The IRS 433-A form is a financial disclosure document used by individuals to provide the Internal Revenue Service with detailed information about their income, expenses, and assets. This form is typically required when taxpayers are seeking to resolve their tax liabilities through an installment agreement or an offer in compromise. To begin the process of filling out the IRS 433-A form, click the button below.
The IRS 433-A form plays a crucial role in the financial landscape for individuals facing tax liabilities. Designed primarily for those who owe back taxes and are seeking to negotiate a payment plan or settle their debts, this form provides the Internal Revenue Service with a comprehensive overview of a taxpayer's financial situation. It requires detailed information about income, expenses, assets, and liabilities, allowing the IRS to assess the taxpayer's ability to pay. Completing the form accurately is essential, as it directly impacts the negotiation process for installment agreements or offers in compromise. Taxpayers must be prepared to disclose various financial documents, such as pay stubs, bank statements, and property valuations, to support the information provided. Understanding the nuances of the IRS 433-A form is vital for anyone navigating the complexities of tax debt resolution.
Form 433-A
Collection Information Statement for Wage
(July 2022)
Earners and Self-Employed Individuals
Department of the Treasury
Internal Revenue Service
Wage Earners Complete Sections 1, 2, 3, 4, and 5 including the signature line on page 4. Answer all questions or write N/A if the question is not applicable. Self-Employed Individuals Complete Sections 1, 3, 4, 5, 6 and 7 and the signature line on page 4. Answer all questions or write N/A if the question is not applicable. For Additional Information, refer to Publication 1854, "How To Prepare a Collection Information Statement."
Include attachments if additional space is needed to respond completely to any question.
Section 1: Personal Information
1a
Full Name of Taxpayer and Spouse (if applicable)
2c
Provide information on all other persons in household or claimed as
dependents
1b
Address (street, city, state, ZIP code and country)
Name
Age
Relationship
3a
Do you or your spouse have any outside business interests? Include
any interest in an LLC, LLP, corporation, partnership, etc.
1c
County of Residence
1d
Home Phone
Yes (percentage of ownership
%)
No
(
)
Title
1e
Cell Phone
1f
Work Phone
3b
Business name
2a
Marital Status:
Married
Unmarried (Single, Divorced, Widowed)
3c
Type of business (select one)
2b
SSN or ITIN
Date of Birth (mmddyyyy)
Partnership
LLC
Corporation
Taxpayer
Other
Spouse
Section 2: Employment Information for Wage Earners
If you or your spouse have self-employment income instead of, or in addition to wage income, complete Business Information in Sections 6 and 7.
4a
Taxpayer's Employer Name
5a
Spouse's Employer Name
4b
5b
4c
Work Telephone Number
4d
Does employer allow contact at work
5c
5d Does employer allow contact at work
Yes
4e
How long with this employer
4f
Occupation
5e
5f Occupation
(years)
(months)
4g
Number claimed as a dependent
4h
Pay Period:
5g
5h Pay Period:
on your Form 1040
Weekly
Bi-weekly
Monthly
Section 3: Other Financial Information (Attach copies of applicable documentation)
6
Are you a party to a lawsuit (If yes, answer the following)
Location of Filing
Represented by
Docket/Case No.
Plaintiff
Defendant
Amount of Suit
Possible Completion Date (mmddyyyy)
Subject of Suit
$
7
Have you ever filed bankruptcy (If yes, answer the following)
Date Filed (mmddyyyy)
Date Dismissed (mmddyyyy)
Date Discharged (mmddyyyy)
Petition No.
Location Filed
8
In the past 10 years, have you lived outside of the U.S for 6 months or longer (If yes, answer the following)
Dates lived abroad: from (mmddyyyy)
To (mmddyyyy)
9a Are you the beneficiary of a trust, estate, or life insurance policy including those located in foreign countries or jurisdictions (If yes, answer the following)
Yes No
Place where recorded:
EIN:
Name of the trust, estate, or policy
Anticipated amount to be received
When will the amount be received
9b
Are you a trustee, fiduciary, or contributor of a trust
Name of the trust:
10
Do you have a safe deposit box (business or personal) including those located in foreign countries or jurisdictions
(If yes, answer the following)
Location (Name, address and box number(s))
Contents
Value
11
In the past 10 years, have you transferred any assets with a fair market value of more than $10,000 including real
property, for less than their full value (if yes, answer the following)
List Asset(s)
Value at Time of Transfer
Date Transferred (mmddyyyy)
To Whom or Where was it Transferred
Catalog Number 20312N
www.irs.gov
Form 433-A (Rev. 7-2022)
Page 2
Section 4: Personal Asset Information for all Individuals (Foreign and Domestic). Include assets located in foreign countries or jurisdictions and add attachment(s) if additional space is needed to respond
12 CASH ON HAND Include cash that is not in a bank
Total Cash on Hand
PERSONAL BANK ACCOUNTS Include all checking, online and mobile (e.g., PayPal etc.) accounts, money market accounts, savings accounts, and stored value cards (e.g., payroll cards, government benefit cards, etc.).
Full Name & Address (Street, City, State, ZIP code and
Account Balance
Type of Account
Country) of Bank, Savings & Loan, Credit Union, or
Account Number
As of
Financial Institution
mmddyyyy
13a
13b
13c
Total Cash (Add lines 13a, 13b, and amounts from any attachments)
INVESTMENTS Include stocks, bonds, mutual funds, stock options, certificates of deposit, and retirement assets such as IRAs, Keogh, 401(k) plans and commodities (e.g., gold, silver, copper, etc.). Include all corporations, partnerships, limited liability companies, or other business entities in which you are an officer, director, owner, member, or otherwise have a financial interest.
Type of Investment
Full Name & Address
Loan Balance (if applicable)
Equity
Current Value
or Financial Interest
(Street, City, State, ZIP code and Country) of Company
Value minus Loan
14a
Phone
14b
DIGITAL ASSETS List all digital assets such as virtual currency (cryptocurrency), non-fungible token (NFT), and smart contracts you own or in which you have a financial interest (e.g., Bitcoin, Ethereum, Litecoin, Ripple, etc.) If applicable, attach a statement with each virtual currency’s public key.
14c List the name(s) of individuals who have access to the private key(s) and/or digital wallets
Name of Digital Asset such as
Email Address Used to Set-up
Digital Asset Amount
Location(s) of Digital Assets
and Value in US
Type of Digital Asset
Virtual Currency Wallet, Exchange
With the Digital Assets such as
(Mobile Wallet, Online, and/or
dollars as of today
or Digital Currency Exchange
Virtual Currency Exchange or
External Hardware storage)
(e.g., 1 Bitcoins
(DCE)
DCE
$38,000.00 USD)
14d
14e
14f Total Equity (Add lines 14a, 14b, 14d and 14e. Also include any amounts from any attachments to your total equity)
AVAILABLE CREDIT Include all lines of credit and bank issued credit cards.
Amount Owed
Available Credit
Credit Limit
(Street, City, State, ZIP code and Country) of Credit Institution
15a
Acct. No
15b
15c
Total Available Credit (Add lines 15a, 15b and amounts from any attachments)
16a
LIFE INSURANCE Do you own or have any interest in any life insurance policies with cash value
If yes, complete blocks 16b through 16f for each policy.
16b
Name and Address of Insurance
Company(ies):
16c
Policy Number(s)
16d
Owner of Policy
16e
Current Cash Value
16f
Outstanding Loan Balance
16g
Total Available Cash (Subtract amounts on line 16f from line 16e and include amounts from any attachments)
Page 3
Section 4: Personal Asset Information for all Individuals (Foreign and Domestic) (Continued)
REAL PROPERTY Include all real property owned or being purchased
Purchase Date
Current Fair
Current Loan
Amount of
Date of Final
Market Value
Payment
(mmddyyyy)
Balance
Monthly Payment
FMV Minus Loan
(FMV)
17a
Property Description
Location (street, city, state, ZIP code, county and country)
Lender/Contract Holder Name, Address (street, city, state, ZIP code), and Phone
17b
17c Total Equity (Add lines 17a, 17b and amounts from any attachments)
PERSONAL VEHICLES LEASED AND PURCHASED Include boats, RVs, motorcycles, all-terrain and off-road vehicles, trailers, etc.
Description (Year, Mileage, Make/Model,
Purchase/
Lease Date
Tag Number, Vehicle Identification Number)
18a Year
Make/Model
Mileage
License/Tag Number
Lender/Lessor Name, Address (street, city, state, ZIP code and country), and Phone
Vehicle Identification Number
18b Year
18c Total Equity (Add lines 18a, 18b and amounts from any attachments)
PERSONAL ASSETS Include all furniture, personal effects, artwork, jewelry, collections (coins, guns, etc.), antiques or other assets. Include intangible assets such as licenses, domain names, patents, copyrights, mining claims, etc.
19a Property Description
Lender/Lessor Name, Address (street, city, state, ZIP code), and Phone
19b Property Description
19c Total Equity (Add lines 19a, 19b and amounts from any attachments)
Page 4
If you are self-employed, sections 6 and 7 must be completed before continuing.
Section 5: Monthly Income and Expenses (Foreign and Domestic)
Monthly Income/Expense Statement (For additional information, refer to Publication 1854.)
Total Income (Amounts reported in U.S. dollars)
Total Living Expenses (Amounts reported in U.S. dollars)
IRS USE ONLY
Source
Gross Monthly
Expense Items 6
Actual Monthly
Allowable Expenses
20
Wages (Taxpayer) 1
35
Food, Clothing and Misc. 7
21
Wages (Spouse) 1
36
Housing and Utilities 8
22
Interest - Dividends
37
Vehicle Ownership Costs 9
23
Net Business Income 2
38
Vehicle Operating Costs 10
24
Net Rental Income 3
39
Public Transportation 11
25
Distributions (K-1, IRA, etc.) 4
40
Health Insurance
26
Pension (Taxpayer)
41
Out of Pocket Health Care Costs 12
27
Pension (Spouse)
42
Court Ordered Payments
28
Social Security (Taxpayer)
43
Child/Dependent Care
29
Social Security (Spouse)
44
Life Insurance
30
Child Support
45
Current year taxes (Income/FICA) 13
31
Alimony
46
Secured Debts (Attach list)
Other Income (Specify below) 5
47
Delinquent State or Local Taxes
32
48
Other Expenses (Attach list)
33
49 Total Living Expenses (add lines 35-48)
34
Total Income (add lines 20-33)
50
Net difference (Line 34 minus 49)
1Wages, salaries, pensions, and social security: Enter gross monthly wages and/or salaries. Do not deduct tax withholding or allotments taken out of pay, such as insurance payments, credit union deductions, car payments, etc. To calculate the gross monthly wages and/or salaries:
If paid weekly - multiply weekly gross wages by 4.3. Example: $425.89 x 4.3 = $1,831.33
If paid biweekly (every 2 weeks) - multiply biweekly gross wages by 2.17. Example: $972.45 x 2.17 = $2,110.22
If paid semimonthly (twice each month) - multiply semimonthly gross wages by 2. Example: $856.23 x 2 = $1,712.46
2Net Income from Business: Enter monthly net business income. This is the amount earned after ordinary and necessary monthly business expenses are paid. This figure is the amount from page 6, line 89. If the net business income is a loss, enter “0”. Do not enter a negative number. If this amount is more or less than previous years, attach an explanation.
3Net Rental Income: Enter monthly net rental income. This is the amount earned after ordinary and necessary monthly rental expenses are paid. Do not include deductions for depreciation or depletion. If the net rental income is a loss, enter “0.” Do not enter a negative number.
4Distributions: Enter the total distributions from partnerships and subchapter S corporations reported on Schedule K-1, and from limited liability companies reported on Form 1040, Schedule C, D or E. Enter total distributions from IRAs if not included under pension income.
5Other Income: Include agricultural subsidies, unemployment compensation, gambling income, oil credits, rent subsidies, sharing economy income from providing on-demand work, services or goods (e.g., Uber, Lyft, AirBnB, VRBO) and income through digital platforms like an app or website (e.g., YouTube, TikTok), etc. Recurring capital gains from the sale of securities including cryptocurrency and non-fungible tokens.
6Expenses not generally allowed: We generally do not allow tuition for private schools, public or private college expenses, charitable contributions, voluntary retirement contributions or payments on unsecured debts. However, we may allow the expenses if proven that they are necessary for the health and welfare of the individual or family or the production of income. See Publication 1854 for exceptions.
7Food, Clothing and Miscellaneous: Total of food, clothing, housekeeping supplies, and personal care products for one month. The miscellaneous allowance is for expenses incurred that are not included in any other allowable living expense items. Examples are credit card payments, bank fees and charges, reading material, and school supplies.
8Housing and Utilities: For principal residence: Total of rent or mortgage payment. Add the average monthly expenses for the following: property taxes, homeowner’s or renter’s insurance, maintenance, dues, fees, and utilities. Utilities include gas, electricity, water, fuel, oil, other fuels, trash collection, telephone, cell phone, cable television and internet services.
9Vehicle Ownership Costs: Total of monthly lease or purchase/loan payments.
10Vehicle Operating Costs: Total of maintenance, repairs, insurance, fuel, registrations, licenses, inspections, parking, and tolls for one month.
11Public Transportation: Total of monthly fares for mass transit (e.g., bus, train, ferry, taxi, etc.)
12Out of Pocket Health Care Costs: Monthly total of medical services, prescription drugs and medical supplies (e.g., eyeglasses, hearing aids, etc.)
13Current Year Taxes: Include state and Federal taxes withheld from salary or wages, or paid as estimated taxes.
Certification: Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities, and other information is true, correct, and complete.
Taxpayer's Signature
Spouse's signature
Date
After we review the completed Form 433-A, you may be asked to provide verification for the assets, encumbrances, income and expenses reported. Documentation may include previously filed income tax returns, pay statements, self-employment records, bank and investment statements, loan statements, bills or statements for recurring expenses, etc.
IRS USE ONLY (Notes)
Filling out the IRS 433-A form requires careful attention to detail. This form is often used to provide the IRS with information about your financial situation. Once completed, it will help in negotiations regarding your tax obligations.
What is the IRS 433-A form?
The IRS 433-A form is a financial statement used by the Internal Revenue Service to collect information about your financial situation. It helps the IRS assess your ability to pay any tax debts you may owe. This form is often required during the process of negotiating payment plans or settling tax liabilities.
Who needs to fill out the IRS 433-A form?
Typically, individuals who owe taxes and are seeking to establish a payment plan, an offer in compromise, or other arrangements with the IRS will need to complete this form. If you are self-employed or have significant assets, the IRS may require this detailed financial information to evaluate your case.
What information do I need to provide on the IRS 433-A form?
You will need to provide comprehensive details about your income, expenses, assets, and liabilities. This includes information about your employment, bank accounts, real estate, vehicles, and any other financial obligations. The IRS uses this information to determine your financial capacity to pay your tax debt.
How do I submit the IRS 433-A form?
After completing the form, you can submit it to the IRS either by mail or electronically, depending on the specific instructions provided by the IRS for your situation. Be sure to keep a copy for your records. If you are working with a tax professional, they may also assist you in submitting the form.
What happens after I submit the IRS 433-A form?
Once the IRS receives your form, they will review the information you provided. This process may take some time. The IRS will contact you if they require additional information or if they have made a decision regarding your payment plan or offer in compromise. Stay patient and be prepared to respond promptly to any requests from the IRS.
Can I make mistakes on the IRS 433-A form?
While mistakes can happen, it’s crucial to provide accurate information on the form. Errors may lead to delays or complications in your case. If you realize you’ve made a mistake after submitting the form, contact the IRS immediately to correct it. Transparency and honesty are essential in dealing with tax matters.
Where can I find help with the IRS 433-A form?
If you need assistance filling out the IRS 433-A form, consider reaching out to a tax professional or an enrolled agent. They can provide guidance tailored to your specific situation. Additionally, the IRS website offers resources and instructions that can help you understand the form better.
Filling out the IRS 433-A form can be daunting, and many people make common mistakes that can lead to delays or issues with their tax situation. One frequent error is not providing complete information. The IRS requires detailed financial information, including income, expenses, and assets. Omitting any of this can raise red flags and complicate the process.
Another mistake is underestimating income. Some individuals may fail to report all sources of income, thinking that minor amounts don’t matter. However, the IRS expects a full picture of your financial situation. Be honest and thorough to avoid potential penalties.
People often forget to update their expenses. Life changes, such as moving or changing jobs, can alter your financial situation. If you don’t reflect these changes on the form, it may appear that you can afford more than you actually can, leading to unrealistic payment plans.
Not documenting assets properly is another common pitfall. When listing your assets, it’s crucial to include all relevant details, such as current values and ownership status. Failing to do so can result in misunderstandings about your financial standing.
Some individuals mistakenly think they can submit the form without reviewing it. Typos and errors can easily slip through, so it’s essential to double-check everything before sending it off. A simple mistake can lead to significant delays in processing.
Ignoring the importance of signatures is also a mistake. The IRS requires signatures from all responsible parties. If you forget to sign or provide a signature from a spouse or partner when needed, the form may be rejected.
Finally, many people underestimate the importance of timely submission. The IRS has strict deadlines. Waiting until the last minute can lead to rushed work and more mistakes. Aim to complete the form well before the deadline to ensure accuracy and peace of mind.
The IRS 433-A form is commonly used for financial disclosure when taxpayers are negotiating payment arrangements with the IRS. To effectively manage this process, several other forms and documents may be needed. Below is a list of related documents that can help streamline communication with the IRS and provide necessary financial information.
Having these forms ready can facilitate smoother interactions with the IRS and help ensure that all necessary information is provided. Being organized and thorough can make a significant difference in resolving tax matters efficiently.
The IRS 433-A form is used for reporting financial information to the Internal Revenue Service, particularly in relation to an individual's ability to pay tax debts. Several other documents serve similar purposes in financial disclosure and tax compliance. Here are five documents that share similarities with the IRS 433-A form:
When filling out the IRS 433-A form, it's important to approach the process with care. This form is used to provide the IRS with information about your financial situation, which can impact your tax obligations and payment plans. Here are five things you should and shouldn't do when completing this form:
By following these guidelines, you can help ensure that your IRS 433-A form is filled out correctly, paving the way for a smoother interaction with the IRS.
The IRS Form 433-A is a critical document used by individuals to report their financial information to the Internal Revenue Service. However, several misconceptions surround this form. Here is a list of ten common misunderstandings:
Understanding these misconceptions can help individuals navigate their interactions with the IRS more effectively and ensure they are prepared to provide the necessary information when required.
The IRS 433-A form is a crucial document for individuals seeking to resolve tax liabilities with the Internal Revenue Service. Here are key takeaways regarding its use and completion: