Payment Date(s): 1
st
15
th
Other
Do you want automatic payments taken out of your bank account?
Yes
No
Kansas Department of Revenue
PAY PLAN REQUEST FOR INDIVIDUALS
https//www.ksrevenue.org/payplan.html
IMPORTANT: Save time and paper by completing your payment plan application electronically. Go to https://debtpay.kdor.ks.gov/iia
TAXPAYER INFORMATION
Name: SSN:
Spouse Name: Spouse SSN:
Street Address: Daytime phone:
City: State: Zip Code:
Email address:
BALANCE DUE AND PAYMENT TERMS
Amount to be paid each month: $
Date(s)
Enter number of payments: Amount enclosed with this request: $
Tax Type: Periods: Estimated Balance: $
Tax Type:
Periods:
Estimated Balance: $
Tax Type: Periods: Estimated Balance: $
Estimated Total Balance Due $
BANKING INFORMATION Information provided here will not generate an automatic draft.
Bank name:
Street address:
City: State: Zip Code:
9-digit Routing number: Account number:
SIGNATURES
Print this form and sign here:
Signature: Spouse’s Signature:
Printed Name: Printed Name:
CM-15 (Rev. 9-19)
310019
0.00
Instructions for Application
Taxpayer Information: Enter the requested information. If married, you must enter your spouse’s information. Remember
to enter the area code when entering your phone number.
Balance Due and Payment Terms:
Amount to be paid each monthEnter the amount to be paid each month.
Payment Date(s)Check the appropriate payment date. If “Other” is selected, enter the date in which the payment
will be due.
Enter number of payments Based on the estimated balance due and the amount to be paid each month, enter the
number of payments that will be made.
Amount enclosed with this request Enter the amount that you are enclosing with this request. If your payment
plan is approved, the first payment may include an additional $25.00 administration fee for plans exceeding 90 days.
You will receive a payment plan confirmation by mail within 14 days once your request has been processed.
Tax Type, Periods and Estimated BalanceIf you know what tax types, periods and estimated balances are that
make up your total balance due, enter the information. If unknown, enter an amount in the Estimated Total Balance Due
line. If you are sending a payment with the application, enter the amount on the appropriate line.
Employer Information: Enter your employer information. If you are married, enter your spouse’s employer information. Banking
Information:
Enter your bank name and address.
Routing Number The 9-digit number is located on the bottom of your check and is the first set of numbers.
Account Number The account number is located on the bottom of your check and is the last set of numbers.
Automatic Withdrawals Once your payment plan is approved, you can authorize the department to take automatic
withdrawals by answering “Yes” to the automatic payment question. Payment withdrawals will be taken on the dates that you
specified in the “Payment Date(s)” line completed on the application.
Signatures: Your application will not be accepted unless the document is signed. A signature from your spouse is required if
spouse information is contained on the application.
Incomplete or missing information will result in delaying the processing of this request. This form can be faxed to 785-291-3616 or
emailed to kstaxpayplanrequest@kdor.ks.gov or mailed to the below address:
KDOR - Compliance Enforcement
Scott Building
PO Box 3506
Topeka, KS 66601-3506
General Information
The Kansas Department of Revenue may consider a payment plan agreement for taxpayers to resolve their accounts if certain criteria are
met. Taxpayers who are granted a payment plan must file and pay all current and future taxes and estimated payments when due. Any
additional debts not included in the agreement or missed payments will be considered default of the agreement and KDOR may take
immediate enforcement action.
Penalty and interest will continue to accrue during the life of the agreement based upon any unpaid tax. Any refunds or other monies due
to the taxpayer will be applied to the liability, even if the taxpayer is/has made all of their installment payments on time.
A tax warrant must be filed with the District Court for pay plans over 6 months. A tax warrant will also be filed if the Statute of Limitations is
due to expire during the term of the payment plan.
If your payment plan is denied, you will receive instructions from KDOR on how to proceed.
Once a payment plan is set, you may choose from one of the following three options offered by KDOR to pay your tax:
Check or Money Order. If you choose this payment method, be sure to write your Social Security Number on your
check or money order and make it payable to “Kansas Income Tax.”
Direct Payment. When you select Direct Payment, you are giving KDOR permission to initiate a payment electronically
from your bank account. This Direct Payment option is not recurring; you will need to authorize each payment
separately. For more information, visit our web site at https://debtpay.kdor.ks.gov/iia
Credit Card. To pay by credit card you must visit one of the service provider’s websites. A convenience fee will be
charged by the service provider based on the amount of tax you are paying. You can find out what the fee is by visiting
their website: https://officialpayments.com
Wage Assignment. To make payment arrangements utilizing a wage assignment(s) through your employer please call
785-296-6121 for information.