Fillable Form 433-B (OIC): Collection Information Statement for Businesses (IRS)

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Form 433-B (OIC): Collection Information Statement for Businesses (IRS)

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Catalog Number 55897B www.irs.gov
Form
433-B (OIC) (Rev. 4-2021)
Form 433-B (OIC)
(April 2021)
Department of the Treasury — Internal Revenue Service
Collection Information Statement for Businesses
Complete this form if your business is a
► Corporation
► Partnership
► Limited Liability Company (LLC) classified as a corporation
► Other LLC
Note: If your business is a sole proprietorship do not use this form. Instead, complete Form 433-A (OIC) Collection Information Statement for
Wage Earners and Self-Employed Individuals. This form should only be used with the Form 656, Offer in Compromise.
Include attachments if additional space is needed to respond completely to any question.
Section 1 Business Information
Business name Employer Identification Number
Business physical address (street, city, state, ZIP code)
Primary phone
( ) -
Secondary phone
( ) -
Business website address
County of business location
Description of business and DBA or "Trade Name"
Business mailing address (if different from above or post office box number)
FAX number
( ) -
Federal contractor
Yes No
Total number of employees
Frequency of tax deposits Average gross monthly payroll
$
Does the business outsource its payroll processing and tax return
preparation for a fee
Yes No
If yes, list provider name and address in box below
(street, city, state, ZIP code)
Provide information about all partners, officers, LLC members, major shareholders (foreign and domestic), etc., associated with the business.
Include attachments if additional space is needed.
Last name First name Title
Percent of ownership and annual salary Social Security Number
- -
Home address (street, city, state, ZIP code)
Primary phone
( ) -
Secondary phone
( ) -
Last name First name Title
Percent of ownership and annual salary Social Security Number
- -
Home address (street, city, state, ZIP code)
Primary phone
( ) -
Secondary phone
( ) -
Last name First name Title
Percent of ownership and annual salary Social Security Number
- -
Home address (street, city, state, ZIP code)
Primary phone
( ) -
Secondary phone
( ) -
Catalog Number 55897B www.irs.gov
Form
433-B (OIC) (Rev. 4-2021)
Page 2
Section 2 Business Asset Information
Gather the most current statement from banks, lenders on loans, mortgages (including second mortgages), monthly payments, loan balances, and
accountant's depreciation schedules, if applicable. Also, include make/model/year/mileage of vehicles and current value of business assets. To estimate
the current value, you may consult resources like Kelley Blue Book (www.kbb.com), NADA (www.nada.com), local real estate postings of properties
similar to yours, and any other websites or publications that show what the business assets would be worth if you were to sell them. Asset value is
subject to adjustment by IRS. Enter the total amount available for each of the following (if additional space is needed, please include attachments).
Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0".
Cash and investments (domestic and foreign)
Cash Checking Savings Money Market Account/CD Online Account Stored Value Card
Bank name Account number
(1a) $
Cash Checking Savings Money Market Account/CD Online Account Stored Value Card
Bank name Account number
(1b) $
Cash Checking Savings Money Market Account/CD Online Account Stored Value Card
Bank name Account number
(1c) $
Total bank accounts from attachment (1d) $
Add lines (1a) through (1d) = (1) $
Investment account Stocks Bonds Other
Name of Financial Institution Account number
Current market value
$ X .8 = $
Minus loan balance
– $
=
(2a) $
Investment Account: Stocks Bonds Other
Name of Financial Institution Account number
Current market value
$ X .8 = $
Minus loan balance
– $
=
(2b) $
Total investment accounts from attachment. [current market value minus loan balance(s)] (2d) $
Add lines (2a) through (2d) = (2) $
Notes Receivable
Do you have notes receivable Yes No
If yes, attach current listing which includes name, age, and amount of note(s) receivable
Accounts Receivable
Do you have accounts receivable, including e-payment, factoring
companies, and any bartering or online auction accounts
Yes No
If yes, provide a list of name, age, and amount of the current accounts receivable
$
=
X .8 = $
=
Current market value in U.S. dollars as of today
(2c) $
Virtual currency
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
Location(s) of virtual
currency
Catalog Number 55897B www.irs.gov
Form
433-B (OIC) (Rev. 4-2021)
Page 3
Section 2 (Continued) Business Asset Information
If the business owns more properties, vehicles, or equipment than shown in this form, please list on a separate attachment.
Real estate (buildings, lots, commercial property, etc.)
Is your real property currently for sale or do you anticipate selling your real property to fund the offer amount
Yes
(listing price)
No
Property address (street address, city,
state, ZIP code, county, and country)
Property description (indicate if rental property, vacant, etc.) Date purchased
Monthly mortgage payment Date of final payment
Name of lender/contract holder
Current market value
$ X .8 = $
Minus loan balance (mortgages, etc.)
– $
Total value of real estate =
(3a) $
Property address (street address, city,
state, ZIP code, county, and country)
Property description (indicate if rental property, vacant, etc.) Date purchased
Monthly mortgage payment Date of final payment
Name of lender/contract holder
Current market value
$ X .8 = $
Minus loan balance (mortgages, etc.)
– $
Total value of real estate =
(3b) $
Total value of property(s) listed from attachment [current market value X .8 minus any loan balance(s)] (3c) $
Add lines (3a) through (3c) = (3) $
Business vehicles (cars, boats, motorcycles, trailers, etc.). If additional space is needed, list on an attachment
Vehicle make & model Year Date purchased Mileage or use hours
Lease
Loan
Name of creditor Date of final payment Monthly lease/loan amount
$
Current market value
$ X .8 = $
Minus loan balance
– $
Total value of vehicle (if the vehicle
is leased, enter 0 as the total value)
=
(4a) $
Vehicle make & model Year Date purchased Mileage or use hours
Lease
Loan
Name of creditor Date of final payment Monthly lease/loan amount
$
Current market value
$ X .8 = $
Minus loan balance
– $
Total value of vehicle (if the vehicle
is leased, enter 0 as the total value)
=
(4b) $
Vehicle make & model Year Date purchased Mileage or use hours
Lease
Loan
Name of creditor Date of final payment Monthly lease/loan amount
$
Current market value
$ X .8 = $
Minus loan balance
– $
Total value of vehicle (if the vehicle
is leased, enter 0 as the total value)
=
(4c) $
Total value of vehicles listed from attachment [current market value X .8 minus any loan balance(s)] (4d) $
Add lines (4a) through (4d) = (4) $
Catalog Number 55897B www.irs.gov
Form
433-B (OIC) (Rev. 4-2021)
Page 4
Section 2 (Continued) Business Asset Information
Other business equipment
[If you have more than one piece of equipment, please list on a separate attachment and put the total of all equipment in box (5b)]
Type of equipment
Current market value
$ X .8 = $
Minus loan balance
– $
Total value of equipment
(if leased or used in the production of
income enter 0 as the total value)
=
(5a) $
Total value of equipment listed from attachment [current market value X .8 minus any loan balance(s)] (5b) $
Total value of all business equipment
Add lines (5a) and (5b) =
(5) $
Do not include amount on the lines with a letter beside the number. Round to the nearest dollar.
Do not enter a negative number. If any line item is a negative number, enter "0" on that line.
Add lines (1) through (5) and enter the amount in Box A =
Box A
Available Equity in Assets
$
Section 3 Business Income Information
Enter the average gross monthly income of your business. To determine your gross monthly income use the most recent 6-12 months documentation of
commissions, invoices, gross receipts from sales/services, etc.; most recent 6-12 months earnings statements, etc., from every other source of income (such as
rental income, interest and dividends, or subsidies); or you may use the most recent 6-12 months Profit and Loss (P&L) to provide the information of income and
expenses.
Note: If you provide a current profit and loss statement for the information below, enter the total gross monthly income in Box B below. Do not
complete lines (6) - (10).
Period provided beginning through
Gross receipts (6) $
Gross rental income (7) $
Interest income (8) $
Dividends (9) $
Other income (specify on attachment)
(10) $
Round to the nearest dollar.
Do not enter a negative number. If any line item is a negative number, enter "0" on that line.
Add lines (6) through (10) and enter the amount in Box B =
Box B
Total Business Income
$
Section 4 Business Expense Information
Enter the average gross monthly expenses for your business using your most recent 6-12 months statements, bills, receipts, or other documents
showing monthly recurring expenses.
Note: If you provide a current profit and loss statement for the information below, enter the total monthly expenses in Box C below. Do not
complete lines (11) - (20).
Period provided beginning through
Materials purchased (e.g., items directly related to the production of a product or service)
(11) $
Inventory purchased (e.g., goods bought for resale)
(12) $
Gross wages and salaries (13) $
Rent (14) $
Supplies (items used to conduct business and used up within one year, e.g., books, office supplies, professional
equipment, etc.)
(15) $
Utilities/telephones (16) $
Vehicle costs (gas, oil, repairs, maintenance)
(17) $
Insurance (other than life)
(18) $
Current taxes (e.g., real estate, state, and local income tax, excise franchise, occupational, personal property,
sales and employer's portion of employment taxes, etc.)
(19) $
Other expenses (e.g., secured debt payments. Specify on attachment. Do not include credit card payments)
(20) $
Round to the nearest dollar.
Do not enter a negative number. If any line item is a negative number, enter "0" on that line.
Add lines (11) through (20) and enter the amount in Box C =
Round to the nearest dollar.
Do not enter a negative number. If any line item is a negative number, enter "0" on that line.
Subtract Box C from Box B and enter the amount in Box D =
Box C
Total Business Expenses
$
Box D
Remaining Monthly Income
$
Catalog Number 55897B www.irs.gov
Form
433-B (OIC) (Rev. 4-2021)
Page 5
Section 5
Calculate Your Minimum Offer Amount
The next steps calculate your minimum offer amount. The amount of time you take to pay your offer in full will affect your minimum offer amount. Paying
over a shorter period of time will result in a smaller minimum offer amount.
If you will pay your offer in 5 or fewer payments within 5 months or less, multiply "Remaining Monthly Income" (Box D) by 12 to get "Future Remaining
Income." Do not enter a number less than zero.
Note: The multipliers below (12 and 24) and the calculated offer amount do not apply if IRS determines you have the ability to pay your tax
debt in full within the legal period to collect.
Round to the nearest whole dollar.
Enter the total from Box D
$
X 12 =
Box E Future Remaining Income
$
If you will pay your offer in 6 to 24 months, multiply "Remaining Monthly Income" (Box D) by 24 to get "Future Remaining Income". Do not enter a
number less than zero.
Enter the total from Box D
$
X 24 =
Box F Future Remaining Income
$
Determine your minimum offer amount by adding the total available assets from Box A to the amount in either Box E or Box F. Your offer amount must
be more than zero.
Enter the amount from Box A*
$
+
Enter the amount from either
Box E or Box F
$
=
Offer Amount
Your offer must be more than zero ($0).
Do not leave blank. Use whole dollars only.
$
You must offer an amount more than $0.
*You may exclude any equity in income producing assets (except real estate) shown in Section 2 of this form.
Section 6 Other Information
Additional information IRS needs to consider settlement of your tax debt. If this business is currently in a bankruptcy proceeding, the
business is not eligible to apply for an offer.
Is the business currently in bankruptcy
Yes No
Has the business filed bankruptcy in the past 10 years
Yes No
If yes, provide
Date filed (mm/dd/yyyy)
Date dismissed or discharged (mm/dd/yyyy)
Petition no. Location filed
Does this business have other business affiliations (e.g., subsidiary or parent companies)
Yes No
If yes, list the name and Employer Identification Number
Do any related parties (e.g., partners, officers, employees) owe money to the business
Yes No
Is the business currently, or in the past, party to litigation
If yes, answer the following
Yes No
If yes and the litigation included tax debt, provide the types of tax and periods involved.
NoYes
Are you or have you been party to litigation involving the IRS/United States (including any tax litigation)
Defendant
Plaintiff
Location of filing Docket/Case numberRepresented by
Possible completion date (mmddyyyy) Subject of litigation
$
Amount in dispute
Catalog Number 55897B www.irs.gov
Form
433-B (OIC) (Rev. 4-2021)
Page 6
Section 7 Signatures
Under penalties of perjury, I declare that I have examined this offer, including accompanying documents, and to the best of my knowledge it
is true, correct, and complete.
►
Signature of Taxpayer Title Date (mm/dd/yyyy)
Remember to include all applicable attachments from the list below.
A current Profit and Loss statement covering at least the most recent 6–12 month period, if appropriate.
Copies of the six most recent complete bank statements for each business account and copies of the three most recent
statements for each investment account.
If an asset is used as collateral on a loan, include copies of the most recent statement from lender(s) on loans, monthly
payments, loan payoffs, and balances.
Copies of the most recent statement of outstanding accounts and notes receivable.
Copies of the most recent statements from lenders on loans, mortgages (including second mortgages), monthly payments, loan
payoffs, and balances.
Copies of relevant supporting documentation of the special circumstances described in the “Explanation of Circumstances” on
Form 656, if applicable.
Attach a Form 2848, Power of Attorney, if you would like your attorney, CPA, or enrolled agent to represent you and you do not
have a current form on file with the IRS. Make sure the current tax year is included.
Completed and current signed Form 656.
In the past 3 years have you transferred any real property (land, house, etc.)
Yes No
If yes, list the type of property, value, and date of the transfer
Has the business been located outside the U.S. for 6 months or longer in the past 10 years
Yes No
Does the business have any funds being held in trust by a third party
Yes No
If yes, how much $ Where
Yes No
Does the business have any lines of credit
If yes, credit limit $ Amount owed $
What property secures the line of credit
Do you have any assets or own any real property outside the U.S.
Yes No
If yes, please provide description, location, and value
In the past 10 years, has the business transferred any assets for less than their full value
Yes No
If yes, provide date, value, and type of asset transferred
Other Information Section 6 (Continued)
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Form 433-B (OIC): Collection Information Statement for Businesses (IRS)

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Completed 4 October 2021

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