intentional or not, can lead to significant issues.

  • Review the Entire Form Before Starting: Understand each section to ensure you know what information is required, reducing the risk of missing something important.

  • Gather Necessary Documentation: Before filling it out, collect all relevant financial documents. These include bank statements, pay stubs, bills, and any other records that reflect your financial situation.

  • Use Additional Sheets If Necessary: If you run out of space in any section, attach additional sheets. Make sure to reference the form's section they relate to meticulously.

  • Sign and Date the Form: An unsigned form is invalid. Ensure you sign and date the form upon completion.

Don't:
  • Estimate Figures: Provide precise numbers rather than estimates. If exact figures aren't available, make a note explaining why and how you arrived at the provided estimate.

  • Leave Sections Blank: If a section does not apply to you, write “N/A” instead of leaving it blank. This indicates you didn’t overlook the section.

  • Ignore Instructions: Each section comes with specific instructions. Ignoring these can lead to errors that may affect your IRS evaluation.

  • Rush Through the Form: Take your time when completing the form to avoid errors. Review your responses thoroughly before submission.

  • Forget to Update Your Contact Information: Ensure your contact details are current. The IRS needs accurate information to contact you regarding your form.

Misconceptions

  • It's only for businesses: A common misconception is that the IRS 433-A form is exclusively for businesses. In reality, this form is designed for individuals to provide financial information to the IRS, typically when setting up a payment plan or an offer in compromise. Businesses use a different form, the 433-B.

  • Filling it out is quick and easy: Many people underestimate the complexity of the IRS 433-A form. It requires detailed financial information, including income, expenses, assets, and liabilities. Completing this form can be time-consuming and may require gathering substantial financial documentation.

  • Once submitted, negotiations are over: There's a belief that after you submit Form 433-A, the negotiation process with the IRS is essentially over. However, submitting this form is often just the beginning of a longer process of negotiation regarding your tax liabilities.

  • You don't need professional help: Although it's possible to complete and submit Form 433-A on your own, the complexity and significant impact of the information you provide can make professional guidance valuable. Tax professionals can help ensure accuracy and advocate on your behalf.

  • The IRS won't verify the information: Some people mistakenly believe that the IRS will take the information on Form 433-A at face value without verification. In fact, the IRS can and often does verify the information provided, which could include checking bank accounts, property records, and other financial data.

  • All assets need to be sold to pay the IRS: While Form 433-A does require disclosing all assets, this doesn't mean that all assets must be sold to satisfy tax debts. The IRS considers various factors and may not require liquidating all assets, especially if doing so would cause economic hardship.

  • It's only for those who can't pay their taxes in full: While it's commonly used by those who cannot pay their tax debt immediately, Form 433-A can also be a tool for negotiating other types of tax-related agreements, even if you could pay the full amount but seeking more favorable terms.

  • The completed form can be shared publicly: There is a dangerous misconception that sharing your completed IRS 433-A form can be done freely. This form contains sensitive financial information. Sharing it publicly could expose you to risk of identity theft or financial fraud. Always keep this and any other tax-related documents secure.

Key takeaways

The IRS 433-A form, officially known as the Collection Information Statement for Wage Earners and Self-Employed Individuals, is a critical document for those negotiating with the IRS over tax debts. Understanding how to effectively complete and utilize this form can significantly impact an individual's tax resolution process. Here are key takeaways to guide individuals through this process.

  • Accuracy is Paramount: The IRS uses the 433-A form to assess an individual's ability to pay back taxes. It is crucial that all the information provided is accurate and complete. Misrepresenting financial information can lead to penalties, further investigations, or a denial of the payment plan request.
  • Document Support is Essential: When filling out the 433-A form, supporting documents should always back the provided information. This can include bank statements, pay stubs, bills, and other financial statements. These documents help substantiate the figures entered on the form, making the case more compelling to the IRS.
  • Determine Reasonable Collection Potential (RCP): The form plays a vital role in determining the Reasonable Collection Potential, which is the amount the IRS deems an individual can pay towards their tax debt. Understanding how to accurately calculate expenses and income can affect this determination, potentially leading to more favorable payment terms.
  • Professional Advice Can Be Beneficial: Given the complexities involved in filling out the form and negotiating with the IRS, seeking advice from a tax professional or a tax resolution specialist can be invaluable. They can provide insights on how to properly complete the form, advise on negotiation strategies, and help secure manageable payment plans.

Effectively dealing with the IRS requires a thorough understanding of the forms and processes involved. The IRS 433-A form is a key element in these interactions, and approaching it with diligence and honesty can lead to a more favorable outcome in resolving tax issues.

Please rate Free IRS 433-A Form in PDF Form
5
(Exceptional)
2 Votes

Additional PDF Templates