The IRS 433-A form is a financial disclosure form used by individuals to provide the Internal Revenue Service with detailed information about their income, expenses, and assets. This form is essential for those seeking to negotiate a payment plan or settle tax debts. To get started on filling out the form, click the button below.
The IRS 433-A form plays a crucial role in the process of resolving tax debts with the Internal Revenue Service. This form is primarily used by individuals who owe back taxes and are seeking to establish a payment plan or settle their tax liabilities through an Offer in Compromise. It requires detailed financial information, including income, expenses, assets, and liabilities, allowing the IRS to assess an individual’s ability to pay. Completing the form accurately is essential, as it provides the IRS with a comprehensive view of one’s financial situation. The form also includes sections for disclosing employment information and other relevant data that may influence the resolution of tax debts. Understanding the requirements and implications of the IRS 433-A is vital for taxpayers navigating the complexities of tax resolution options.
Form 433-A
Collection Information Statement for Wage
(July 2022)
Earners and Self-Employed Individuals
Department of the Treasury
Internal Revenue Service
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.
Section 1: Personal Information
1a
Full Name of Taxpayer and Spouse (if applicable)
2c
Provide information on all other persons in household or claimed as
dependents
1b
Address (street, city, state, ZIP code and country)
Name
Age
Relationship
3a
Do you or your spouse have any outside business interests? Include
any interest in an LLC, LLP, corporation, partnership, etc.
1c
County of Residence
1d
Home Phone
Yes (percentage of ownership
%)
No
(
)
Title
1e
Cell Phone
1f
Work Phone
3b
Business name
2a
Marital Status:
Married
Unmarried (Single, Divorced, Widowed)
3c
Type of business (select one)
2b
SSN or ITIN
Date of Birth (mmddyyyy)
Partnership
LLC
Corporation
Taxpayer
Other
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.
4a
Taxpayer's Employer Name
5a
Spouse's Employer Name
4b
5b
4c
Work Telephone Number
4d
Does employer allow contact at work
5c
5d Does employer allow contact at work
Yes
4e
How long with this employer
4f
Occupation
5e
5f Occupation
(years)
(months)
4g
Number claimed as a dependent
4h
Pay Period:
5g
5h Pay Period:
on your Form 1040
Weekly
Bi-weekly
Monthly
Section 3: Other Financial Information (Attach copies of applicable documentation)
6
Are you a party to a lawsuit (If yes, answer the following)
Location of Filing
Represented by
Docket/Case No.
Plaintiff
Defendant
Amount of Suit
Possible Completion Date (mmddyyyy)
Subject of Suit
$
7
Have you ever filed bankruptcy (If yes, answer the following)
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)
Dates lived abroad: from (mmddyyyy)
To (mmddyyyy)
9a Are you the beneficiary of a trust, estate, or life insurance policy including those located in foreign countries or jurisdictions (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
Name of the trust:
10
Do you have a safe deposit box (business or personal) including those located in foreign countries or jurisdictions
(If yes, answer the following)
Location (Name, address and box number(s))
Contents
Value
11
In the past 10 years, have you transferred any assets with a fair market value of more than $10,000 including real
property, for less than their full value (if yes, answer the following)
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. 7-2022)
Page 2
Section 4: Personal Asset Information for all Individuals (Foreign and Domestic). Include assets located in foreign countries or jurisdictions and add attachment(s) if additional space is needed to respond
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.).
Full Name & Address (Street, City, State, ZIP code and
Account Balance
Type of Account
Country) of Bank, Savings & Loan, Credit Union, or
Account Number
As of
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.
Type of Investment
Full Name & Address
Loan Balance (if applicable)
Equity
Current Value
or Financial Interest
(Street, City, State, ZIP code and Country) of Company
Value minus Loan
14a
Phone
14b
DIGITAL ASSETS List all digital assets such as virtual currency (cryptocurrency), non-fungible token (NFT), and smart contracts 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.
14c List the name(s) of individuals who have access to the private key(s) and/or digital wallets
Name of Digital Asset such as
Email Address Used to Set-up
Digital Asset Amount
Location(s) of Digital Assets
and Value in US
Type of Digital Asset
Virtual Currency Wallet, Exchange
With the Digital Assets such as
(Mobile Wallet, Online, and/or
dollars as of today
or Digital Currency Exchange
Virtual Currency Exchange or
External Hardware storage)
(e.g., 1 Bitcoins
(DCE)
DCE
$38,000.00 USD)
14d
14e
14f Total Equity (Add lines 14a, 14b, 14d and 14e. Also include any amounts from any attachments to your total equity)
AVAILABLE CREDIT Include all lines of credit and bank issued credit cards.
Amount Owed
Available Credit
Credit Limit
(Street, City, State, ZIP code and Country) of Credit Institution
15a
Acct. No
15b
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
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)
Page 3
Section 4: Personal Asset Information for all Individuals (Foreign and Domestic) (Continued)
REAL PROPERTY Include all real property owned or being purchased
Purchase Date
Current Fair
Current Loan
Amount of
Date of Final
Market Value
Payment
(mmddyyyy)
Balance
Monthly Payment
FMV Minus Loan
(FMV)
17a
Property Description
Location (street, city, state, ZIP code, county and country)
Lender/Contract Holder Name, Address (street, city, state, ZIP code), and Phone
17b
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/
Lease Date
Tag Number, Vehicle Identification Number)
18a Year
Make/Model
Mileage
License/Tag Number
Lender/Lessor Name, Address (street, city, state, ZIP code and country), and Phone
Vehicle Identification Number
18b Year
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.
19a Property Description
Lender/Lessor Name, Address (street, city, state, ZIP code), and Phone
19b Property Description
19c Total Equity (Add lines 19a, 19b and amounts from any attachments)
Page 4
If you are self-employed, sections 6 and 7 must be completed before continuing.
Section 5: Monthly Income and Expenses (Foreign and Domestic)
Monthly Income/Expense Statement (For additional information, refer to Publication 1854.)
Total Income (Amounts reported in U.S. dollars)
Total Living Expenses (Amounts reported in U.S. dollars)
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 (e.g., YouTube, TikTok), etc. Recurring capital gains from the sale of securities including cryptocurrency and non-fungible tokens.
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)
Filling out the IRS 433-A form is an important step in addressing your tax situation. Completing this form accurately can help you communicate effectively with the IRS regarding your financial status. Follow these steps carefully to ensure that you provide all necessary information.
After completing the form, make sure to keep a copy for your records. You will need to submit it to the IRS as part of your request for assistance. Double-check that you have included all required information to avoid any delays in processing your request.
The IRS 433-A form is a financial disclosure form that individuals use to provide the IRS with detailed information about their financial situation. This form is typically required when a taxpayer is seeking to establish an installment agreement, request an offer in compromise, or apply for currently not collectible status. By completing this form, taxpayers can help the IRS understand their ability to pay tax debts.
Individuals who owe taxes and are looking for relief options may need to complete the IRS 433-A form. This includes those applying for an installment agreement, an offer in compromise, or those who believe they cannot pay their tax debts due to financial hardship. It is crucial to provide accurate and complete information to avoid delays in processing your request.
The form requires detailed information about your income, expenses, assets, and liabilities. You will need to provide:
Providing complete and accurate information is essential for the IRS to assess your financial situation effectively.
You can submit the IRS 433-A form by mailing it directly to the appropriate IRS office. Be sure to check the specific address based on your location and the type of request you are making. Alternatively, if you are working with a tax professional, they may submit it on your behalf. Always keep a copy for your records.
Once the IRS receives your completed form, they will review the information provided. This review process may take some time, depending on the volume of requests they are handling. The IRS may reach out for additional information or clarification if needed. After their review, they will communicate their decision regarding your request for an installment agreement, offer in compromise, or currently not collectible status.
Filling out the IRS 433-A form can be a daunting task. Many people make common mistakes that can lead to delays or issues with their tax situation. One frequent error is failing to provide complete information. Incomplete forms can result in the IRS needing to request additional details, which can prolong the process.
Another mistake is underestimating income. Some individuals might not report all sources of income, whether it's from side jobs, investments, or rental properties. This can create discrepancies that the IRS will notice, potentially leading to penalties.
People often overlook their expenses as well. When filling out the form, it’s important to accurately list all monthly expenses. Underreporting these can give a misleading picture of financial capability, which can affect negotiations with the IRS.
Additionally, failing to sign and date the form is a simple but critical mistake. An unsigned form is considered incomplete, and the IRS will not process it until it is properly signed.
Another common error is not providing supporting documentation. The IRS may require proof of income or expenses. Without these documents, the form may be rejected or questioned.
Some individuals also miscalculate their financial information. Double-checking figures is essential. Errors in math can lead to incorrect assessments of ability to pay, which can complicate negotiations.
People sometimes forget to update their information. If there have been recent changes in income or expenses, it’s crucial to reflect those accurately on the form. Outdated information can mislead the IRS.
Ignoring the importance of clarity can also be a pitfall. Writing clearly and legibly is vital. Illegible handwriting can lead to misunderstandings and delays.
Finally, many overlook the deadlines for submission. Submitting the form late can lead to additional penalties or complications in resolving tax issues. It’s essential to be aware of and adhere to all timelines.
By avoiding these common mistakes, individuals can improve their chances of a smoother process with the IRS when filling out the 433-A form.
The IRS 433-A form is a critical document used for financial disclosure when negotiating tax liabilities with the Internal Revenue Service. To provide a complete financial picture, several other forms and documents are often required. Below is a list of these documents, along with a brief description of each.
Gathering these documents along with the IRS 433-A form is essential for a thorough financial assessment. Each document plays a role in ensuring that the IRS has a complete understanding of the taxpayer's financial situation, which can facilitate negotiations and resolutions.
The IRS 433-A form is used for collecting financial information from individuals or businesses to determine their ability to pay taxes. Several other documents serve similar purposes in different contexts. Here are seven documents that are comparable to the IRS 433-A form:
When completing the IRS 433-A form, it is essential to approach the task with care. This form is crucial for individuals seeking to resolve tax issues with the Internal Revenue Service. Below is a list of things you should and shouldn’t do when filling out this form.
The IRS 433-A form is often misunderstood, leading to confusion among taxpayers. Here are seven common misconceptions about this form, along with clarifications to help you better understand its purpose and use.
Understanding these misconceptions can help you navigate the complexities of tax negotiations more effectively. Always consider consulting with a tax professional for personalized advice and assistance.
The IRS 433-A form is an essential document for individuals seeking to resolve tax debts with the Internal Revenue Service. Understanding how to accurately fill out and utilize this form can significantly impact your financial situation. Here are some key takeaways to consider:
Filling out the IRS 433-A form is a significant step towards resolving tax issues. Taking the time to understand its requirements can lead to a more favorable outcome.