Installment Agreements

Attached: (1) Assignment Case; (2) Memo Format with a brief decription of what should be included in each section; (3) PPT for reseach (please try to check this as I was advised to look at the lecture and use code, reg, cases); (4) & (5) Form 433-A & Form 9465 (This is just presented as additional documentation but this is NOT required to be filled out).

INSTALLMENT AGREEMENT
Application for Installment Payment Agreement general information: Following the filing of a
return without payment in full or following an examination and the exhaustion or waiver of Appeals
Division and the United States Tax Court options, the tax is assessed. If the taxpayer is unable to pay
in full, the taxpayer may request an Installment Payment Agreement (“IPA”) or may file an Offer in
Compromise (“OIC”) to reduce the obligation. In addition, IRS may file a tax lien of record and
propose to levy on taxpayer assets. The taxpayer is entitled to a Collection Due Process hearing
(“CDP”) if any administrative rights were not provided or were denied. This includes after the filing
of a lien, prior to a levy, and collection alternatives, including an IPA and an OIC. The United States
Tax Court has jurisdiction to review adverse results of CDP proceedings. The United States Tax Court
does not have jurisdiction to review self-assessed tax because there is no deficiency in tax.
Assignment:
Archie and Betty Veronica, your clients, have filed their 2020 tax return timely on 4/15/2021. They
had a great year in the stock market in 2019. However, much of that was lost in 2020 when they
had to sell stocks being held on margin at substantial losses due to the market mini crash. Their
cash position, at the time of filing, was bad. They were forced to file owing $54,000 in taxes for
2020. They cannot possibly pay their taxes today. They are unable to borrow any money. Your firm
routinely charges $5,000 for the preparation of an installment agreement involving the preparation
of a Form 433-A. Your clients understand this and are willing to pay assuming that there are no
better options.
They have substantial assets, but those assets are locked up in investments that cannot be liquidated
easily or quickly. They also maintain an expensive lifestyle. They are not a candidate for an Offer in
Compromise.
They have received several IRS letters requesting payment. They do not know what to do. They have
come to your office so that you can advise them what is the best course of action for them to take. They
have asked that you provide them with alternatives and have asked you several questions. They are
also fee sensitive but will pay whatever it takes if they can. They have asked you the following:
1. “If we can come up with the cash relatively quickly, somehow, can you hold off the
IRS without having to go through the expense of doing an installment agreement.
2. “Assuming we cannot come up with any money at all right now what kind of an installment
agreement can we get? “
3. “What needs to be filed or what needs to be done under each of the preceding scenarios in order
to secure the installment agreement and if we secure an installment agreement what is the
maximum amount of time, we can get to pay off our IRS debt?”
4. Will penalty and interest stop, or rates change if we enter an installment agreement? What are
the current rates of interest and the penalty levels if these continue after the installment
agreement?”
Tax Research Memo
Sample Format
Your Firm
Your Town and State
Date
Relevant Facts
This section should summarize the important facts of the research case. Only
include the relevant facts in a clear and concise manner.
Specific Issues
Identify the issue(s) and state the issue(s) in the form of a question.
Conclusions
Think of your conclusion as the “short” answer to your issue. The conclusion
section is the place to provide tax advice, recommend action(s) for the client to take,
or identify the need for additional information. There may not be a single “best”
alternative to the client’s issue so be sure to consider all applicable alternatives.
Support your conclusion by referencing back to the authority you discussed in the
discussion and analysis section.
Support
This section discusses the issue(s). Begin with the relevant code section(s).
Identify the code section, paraphrase what it says and then discus why it’s
important. Discussion of the relevant Treasury Regulations should follow. Identify the
regulation, paraphrase the important sections, and then address the importance of
the regulation given the facts.
The
discussion
should continue by
reviewing relevant Treasury
pronouncements (Revenue Rulings, Revenue Procedures, Letter Rulings, etc.) and
cases. Be sure to include complete cite for each authority. Summarize the important
facts for the pronouncement/case and then compare the facts of the
pronouncement/case to the research facts. Discuss how the facts are similar or
different. Explain how each ruling or case supports or weakens the clients’ position.
Documentation is a very important part communicating tax research and all
statements or opinions should be substantiated with supporting cites. Supporting
cites should be to primary sources only except in rare or unusual situations.
Assessment Process,
Collection of Tax and
Enforcement
WEEK 5, PART 1
Assessment does not determine liability
for the tax
The assessment is the key event that records on the IRS’s books
the taxpayer’s liability for a tax. The taxpayer has a tax due that
has not been previously assessed. § 6203.
The IRS Collection process begins with the Assessment!
Assessment is the statutorily required recording of the tax
liability. Section 6203. Assessment is made by recording the
taxpayer’s name, address, and tax liability.
An assessment does not mean that the taxpayer owes the tax. It
just means that, administratively, the IRS acts as if the taxpayer
owes the assessed tax (as well as interest and penalties). Most
importantly, this means that the IRS will send the taxpayer a bill
(called a notice and demand for payment) and, failing payment,
will undertake collection measures.
Types of Assessment
The two most common types of assessment are: deficiency and summary. There are also
jeopardy and termination assessments.
Summary:§6201(a): made for the amount shown on the tax return, as reported by the taxpayer
or if there is a mathematical error. Time to assess: IRS has 3 years from the date of filing.
Deficiency: §6212:Results from the service’s examination of the return. Procedures for
prepayment review then apply (petition in tax court). Time to assess: There can be no
assessment of the tax or collection until the expiration of the 90-day period or 150-day period,
or if a petition has been filed in the tax court, until the decision becomes final.
To litigate or not litigate…that is the question!
If the taxpayer litigated the issue in the Tax Court prior to assessment, the taxpayer owes the
tax, and that is the end of the matter in terms of his liability for the tax. Remember, the Tax
Court is a preassessment remedy (i.e., a remedy made in response to a notice of deficiency
which precedes the assessment).
If, however, by the time of assessment, the taxpayer has not yet litigated the liability for the tax,
the taxpayer can still litigate the liability. The taxpayer subject to an unpaid assessment may
litigate liability in a refund action and the TP can litigate liability in a collection suit filed by the
Government when and if the Government chooses to bring one.
Differences between pre-assessment and post-assessment procedures
Prepayment judicial procedures permit the taxpayer, without financial hardship (ie; the need to
first pay the tax) to dispute the IRS administrative determination. §6213: There can be no
assessment of the tax or collection until the expiration of the 90-day period or 150-day period,
or if a petition has been filed in the tax court, until the decision becomes final.
Deficiency procedures (pre-assessment) are fundamentally different Refund procedures (post
assessment):
◦ A deficiency does not have the force of a judgment, it is a provisional determination that the Tax Court
can modify or reject in whole if a tax court petition is filed.
◦ An assessment does have the force and effect of a judgement and can be collected by a levy until paid
in full. If the service has collected in error, the taxpayer must pay in full and then file a claim for refund
within 2 years.
1
2
1. Assessment enforces a tax
statute: establishes the TP’s
liability under the tax statute for
the amount of tax due and
unpaid.
2. An Assessment has the force
of a judgement: pursuit of an
action on a debt like a creditor
3
/
3. An Assessment is the
foundation of the IRS
administrative collection
procedures: notice of the
assessment and demand for
payment.
4
4. The assessment procedure
separates deficiency procedures
from refund procedures. The
division of pre-assessment
procedures and post-assessment
procedures “is the most
fundamental characteristic in tax
procedures.” What do we mean
by that?
How does an assessment work in the
administration of the tax laws?
Time to assess: No return or the filing of a
substituted return
Where the taxpayer fails to file a tax return, the tax can be assessed at any time or collection can
start at any time without assessment.
But, unlike a fraudulent return, the three-year SOL for assessment can be triggered upon the
filing of a nonfraudulent, delinquent return. This is true even if the failure to file was due to
fraud.
Alternatively, the IRS can file a substituted return when a taxpayer fails to file a return
voluntarily. But, the filing by the IRS of this substituted return has no bearing on the running of
the SOL on assessment and collection. In other words, the statute will remain open indefinitely
until the taxpayer files a sufficient tax return.
Time to Assess: Amended Returns
The Code and regulations only set forth statutory filing dates for one original return and, absent
a claim for refund, there are no specific procedural provisions for amending incorrect returns. If
the original return satisfies the requirements of a valid return, then any subsequent amended
returns will not have an effect on the SOL.
In other words, the amended return does not extend the SOL for the assessment period.
Time to Assess: Substantial Omissions
When taxpayer omits or fails to report gross income which exceeds 25 percent of the reported
gross income stated in the return, the general SOL rules will not apply. Instead, the IRS will get
six years to make an assessment if the return omits (intentional or otherwise) more than 25
percent of gross income.
Once the IRS has sufficiently demonstrated that there was a substantial omission of income (the
IRS has the burden of proving the six-year SOL applies), the six-year SOL applies to all items in
the return, not just the specific item or items that were omitted.
But, the six-year rule only applies to items of gross income that are completely omitted from the
return, as opposed to items which were merely understated or miscalculated.
Jeopardy Assessments
A Jeopardy Assessment can mark a significant escalation of a tax problem. It is made when the IRS
believes it is at risk of losing its money because a taxpayer (or someone who holds cash of another
taxpayer) is going to take some sort of action that will make it difficult for the IRS to later collect.
This assessment allows the IRS to forgo the typical assessment process that can take months (if a taxpayer
files a return) or years, (if no return is filed and the IRS prepares a substitute-filed return).​ As soon as a
“jeopardy assessment” is made, the tax, penalties, and interest become due and payable. IRC §§ 6851 and
6861. See IRM 5.1.4, Jeopardy, Termination, Quick and Prompt Assessments, for procedures for making
jeopardy assessments.
Policy: According to IRM 1.2.13.1.27 (Policy Statement 4-88):
“Jeopardy Assessments should be used sparingly and care should be taken to avoid excessive and
unreasonable assessments. They should be limited to amounts which reasonably can be expected to
protect the Government. Each Jeopardy Assessment must receive the personal approval of the District
Director, or other delegated official. In addition, prior approval (in writing) by Chief Counsel (or such
delegate) is required.”
Circumstance Warranting Approval
A taxpayer is, or appears to be, quickly departing from the United States or going “underground”
and making it impossible to find him;
A taxpayer is, or appears to be, quickly attempting to place his property beyond the reach of the
Government; either by removing it from the United States, by concealing it, by dissipating it, or by
transferring it to other persons;
A taxpayer’s financial solvency is, or appears to be, imperiled from reasons other than incurring a
tax debt;
A third party is in possession of $10,000 or more in cash (or equivalent) that is not his, and, pursuant
to 26 USC 6867, the IRS presumes a tax debt must be due to whoever owns the cash, and the IRS
will be in jeopardy of losing the tax if they don’t act quickly (this might not be a big issue for the
person holding the cash; the IRS will make the Jeopardy Assessment, which will give the legal ability
to pay over the cash without repercussions from the one who actually owns the money.)
10 factors warranting jeopardy: Checklist 10.1 p. 10-62
Taxpayer Options
After a jeopardy assessment is made, the IRS is required to send notice and demand to the
taxpayer for the amount of the jeopardy assessment. Regardless of whether the taxpayer has
filed a petition with the Tax Court, the amount of the assessment must be paid within 10 days
unless a bond is filed as provided in IRC § 6863. See Treas. Reg. § 301.6861-1(d).
The taxpayer has 30 days from the date of receiving the written statement of the reasons for
making the jeopardy assessment, or 35 days from the date of the assessment to file a written
request for administrative review of the assessment action which will be reviewed by the
Appeals Office.
If possible, an immediate conference will be held, and a decision made within 15 days after the
request is filed. In addition, under the provisions of IRC 7429(b)(1), taxpayers can initiate judicial
review of the assessment, if they have first requested an administrative review.
Termination Assessment
Termination assessments are very similar to jeopardy assessments except that, under the provisions of §6851,
they are made only for the current or immediately preceding taxable year and can be made any time prior to
the due date for filing those years returns. Typically the return is not yet due.
Termination assessment action makes the tax for those years immediately due and payable. The conditions
which must be present for a termination assessment to be made are the same as for jeopardy assessments
and also include cases involving taxpayers engaged in organized crime, wagering cases, Strike Force cases,
cases involving taxpayers who are believed to be receiving income from an illegal activity, cases involving
taxpayers believed to be about to leave the country without making provisions for tax payment or cases
outlined in §6867. Procedures involving assessment, review, abatement, etc., are contained in IRM 5.17.15
Termination and Jeopardy Assessments and Jeopardy Collection.
Features of Various Assessments: Summary Chart Table 10.1 p. 10-16 :
Compares Deficiency, Jeopardy, and Termination Assessments
Case Law: Assessment is a “Collection Propelling Function”
“Cases analyzing these provisions have characterized assessments as serving a collectionpropelling function”–one that facilitates the collection of unpaid taxes. Whereas the IRS may
enforce a taxpayer’s tax obligations in various ways, its broadest enforcement powers, such as
the use of liens and levies, are available only when an assessment is made. See 26 U.S.C. §§
6331(a), 6322 (lien shall arise “at the time the assessment is made”), 6502. Moreover, where the
assessment of any tax imposed by this title has been made within the period of limitation
properly hereto, the period in which such tax may be collected by levy or by a proceeding in
court is extended from three years to 10 years after the assessment. 26 U.S.C. § 6502.”
Collection
This is just a debt collection process that must be managed as
efficiently as possible, balancing costs of collecting against
benefits to be derived.
Steps:
◦ Notice and Demand for Payment
◦ Tax Liens
◦ Administrative Levy and Judicial Enforcement
Notice and Demand for Payment
Within 60 days after the assessment, the IRS must send notice to the taxpayer of the assessment
and demand payment. § 6303(a). (This is often referred to as “the notice and demand for
payment” or simply “notice and demand”). The notice and demand must be sent properly to
the taxpayer; it need not be received by the taxpayer.
The notice and demand is sometimes not sent within the required 60 days. Does that mean that
the assessment is invalid? The answer is no. The assessment is valid.
The “cost” or “penalty” to the IRS for failure to satisfy the statutory command for timely notice
and demand is that the IRS may not use the administrative collection remedies, most
prominently levy and filed lien, but the IRS can sue to reduce the assessment to judgment and
then collect on the judgment.
The notice and demand for payment triggers three key
consequences. First, a lien arises in favor of the IRS. This lien is
sometimes referred to as the general tax lien, the automatic tax
lien or the secret or silent tax lien, because it arises upon the
mere assessment, demand for payment, and nonpayment of the
tax and requires no other filing anywhere or even specific notice
to the taxpayer or to third parties.
Second, the notice and demand permits the IRS to use its
administrative collection measures, including levy. Note that the
notice and demand is not a predicate for other actions,
particularly judicial actions for the tax liability in a collection suit
(or its equivalent, a counterclaim in a refund suit).
Third, the failure to pay penalty will accrue from the date of
notice and demand unless the assessed amount is paid within 21
days. The failure to pay penalty may be avoided byshowing that
the failure to pay is due to reasonable cause and not willful
neglect. § 6651(a)(2).
Consequences
of the Notice
and Demand
for Payment
Payment Issues
If the taxpayer can pay after receipt of the notice and demand, the taxpayer
should do so. Paying will avoid (i) the late payment penalties from accruing, (ii)
further accrual of interest and (iii) the taxpayer being subject to IRS collection
measures. Payment will conclude the matter except where the taxpayer desires
to file a claim for refund and, if denied, then sue for refund.
What if the taxpayer does not have the money to pay?
TP can request an installment agreement or file a request for an offer-incompromise.
Section 6159 authorizes the IRS to enter “written agreements” allowing the
taxpayer to pay “in installment payments” as IRS determines necessary to
facilitate “full or partial collections” of the tax liability.
Offer in Compromise
An offer in compromise allows the TP to settle tax debt for less than the full amount owed. It may be
a legitimate option if TP can’t pay the full tax liability or doing so creates a financial hardship. The IRS
will consider TP’s unique set of facts and circumstances:
Ability to pay;
Income;
Expenses; and
Asset equity.
The Service will generally approve an offer in compromise when the amount offered represents the
most it can expect to collect within a reasonable period of time. Explore all other payment options
before submitting an offer in compromise. Penalties and interest will continue to accrue during
consideration of the offer. The scope of the compromise is determined under contract law principles.
IRS Form 656 Booklet: Offer in Compromise https://www.irs.gov/pub/irs-pdf/f656b.pdf
Tax Liens
A lien is a legal claim against all TP’s current and future property. When the TP fails to pay the first bill
for taxes due, a lien is created by operation of law and attaches to TP’s property. This is known as an
unfiled tax lien. A Notice of Federal Tax Lien (NFTL) provides public notice to creditors and is filed to
establish priority of the IRS claim versus the claims of other creditors. This is known as a filed tax lien.
The amount of the lien is the unpaid tax plus “any interest, additional amount, addition to tax, or
assessable penalty, together with any costs that may accrue in addition thereto.”
The scope of the lien “is broad and reveals on its face that Congress meant to reach every interest in
property that a taxpayer might have.” The general tax lien continues until the tax giving rise to the
lien is paid or becomes unenforceable pursuant to the statute of limitations. § 6322.
The filed tax lien is “self-releasing” on the date indicated in the NFTL (usually 10 years after the tax is
assessed). In other cases where the taxpayer is entitled to release of the lien (e.g., upon payment or
abatement of the tax, penalties or interest), the IRS will issue a certificate of release of tax lien upon
the taxpayer’s request. § 6325(a).
Taxpayer’s Rights
Congress has given taxpayers certain rights with respect to the filing of tax liens. The IRS must
notify the taxpayer in writing of the filing of the tax lien and in the notice must:
• explain, in simple terms, the amount of unpaid tax, other administrative appeal rights available
to the taxpayer, and provisions of the law and procedures relating to the release of the lien on
the property (including the possibility of “denial, revocation, or limitation” of the taxpayer’s
passport for “seriously delinquent tax debts” under§ 7345).
• advise the taxpayer of the right for a CDP hearing under § 6320 (including the procedural steps
require to invoke the right, including the critical 30-day period to invoked the right. Collection
Due Process.
• give the taxpayer the notice in person, leave the notice at the taxpayer’s home or business
address, or send the notice by certified or registered mail to the taxpayer’s last known address.
Statute of Limitations for Collection
The general rule is that the statute of limitations is 10 years from the date of assessment. § 6502(a). As with the statute
of limitations on assessment, the statute of limitations on collection is suspended by certain events, the most significant
of which are:
1. Filing of an offer in compromise. During the pendency of the offer, the IRS generally is prohibited from taking
collection measures, so there is a corollary suspension of the statute of limitations while an OIC is pending.
2. Filing of a CDP Proceeding. The collection statute of limitations is suspended on while a CDP proceeding, and any
appeals are pending and for a period of 90 days after the proceeding become final.
3. Extended absence from the United States. If the taxpayer is outside the United States for a period of at least 6
continuous months, the statute is extended during the period of absence. Further, in order to provide the IRS time to act
upon the taxpayer’s return after such absence from the United States, the statute of limitations will not expire before 6
months after his or her return.
4. Filing for bankruptcy. To the extent that the taxpayer’s tax liability is not discharged in the bankruptcy proceeding, the
statute of limitations is suspended (a) during the period the IRS may not collect outside the bankruptcy and (b) 6 months
thereafter.
5. Extensions by Agreement. The IRS and taxpayers may extend by agreement if the extension is (1) agreed to at the
same time as an installment agreement between the taxpayer and the Service, or (2) agreed to prior to a release of levy
under § 6343 which occurs after the expiration of the statutory ten-year period for collection.
Administrative Levy and Judicial Enforcement
A lien is not self-executing; it simply represents a claim against property and the IRS must take
further action to enforce the lien, such as filing the lien, a levy (i.e., a seizure of property subject
to the lien) or a judicial action to foreclose on the lien.
Except in case of jeopardy, the formal written notice of intent to levy at least 30 days in advance
is a condition precedent to an actual levy. § 6331(d). The IRS must include in the notice certain
information regarding the levy, including the Code provisions and procedures regarding levy, the
administrative appeals, including Collection Due Process (“CDP”), available, collection
alternatives such as installment agreements and offers in compromise. Suffice it to say at this
point, the administrative effort is designed to encourage the taxpayer to pay without further
action by the IRS.
What is a levy?
Levy includes the power to seize and sell the taxpayer’s property (including interests in property
and personal service compensation, such as wages). § 6331(b) (levy); § 6335 (rules for sale).
A levy–often referred to as a seizure–is a “summary, non-judicial process, a method of self help
authorized by statute which provides the Commissioner with a prompt and convenient method
for satisfying delinquent tax claims.”
The Supreme Court has said: “The IRS need never go into court to assess and collect the amount
owed; it is empowered to collect the tax by non-judicial means. . . without having to prove to a
court the validity of the underlying tax liability.”
The IRS can use the summons power to discover leviable property. The IRS can summons the
taxpayer to attempt through a Q&A to discover the taxpayer’s leviable property. This is called a
citation to discover assets.
Who can be levied against?
The IRS levy can involve a direct seizure of the property but more often the levy is accomplished
by notice of levy to the taxpayer or third parties requiring them to turn over the taxpayer’s
property in their possession. Thus, the IRS can serve notice of levy a bank to obtain the funds in
the taxpayer’s bank account or can levy a brokerage firm to obtain the investments in the
taxpayer’s bank account. The IRS can also levy persons or entities who appear to be third
parties, asserting that they are nominees or alter egos of the taxpayer.
Once the person is given the notice of levy, the IRS has the right to the property levied. As to the
property, the person receiving the notice of levy holds the property in a form of custodial
relationship to the IRS. The person receiving the notice of levy takes substantial risks in not
responding to the levy. The person receiving a levy is liable for the value of the property levied
upon and not turned over, plus a penalty of 50%. § 6332(d).
Property Exempt from Levy
State law protections against creditors do not prevent the IRS from collecting tax debts, via levy
or judicial enforcement, as appropriate.
The Code provides exemptions from levy for certain types of property Congress deemed to be
bare essentials that should not be subject to levy. § 6334. Thus, the IRS may not seize wearing
apparel or schoolbooks, fuel, furniture or personal property up to a value of $6,250, business
assets up to a value of $3,125. Wages and salaries are exempt up to an amount equaling the
standard deduction.
Residences and businesses are not generally exempt from levy. However, the 1998 Restructuring
Act exempted residences from levy for small deficiencies ($5,000 or less).
Although retirement-type assets (e.g., pension plan, IRAs, regular Social Security payments) are
exempt or partially exempt under state and federal laws from ordinary creditors’claims, they are
not exempt from IRS levy.
Civil Enforcement Court Action
In addition to or as an alternative to levy, the Government may bring judicial enforcement
proceedings to obtain property or extend the period for collection. The judicial proceeding is a
collection suit. If it is against the taxpayer and the taxpayer has not yet litigated his or her
liability for the tax, the liability issue can be litigated in the collection suit. And, if the
Government obtains judgment in the case, it will then have a judgment lien against the taxpayer
that can then be judicially enforced against after-acquired property or property subsequently
located.
Collection Due Process Hearing
In 1998, Congress enacted certain collection due process rights to address perceived abuses in
the IRS collection system as then implemented. The rights consist of administrative rights,
principally an appeal to the IRS Appeals Office, and judicial rights in the Tax Court if the
administrative rights do not produce relief.
Section 6702(b)(2)(B) provides a penalty for a specified frivolous submission, which includes a
request for CDP review.
The IRS may exercise discretion not to consider a CDP request if the taxpayer is not otherwise in
compliance (e.g. filed all relevant tax returns) and the Courts may sustain that exercise of
discretion.
CDP Procedure
An IRS notice that it
intends to take certain
action–filing of a tax
lien or levy–triggers the
taxpayer’s right to
invoke the CDP process
by filing a written
request for CDP review.
The request for CDP review
must be filed within 30
days of the notice giving
rise to the right for CDP
review–i.e., the notice of
federal tax lien or the
notice of intent to levy.
The CDP review is initially an
administrative review by the Appeals
office. The Appeals Office will state
its conclusions from that review in a
Notice of Determination (or
Determination Letter) sent to the
taxpayer which, if the taxpayer is
unsatisfied, will constitute the
taxpayer’s jurisdictional ticket to
judicial review of the determination.
The taxpayer invokes judicial
review by making a request
for a hearing.
Defenses and Appeals
The taxpayer may raise any appropriate defense, including spousal defenses, the propriety of IRS
collection measures and alternatives to collection measures (posting bond, substitution of
collateral, etc.). Virtually everything is on the table except frivolous arguments identified or
arguments intended to delay the administration of the tax laws.
The taxpayer has the right to judicial review by the Tax Court of the IRS’s CDP determinations.
The judicial appeal must be taken within 30 days of the Appeals Office Notice of Determination.
Collection actions are normally suspended pending final determination of the hearings.
However, there are two significant exceptions: (1) the IRS has determined collection of the tax to
be in jeopardy (in much the way that it makes the determination for a jeopardy assessment or
tax year termination under §§ 6851 and 6861), although the taxpayer will be provided a postlevy opportunity for hearing; and (2) after a trial level CDP hearing, if the merits of the tax
liability are not in issue and the court determines that the IRS has shown “good cause.”
Form
433-A
Collection Information Statement for Wage
Earners and Self-Employed Individuals
(May 2020)
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.
SSN or ITIN on IRS Account
Name on Internal Revenue Service (IRS) Account
Employer Identification Number EIN
Section 1: Personal Information
1a Full Name of Taxpayer and Spouse (if applicable)
1b Address (Street, City, State, ZIP code) (County of Residence)
1c Home Phone
(
)
1e Business Phone
(
)
1d Cell 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)
SSN or ITIN
Date of Birth (mmddyyyy)
Driver’s License Number and State
3a Taxpayer
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)
4d Does employer allow contact at work
Yes
No
4e How long with this employer 4f Occupation
(years)
(months)
4g Number of withholding allowances 4h Pay Period:
claimed on Form W-4
Weekly
Bi-weekly
Monthly
Other
5d Does employer allow contact at work
Yes
No
5e How long with this employer 5f Occupation
(years)
(months)
5g Number of withholding allowances 5h Pay Period:
claimed on Form W-4
Weekly
Bi-weekly
Monthly
Other
4c Work Telephone Number
(
)
5c Work Telephone Number
(
)
Section 3: Other Financial Information (Attach copies of applicable documentation)
6
7
Are you a party to a lawsuit (If yes, answer the following)
Location of Filing
Represented by
Plaintiff
Defendant
Amount of Suit
Possible Completion Date (mmddyyyy)
Subject of Suit
$
Have you ever filed bankruptcy (If yes, answer the following)
Date Filed (mmddyyyy)
Date Dismissed (mmddyyyy)
Date Discharged (mmddyyyy)
Petition No.
Yes
Docket/Case No.
No
Yes
Location Filed
No
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:
Anticipated amount to be received When will the amount be received
Name of the trust, estate, or policy
$
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
Value
Location (Name, address and box number(s))
Contents
$
11
In the past 10 years, have you transferred any assets for less than their full value (If yes, answer the following)
Yes
No
Value at Time of Transfer Date Transferred (mmddyyyy)
List Asset(s)
To Whom or Where was it Transferred
$
Catalog Number 20312N
www.irs.gov
Form 433-A (Rev. 5-2020)
Page 2
Form 433-A (Rev. 2-2019)
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
Account Balance
Full Name & Address (Street, City, State, ZIP code) of Bank,
Savings & Loan, Credit Union, or Financial Institution
Account Number
As of
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.
Full Name & Address
(Street, City, State, ZIP code) of Company
Type of Investment
or Financial Interest
Current Value
Loan Balance (if applicable)
As of
mmddyyyy
Equity
Value minus Loan
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.
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
Virtual Currency
Location(s) of Virtual Currency Amount and Value in
(Mobile Wallet, Online, and/or
US dollars as of
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
$
$
$
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 (Term Life insurance does not have a cash value)
If yes, complete blocks 16b through 16f for each policy.
Yes
No
16b Name and Address of Insurance
Company(ies):
16c
16d
16e
16f
Policy Number(s)
Owner of Policy
Current Cash Value
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)
Page 3
Form 433-A (Rev. 2-2019)
REAL PROPERTY Include all real property owned or being purchased
Current Fair
Market Value
(FMV)
Purchase Date
(mmddyyyy)
Current Loan
Balance
Amount of
Monthly Payment
Date of Final
Payment
(mmddyyyy)
Equity
FMV Minus Loan
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,
Tag Number, Vehicle Identification Number)
18a Year
Mileage
Purchase/
Lease Date
(mmddyyyy)
Current Fair
Market Value
(FMV)
Current Loan
Balance
Amount of
Monthly Payment
Date of Final
Payment
(mmddyyyy)
Equity
FMV Minus Loan
Make/Model
License/Tag Number
$
$
$
Lender/Lessor Name, Address (Street, City, State, ZIP code), and Phone
$
Vehicle Identification Number
Phone
18b Year
Mileage
Make/Model
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/
Lease Date
(mmddyyyy)
Current Fair
Market Value
(FMV)
Current Loan
Balance
Date of Final
Amount of
Payment
Monthly Payment (mmddyyyy)
Equity
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)
Page 4
Form 433-A (Rev. 2-2019)
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
Expense Items 6
Gross Monthly
Source
Actual Monthly
20 Wages (Taxpayer) 1
$
35 Food, Clothing and Misc. 7
$
$
36 Housing and Utilities 8
$
21 Wages (Spouse) 1
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)
$
IRS USE ONLY
Allowable Expenses
1 Wages, 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
2 Net 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.
3 Net 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.
4 Distributions: 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.
5 Other 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.
6 Expenses 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.
7 Food, 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.
8 Housing 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.
9
10
11
12
13
Vehicle Ownership Costs: Total of monthly lease or purchase/loan payments.
Vehicle Operating Costs: Total of maintenance, repairs, insurance, fuel, registrations, licenses, inspections, parking, and tolls for one month.
Public Transportation: Total of monthly fares for mass transit (e.g., bus, train, ferry, taxi, etc.)
Out of Pocket Health Care Costs: Monthly total of medical services, prescription drugs and medical supplies (e.g., eyeglasses, hearing aids, etc.)
Current 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)
Page 5
Form 433-A (Rev. 2-2019)
Sections 6 and 7 must be completed only if you are SELF-EMPLOYED.
Section 6: Business Information
52
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.
Business Name & Address (if different than 1b)
53
Employer Identification Number
56
Business Website (web address)
57
Total Number of Employees
59
Frequency of Tax Deposits
60
Does the business engage in e-Commerce
(Internet sales) If yes, complete lines 61a and 61b
51
54
55
Type of Business
58
Is the business a
Federal Contractor
Yes
Average Gross Monthly Payroll
Yes
No
No
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
Issuing Bank Name & Address (Street, City, State, ZIP code)
Merchant Account Number
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
Account Balance
Full name & Address (Street, City, State, ZIP code)
of Bank,Savings & Loan, Credit Union or Financial Institution.
Account Number
As of
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.
(e.g., age,
Accounts/Notes Receivable & Address (Street, City, State, ZIP code) Status
factored, other)
Date Due
(mmddyyyy)
Invoice Number or Government
Grant or Contract Number
Amount Due
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)
Page 6
Form 433-A (Rev. 2-2019)
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/
Lease Date
(mmddyyyy)
66a
Current Fair
Market Value
(FMV)
Current Loan
Balance
Date of Final
Amount of
Payment
Monthly Payment (mmddyyyy)
Equity
FMV Minus Loan
Property Description
$
$
$
$
Lender/Lessor/Landlord Name, Address (Street, City, State, ZIP code), and Phone
Location (Street, City, State, ZIP code) and Country
Phone
66b
Property Description
$
$
$
$
Lender/Lessor/Landlord Name, Address (Street, City, State, ZIP code), and Phone
Location (Street, City, State, ZIP code) and Country
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)
Expense Items
Actual Monthly
Source
Gross Monthly
Materials Purchased 1
$
Inventory Purchased 2
$
Gross Wages & Salaries
$
Rent
$
Supplies 3
$
Utilities/Telephone 4
$
$
Vehicle Gasoline/Oil
$
72
$
Repairs & Maintenance
$
73
$
Insurance
$
74
5
$
Current
Taxes
$
75
Other Expenses, including installment payments
76 Total Income (Add lines 67 through 75)
$
(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.
1 Materials Purchased: Materials are items directly related to the
5 Current Taxes: Real estate, excise, franchise, occupational,
production of a product or service.
personal property, sales and employer’s portion of employment
taxes.
2 Inventory Purchased: Goods bought for resale.
67
68
69
70
71
Gross Receipts
Gross Rental Income
Interest
Dividends
Cash Receipts not included in lines 67-70
Other Income (Specify below)
77
78
79
80
81
82
83
84
85
86
87
$
$
$
$
$
3 Supplies: 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.
4 Utilities/Telephone: Utilities include gas, electricity, water, oil, other
fuels, trash collection, telephone, cell phone and business internet.
6 Net 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)
9465
Form
(Rev. September 2020)
Department of the Treasury
Internal Revenue Service
Installment Agreement Request
▶ Go to www.irs.gov/Form9465 for instructions and the latest information.
OMB No. 1545-0074
▶ If you are filing this form with your tax return, attach it to the front of the return.
▶ See separate instructions.
Tip: If you owe $50,000 or less, you may be able to avoid filing Form 9465 and establish an installment agreement online, even if you
haven’t yet received a tax bill. Go to www.irs.gov/OPA to apply for an Online Payment Agreement. If you establish your installment
agreement using the Online Payment Agreement application, the user fee that you pay will be lower than it would be with Form 9465.
Part I
Installment Agreement Request
This request is for Form(s) (for example, Form 1040 or Form 941) ▶
Enter tax year(s) or period(s) involved (for example, 2018 and 2019, or January 1, 2019, to June 30, 2019) ▶
Last name
1a Your first name and initial
Your social security number
Spouse’s social security number
If a joint return, spouse’s first name and initial Last name
Current address (number and street). If you have a P.O. box and no home delivery, enter your box number.
Apt. number
City, town or post office, state, and ZIP code. If a foreign address, also complete the spaces below (see instructions).
Foreign country name
Foreign province/state/county
1b If this address is new since you filed your last tax return, check here
Name of your business (must no longer be operating)
2
3
.
.
.
.
.
.
.
Foreign postal code
.
.
.
.
.
.
.
.
.
.
▶
Employer identification number (EIN)
4
Your home phone number
Best time for us to call
Your work phone number
Ext.
Best time for us to call
5
6
Enter the total amount you owe as shown on your tax return(s) (or notice(s)) . . . . . . . .
5
If you have any additional balances due that aren’t reported on line 5, enter the amount here (even if
the amounts are included in an existing installment agreement) . . . . . . . . . . . .
6
7
Add lines 5 and 6 and enter the result . . . . . . . . . . . . . . . . . . . .
7
8
Enter the amount of any payment you’re making with this request. See instructions . . . . .
8
9
Amount owed. Subtract line 8 from line 7 and enter the result
. . . . . . . . . . . .
9
10
Divide the amount on line 9 by 72.0 and enter the result . . . . . . . . . . . . . .
10
11a Enter the amount you can pay each month. Make your payment as large as possible to limit interest
and penalty charges, as these charges will continue to accrue until you pay in full. If you have
an existing installment agreement, this amount should represent your total proposed monthly
payment amount for all your liabilities. If no payment amount is listed on line 11a, a payment will
be determined for you by dividing the balance due on line 9 by 72 months . . . . . . .
11a $
b If the amount on line 11a is less than the amount on line 10 and you’re able to increase your payment
to an amount that is equal to or greater than the amount on line 10, enter your revised monthly payment 11b $
• If you can’t increase your payment on line 11b to more than or equal to the amount shown on line 10, check the box. Also,
complete and attach Form 433-F, Collection Information Statement . . . . . . . . . . . . . . . . . . .
• If the amount on line 11a (or 11b, if applicable) is more than or equal to the amount on line 10 and the amount you owe is
over $25,000 but not more than $50,000, then you don’t have to complete Form 433-F. However, if you don’t complete Form
433-F, then you must complete either line 13 or 14.
• If the amount on line 9 is greater than $50,000, complete and attach Form 433-F.
12
12
Enter the date you want to make your payment each month. Don’t enter a date later than the 28th
13
If you want to make your payments by direct debit from your checking account, see the instructions and fill in lines 13a and
13b. This is the most convenient way to make your payments and it will ensure that they are made on time.
▶ a Routing number
▶ b Account number
I authorize the U.S. Treasury and its designated Financial Agent to initiate a monthly ACH debit (electronic withdrawal) entry to the financial institution account
indicated for payments of my federal taxes owed, and the financial institution to debit the entry to this account. This authorization is to remain in full force and
effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke payment, I must contact the U.S. Treasury Financial Agent at
1-800-829-1040 no later than 14 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the
electronic payments of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payments.
c
14
Low-income taxpayers only. If you’re unable to make electronic payments through a debit instrument by providing your
banking information on lines 13a and 13b, check this box and your user fee will be reimbursed upon completion of your
installment agreement. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you want to make payments by payroll deduction, check this box and attach a completed Form 2159 . . . . . . .
By signing and submitting this form, I authorize the IRS to contact third parties and to disclose my tax information to third parties in order to process this
request and administer the agreement over its duration. I also agree to the terms of this agreement, as provided in the instructions, if it’s approved by the IRS.
Your signature
Date
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Spouse’s signature. If a joint return, both must sign.
Cat. No. 14842Y
Date
Form 9465 (Rev. 9-2020)
Page 2
Form 9465 (Rev. 9-2020)
Part II
Additional Information
Complete this Part only if all three conditions below apply:
1. You defaulted on an installment agreement in the past 12 months;
2. You owe more than $25,000 but not more than $50,000; and
3. The amount on line 11a (or 11b, if applicable) is less than line 10.
Note: If you owe more than $50,000, also complete and attach Form 433-F.
15
In which county is your primary residence?
16a
Marital status:
Single. Skip question 16b and go to question 17.
Married. Go to question 16b.
b Do you share household expenses with your spouse?
Yes.
No.
17
How many dependents will you be able to claim on this year’s tax return?.
.
.
.
.
.
.
.
.
17
18
How many people in your household are 65 or older?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
18
19
How often are you paid?
Once a week.
Once every 2 weeks.
Once a month.
Twice a month.
20
What is your net income per pay period (take home pay)? .
.
.
.
.
.
.
.
.
.
.
.
.
.
20 $
.
Note: Complete lines 21 and 22 only if you have a spouse and meet certain conditions (see instructions). If you don’t
have a spouse, go to line 23.
21
How often is your spouse paid?
Once a week.
Once every 2 weeks.
Once a month.
Twice a month.
22
What is your spouse’s net income per pay period (take home pay)? .
.
.
.
.
.
.
.
.
.
.
22 $
23
How many vehicles do you own? .
.
.
.
.
.
.
.
.
.
.
23
24
How many car payments do you have each month? . . . . . . . . . . . . . . . . . . .
24
25a
Do you have health insurance?
Yes. Go to question 25b.
.
.
.
.
.
.
.
.
.
.
.
No. Skip question 25b and go to question 26a.
b Are your health insurance premiums deducted from your paycheck?
Yes. Skip question 25c and go to question 26a.
No. Go to question 25c.
c
26a
How much are your monthly health insurance premiums? .
Do you make court-ordered payments?
Yes. Go to question 26b.
.
.
.
.
.
.
.
.
.
.
.
.
.
25c $
.
.
.
.
.
26c $
No. Go to question 27.
b Are your court-ordered payments deducted from your paycheck?
Yes. Go to question 27.
No. Go to question 26c.
c
27
How much are your court-ordered payments each month?
.
.
.
.
.
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Not including any court-ordered payments for child and dependent support, how much do you pay
for child or dependent care each month? . . . . . . . . . . . . . . . . . . .
27 $
Form 9465 (Rev. 9-2020)