Fillable Form 9465: Installment Agreement Request (IRS)

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Form 9465: Installment Agreement Request (IRS)

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The Form 9465: Installment Agreement Request (IRS) form is 1 page long and contains:

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  • 61 other fields

Country of origin: US
File type: PDF

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The Internal Revenue Service (IRS) is a government agency responsible for collecting taxes and administering the federal statutory tax laws of the United States. The IRS provide tax assistance to taxpayers and pursue and resolve fraudulent tax filings.

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5
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
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INSTRUCTIONS TO PRINTERS
FORM 9465, PAGE 1 of 4
MARGINS: TOP 13mm (
1
⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216mm (8
1
⁄2 ") 279mm (11")
PERFORATE: (NONE)
OMB No. 1545-0074
Installment Agreement Request
Form 9465
Department of the Treasury
Internal Revenue Service
䊳
If you are filing this form with your tax return, attach it to the
front of the return. Otherwise, see instructions.
1
Your first name and initial Last name
Your social security number
If a joint return, spouse’s first name and initial Last name
Spouse’s social security number
Your current address (number and street). If you have a P.O. box and no home delivery, enter your box number. Apt. number
City, town or post office, state, and ZIP code. If a foreign address, enter city, province or state, and country. Follow the country’s practice for entering the
postal code.
If this address is new since you filed your last tax return, check here
䊳
Your home phone number
Enter the tax year for which you are making this request (for example, 2005)
䊳
Enter the total amount you owe as shown on your tax return (or notice)
Enter the date you want to make your payment each month. Do not enter a date later than the 28th
䊳
Your signature Date Spouse’s signature. If a joint return, both must sign. Date
2
34
()
7
8
9
11
12
Name of your bank or other financial institution:56
Cat. No. 14842Y
(Rev. November 2005)
Form 9465 (Rev. 11-2005)
Best time for us to call Ext.
Your employer’s name:
Address
City, state, and ZIP code
Address
City, state, and ZIP code
Your work phone number
()
Best time for us to call
Enter the amount of any payment you are making with your tax return (or notice). See instructions10
Caution: Do not file this form if you are currently making payments on an installment agreement. Instead, call 1-800-829-1040.
If you are in bankruptcy or we have accepted your offer-in-compromise, see Bankruptcy or offer-in-compromise on
page 2.
If you want to make your payments by electronic funds withdrawal from your checking account, see the instructions and fill in lines 13a
and 13b. This is the most convenient way to make your payments and it will ensure that they are made on time.
13
Enter the amount you can pay each month. Make your payments as large as possible to limit
interest and penalty charges. The charges will continue until you pay in full
General Instructions
11
10
Enter the tax return for which you are making this request (for example, Form 1040)
䊳
I authorize the U.S. Treasury and its designated Financial Agent to initiate a monthly ACH electronic funds withdrawal entry to
the financial institution account indicated for payments of my federal taxes owed, and the financial institution to debit the entry
to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate
the authorization. To revoke payment, I must contact the U.S. Treasury Financial Agent at 1-800-829-1040 no later than 7
business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the
electronic payments of taxes to receive confidential information necessary to answer inquiries and resolve issues related to
the payments.
a
䊳
Routing number
b
䊳
Account number
9
For Privacy Act and Paperwork Reduction Act Notice, see page 3.
Section references are to the Internal Revenue Code.
Guaranteed installment agreement. Your request for an
installment agreement cannot be turned down if the tax you
owe is not more than $10,000 and all three of the following
apply.
Purpose of Form
Use Form 9465 to request a monthly installment plan if you
cannot pay the full amount you owe shown on your tax
return (or on a notice we sent you). Generally, you can have
up to 60 months to pay. In certain circumstances, you can
have longer to pay or your agreement can be approved for
an amount that is less than the amount of tax you owe. But
before requesting an installment agreement, you should
consider other less costly alternatives, such as a bank loan
If you do not wish to enter into an installment agreement
on Form 9465, the IRS offers alternative payment options.
Some of these options that you may qualify for are:
● 120 day extension to pay, and
● Payroll deduction installment ageement.
For information on these and other methods of payment,
call 1-800-829-1040.
or credit card payment. If you have any questions about this
request, call 1-800-829-1040.
5
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
INSTRUCTIONS TO PRINTERS
FORM 9465, PAGE 2 of 4
MARGINS: TOP 13mm (
1
⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216mm (8
1
⁄2 ") 279mm (11")
PERFORATE: (NONE)
Form 9465 (Rev. 11-2005) Page 2
IF you live in . . . THEN use this address . . .
Alabama, Delaware, Florida, Georgia,
North Carolina, Rhode Island, South Carolina,
Virginia
Atlanta, GA
39901
District of Columbia, Maine, Maryland,
Massachusetts, New Hampshire, New York,
Vermont
Andover, MA
05501
Connecticut, Illinois, Indiana, Iowa, Michigan,
Minnesota, Missouri, North Dakota, Ohio,
Wisconsin
Kansas City, MO
64999
New Jersey, Pennsylvania
Philadelphia, PA
19255
Alaska, Arizona, California, Colorado, Hawaii,
Idaho, Montana, Nebraska, Nevada, New
Mexico, Oregon, South Dakota, Utah,
Washington, Wyoming
Fresno, CA
93888
Where To File
Attach Form 9465 to the front of your return and send it to
the address shown in your tax return booklet. If you have
already filed your return or you are filing this form in
response to a notice, file Form 9465 by itself with the Internal
Revenue Service Center at the address below for the place
where you live. No street address is needed.
If you do not make your payments on time or you have an
outstanding past-due amount in a future year, you will be in
default on your agreement and we may take enforcement
After we receive each payment, we will send you a letter
showing the remaining amount you owe, and the due date
and amount of your next payment. But if you choose to have
your payments automatically withdrawn from your checking
account, you will not receive a letter. Your bank statement is
your record of payment. You can also make your payments
by credit card. For details on how to pay, see your tax return
instructions or visit www.irs.gov. We will also send you an
annual statement showing the amount you owed at the
beginning of the year, all payments made during the year,
and the amount you owe at the end of the year.
By approving your request, we agree to let you pay the tax
you owe in monthly installments instead of immediately
paying the amount in full. All payments received will be
applied to your account in the best interests of the United
States. In return, you agree to make your monthly payments
on time. You also agree to meet all your future tax liabilities.
This means that you must have enough withholding or
estimated tax payments so that your tax liability for future
years is paid in full when you timely file your return. Your
request for an installment agreement will be denied if all
required tax returns have not been filed. Any refund due you
in a future year will be applied against the amount you owe.
If your refund is applied to your balance, you are still
required to make your regular monthly installment payment.
You will be charged a $43 fee if your request is approved.
Do not include the fee with this form. After approving your
request, we will bill you for the fee with your first payment.
What Will You Be Charged
You will also be charged interest and may be charged a
late payment penalty on any tax not paid by its due date,
even if your request to pay in installments is granted. Interest
and any applicable penalties will be charged until the balance
is paid in full. To limit interest and penalty charges, file your
return on time and pay as much of the tax as possible with
your return (or notice).
If we approve your request, we will send you a letter. It will
tell you how to pay the fee and make your first installment
payment. We will usually let you know within 30 days after
we receive your request whether it is approved or denied.
But if this request is for tax due on a return you filed after
March 31, it may take us longer than 30 days to reply.
How Does the Installment
Agreement Work
American Samoa, nonpermanent residents
of Guam or the Virgin Islands*, Puerto Rico
(or if excluding income under Internal
Revenue Code Section 933), dual-status
aliens, non-resident aliens, and anyone
filing Form 4563.
* Permanent residents of Guam and the Virgin Islands cannot use
Form 9465.
Arkansas, Kansas, Kentucky, Louisiana,
Mississippi, Oklahoma, Tennessee, Texas,
West Virginia
Austin, TX
73301
● The IRS determines that you cannot pay the tax owed in
full when it is due and you give the IRS any information
needed to make that determination.
● You agree to pay the full amount you owe within 3 years
and to comply with the tax laws while the agreement is in
effect.
A Notice of Federal Tax Lien may be filed to protect
the government’s interests until you pay in full.
Bankruptcy or offer-in-compromise. If you are in
bankruptcy or we have accepted your offer-in-compromise,
do not file this form. Instead, call 1-800-829-1040 to get the
number of your local IRS Insolvency function for bankruptcy
or Technical Support function for offer-in-compromise.
● During the past 5 tax years, you (and your spouse if filing a
joint return) have timely filed all income tax returns and paid
any income tax due, and have not entered into an installment
agreement for payment of income tax.
actions, such as a Notice of Federal Tax Lien or an IRS levy,
to collect the entire amount you owe. To ensure that your
payments are made timely, you should consider making them
by electronic funds withdrawal (see the instructions for lines
13a and 13b).
Line 1
If you are making this request for a joint tax return, show the
names and social security numbers (SSNs) in the same order
as on your tax return.
If the total amount you owe is more than $25,000
(including any amounts you owe from prior years),
complete and attach Form 433-F, Collection
Information Statement. You can get Form 433-F by visiting
the IRS website at www.irs.gov.
Specific Instructions
Line 9
Enter the total amount you owe as shown on your tax return
(or notice).
CAUTION
To find out more about the IRS collection process, see
Pub. 594, The IRS Collection Process.
CAUTION
All APO and FPO addresses, a foreign
country: U.S. citizens and anyone filing
Form 2555 or 2555-EZ.
Philadelphia, PA
19255
USA
Austin, TX
73301
USA
5
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
INSTRUCTIONS TO PRINTERS
FORM 9465, PAGE 3 of 4 (PAGE 4 IS BLANK)
MARGINS: TOP 13mm (
1
⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216mm (8
1
⁄2 ") 279mm (11")
PERFORATE: (NONE)
Form 9465 (Rev. 11-2005) Page 3
Line 11
You should try to make your payments large enough so that
your balance due will be paid off by the due date of your
next tax return.
Line 12
You can choose the date your monthly payment is due. This
can be on or after the 1st of the month, but no later than the
28th of the month. For example, if your rent or mortgage
payment is due on the 1st of the month, you may want to
make your installment payments on the 15th. When we
approve your request, we will tell you the month and date
that your first payment is due.
The average time and expenses required to complete and
file this form will vary depending on individual circumstances.
For the estimated averages, see the instructions for your
income tax return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for
your income tax return.
If we have not replied by the date you chose for your first
payment, you can send the first payment to the Internal
Revenue Service Center at the address shown on page 2
that applies to you. See the instructions for line 10 above to
find out what to write on your payment.
Privacy Act and Paperwork Reduction Act Notice. Our
legal right to ask for the information on this form is sections
6001, 6011, 6012(a), 6109, and 6159 and their regulations.
We will use the information to process your request for an
installment agreement. The reason we need your name and
social security number is to secure proper identification. We
require this information to gain access to the tax information
in our files and properly respond to your request. If you do
not enter the information, we may not be able to process
your request.
Line 13b. The account number can be up to 17 characters
(both numbers and letters). Include hyphens but omit spaces
and special symbols. Enter the number from left to right and
leave any unused boxes blank. On the sample check on this
page, the account number is 20202086. Do not include the
check number.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be
retained as long as their contents may become material in
the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
section 6103. However, we may give this information to the
Department of Justice for civil and criminal litigation, and to
cities, states, and the District of Columbia to carry out their
tax laws. We may also disclose this information to other
countries under a tax treaty, to federal and state agencies to
enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism.
Lines 13a and 13b
To pay by electronic funds withdrawal from your checking
account at a bank or other financial institution (such as
mutual fund, brokerage firm, or credit union), fill in lines 13a
and 13b. Check with your financial institution to make sure
that an electronic funds withdrawal is allowed and to get the
correct routing and account numbers.
Note. We will send you a bill for the first payment and the
fee. All other payments will be electronically withdrawn.
Line 13a. The routing number must be nine digits. The first
two digits of the routing number must be 01 through 12 or
21 through 32. Use a check to verify the routing numbers.
On the sample check on this page, the routing number is
250250025. But if your check is payable through a financial
institution different from the one at which you have your
checking account, do not use the routing numbers on that
check. Instead, contact your financial institution for the
correct routing numbers.
Making your payments by electronic funds withdrawal
will help ensure that your payments are made timely
and that you are not in default of this agreement.
TIP
The electronic funds withdrawal from your checking
account will not be approved unless you (and your
spouse if a joint return) sign Form 9465.
TIP
Do not include
the check number.
1234
SAMPLE
JEFFREY MAPLE
SUZANNE MAPLE
123 Pear Lane
Anyplace, VA 20000
15-0000/0000
PAY TO THE
ORDER OF
$
DOLLARS
ANYPLACE BANK
Anyplace, VA 20000
For
|
:250250025
|
:202020
"’
86
"
.
1234
The routing and account numbers may be in different places on your check.
(line 13a) (line 13b)
Routing
number
Account
number
䊲
䊲
Sample Check—Lines 13a and 13b
TIP
If you are filing this form by itself, such as in response to a
notice, attach a check or money order payable to the “United
States Treasury.” Do not send cash. Be sure to include:
● Your name, address, SSN, and daytime phone number.
● The tax year and tax return (for example, “2005 Form
1040”) for which you are making this request.
Line 10
Even if you cannot pay the full amount you owe now, you
should pay as much as possible to limit penalty and interest
charges. If you are filing this form with your tax return, make
the payment with your return. For details on how to pay, see
your tax return instructions.
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Form 9465: Installment Agreement Request (IRS)

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Completed 17 June 2021

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