The IRS 433-F form is a financial statement used by individuals to provide the IRS with information about their income, assets, and expenses. Completing this form is an important step in negotiating payment arrangements or settling tax debts. Ready to take control of your tax situation? Fill out the form by clicking the button below.
The IRS 433-F form is an important tool for taxpayers dealing with financial hardship or seeking relief from tax liabilities. Designed for individuals and businesses, this form serves as a financial statement that provides the Internal Revenue Service with a comprehensive view of your income, expenses, and assets. It enables the IRS to evaluate your ability to pay taxes owed or to determine eligibility for payment plans. Completing this form requires careful consideration of your financial situation, including details such as monthly income, living expenses, and any outstanding debts. Additionally, the 433-F is not just a simple questionnaire; it plays a critical role in negotiations with the IRS, particularly if you are attempting to settle your tax debt for less than you owe or establish an installment agreement. By accurately filling out this form, you can improve your communication with the IRS and potentially ease the financial burden on your shoulders.
Form 433-F
(February 2019)
Department of the Treasury - Internal Revenue Service
Collection Information Statement
Name(s) and Address
Your Social Security Number or Individual Taxpayer Identification Number
Your Spouse’s Social Security Number or Individual Taxpayer Identification Number
If address provided above is different than last return filed,
Your telephone numbers
Spouse’s telephone numbers
please check here
Home:
County of Residence
Work:
Cell:
Enter the number of people in the household who can be claimed on this year’s tax return including you and your spouse. Under 65
65 and Over
If you or your spouse are self employed or have self employment income, provide the following information:
Name of Business
Business EIN
Type of Business
Number of Employees (not counting owner)
A. ACCOUNTS / LINES OF CREDIT
PERSONAL BANK ACCOUNTS Include checking, online, mobile (e.g., PayPal), savings accounts, money market accounts. (Use additional sheets if necessary.)
Name and Address of Institution
Account Number
Type of Account
Current
Balance/Value
Check if
Business Account
INVESTMENTS Include Certificates of Deposit, Trusts, Individual Retirement Accounts (IRAs), Keogh Plans, Simplified Employee Pensions, 401(k) Plans, Profit Sharing Plans, Mutual Funds, Stocks, Bonds, Commodities (Silver, Gold, etc.), and other investments. If applicable, include business accounts. (Use additional sheets if necessary.)
VIRTUAL CURRENCY (CRYPTOCURRENCY) List all virtual currency you own or in which you have a financial interest (e.g., Bitcoin, Ethereum, Litecoin, Ripple, etc.). (Use additional sheets if necessary.)
Type of Virtual Currency
Name of Virtual Currency Wallet,
Exchange or Digital Currency
Exchange (DCE)
Email Address Used to Set-up
With the Virtual Currency
Exchange or DCE
Location(s) of Virtual Currency (Mobile Wallet, Online, and/or External Hardware storage)
Virtual Currency
Amount and Value in US dollars as of today (e.g., 10 Bitcoins $64,600 USD)
B. REAL ESTATE Include home, vacation property, timeshares, vacant land and other real estate. (Use additional sheets if necessary.)
Description/Location/County
Monthly Payment(s)
Financing
Current Value
Balance Owed
Equity
Year Purchased
Purchase Price
Primary Residence
Other
Year Refinanced
Refinance Amount
C. OTHER ASSETS Include cars, boats, recreational vehicles, whole life policies, etc. Include make, model and year of vehicles and name of Life Insurance company in Description. If applicable, include business assets such as tools, equipment, inventory, etc. (Use additional sheets if necessary.)
Description
Monthly Payment Year Purchased Final Payment (mo/yr) Current Value
/
D. CREDIT CARDS (Visa, MasterCard, American Express, Department Stores, etc.)
Type
Credit Limit
Minimum Monthly Payment
TURN PAGE TO CONTINUE
Catalog Number 62053J
www.irs.gov
Form 433-F (Rev. 2-2019)
Page 2 of 4
E. BUSINESS INFORMATION Complete E1 for Accounts Receivable owed to you or your business. (Use additional sheets if necessary.) Complete E2 if you or your business accepts credit card payments. Include virtual currency wallet, exchange or digital currency exchange.
E1. Accounts Receivable owed to you or your business
Name
Address
Amount Owed
List total amount owed from additional sheets
Total amount of accounts receivable available to pay to IRS now
E2. Name of individual or business on account
Credit Card
(Visa, Master Card, etc.)
Issuing Bank Name and Address
Merchant Account Number
F. EMPLOYMENT INFORMATION If you have more than one employer, include the information on another sheet of paper. (If attaching a copy of current pay stub, you do not need to complete this section.)
Your current Employer (name and address)
How often are you paid (check one)
Weekly
Biweekly
Semi-monthly
Monthly
Gross per pay period
Taxes per pay period (Fed)
(State)
(Local)
How long at current employer
Spouse’s current Employer (name and address)
G. NON-WAGE HOUSEHOLD INCOME List monthly amounts. For Self-Employment and Rental Income, list the monthly amount received after expenses or taxes and attach a copy of your current year profit and loss statement.
Alimony Income
Child Support Income
Net Self Employment Income
Net Rental Income
Unemployment Income
Pension Income
Interest/Dividends Income
Social Security Income
Other:
H. MONTHLY NECESSARY LIVING EXPENSES List monthly amounts. (For expenses paid other than monthly, see instructions.)
1. Food / Personal Care See instructions. If you do not spend more than
4. Medical
Actual Monthly
IRS Allowed
the standard allowable amount for your family size, fill in the Total amount
Health Insurance
Expenses
only.
Out of Pocket Health Care
Food
Total
Housekeeping Supplies
Clothing and Clothing Services
5. Other
Personal Care Products & Services
Miscellaneous
Child / Dependent Care
Estimated Tax Payments
2. Transportation
Term Life Insurance
Retirement (Employer Required)
Gas / Insurance / Licenses /
Retirement (Voluntary)
Parking / Maintenance etc.
Union Dues
Public Transportation
Delinquent State & Local Taxes
(minimum payment)
3. Housing & Utilities
Student Loans (minimum
payment)
Rent
Court Ordered Child Support
Electric, Oil/Gas, Water/Trash
Court Ordered Alimony
Telephone/Cell/Cable/Internet
Other Court Ordered Payments
Real Estate Taxes and Insurance
Other (specify)
(if not included in B above)
Maintenance and Repairs
Under penalty of perjury, I declare to the best of my knowledge and belief this statement of assets, liabilities and other information is true, correct and complete.
Your signature
Spouse’s signature
Date
Page 3 of 4
Instructions for Form 433-F, Collection Information Statement
What is the purpose of Form 433F?
Form 433-F is used to obtain current financial information necessary for determining how a wage earner or self-employed individual can satisfy an outstanding tax liability.
Note: You may be able to establish an Online Payment Agreement on the IRS web site. To apply online, go to https://www.irs.gov, click on “I need to pay my taxes,” and select “Installment Agreement” under the heading “What if I can't pay now?”
If you are requesting an Installment Agreement, you should submit Form 9465, Installment Agreement Request, along with Form 433-F. (A large down payment may streamline the installment agreement process, pay your balance faster and reduce the amount of penalties and interest.
Please retain a copy of your completed form and supporting documentation. After we review your completed form, we may contact you for additional information. For example, we may ask you to send supporting documentation of your current income or substantiation of your stated expenditures.
If any section on this form is too small for the information you need to supply, please use a separate sheet.
Section A – Accounts / Lines of Credit
List all accounts, even if they currently have no balance. However, do not enter bank loans in this section. Include business accounts, if applicable. If you are entering information for a stock or bond, etc. and a question does not apply, enter N/A.
Section B – Real Estate
List all real estate you own or are purchasing including your home. Include insurance and taxes if they are included in your monthly payment. The county/description is needed if different than the address and county you listed above. To determine equity, subtract the amount owed for each piece of real estate from its current market value.
Section C – Other Assets
List all cars, boats and recreational vehicles with their make, model and year. If a vehicle is leased, write “lease” in the “year purchased” column. List whole life insurance policies with the name of the insurance company. List other assets with a description such as “paintings”, “coin collection”, or “antiques”. If applicable, include business assets, such as tools, equipment, inventory, and intangible assets such as domain names, patents, copyrights, etc. To determine equity, subtract the amount owed from its current market value. If you are entering information for an asset and a question does not apply, enter N/A.
Section D – Credit Cards
List all credit cards and lines of credit, even if there is no balance owed.
Section E – Business Information
Complete this section if you or your spouse are self-employed, or have self-employment income. This includes self-employment income from online sales.
E1: List all Accounts Receivable owed to you or your business. Include federal, state and local grants and contracts.
E2: Complete if you or your business accepts credit card payments (e.g., Visa, MasterCard, etc.) and/or virtual currency wallet, exchange or digital currency exchange.
Section F – Employment Information
Complete this section if you or your spouse are wage earners.
If attaching a copy of current pay stub, you do not need to complete this section.
Section G – Non-Wage Household Income
List all non-wage income received monthly.
Net Self-Employment Income is the amount you or your
spouse earns after you pay ordinary and necessary monthly business expenses. This figure should relate to the yearly net profit from Schedule C on your Form 1040 or your current year profit and loss statement. Please attach a copy of Schedule C or your current year profit and loss statement. If net income is a loss, enter “0”.
Net Rental Income is the amount you earn after you pay ordinary and necessary monthly rental expenses. This figure should relate to the amount reported on Schedule E of your Form 1040.
Do not include depreciation expenses. Depreciation is a non-cash expense. Only cash expenses are used to determine ability to pay).
If net rental income is a loss, enter “0”.
Other Income includes 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. It also includes agricultural subsidies, gambling income, oil credits, and rent subsidies. Enter total distributions from IRAs if not included under Pension Income.
Section H – Monthly Necessary Living Expenses
Enter monthly amounts for expenses. For any expenses not paid monthly, convert as follows:
If a bill is paid …
Calculate the monthly
amount by …
Quarterly
Dividing by 3
Multiplying by 4.3
Biweekly (every two
Multiplying by 2.17
weeks)
Semimonthly (twice
Multiplying by 2
each month)
Page 4 of 4
For expenses claimed in boxes 1 and 4, you should provide the IRS allowable standards, or the actual amount you pay if the amount exceeds the IRS allowable standards. IRS allowable standards can be found by accessing https://www.irs.gov/ businesses/small-businesses-self-employed/collection-financial- standards.
Substantiation may be required for any expenses over the standard once the financial analysis is completed.
The amount claimed for Miscellaneous cannot exceed the standard amount for the number of people in your family. 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.
If you do not have access to the IRS web site, itemize your actual expenses and we will ask you for additional proof, if required. Documentation may include pay statements, bank and investment statements, loan statements and bills for recurring expenses, etc.
Housing and Utilities – Includes expenses for your primary residence. You should only list amounts for utilities, taxes and insurance that are not included in your mortgage or rent payments.
Rent – Do not enter mortgage payment here. Mortgage payment is listed in Section B.
Transportation – Include the total of maintenance, repairs, insurance, fuel, registrations, licenses, inspections, parking, and tolls for one month.
Public Transportation – Include the total you spend for public transportation if you do not own a vehicle or if you have public transportation costs in addition to vehicle expenses.
Medical – You are allowed expenses for health insurance and out-of-pocket health care costs.
Health insurance – Enter the monthly amount you pay for yourself or your family.
Out-of-Pocket health care expenses – are costs not
covered by health insurance, and include:
•Medical services
•Prescription drugs
•Dental expenses
•Medical supplies, including eyeglasses and contact lenses. Medical procedures of a purely cosmetic nature, such as plastic surgery or elective dental work are generally not allowed.
Child / Dependent Care – Enter the monthly amount you pay for the care of dependents that can be claimed on your Form 1040.
Estimated Tax Payments – Calculate the monthly
amount you pay for estimated taxes by dividing the quarterly amount due on your Form 1040ES by 3.
Life Insurance – Enter the amount you pay for term life insurance only. Whole life insurance has cash value and should be listed in Section C.
Delinquent State & Local Taxes – Enter the minimum
amount you are required to pay monthly. Be prepared to provide a copy of the statement showing the amount you owe and if applicable, any agreement you have for monthly payments.
Student Loans – Minimum payments on student loans for the taxpayer’s post-secondary education may be allowed if they are guaranteed by the federal government. Be prepared to provide proof of loan balance and payments.
Court Ordered Payments – For any court ordered
payments, be prepared to submit a copy of the court order portion showing the amount you are ordered to pay, the signatures, and proof you are making the payments. Acceptable forms of proof are copies of cancelled checks or copies of bank or pay statements.
Other Expenses not listed above – We may allow
other expenses in certain circumstances. For example, if the expenses are necessary for the health and welfare of the taxpayer or family, or for the production of income. Specify the expense and list the minimum monthly payment you are billed.
Completing IRS Form 433-F is an essential step if you are looking to discuss your financial situation with the IRS. By gathering the required information and filling out the form correctly, you can present a clear picture of your finances. Follow these steps carefully to ensure you complete the form accurately.
After filling out the form, it’s important to submit it to the appropriate IRS office. Depending on your circumstances, you may need to mail it in or submit it electronically. Keep copies for your records and follow up if you do not receive confirmation of your submission.
The IRS 433-F form is a financial disclosure form used by the Internal Revenue Service to evaluate a taxpayer’s financial situation. It provides a detailed overview of your income, expenses, assets, and liabilities. This information is crucial for the IRS when determining payment plans or settling tax debts.
When you face tax debt or are seeking to negotiate payment options with the IRS, the 433-F form plays a vital role. It allows the IRS to assess your ability to pay what you owe. Completing this form helps establish whether you qualify for an installment agreement, an offer in compromise, or other relief options.
You can easily obtain the IRS 433-F form from the IRS website. It is available for download and printing. Additionally, you may request a physical copy by calling the IRS or visiting a local IRS office. Ensure you have the most current version of the form.
Once you submit the 433-F form, the IRS will review your financial information. Depending on your financial situation, they may propose a payment plan, accept an offer in compromise, or take other appropriate actions. The timeline for this process can vary, so be sure to stay in communication with the IRS for updates.
Currently, the IRS does not allow electronic submission of the 433-F form. You must print and sign the document before mailing it to the appropriate IRS address. Double-check that all required sections are completed to avoid delays.
While supporting documents are not required when submitting the 433-F form, including them can strengthen your case. Documents such as pay stubs, bank statements, and bills can help validate your financial claims and provide a clearer picture of your circumstances.
If your financial situation changes significantly, it’s essential to inform the IRS. They may ask for updated information, or you can submit a revised 433-F form reflecting your new circumstances. Keeping the IRS informed ensures that you remain compliant and that your payment arrangements are appropriate for your situation.
Yes, many resources are available to assist you. You can consult with a tax professional, such as an accountant or an enrolled agent, who is familiar with IRS processes. Additionally, the IRS provides guidelines and resources on their website that can help clarify any questions you may have while filling out the form.
Refusing to complete the 433-F form can lead to serious consequences. The IRS may take aggressive collection actions, including wage garnishments or bank levies. It is in your best interest to cooperate and complete the form to ensure your rights are protected and to explore potential options for resolving your tax obligations.
When tackling the IRS 433-F form, many individuals often stumble upon several common pitfalls. These mistakes can lead to delays in processing or even unfavorable outcomes with the IRS. Understanding these missteps can save you time, money, and stress.
One prevalent error occurs when people fail to provide complete information about their income. The IRS requires a detailed account of not only wages, but also any other income sources. Omitting details can give the impression of attempting to hide information, which could raise red flags.
Another mistake is inadequate documentation of expenses. When filling out the form, it’s crucial to include proof of necessary living expenses. Forgetting to attach supporting documents, such as receipts or bank statements, can lead to misunderstandings when the IRS reviews your claim.
People also often miscalculate their monthly expenses. It's easy to overlook certain costs, like utilities or medical expenses, especially if you don’t regularly track them. Rounding numbers or guessing can result in discrepancies, ultimately affecting your overall financial picture presented to the IRS.
Additionally, failing to sign and date the form is a common oversight. A neglected signature can delay your submission or even render the form invalid. Always double-check that the form is completed in its entirety before sending it off.
Some individuals mistakenly think they can submit the form online. The IRS 433-F is typically required to be filed in hard copy. Confusion around submission methods can lead to frustration, so be sure you are aware of the correct procedure.
Another frequent error involves unclear or incomplete descriptions of assets. Whether it's property, vehicles, or bank accounts, providing vague details about your assets can lead to further inquiries from the IRS. Clarity and thoroughness are your allies in this situation.
Poor organization can also hinder the process. Many forget to include all relevant details on each section of the form. A well-organized submission helps create a clearer picture of your financial situation, making it easier for IRS personnel to assess your case.
Sometimes, individuals neglect to consult a professional when needed. While it’s possible to fill out the form independently, seeking expert advice can clarify confusing areas and improve the correctness of your submission.
Finally, not keeping copies of your submitted forms is a mistake that can complicate future communication with the IRS. Having records on hand can help you address any issues that may arise after submission and provide evidence should there be any disputes.
The IRS Form 433-F is used by individuals to report their financial information to the IRS when applying for an installment agreement or an offer in compromise. When completing this form, you may also need to submit additional documents that provide further support for your financial situation.
Submitting these documents along with Form 433-F can support your case and help the IRS understand your current financial circumstances. Being thorough and accurate will improve your chances of a favorable outcome.
When completing the IRS 433-F form, there are important guidelines to follow. Here’s a helpful list of things you should and shouldn’t do:
This is not true. While many people who owe significant amounts may use this form, it is also a tool for those with smaller debts. The form helps the IRS understand a taxpayer’s financial situation, regardless of the amount owed.
This misconception can lead to disappointment. Completing the form does not automatically result in reduced tax liability. It is an information-gathering tool used by the IRS to evaluate payment options.
While all three forms serve similar purposes, they are not interchangeable. The 433-F is specifically used for individuals, whereas the 433-A and 433-B are for more complex situations, such as business owners or higher-income taxpayers.
Although the IRS may request this form, submitting it voluntarily can be beneficial. By providing the IRS with a clear picture of your financial situation, you may facilitate a resolution to your tax issues.
Unfortunately, this is not always the case. The IRS processes forms at its own pace. Delays can occur for various reasons, including high volumes of submissions or additional inquiries based on the information provided.
This is a misunderstanding of IRS policies. While the IRS does protect taxpayer information, the details provided on the 433-F form may be shared internally within the agency or with other relevant governmental bodies if necessary.
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