The IRS 433-A form is a financial statement used by individuals to provide the Internal Revenue Service with detailed information about their income, expenses, and assets. This form is essential for those seeking to negotiate a payment plan or settle tax debts. Understanding how to accurately complete the 433-A can significantly impact one's ability to resolve tax issues effectively.
The IRS 433-A form is an essential tool for individuals navigating the complexities of tax debt and financial disclosures. This form primarily serves as a comprehensive financial statement, detailing a taxpayer's income, expenses, assets, and liabilities. When facing tax issues, such as the inability to pay owed taxes or negotiating an installment agreement, the IRS 433-A becomes crucial. It allows the IRS to assess a taxpayer's financial situation accurately. By providing a clear picture of one’s financial health, the form aids in determining the best course of action for resolving tax debts. Moreover, understanding how to complete this form correctly can significantly impact the outcome of negotiations with the IRS, potentially leading to more favorable repayment options. Whether you’re an individual taxpayer or a business owner, familiarity with the IRS 433-A is vital for effectively managing tax obligations and ensuring compliance with federal regulations.
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)
Completing the IRS 433-A form requires careful attention to detail. This form is essential for individuals seeking to resolve tax issues. Below are the steps to guide you through the process of filling it out.
After completing the form, review it for accuracy. Make sure all sections are filled out correctly. Once you are satisfied, submit the form as directed by the IRS.
The IRS 433-A form is a financial statement used by the Internal Revenue Service (IRS) to assess an individual’s ability to pay their tax debt. This form provides a detailed overview of a taxpayer's financial situation, including income, expenses, assets, and liabilities. It is commonly used during the process of setting up an installment agreement or when applying for an offer in compromise.
Individuals who owe back taxes and wish to negotiate payment options with the IRS may need to complete this form. Specifically, it is typically required for those seeking to establish an installment agreement or an offer in compromise. Taxpayers who have received a notice from the IRS regarding their tax debt will often find that filling out the 433-A is a necessary step in resolving their tax issues.
The form requires detailed financial information, which includes:
Completing the form accurately is crucial, as it helps the IRS understand the taxpayer's financial situation and determine the best course of action for repayment.
Once the IRS 433-A form is completed, it can be submitted to the IRS either by mail or electronically, depending on the situation. If you are applying for an installment agreement, you may need to send the form along with your application to the appropriate IRS address. It is advisable to keep a copy of the form for your records. If you are working with a tax professional, they may assist in the submission process.
After submission, the IRS will review the information provided on the form. They may contact you for additional information or clarification if needed. The IRS will then determine your eligibility for an installment agreement or an offer in compromise based on your financial situation. You will receive a notification regarding their decision, which may take several weeks. It is important to continue making payments on any outstanding tax debt during this review period to avoid further penalties.
Filling out the IRS 433-A form can be a daunting task. Many individuals make common mistakes that can delay the process or lead to complications. One frequent error is providing inaccurate personal information. Ensure your name, Social Security number, and address are correct. Even a small typo can cause significant issues.
Another mistake is underreporting income. It’s crucial to include all sources of income, including side jobs and freelance work. Omitting any income can raise red flags and potentially lead to penalties. Be thorough and honest when detailing your financial situation.
People often forget to list all assets. This includes bank accounts, real estate, and vehicles. Failing to disclose assets can result in the IRS questioning your financial integrity. Make a comprehensive list to avoid this pitfall.
Some individuals do not provide adequate documentation to support their claims. If you state expenses or debts, be prepared to back them up with receipts or statements. Incomplete documentation can lead to delays in processing your form.
Another common error is miscalculating expenses. Carefully review your monthly expenses and ensure they accurately reflect your financial obligations. Overstating or understating these figures can mislead the IRS and complicate your case.
Additionally, many people neglect to sign and date the form. This simple oversight can result in the form being rejected outright. Always double-check that you have completed all required signatures before submission.
Some filers fail to keep copies of their submitted forms. Retaining a copy is essential for your records and can be invaluable if any questions arise later. Always make sure to save a copy for your files.
Lastly, not following up after submission is a mistake that can have serious consequences. After sending in the IRS 433-A form, monitor your status. If you do not hear back in a reasonable timeframe, reach out to the IRS to ensure everything is in order.
The IRS 433-A form is an important document used by individuals to provide financial information to the IRS, particularly when negotiating payment plans or settling tax debts. Several other forms and documents often accompany it to support the financial disclosures and facilitate the resolution process. Below is a list of these related forms.
These forms and documents work together to create a comprehensive financial profile for the IRS, helping taxpayers navigate their obligations more effectively. Proper preparation and submission of these documents can significantly impact the resolution of tax issues.
The IRS 433-A form is a financial statement used by the Internal Revenue Service to evaluate an individual’s ability to pay tax debts. It collects detailed information about a taxpayer's income, expenses, assets, and liabilities. One document that shares similarities with the 433-A is the Form 1040, the individual income tax return. Both forms require a comprehensive overview of an individual's financial situation. While the 1040 focuses primarily on income for tax calculation, the 433-A digs deeper into financial health, assessing what a taxpayer can realistically afford to pay toward their tax liabilities.
Another document comparable to the IRS 433-A is the IRS Form 9465, which is an application for an installment agreement. This form is used by taxpayers who want to pay their tax debts over time. Like the 433-A, it necessitates a thorough understanding of a taxpayer's financial circumstances. The 9465 requires information about income and expenses, which helps the IRS determine an appropriate payment plan. However, while the 433-A provides a snapshot of overall financial health, the 9465 is more focused on establishing a payment structure for debts.
The IRS Form 433-B is another document that aligns closely with the 433-A. This form is specifically designed for businesses and is used to collect similar financial information. Just as the 433-A assesses an individual’s ability to pay, the 433-B evaluates a business’s financial condition. Both forms aim to provide the IRS with a clear picture of the taxpayer’s financial situation to make informed decisions regarding tax liabilities.
Moving to personal finance, the Financial Disclosure Statement (FDS) is a document often used in various legal contexts, including divorce proceedings. Like the IRS 433-A, the FDS requires a detailed account of an individual’s assets, liabilities, income, and expenses. Both documents serve the purpose of revealing financial realities, although the FDS is typically used in family law to ensure fair settlements, while the 433-A is focused on tax obligations.
The Bankruptcy Schedule I and J are also similar in nature to the IRS 433-A. These forms are part of the bankruptcy filing process and require individuals to disclose their income and expenses. Just as the 433-A helps the IRS assess a taxpayer's ability to pay, Schedules I and J help the bankruptcy court evaluate a debtor's financial situation. Both sets of documents aim to provide a clear financial picture to facilitate appropriate decisions regarding debts.
The Net Worth Statement is another document that can be compared to the IRS 433-A. This financial statement outlines an individual's total assets and liabilities, ultimately revealing their net worth. Like the 433-A, it provides insight into a person's financial health. However, while the 433-A is specifically geared toward tax obligations, the Net Worth Statement is often used in various financial contexts, such as loan applications or estate planning.
Lastly, the Uniform Residential Loan Application (URLA) is a form used when applying for a mortgage. This application requires detailed financial information, including income, assets, and liabilities, similar to the IRS 433-A. Both documents help assess the financial situation of an individual, but the URLA is specifically tailored for lenders to evaluate creditworthiness for a home loan, while the 433-A is focused on tax compliance and payment ability.
When filling out the IRS 433-A form, it's essential to approach the task with care. Here are some key dos and don'ts to keep in mind:
Following these guidelines can help ensure a smoother process when dealing with the IRS.
The IRS 433-A form is often misunderstood. Here are six common misconceptions about this form:
The IRS 433-A form is a crucial document for individuals seeking to negotiate their tax liabilities with the Internal Revenue Service. Here are some key takeaways regarding its use and completion:
Free IRS 433-A Template in PDF