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Blank IRS 433-F Form

The IRS 433-F form is a financial statement used by taxpayers to provide the Internal Revenue Service (IRS) with a detailed overview of their financial situation. This form is typically required when individuals seek to negotiate payment plans or settle tax debts. Understanding how to accurately complete this form is crucial for anyone looking to manage their tax obligations effectively.

Outline

The IRS 433-F form plays a crucial role in the process of negotiating a taxpayer's financial situation with the Internal Revenue Service. This form is primarily used to provide a comprehensive overview of an individual's or business's financial status, including income, expenses, assets, and liabilities. By filling out the 433-F, taxpayers can present their case for various tax relief options, such as an Offer in Compromise or a payment plan. It’s essential to accurately report your financial information, as the IRS relies on this data to make informed decisions about your tax obligations. The form requires detailed information about your living expenses, monthly income, and any assets you may own, which helps the IRS assess your ability to pay. Understanding how to effectively complete this form can significantly impact your negotiations with the IRS, potentially leading to more favorable outcomes in resolving tax debts.

Sample - IRS 433-F Form

Form 433-F	Department of the Treasury - Internal Revenue Service
(July 2024)	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:	Home:
County of Residence		Work:	Work:
		Cell:	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.)

Name and Address of Institution

Account Number

Type of Account

Current

Balance/Value

Check if

Business Account

DIGITAL ASSETS (CRYPTOCURRENCY) List all digital assets you own or in which you have a financial interest (e.g., Bitcoin, Ethereum, Litecoin, Ripple, etc.). (Use additional sheets if necessary.)

Type of Digital Currency

Name of Digital Assets Wallet,

Exchange or Digital Currency

Exchange (DCE)

Email Address Used to Set-up

With the Digital Currency

Exchange or DCE

Location(s) of Digital Assets (Mobile Wallet, Online, and/or External Hardware storage)

Digital Assets 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
Primary Residence	Other

			Year Purchased	Purchase Price

Primary Residence	Other		Year Refinanced	Refinance Amount
Primary Residence	Other

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

Balance Owed

Equity

D. CREDIT CARDS (Visa, MasterCard, American Express, Department Stores, etc.)

Type

Credit Limit

Balance Owed

Minimum Monthly Payment

	TURN PAGE TO CONTINUE

Catalog Number 62053J	www.irs.gov	Form 433-F (Rev. 7-2024)

Page 2

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 digital assets 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
How long at current employer

Spouse’s 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
How long at current employer

National

Standards

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	Net Rental Income	Interest/Dividends Income
Child Support Income	Unemployment Income	Social Security Income
Net Self Employment Income	Pension 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.
only.	Actual Monthly	IRS Allowed
	Actual Monthly		Out of Pocket Health Care
	Expenses		Out of Pocket Health Care
Food			Expenses
			Expenses
			Total
Housekeeping Supplies			Total
Clothing and Clothing Services			5. Other	Actual Monthly	IRS Allowed
Personal Care Products & Services			5. Other	Expenses	IRS Allowed
Personal Care Products & Services				Expenses
Miscellaneous			Child / Dependent Care
Total			Estimated Tax Payments
2. Transportation	Actual Monthly	IRS Allowed	Term Life Insurance
	Expenses	IRS Allowed	Retirement (Employer Required)
	Expenses		Retirement (Employer Required)
Gas / Insurance / Licenses /			Retirement (Voluntary)
Parking / Maintenance etc.			Union Dues
Public Transportation			Delinquent State & Local Taxes
Total			(minimum payment)
3. Housing & Utilities	Actual Monthly	IRS Allowed	Student Loans (minimum
	Expenses	IRS Allowed	payment)
	Expenses		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)			Other (specify)
Maintenance and Repairs			Other (specify)
Total			Total

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

Catalog Number 62053J	www.irs.gov	Form 433-F (Rev. 7-2024)

Page 3

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 digital assets 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
	If a bill is paid …	amount by …
		amount by …
	Quarterly	Dividing by 3

	Weekly	Multiplying by 4.3

	Biweekly (every two	Multiplying by 2.17
	weeks)	Multiplying by 2.17
	weeks)
	Semimonthly (twice	Multiplying by 2
	each month)	Multiplying by 2
	each month)

Catalog Number 62053J

www.irs.gov

Form 433-F (Rev. 7-2024)

Page 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.

Catalog Number 62053J

www.irs.gov

Form 433-F (Rev. 7-2024)

Click for PDF

Form Information

Fact Name	Description
Purpose	The IRS 433-F form is used to collect financial information from taxpayers who owe back taxes.
Filing Requirement	Taxpayers must submit this form when applying for an installment agreement or an offer in compromise.
Information Collected	The form gathers details about income, expenses, assets, and liabilities.
Submission Method	Taxpayers can submit the form via mail or electronically, depending on the specific IRS guidelines.
State-Specific Forms	Some states have their own financial disclosure forms, which may be governed by state tax laws.
Confidentiality	Information provided on the form is confidential and protected by federal privacy laws.
Deadline	There is no specific deadline for submitting Form 433-F, but it should be filed as soon as possible when requested by the IRS.
Impact on Tax Resolution	Accurate and complete information can significantly affect the outcome of tax resolution efforts.

Detailed Guide for Filling Out IRS 433-F

After gathering the necessary information, you will proceed to fill out the IRS 433-F form. This form requires specific financial details to assess your current financial situation. Follow these steps to complete the form accurately.

Start with your personal information at the top of the form. Enter your name, address, and Social Security number.
Provide information about your spouse if applicable. Include their name and Social Security number.
List your monthly income. Include all sources such as wages, self-employment income, and any other income streams.
Detail your monthly expenses. This includes housing costs, utilities, food, transportation, and any other necessary expenses.
Document your assets. Include bank account balances, real estate, vehicles, and any other significant assets you own.
Complete the liabilities section. List any debts you owe, including credit cards, loans, and mortgages.
Review all entered information for accuracy. Ensure there are no errors or omissions.
Sign and date the form. If you are filing jointly, your spouse must also sign.

Obtain Answers on IRS 433-F

What is the IRS 433-F form?
The IRS 433-F form is a financial statement that individuals and businesses use to provide the IRS with detailed information about their financial situation. This form is often required when taxpayers are seeking to resolve tax debts or negotiate payment plans.
Who needs to fill out the IRS 433-F form?
Typically, anyone who owes back taxes and is looking to set up an installment agreement or apply for an offer in compromise may need to complete this form. It is essential for those who want to demonstrate their inability to pay the full tax amount owed.
What information is required on the IRS 433-F form?
The form asks for various details, including:
- Your personal information, such as name, address, and Social Security number.
- Income details, including wages, self-employment income, and any other sources of income.
- Assets, such as bank accounts, real estate, and vehicles.
- Monthly expenses, which cover housing costs, utilities, food, and transportation.
How do I submit the IRS 433-F form?
You can submit the IRS 433-F form by mailing it to the appropriate IRS office. If you are working with a tax professional, they may also submit it on your behalf. Always ensure that you keep a copy for your records.
Can I fill out the IRS 433-F form online?
Currently, the IRS does not offer an online submission option for the 433-F form. However, you can download it from the IRS website, fill it out, and then print it for submission.
What happens after I submit the IRS 433-F form?
Once submitted, the IRS will review your financial information. They may contact you for additional details or clarification. Depending on your situation, they will either approve your request for a payment plan or offer in compromise or suggest alternative solutions.
How long does it take to process the IRS 433-F form?
The processing time can vary. Generally, you can expect to wait several weeks for the IRS to review your form. If there are any issues or if more information is needed, this could extend the timeline.
What should I do if my financial situation changes after submitting the form?
If your financial circumstances change significantly after you submit the IRS 433-F form, it’s important to inform the IRS as soon as possible. This can affect your payment plan or offer in compromise, and keeping the IRS updated helps avoid complications.

Common mistakes

Filling out the IRS 433-F form can be a daunting task, and many people make mistakes that can complicate their financial situation. One common error is underreporting income. When individuals fail to accurately disclose all sources of income, they risk jeopardizing their chances of negotiating a favorable settlement with the IRS. It's essential to include every dollar earned, whether from a job, freelance work, or other income streams. Being thorough ensures that the IRS has a complete picture of your financial situation.

Another frequent mistake is providing outdated or incorrect personal information. This includes not just your name and address, but also your Social Security number and any other identifying details. If the IRS cannot match your form to their records due to discrepancies, it can lead to delays or even denial of your request. Always double-check that all personal information is current and accurate before submitting the form.

Additionally, many individuals overlook the importance of documenting their expenses. When filling out the IRS 433-F, it’s vital to provide a clear and detailed account of monthly living expenses. This includes rent or mortgage payments, utility bills, and other necessary costs. Failing to provide this information can lead the IRS to assume you have more disposable income than you actually do, which could negatively impact your negotiations.

Finally, not signing the form is a surprisingly common mistake. Even if all other information is accurate, a missing signature can render the entire submission invalid. Always ensure that you have signed and dated the form before sending it off. This simple step can save you from unnecessary complications and delays in the process.

Documents used along the form

The IRS 433-F form is a critical document used for financial disclosures when negotiating tax payments or settlements with the IRS. It’s often accompanied by several other forms and documents to provide a comprehensive view of an individual's financial situation. Below is a list of common forms and documents that may be used alongside the IRS 433-F.

Form 9465: This is the Installment Agreement Request form. Taxpayers use it to request a monthly payment plan if they cannot pay their tax bill in full.
Form 2848: The Power of Attorney and Declaration of Representative form allows taxpayers to authorize someone to represent them before the IRS, which can be crucial during negotiations.
Form 8821: This form is a Tax Information Authorization. It permits an individual to receive tax information on behalf of the taxpayer, which can be helpful for financial advisors or representatives.
Financial Statements: These include personal financial statements that detail income, expenses, assets, and liabilities. They provide additional context to the IRS about a taxpayer's financial situation.

Using these forms and documents in conjunction with the IRS 433-F can help streamline communication with the IRS and facilitate better outcomes in tax negotiations. Each document serves a specific purpose and contributes to a clearer understanding of an individual's financial circumstances.

Similar forms

The IRS Form 433-F is a financial statement used by taxpayers to report their financial situation to the Internal Revenue Service. Several other documents serve similar purposes in various contexts. Below is a list of seven documents that share similarities with the IRS 433-F form:

IRS Form 433-A: This form is also a financial statement used for individuals but is more detailed than the 433-F. It is typically used for individuals who owe a larger amount of tax debt and require a more comprehensive financial disclosure.
IRS Form 433-B: This form is designed for businesses and is used to report financial information similar to the 433-F. It provides a snapshot of a business's financial status, including assets and liabilities.
Bankruptcy Petition: When individuals file for bankruptcy, they must disclose their financial situation, including income, expenses, assets, and debts. This document serves a similar purpose in assessing a person's financial health.
Financial Disclosure Statement: Often required in divorce proceedings, this document outlines an individual's financial situation, including income, expenses, and assets, similar to the information requested in the 433-F.
Loan Application: When applying for a loan, individuals must provide detailed financial information, including income, debts, and assets. This is comparable to the financial information required by the IRS 433-F.
Debt Settlement Proposal: In negotiations with creditors, individuals may submit a financial statement detailing their income and expenses to propose a settlement. This document serves a similar purpose in assessing financial capability.
Income Verification Form: Used by various agencies, this form collects information about an individual's income and expenses. It is similar to the 433-F in that it aims to assess financial standing.

Dos and Don'ts

When filling out the IRS 433-F form, attention to detail is crucial. Here are five important do's and don'ts to keep in mind:

Do provide accurate and complete information about your financial situation.
Do include all sources of income, including wages, self-employment earnings, and any other income streams.
Do carefully list your monthly expenses to reflect your true financial obligations.
Don't omit any debts or liabilities, as this could lead to complications in your case.
Don't rush through the form; take your time to ensure everything is correct before submission.

Misconceptions

The IRS 433-F form is often misunderstood, leading to confusion among taxpayers. Here are seven common misconceptions about this important document:

The IRS 433-F form is only for people with significant tax debt.
This is not true. While it is frequently used by individuals who owe a substantial amount, anyone who needs to negotiate a payment plan or discuss their financial situation with the IRS may find this form helpful.
Filling out the IRS 433-F form is optional.
In many cases, it is required. If you are seeking a payment plan or an offer in compromise, the IRS will request this form to assess your financial situation.
Once submitted, the IRS will automatically grant my request.
This is a misconception. Submitting the form does not guarantee approval of your request. The IRS reviews each case individually and may require additional information.
The IRS 433-F form is only for individuals.
This is incorrect. Businesses can also use this form to provide the IRS with their financial information when negotiating tax issues.
Completing the form is straightforward and quick.
While it may seem simple, accurately completing the form can be complex. It requires detailed financial information, and taking the time to gather this data is essential for a complete submission.
The IRS does not consider my expenses when reviewing the form.
This is a misconception. The IRS takes your necessary living expenses into account when evaluating your financial situation, which can influence their decision on your request.
I can submit the IRS 433-F form online.
Currently, the IRS does not allow online submissions for this form. You must print it out and send it via mail or fax, which can be an important detail to remember.

Understanding these misconceptions can help you navigate the process more effectively and ensure that you provide the necessary information to the IRS. Proper preparation is key to achieving a favorable outcome.

Key takeaways

The IRS 433-F form is an important document used for financial disclosure to the IRS. Here are some key takeaways to consider when filling out and using this form:

Purpose of the Form: The IRS 433-F is primarily used to report your financial situation to the IRS. This information helps the IRS determine your ability to pay taxes owed.
Accurate Information: Ensure that all information provided on the form is accurate and up-to-date. Inaccuracies can lead to delays or complications in your case.
Detail Your Assets: List all your assets, including bank accounts, real estate, and vehicles. The IRS needs a complete picture of your financial situation.
Income Disclosure: Report all sources of income, including wages, self-employment earnings, and any other income streams. Full disclosure is crucial.
Monthly Expenses: Provide a detailed account of your monthly expenses. This helps the IRS understand your financial obligations and assess your ability to pay.
Submission Process: After completing the form, submit it as instructed. Keep a copy for your records and follow up to ensure it has been received.