Fillable IRS - Form 656B Offer in Compromise

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IRS - Form 656B Offer in Compromise

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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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Form 656 Booklet
Offer in
Compromise
CONTENTS
■ What you need to know................................................................................. 1
■ Paying for your offer ..................................................................................... 3
■ How to apply ................................................................................................ 4
■ Completing the application package ............................................................ 5
■ Important information ................................................................................... 6
■ Removable Forms - Form 433-A (OIC), Collection Information Statement
for Wage Earners and Self-Employed; Form 433-B (OIC), Collection
Information Statement for Businesses; Form 656, Offer in Compromise ..... 7
■ Application Checklist .................................................................................... 29
IRS contact information
If you want to see if you qualify for an offer in compromise before filling out the paperwork, you may use the
Offer in Compromise Pre-Qualifier tool. The questionnaire format assists in gathering the information needed
and provides instant feedback as to your eligibility based on the information you provided. The tool will also
assist you in determining a preliminary offer amount for consideration of an acceptable offer. The Pre-Qualifier
tool is located on our website at www.irs.gov.
If you have questions regarding qualifications for an offer in compromise, please call our toll-free number at
1-800-829-1040. You can get forms and publications by calling 1-800-TAX-FORM (1-800-829-3676), by
visiting your local IRS office, or at www.irs.gov.
Taxpayer resources
The Taxpayer Advocate Service (TAS) is an independent organization within the Internal Revenue Service that
helps taxpayers and protects taxpayer rights. TAS helps taxpayers whose problems with the IRS are causing
financial difficulties, who've tried but haven't been able to resolve their problems with the IRS, or believe an IRS
system or procedure isn't working as it should. And the service is free. Your local advocate's number is in your
local directory and at taxpayeradvocate.irs.gov. You can also call us at 1-877-777-4778. For more information
about TAS and your rights under the Taxpayer Bill of Rights, go to taxpayeradvocate.irs.gov. TAS is your voice
at the IRS.
Low-Income Taxpayer Clinics (LITCs) are independent from the IRS. LITCs serve individuals whose income is
below a certain level and who need to resolve a tax problem with the IRS. LITCs provide professional
representation before the IRS or in court on audits, appeals, tax collection disputes, and other issues for free or
for a small fee. For more information and to find a LITC near you, see the LITC page at
www.taxpayeradvocate.irs.gov/litcmap or IRS Publication 4134, Low-Income Taxpayer Clinic List. This
Publication is also available by calling the IRS toll-free at 1-800-829-3676 or visiting your local IRS office.
WHAT YOU NEED TO KNOW
What is an Offer? An Offer in Compromise (offer) is an agreement between you (the taxpayer) and
the IRS that settles a tax debt for less than the full amount owed. The offer
program provides eligible taxpayers with a path toward paying off their tax debt
and getting a fresh start. The ultimate goal is a compromise that suits the best
interest of both the taxpayer and the IRS. To be considered, generally you must
make an appropriate offer based on what the IRS considers your true ability to
pay.
Submitting an application does not ensure that the IRS will accept your offer.
It begins a process of evaluation and verification by the IRS, taking into
consideration any special circumstances that might affect your ability to pay.
This booklet will lead you through a series of steps to help you calculate an
appropriate offer based on your assets, income, expenses, and future earning
potential. The application requires you to describe your financial situation in detail,
so before you begin, make sure you have the necessary information and
documentation.
Are You Eligible? Before your offer can be considered, you must (1) file all tax returns you are legally
required to file, (2) have received a bill for at least one tax debt included on your
offer, (3) make all required estimated tax payments for the current year, and (4)
make all required federal tax deposits for the current quarter if you are a business
owner with employees. Your offer will be immediately returned without further
consideration if you have not filed all tax returns you are legally required to file.
Note: If it is determined you have not filed all tax returns you are legally
required to file, the IRS will apply any initial payment you sent with your offer
to your tax debt and return both your offer and application fee to you. You
cannot appeal this decision.
Bankruptcy, Open Audit or
Innocent Spouse Claim
If you or your business is currently in an open bankruptcy proceeding, you are not
eligible to apply for an offer. Any resolution of your outstanding tax debts generally
must take place within the context of your bankruptcy proceeding.
If you are not sure of your bankruptcy status, contact the Centralized Insolvency
Operation at 1-800-973-0424. Be prepared to provide your bankruptcy case
number and/or Taxpayer Identification Number.
If you currently have any open audit or outstanding innocent spouse claim,
wait for those issues to be resolved before you submit an offer.
For any additional questions see www.irs.gov. Offer in Compromise FAQs.
Can You Pay in Full? Generally, the IRS will not accept an offer if you can pay your tax debt in full or
through an installment agreement and/or equity in assets.
Note: Adjustments or exclusions, which may be considered during the offer
investigation, such as allowance of $1,000 to a bank balance or $3,450 against the
value of a car, are only applied after it is determined that you cannot pay your tax
debt in full.
Your Future Tax Refunds The IRS will keep any refund, including interest, for tax periods extending through
the calendar year that the IRS accepts the offer. For example, if your offer is
accepted in 2019 and you file your 2019 Form 1040 on April 15, 2020 showing a
refund, the IRS will apply your refund to your tax debt. The refund is not
considered as a payment toward your offer.
1
If you have a legitimate doubt that you owe part or all of the tax debt, complete and
submit a Form 656-L, Offer in Compromise (Doubt as to Liability). The Form
656-L is not included as part of this package. To request a Form 656-L, visit www.
irs.gov or a local IRS office or call toll-free 1-800-TAX-FORM (1-800-829-3676).
Note: Do not submit both a Doubt as to Liability offer and an offer under
Doubt as to Collectibility or Effective Tax Administration at the same time.
Any doubt you owe part or all of the tax debt must be resolved before
sending in an offer based on your ability to pay.
Doubt as to Liability
Notice of Federal Tax Lien A lien is a legal claim against all your current and future property. When you don’t
pay your first bill for taxes due, a lien is created by law and attaches to your
property. A Notice of Federal Tax Lien (NFTL) provides public notice to creditors
and is filed to establish priority of the IRS claim versus the claims of other
creditors. The IRS may file a NFTL while your offer is being considered. You may
be entitled to file an appeal under the Collection Appeal Program (CAP) before this
occurs or request a Collection Due Process hearing after this occurs.
Note: A Notice of Federal Tax Lien (NFTL) will not be filed on any individual shared
responsibility payment under the Affordable Care Act.
Trust Fund Taxes If your business owes trust fund taxes, responsible individuals may be held liable
for the trust fund portion of the tax. Trust fund taxes are the money withheld from
an employee's wages, such as income tax, Social Security, and Medicare taxes.
You are not eligible for consideration of an offer unless the trust fund portion of the
tax is paid or the Trust Fund Recovery Penalty determination(s) has/have been
made on all potentially responsible individual(s). However, if you are submitting the
offer as a victim of payroll service provider fraud or failure, the trust fund
assessment discussed above is not required prior to submitting the offer.
Other Important Facts Each and every taxpayer has a set of fundamental rights they should be aware of
when dealing with the IRS. Explore your rights and our obligations to protect them.
For more information on your rights as a taxpayer, go to http://www.irs.gov/
Taxpayer-Bill-of-Rights.
Penalties and interest will continue to accrue during consideration of your offer.
After you submit your offer, you must continue to timely file and pay all required tax
returns, estimated tax payments, and federal tax payments. Failure to meet your
filing and payment responsibilities during consideration of your offer will result in
your offer being returned. If your offer is accepted, you must continue to stay
current with all tax filing and payment obligations through the fifth year after your
offer is accepted (including any extensions).
Note: If you have filed your tax returns but you have not received a bill for at
least one tax debt included on your offer, your offer and application fee may
be returned and any initial payment sent with your offer will be applied to
your tax debt. Include a complete copy of any tax return filed within 60 days
prior to this offer submission.
An offer cannot be accepted for processing if the IRS has referred your case, or
cases, involving all of the liabilities identified in the offer to the Department of
Justice. In addition, the IRS cannot compromise any tax liability arising from a
restitution amount ordered by a court or a tax debt that has been reduced to
judgment.
The law requires the IRS to make certain information from accepted offers
available for public inspection and review. Instructions to request a public
inspection file can be found on www.irs.gov.
2
PAYING FOR YOUR OFFER
Application Fee Offers require a $186 application fee.
Exception: If you are an individual and meet the Low-Income Certification
guidelines, you are not required to send any money with your offer. You are
considered an individual if you are seeking compromise of a liability for which you
are personally responsible, including any liability you incurred as a sole proprietor
or any Form 941 liability incurred prior to January 1, 2009 as a disregarded single
member LLC.
Payment Options You must select a payment option and include the payment with your offer. The
amount of the initial payment and subsequent payments will depend on the total
amount of your offer and which of the following payment options you choose:
Lump Sum Cash: This option requires 20% of the total offer amount to be paid
with the offer and the remaining balance paid in 5 or fewer payments within 5 or
fewer months of the date your offer is accepted.
Periodic Payment: This option requires the first payment to be paid with the offer
and the remaining balance paid in monthly payments within 6 to 24 months, in
accordance with your proposed offer terms.
Note: Under this option, you must continue to make monthly payments
while the IRS is evaluating your offer. Failure to make these payments, until
you have received a final decision letter, will cause your offer to be returned.
There is no appeal. Total payments must equal the total offer amount.
Exception: If you are an individual and meet the Low-Income Certification
guidelines, you will not be required to send the initial payment or make the
required monthly payments while your offer is being considered.
Generally, payments made on an offer will not be returned. You may make a
deposit, as described in Form 656, Section 5, which may be returned if the offer is
not accepted. If your offer is accepted, your payments made during the offer
process, including any money designated as a deposit, will be applied to your offer
amount.
If you do not have sufficient cash to pay for your offer, you may need to consider
borrowing money from a bank, friends, and/or family. Other options may include
borrowing against or selling other assets. If you are an individual, use the OIC
Pre-Qualifier tool located on our website at www.irs.gov to assist in
determining a starting point for your offer amount.
Note: You may not pay your offer amount with an expected or current tax
refund, money already paid, funds attached by any collection action, or
anticipated benefits from a capital or net operating loss. If you are planning
to use your retirement savings from an IRA or 401k plan, you may have
future tax debt as a result. Contact the IRS or your tax advisor before taking this
action.
3
The IRS may levy your assets up to the time the IRS official signs and
acknowledges your offer as pending. In addition, the IRS may keep any proceeds
received from the levy. If your assets are levied after your offer is submitted and
pending evaluation, immediately contact the IRS person whose name and phone
number are listed on the levy.
If you currently have an approved installment agreement, you will not be required
to make your installment agreement payments while your offer is being
considered. If your offer is not accepted and you have not incurred any additional
tax debt, your installment agreement with the IRS will be reinstated with no
additional fee.
HOW TO APPLY
Application Process
The application must include:
• Form 656, Offer in Compromise
• Completed and signed Form 433-A (OIC), Collection Information Statement for
Wage Earners and Self-Employed Individuals, if applicable
• Completed and signed Form 433-B (OIC), Collection Information Statement for
Businesses, if applicable
• $186 application fee, unless you meet Low-Income Certification
• Initial offer payment based on the payment option you choose, unless you
meet Low-Income Certification
Note: Your offer(s) cannot be considered without the completed and signed Form
433-A (OIC) and/or 433-B (OIC) and supporting documentation.
If You and Your Spouse Owe
Joint and Separate Tax Debts
If you and your spouse have joint tax debt(s) and you and/or your spouse are also
responsible for separate tax debt(s), you will each need to send in a separate
Form 656. You will complete one Form 656 for yourself listing all your joint and any
separate tax debts and your spouse will complete one Form 656 listing all his or
her joint tax debt(s) plus any separate tax debt(s), for a total of two Forms 656.
If you and your spouse or ex-spouse have a joint tax debt and your spouse or ex-
spouse does not want to be part of the offer, you on your own may submit a Form
656 to compromise your responsibility for the joint tax debt.
Each Form 656 will require the $186 application fee and initial payment
unless you are an individual and meet the Low-Income Certification
guidelines. You are considered an individual if you are seeking compromise
of a liability for which you are personally responsible, including any liability
you incurred as a sole proprietor, or any Form 941 liability incurred prior to
January 1, 2009 as a disregarded single member LLC.
If You Owe Individual and
Business Tax Debt
If you have individual and business tax debt that you wish to compromise, you will
need to send in two Forms 656. Complete one Form 656 for your individual tax
debts and one Form 656 for your business tax debts. Each Form 656 will require
the $186 application fee and initial payment.
Note: A business is defined as a corporation, partnership, or any business that is
operated as other than a sole-proprietorship. An individual's share of a partnership
debt will not be compromised. The partnership must submit its own offer based on
the partnership's and partners' ability to pay.
If You Have Tax Debt From a
Limited Liability Company (LLC)
Individuals or individuals operating as a disregarded single member LLC taxed as
a sole proprietor with tax debts (including employment taxes) incurred before
January 1, 2009 may be included on your individual Form 656. However, in those
instances where an LLC incurred employment taxes on or after January 1, 2009 or
excise taxes on or after January 1, 2008, two Forms 656 must be sent with a
separate application fee and initial payment for each offer, even if the tax
debts were reported under the same Tax Identification Number. One Form 656 will
be for the individual tax debts while the second Form 656 will be for the LLC
employment tax debts incurred on or after January 1, 2009 and excise tax debts
on or after January 1, 2008.
4
COMPLETING THE APPLICATION PACKAGE
To calculate an offer amount, you will need to gather information about your
financial situation, including cash, investments, available credit, assets, income,
and debt.
You will also need to gather information about your household's average gross
monthly income and actual expenses. The entire household includes all those in
addition to yourself who contribute money to pay expenses relating to the
household such as, rent, utilities, insurance, groceries, etc. This is necessary for
the IRS to accurately evaluate your offer. It may also be used to determine your
share of the total household income and expenses.
In general, the IRS will not consider expenses for tuition for private schools,
college expenses, charitable contributions, and other unsecured debt payments as
part of the expense calculation.
Step 1 – Gather Your Information
Step 2 – Fill out Form 433-A
(OIC), Collection Information
Statement for Wage Earners and
Self-Employed Individuals
Fill out Form 433-A (OIC) if you are an individual wage earner, or operate or
operated as a sole proprietor, a disregarded single member LLC taxed as a sole
proprietor prior to 2009 or are authorized to submit an offer on behalf of the estate
of a deceased individual. If you are married but living separately from your spouse
then you each must submit a Form 433-A (OIC). This will be used to calculate an
appropriate offer amount based on your assets, income, expenses, and future
earning potential. You will have the opportunity to provide a written explanation of
any special circumstances that affect your financial situation.
Step 3 – Fill out Form 433-B (OIC),
Collection Information Statement
for Businesses
Fill out Form 433-B (OIC) if the business is a Corporation, Partnership, LLC
classified as a corporation, single member LLC taxed as a corporation, or other
multi-owner/multi-member LLC. This will be used to calculate an appropriate offer
amount based on the business assets, income, expenses, and future earning
potential. If the business has assets that are used to produce income (for example,
a tow truck used in the business for towing vehicles), the business may be allowed
to exclude equity in these assets.
Step 4 – Attach Required
Documentation
You will need to attach supporting documentation with Form(s) 433-A (OIC) and
433-B (OIC). A list of the documents required will be found at the end of each
form. Include copies of all required attachments. Do not send original
documents.
Step 5 – Fill out Form 656, Offer
in Compromise
Fill out Form 656. The Form 656 identifies the tax years and type of tax you would
like to compromise. It also identifies your offer amount and the payment terms.
Step 6 – Include Initial Payment
and $186 Application Fee
Include a personal check, cashier's check, or money order for your initial payment
based on the payment option you selected (20% of the offer amount for a lump
sum cash offer or the first month's payment for a periodic payment offer).
Generally, initial payments will not be returned but will be applied to your tax debt if
your offer is not accepted.
Include a separate personal check, cashier's check, or money order for the
application fee ($186).
Make both payments payable to the “United States Treasury”. All payments must
be made in U.S. dollars.
Reminder: If you meet the Low-Income Certification guidelines DO NOT send
any money with your offer since the initial payment and application fee are
not required.
Step 7 – Mail the Application
Package
Make a copy of your application package and keep it for your records.
Mail the completed application package to the appropriate IRS facility. See page
29, Application Checklist, for details.
Note: If you are working with an IRS employee, let him or her know you are
sending or have sent an offer to compromise your tax debt(s).
5
IMPORTANT INFORMATION
After You Mail Your Application: We will contact you after we receive and review your offer application. Promptly
reply to any requests for additional information within the time frame specified.
Failure to reply timely will result in the return of your offer without appeal rights.
If you selected the Periodic Payment option, you must continue to make the
payments during consideration of your offer, unless you meet the Low-Income
Certification. Failure to make monthly payments (until you have received a final
decision letter) will result in the return of your offer without appeal rights.
If your offer is accepted, you must continue to timely file all required tax returns
and timely pay all estimated tax payments and federal tax payments that become
due in the future. If you fail to timely file and timely pay any tax obligations that
become due within the five years after your offer is accepted (including any
extensions) your offer may be defaulted. If your offer is defaulted, you will be liable
for the original tax debt, less payments made, and all accrued interest and
penalties. An offer does not stop the accrual of interest and penalties. Please note
that if your final payment is more than the agreed amount by $50 or less, the
money will not be returned but will be applied to your tax debt. If your final payment
is more than $50 over the agreed amount, then the overpayment will be returned
to you.
In addition, your offer may be defaulted if you fail to promptly pay any tax debts
assessed after acceptance of your offer for any tax years prior to acceptance that
were not included in your original offer.
6
Catalog Number 55896Q www.irs.gov
Form
433-A (OIC) (Rev. 3-2019)
Form 433-A (OIC)
(March 2019)
Department of the Treasury — Internal Revenue Service
Collection Information Statement for Wage Earners and
Self-Employed Individuals
Use this form if you are
► An individual who owes income tax on a Form 1040, U.S.
Individual Income Tax Return
► An individual with a personal liability for Excise Tax
► An individual responsible for a Trust Fund Recovery Penalty
► An individual who is self-employed or has self-employment
income. You are considered to be self-employed if you are in
business for yourself, or carry on a trade or business.
► An individual who is personally responsible for a partnership
liability (only if the partnership is submitting an offer)
► An individual who operated as a disregarded single member
Limited Liability Company (LLC) taxed as a sole proprietor
prior to 2009
► An individual who is submitting an offer on behalf of the estate
of a deceased person
Note: Include attachments if additional space is needed to respond completely to any question. This form should only be used with the Form
656, Offer in Compromise.
Section 1 Personal and Household Information
Last name First name
Date of birth (mm/dd/yyyy)
Social Security Number
- -
Marital status
Unmarried Married
If married, date of marriage (mm/dd/yyyy)
Home physical address (street, city, state, ZIP code)
Do you
Own your home Rent
Other (specify e.g., share rent, live with relative, etc.)
County of residence Primary phone
( ) -
Secondary phone
( ) -
FAX number
( ) -
Home mailing address (if different from above or post office box number)
Provide information about your spouse.
Spouse's last name Spouse's first name Date of birth (mm/dd/yyyy)
Provide information for all other persons in the household or claimed as a dependent.
Name Age Relationship
Claimed as a dependent
on your Form 1040
Contributes to
household income
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Social Security Number
- -
Section 2 Employment Information for Wage Earners
Complete this section if you or your spouse are wage earners and receive a Form W-2. If you or your spouse have self-employment income (that is
you file a Schedule C, E, F, etc.) instead of, or in addition to wage income, you must also complete Business Information in Sections 4, 5, and 6.
Your employer’s name Pay period
Weekly Bi-weekly
Monthly Other
Employer’s address (street, city, state, ZIP code)
Do you have an ownership interest in this
business
Yes No
If yes, check the business interest that
applies
Partner Officer
Sole proprietor
Your occupation How long with this employer
(years) (months)
Spouse’s employer's name Pay period
Weekly Bi-weekly
Monthly Other
Employer’s address (street, city, state, ZIP code)
Does your spouse have an ownership
interest in this business
Yes No
If yes, check the business interest that
applies
Partner Officer
Sole proprietor
Spouse's occupation How long with this employer
(years) (months)
Catalog Number 55896Q www.irs.gov
Form
433-A (OIC) (Rev. 3-2019)
Page 2
Section 3 Personal Asset Information
Use the most current statement for each type of account, such as checking, savings, money market and online accounts, stored value cards (such as a
payroll card from an employer), investment, retirement accounts (IRAs, Keogh, 401(k) plans, stocks, bonds, mutual funds, certificates of deposit) and virtual currency
(such as Bitcoin, Ripple, Ethereum, etc.)
, life insurance policies that have a cash value, and safe deposit boxes. Asset value is subject to adjustment by IRS
based on individual circumstances. Enter the total amount available for each of the following (if additional space is needed 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) $
Checking Savings Money Market Account/CD Online Account Stored Value Card
Bank name Account number
(1b) $
Total of bank accounts from attachment (1c) $
Add lines (1a) through (1c) minus ($1,000) = (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) $
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
$
=
X .8 = $
=
Current market value in U.S. dollars as of today
(2c) $
Retirement account 401K IRA Other
Name of Financial Institution Account number
Current market value
$ X .8 = $
Minus loan balance
– $
=
(3a) $
Total of retirement accounts from attachment. [current market value X .8 minus loan balance(s)] (3b) $
Add lines (3a) through (3b) = (3) $
Note: Your reduction from current market value may be greater than 20% due to potential tax consequences/withdrawal penalties.
Cash value of Life Insurance Policies
Name of Insurance Company Policy number
Current cash value
$
Minus loan balance
– $
=
(4a) $
Total cash value of life insurance policies from attachment
$
Minus loan balance(s)
– $
=
(4b) $
Add lines (4a) through (4b) = (4) $
Catalog Number 55896Q www.irs.gov
Form
433-A (OIC) (Rev. 3-2019)
Page 3
Section 3 (Continued) Personal Asset Information
Real property (enter information about any house, condo, co-op, time share, etc. that you own or are buying)
Property description (indicate if personal residence) Purchase/Lease date (mm/dd/yyyy)
Amount of mortgage/rent payment Date of final payment How title is held (joint tenancy, etc.)
Location (street, city, state, ZIP code, county, and country) Lender/Lessor/Landlord name, address (street, city,
state, ZIP code)
and phone
Current market value
$ X .8 = $
Minus loan balance (mortgages, etc.)
– $
(total value of real estate) = (5a) $
Property description (indicate if personal residence) Purchase/Lease date (mm/dd/yyyy)
Amount of mortgage/rent payment Date of final payment How title is held (joint tenancy, etc.)
Location (street, city, state, ZIP code, county, and country) Lender/Lessor/Landlord name, address (street, city,
state, ZIP code)
and phone
Current market value
$ X .8 = $
Minus loan balance (mortgages, etc.)
– $
(total value of real estate) = (5b) $
Total value of property(s) from attachment [current market value X .8 minus any loan balance(s)] (5c) $
Add lines (5a) through (5c) = (5) $
Vehicles (enter information about any cars, boats, motorcycles, etc. that you own or lease)
Vehicle make & model Year Date purchased Mileage
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)
=
(6a) $
Subtract $3,450 from line (6a)
(If line (6a) minus $3,450 is a negative number, enter "0")
(6b) $
Vehicle make & model Year Date purchased Mileage
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)
=
(6c) $
If you are filing a joint offer, subtract $3,450 from line (6c)
(If line (6c) minus $3,450 is a negative number, enter "0")
If you are not filing a joint offer, enter the amount from line (6c)
(6d) $
Total value of vehicles listed from attachment [current market value X .8 minus any loan balance(s)] (6e) $
Total lines (6b), (6d), and (6e) = (6) $
Catalog Number 55896Q www.irs.gov
Form
433-A (OIC) (Rev. 3-2019)
Page 4
Section 3 (Continued) Personal Asset Information
Other valuable items (artwork, collections, jewelry, items of value in safe deposit boxes, interest in a company or business that is not publicly traded, etc.)
Description of asset(s)
Current market value
$ X .8 = $
Minus loan balance
– $
=
(7a) $
Value of remaining furniture and personal effects (not listed above)
Description of asset
Current market value
$ X .8 = $
Minus loan balance
– $
=
(7b) $
Total value of valuable items listed from attachment [current market value X .8 minus any loan balance(s)] (7c) $
Add lines (7a) through (7c) minus IRS deduction of $9,540 = (7) $
Do not include amount on the lines with a letter beside the number. Round to the nearest whole dollar.
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
Add lines (1) through (7) and enter the amount in Box A =
Box A
Available Individual Equity in Assets
$
NOTE: If you or your spouse are self-employed, Sections 4, 5, and 6 must be completed before continuing with Sections 7 and 8.
Section 4 Self-Employed Information
If you or your spouse are self-employed (e.g., files Schedule(s) C, E, F, etc.), complete this section.
Is your business a sole proprietorship
Yes No
Name of business
Address of business (if other than personal residence)
Business telephone number
( ) -
Employer Identification Number Business website address Trade name or DBA
Description of business Total number of employees Frequency of tax deposits Average gross monthly
payroll $
Do you or your spouse have any other business interests? Include any
interest in an LLC, LLP, corporation, partnership, etc.
Yes
(percentage of ownership: )
Title
No
Business address (street, city, state, ZIP code)
Business name
Business telephone number
( ) -
Employer Identification Number
Type of business (select one)
Partnership LLC Corporation Other
Section 5 Business Asset Information (for Self-Employed)
List business assets such as bank accounts, virtual currency (cryptocurrency), tools, books, machinery, equipment, business vehicles and real property
that is owned/leased/rented. If additional space is needed, attach a list of items. Do not include personal assets listed in Section 3.
Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative number, enter "0".
Cash Checking Savings Money Market Account/CD Online Account Stored Value Card
Bank name Account number
(8a) $
Cash Checking Savings Money Market Account/CD Online Account Stored Value Card
Bank name Account number
(8b) $
Total bank accounts from attachment (8d) $
Add lines (8a) through (8d) = (8) $
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
$
=
X .8 = $
=
Current market value in U.S. dollars as of today
(8c) $
Catalog Number 55896Q www.irs.gov
Form
433-A (OIC) (Rev. 3-2019)
Page 5
Section 5 (Continued) Business Asset Information (for Self-Employed)
Description of asset
Current market value
$ X .8 = $
Minus loan balance
– $
Total value (if leased or used
in the production of income,
enter 0 as the total value)
=
(9a) $
Description of asset:
Current market value
$ X .8 = $
Minus Loan Balance
– $
Total value (if leased or used
in the production of income,
enter 0 as the total value)
=
(9b) $
Total value of assets listed from attachment [current market value X .8 minus any loan balance(s)] (9c) $
Add lines (9a) through (9c) = (9) $
IRS allowed deduction for professional books and tools of trade – (10) $
Enter the value of line (9) minus line (10). If less than zero enter zero. = (11) $
Notes Receivable
Do you have notes receivable Yes No
If yes, attach current listing that includes name(s) 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, you may be asked to provide a list of your account(s) receivable
Do not include amounts from the lines with a letter beside the number [for example: (9c)].
Round to the nearest whole dollar.
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
Add lines (8) and (11) and enter the amount in Box B =
Box B
Available Business Equity in
Assets
$
Section 6 Business Income and Expense Information (for Self-Employed)
If you provide a current profit and loss (P&L) statement for the information below, enter the total gross monthly income on line 17 and your monthly
expenses on line 29 below. Do not complete lines (12) - (16) and (18) - (28). You may use the amounts claimed for income and expenses on your most
recent Schedule C; however, if the amount has changed significantly within the past year, a current P&L should be submitted to substantiate the claim.
Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative number, enter "0".
Business income (you may average 6-12 months income/receipts to determine your gross monthly income/receipts)
Gross receipts (12) $
Gross rental income (13) $
Interest income (14) $
Dividends (15) $
Other income (16) $
Add lines (12) through (16) = (17) $
Business expenses (you may average 6-12 months expenses to determine your average expenses)
Materials purchased (e.g., items directly related to the production of a product or service) (18) $
Inventory purchased (e.g., goods bought for resale) (19) $
Gross wages and salaries (20) $
Rent (21) $
Supplies (items used to conduct business and used up within one year, e.g., books, office supplies, professional equipment, etc.) (22) $
Utilities/telephones (23) $
Vehicle costs (gas, oil, repairs, maintenance) (24) $
Business insurance (25) $
Current business taxes (e.g., real estate, excise, franchise, occupational, personal property, sales and employer's portion of
employment taxes)
(26) $
Secured debts (not credit cards) (27) $
Other business expenses (include a list) (28) $
Add lines (18) through (28) = (29) $
Round to the nearest whole dollar.
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
Subtract line (29) from line (17) and enter the amount in Box C =
Box C
Net Business Income
$
[4,770]
Catalog Number 55896Q www.irs.gov
Form
433-A (OIC) (Rev. 3-2019)
Page 6
Section 7 Monthly Household Income and Expense Information
Enter your household's gross monthly income. The information below is for yourself, your spouse, and anyone else who contributes to
your household's income. The entire household includes spouse, non-liable spouse, significant other, children, and others who
contribute to the household. This is necessary for the IRS to accurately evaluate your offer.
Monthly Household Income
Note: Entire household income should also include income that is considered not taxable and may not be included on your
tax return.
Round to the nearest whole dollar.
Primary taxpayer
Gross wages
$
Social Security
+ $
Pension(s)
+ $
Other income (e.g. unemployment)
+ $
Total primary
taxpayer income =
(30) $
Spouse
Gross wages
$
Social Security
+ $
Pension(s)
+ $
Other Income (e.g. unemployment)
+ $
Total spouse
income =
(31) $
(32) $
Distributions (e.g., income from partnerships, sub-S Corporations, etc.) (34) $
Net rental income (35) $
Net business income from Box C (36) $
Child support received (37) $
Alimony received (38) $
Round to the nearest whole dollar.
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
Add lines (30) through (38) and enter the amount in Box D =
Box D
Total Household Income
$
Food, clothing, and miscellaneous (e.g., housekeeping supplies, personal care products , minimum payment on credit card).
A reasonable estimate of these expenses may be used
(39) $
Housing and utilities (e.g., rent or mortgage payment and average monthly cost of property taxes, home insurance,
maintenance, dues, fees and utilities including electricity, gas, other fuels, trash collection, water, cable television and internet,
telephone, and cell phone)
(40) $
Vehicle loan and/or lease payment(s) (41) $
Vehicle operating costs (e.g., average monthly cost of maintenance, repairs, insurance, fuel, registrations, licenses,
inspections, parking, tolls, etc.)
. A reasonable estimate of these expenses may be used
(42) $
Public transportation costs (e.g., average monthly cost of fares for mass transit such as bus, train, ferry, taxi, etc.). A
reasonable estimate of these expenses may be used (43) $
Health insurance premiums (44) $
Out-of-pocket health care costs (e.g. average monthly cost of prescription drugs, medical services, and medical supplies like
eyeglasses, hearing aids, etc.)
(45) $
Court-ordered payments (e.g., monthly cost of any alimony, child support, etc.) (46) $
Child/dependent care payments (e.g., daycare, etc.) (47) $
Term life insurance premiums (48) $
Current monthly taxes (e.g., monthly cost of federal, state, and local tax, personal property tax, etc.) (49) $
Interest and dividends (33) $
Additional sources of income used to support the household, e.g., non-liable spouse, or anyone else who may
contribute to the household income, etc.
List source(s)
(50) $
Enter the amount of your monthly delinquent state and/or local tax payment(s) (51) $
Round to the nearest whole dollar.
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
Add lines (39) through (51) and enter the amount in Box E =
Box E
Total Household Expenses
$
Round to the nearest whole dollar.
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
Subtract Box E from Box D and enter the amount in Box F =
Box F
Remaining Monthly Income
$
Monthly Household Expenses
Enter your average monthly expenses.
Note: For expenses claimed in boxes (39) and (45) only, you should list the full amount of the allowable standard even if the
actual amount you pay is less. For the other boxes input your actual expenses. You may find the allowable standards at
http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Collection-Financial-Standards.
Round to the nearest whole dollar.
Secured debts (e.g., any loan where you pledged an asset as collateral not previously listed, government guaranteed student
loan)
List debt(s)
Catalog Number 55896Q www.irs.gov
Form
433-A (OIC) (Rev. 3-2019)
Page 7
Section 8 Calculate Your Minimum Offer Amount
If you will pay your offer in 5 or fewer payments within 5 months or less, multiply "Remaining Monthly Income" (Box F) by 12 to get "Future Remaining
Income" (Box G). Do not enter a number less than $0.
Enter the total from Box F
$
X 12 =
Box G Future Remaining Income
$
If you will pay your offer in 6 to 24 months, multiply "Remaining Monthly Income" (Box F) by 24 to get "Future Remaining Income" (Box H). Do not enter
a number less than $0.
Enter the total from Box F
$
X 24 =
Box H Future Remaining Income
$
Determine your minimum offer amount by adding the total available assets from Box A and Box B (if applicable) to the amount in either Box G or Box H.
Enter the amount from Box A
plus Box B (if applicable)
$
+
Enter the amount from either
Box G or Box H
$
=
Offer Amount
Your offer must be more than zero ($0). Do
not leave blank. Use whole dollars only.
$
If you cannot pay the Offer Amount shown above due to special circumstances, explain on the Form 656, Offer in
Compromise, Section 3, Reason for Offer, Explanation of Circumstances. You must offer an amount more than
$0.
Section 9 Other Information
Additional information IRS needs to consider settlement of your tax debt. If you or your business are currently in a bankruptcy proceeding,
you are not eligible to apply for an offer.
Have you filed bankruptcy in the past 7 years (if yes, answer the following)
Yes No
Date filed (mmddyyyy)
Date dismissed (mmddyyyy) Date discharged (mmddyyyy)
Petition no. Location filed
In the past 10 years, have you lived outside of the U.S. for 6 months or longer (if yes, answer the following) Yes No
Dates lived abroad: From (mmddyyyy) To (mmddyyyy)
Are you a party to or involved in litigation (if yes, answer the following) Yes No
Defendant
Plaintiff
Location of filing Docket/Case numberRepresented by
Possible completion date (mmddyyyy) Subject of litigation
$
Amount of dispute
If yes and the litigation included tax debt, provide the types of tax and periods involved
NoYesAre you or have you ever been party to any litigation involving the IRS/United States (including any tax litigation)
Are you a trustee, fiduciary, or contributor of a trust Yes No
EIN
Do you have a safe deposit box (business or personal) (if yes, answer the following) Yes No
Location (name, address and box number(s)) Contents
Value
$
Name of the trust
Are you the beneficiary of a trust, estate, or life insurance policy (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
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.
Note: The multipliers below (12 and 24) and the calculated offer amount (which included the amount(s) allowed for vehicles and bank
accounts) do not apply if the 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.
Yes No
List asset(s)
Value at time of transfer
$
Date transferred (mmddyyyy)
To whom or where was it transferred
In the past 10 years, have you transferred any assets, including real property, for less than their full value (if yes, answer the
following)
Catalog Number 55896Q www.irs.gov
Form
433-A (OIC) (Rev. 3-2019)
Page 8
Section 10 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
Date (mm/dd/yyyy)
►
Signature of Spouse
Date (mm/dd/yyyy)
Remember to include all applicable attachments listed below.
Copies of the most recent pay stub, earnings statement, etc., from each employer.
Copies of the most recent statement for each investment and retirement account.
Copies of the most recent statement, etc., from all other sources of income such as pensions, Social Security, rental income,
interest and dividends (including any received from a related partnership, corporation, LLC, LLP, etc.), court order for child
support, alimony, and rent subsidies.
Copies of individual bank statements for the three most recent months. If you operate a business, copies of the six most recent
statements for each business bank account.
Copies of the most recent statement from lender(s) on loans such as mortgages, second mortgages, vehicles, etc., showing
monthly payments, loan payoffs, and balances.
List of Notes Receivable, if applicable.
Verification of delinquent State/Local Tax Liability showing total delinquent state/local taxes and amount of monthly payments, if
applicable.
Documentation to support any 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.
Completed and signed current Form 656.
Do you have any assets or own any real property outside the U.S. Yes No
If yes, provide description, location, and value
Do you have any funds being held in trust by a third party Yes No
If yes, how much $ Where
Other Information Section 9 (Continued)
Catalog Number 55897B www.irs.gov
Form
433-B (OIC) (Rev. 3-2019)
Form 433-B (OIC)
(March 2019)
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 or was a disregarded single member LLC taxed as a sole proprietor (filing Schedule C, D, E, F,
etc.) prior to 2009, 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. 3-2019)
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, you may be asked to provide a list of name, age, and amount of the account(s) 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. 3-2019)
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.)
Property address (street address, city, state, ZIP
code, county, and country)
Property description Date purchased
Monthly mortgage/rent payment Date of final payment
Name of creditor
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 Date purchased
Monthly mortgage/rent payment Date of final payment
Name of creditor
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. 3-2019)
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). Entire household income should also include income that is considered as not taxable and may not be included on your tax
return.
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).
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. 3-2019)
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. 3-2019)
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 bank statements for each business account and copies of the three most recent statements for
each investment and retirement accounts.
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 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)
Catalog Number 16728N www.irs.gov
Form
656 (Rev. 8-2019)
Form 656
(August 2019)
Offer in Compromise
Department of the Treasury — Internal Revenue Service
►
To: Commissioner of Internal Revenue Service
In the following agreement, the pronoun "we" may be assumed in place of "I" when there are joint liabilities and both parties
are signing this agreement.
I submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and additional amounts
required by law for the tax type and period(s) marked in Section 1 or Section 2 below.
IRS Received Date
Did you use the Pre-Qualifier tool located on our website at http://irs.treasury.gov/oic_pre_qualifier/ prior to filling out this form
Note: The use of the Pre-Qualifier tool is not mandatory before sending in your offer. However, it is recommended.
Yes No
Include the $186 application fee and initial payment (personal check, cashier's check, or money order) with your Form 656 unless you qualify for the low-
income certification. You must also include the completed Form 433-A (OIC) and/or 433-B (OIC) and supporting documentation. You should fill out either
Section 1 or Section 2, but not both, depending on the tax debt you are offering to compromise.
If you are a 1040 filer, an individual with personal liability for Excise tax, individual responsible for Trust Fund Recovery Penalty, self-employed
individual, individual personally responsible for partnership liabilities, and/or an individual who operated as a disregarded single member Limited Liability
Company (LLC) taxed as a sole proprietor prior to 2009 you should fill out Section 1.
Section 1 Individual Information (Form 1040 filers)
Your first name, middle initial, last name Social Security Number (SSN)
- -
If a joint offer, spouse's first name, middle initial, last name Social Security Number (SSN)
- -
Your home physical address (street, city, state, ZIP code, county of residence)
Your home mailing address (if different from above or post office box number)
Is this a new address
Yes No
If yes, would you like us to update our records to this address
Yes No
Your Employer Identification Number (if applicable)
-
Individual Tax Periods (If Your Offer is for Individual Tax Debt Only)
1040 Income Tax-Year(s)
Trust Fund Recovery Penalty as a responsible person of (enter business name)
for failure to pay withholding and Federal Insurance Contributions Act taxes (Social Security taxes), for period(s) ending
941 Employer's Quarterly Federal Tax Return - Quarterly period(s)
940 Employer's Annual Federal Unemployment (FUTA) Tax Return - Year(s)
Other Federal Tax(es) [specify type(s) and period(s)]
Note: If you need more space, use attachment and title it “Attachment to Form 656 dated .” Make sure to sign and date the
attachment.
Warning: The IRS will not compromise any amounts of restitution assessed by the IRS. Any liability arising from restitution is excluded
from this offer.
Catalog Number 16728N www.irs.gov
Form
656 (Rev. 8-2019)
I qualify for the low-income certification because my adjusted gross income is equal to or less than the amount shown in the table below.
I qualify for the low-income certification because my household's size and gross monthly income x 12 is equal to or less than the income shown in
the table below.
Note: By checking one of the boxes you are certifying that your adjusted gross income or your household’s gross monthly income x 12 and
size of your family qualify you for the Low-Income Certification.
Payment - By checking this box I am requesting all money to be applied to my tax debt
Deposit - By checking this box I am requesting all money to be treated as a deposit and returned if my offer is not accepted
Please note that failure to check either box or checking both boxes above will result in all payments being applied to your tax debt and not
returned to you.
Size of family unit 48 contiguous states and D.C. Hawaii Alaska
1 $30,348 $34,896 $37,956
2 $41,148 $47,328 $51,456
3 $51,948 $59,748 $64,956
4 $62,748 $72,180 $78,456
5 $73,548 $84,600 $91,956
6 $84,348 $97,020 $105,456
7 $95,148 $109,452 $118,956
8 $105,948 $121,872 $132,456
For each additional person, add $10,800 $12,420 $13,500
Low-Income Certification (Individuals and Sole Proprietors Only)
Do you qualify for Low-Income Certification? You qualify if your adjusted gross income, as determined by your most recently filed Individual Income Tax
return (Form 1040) or your household’s gross monthly income from Form 433-A(OIC) x 12, is equal to or less than the amount shown in the chart below
based on your family size and where you live. If you qualify, you are not required to submit any payments or the application fee upon submission or
during the consideration of your offer. If your business is other than a sole proprietor or disregarded single member LLC taxed as a sole proprietor and
you owe employment taxes on or after January 1, 2009, you cannot qualify for the waiver. The IRS will verify whether you qualify for low-income
certification.
Business Information (Form 1120, 1065, etc., filers)
Business Tax Periods (If Your Offer is for Business Tax Debt Only)
1120 Income Tax-Year(s)
941 Employer's Quarterly Federal Tax Return - Quarterly period(s)
940 Employer's Annual Federal Unemployment (FUTA) Tax Return - Year(s)
Other Federal Tax(es) [specify type(s) and period(s)]
Note: If you need more space, use attachment and title it “Attachment to Form 656 dated .” Make sure to sign and date the
attachment.
Section 2
If your business is a Corporation, Partnership, LLC, or LLP and you want to compromise those tax debts, you must complete this section. You must also
include all required documentation including the Form 433-B (OIC), and a separate $186 application fee, and initial payment.
Business name
Business physical address (street, city, state, ZIP code)
Business mailing address (street, city, state, ZIP code)
Employer Identification Number
(EIN)
-
Name and title of primary contact Telephone number
( ) -
Page 2
IF YOU QUALIFY FOR THE LOW-INCOME CERTIFICATION DO NOT INCLUDE ANY PAYMENTS WITH YOUR OFFER. However, if you elect to
send in money and the Low-Income Certification box is checked, you MUST check ONE of the options listed below.
Catalog Number 16728N www.irs.gov
Form
656 (Rev. 8-2019)
Section 3
Reason for Offer
Doubt as to Collectibility - I do not have enough in assets and income to pay the full amount
Exceptional Circumstances (Effective Tax Administration) - I owe this amount and have enough in assets and income to pay the full amount,
but due to my exceptional circumstances, requiring full payment would cause an economic hardship or collection of the full liability would
undermine public confidence that the tax laws are being administered in a fair and equitable manner. I am submitting a written narrative explaining
my circumstances
Explanation of Circumstances (Add additional pages, if needed) – The IRS understands that there are unplanned events or special circumstances, such
as serious illness, where paying the full amount or the minimum offer amount might impair your ability to provide for yourself and your family. If this is the
case and you can provide documentation to prove your situation, then your offer may be accepted despite your financial profile. If applicable, describe
your special circumstances below and attach appropriate documents to this offer application
Page 3
Section 4 Payment Terms
Check one of the payment options below to indicate how long it will take you to pay your offer in full. You must
offer more than $0. The offer amount should be in whole dollars only.
▼ ▼
Lump Sum Cash
Check here if you will pay your offer in 5 or fewer payments within 5 or fewer months from the date of acceptance:
Enclose a check for 20% of the offer amount (waived if you met the requirements for Low-Income Certification) and fill in the amount(s) of your
future payment(s).
Total offer amount
-
20% initial payment
=
Remaining balance
$ - $ = $
You may pay the remaining balance in one payment after acceptance of the offer or up to five payments, but cannot exceed 5
months.
Amount of payment $ payable within Month after acceptance
Amount of payment $ payable within Months after acceptance
Amount of payment $ payable within Months after acceptance
Amount of payment $ payable within Months after acceptance
Amount of payment $ payable within Months after acceptance
You must continue to make these monthly payments while the IRS is considering the offer (waived if you met the requirements for Low-
Income Certification)
. Failure to make regular monthly payments until you have received a final decision letter will cause your offer to be
returned with no appeal rights.
Periodic Payment
Check here if you will pay your offer in full in 6 to 24 months
Enter the amount of your offer $
Note: The total months may not exceed a total of 24, including the first payment. Your first payment is considered to be month 1;
therefore, the remainder of the payments must be made within 23 months for a total of 24.
Enclose a check for the first month's payment (waived if you met the requirements for the Low-Income Certification).
The first monthly payment of $ is included with this offer then $ will be sent in on the
day of each month thereafter for a total of months with a final payment of $ to be paid on the
day
of the
month.
IRS Use Only
Attached is an addendum dated (insert date)
setting forth the amended offer amount and payment terms.
1
2
3
4
5
Catalog Number 16728N www.irs.gov
Form
656 (Rev. 8-2019)
Page 4
Section 5 Designation of Payment, Electronic Federal Tax Payment System (EFTPS), and Deposit
Designation of Payment
If you want your payment to be applied to a specific tax year and a specific tax debt, such as a Trust Fund Recovery Penalty, please tell us the tax
year/quarter . If you do not designate a preference, we will apply any money you send to the government's best interest. If you
want to designate any payments not included with this offer, you must designate a preference for each payment at the time the payment is made.
However, you cannot designate the application fee or any payment after the IRS accepts the offer.
Note: Payments submitted with your offer cannot be designated as estimated tax payments for a current or past tax year.
Electronic Federal Tax Payment System (EFTPS)
Did you make your payment through the Electronic Federal Tax Payment System (EFTPS)
Yes No
If yes, provide the amount of your payment(s) $ , the date paid
,
and the 15 digit Electronic Funds Transfer (EFT) Number
.
Note: Any initial payments paid through the EFTPS system must be made the same date your offer is mailed.
Deposit
If you are paying more than the initial payment with your offer and you want any part of that payment treated as a deposit, check the box below
and insert the amount.
My payment of $ includes the $186 application fee and $ for my first month's payment. I am requesting the
additional amount of $ be held as a deposit.
If your offer is rejected, returned, or withdrawn please check one of the boxes below and let us know what you would like us to do with your deposit.
Return it to you (
Initial here
)
Apply it to your tax debt (
Initial here
)
Your deposit will be returned to you, unless you indicated in the above check box that you want it applied to your tax debt.
Section 6
Source of Funds, Making Your Payment, Filing Requirements, and Tax Payment Requirements
Source of Funds
Tell us where you will obtain the funds to pay your offer. You may consider borrowing from friends and/or family, taking out a loan, or selling assets
Making Your Payment
Include separate checks for the payment and application fee.
Make checks payable to the “United States Treasury” and attach to the front of your Form 656, Offer in Compromise. All payments must be in U.S.
dollars. Do not send cash. Send a separate application fee with each offer; do not combine it with any other tax payments, as this may delay
processing of your offer. You may also make payments through the Electronic Federal Tax Payment System (EFTPS). Your offer will be returned to
you if the application fee and the required payment are not included, or if your check is returned for insufficient funds.
Filing Requirements
I have filed all required tax returns and have included a complete copy of any tax return filed within 60 days prior to this offer submission
I was not required to file a tax return for the following years
Note: Do not include original tax returns with your offer. You must either electronically file your tax return or mail it to the appropriate
IRS processing office before sending in your offer.
Tax Payment Requirements (check all that apply)
I have made all required estimated tax payments for the current tax year
I am not required to make any estimated tax payments for the current tax year
I have made all required federal tax deposits for the current quarter
I am not required to make any federal tax deposits for the current quarter
CAUTION: Do NOT designate the amounts sent in with your offer to cover the initial payment and application fee as "deposits." Doing so will
result in the return of your offer without appeal rights.
Catalog Number 16728N www.irs.gov
Form
656 (Rev. 8-2019)
Page 5
Section 7
Offer Terms
By submitting this offer, I have read, understand and agree to the following terms and conditions:
a) I request that the IRS accept the offer amount listed in this offer application as payment of my outstanding tax
debt (including interest, penalties, and any additional amounts required by law) as of the date listed on this form. I
authorize the IRS to amend Section 1 and/or Section 2 if I failed to list any of my assessed tax debt or tax debt
assessed before acceptance of my offer. By submitting a joint offer, both signers grant approval to the Internal
Revenue Service to disclose the existence of any separate liabilities owed.
Terms, Conditions, and Legal
Agreement
b) I also authorize the IRS to amend Section 1 and/or Section 2 by removing any tax years on which there is
currently no outstanding liability. I understand that my offer will be accepted, by law, unless IRS notifies me
otherwise, in writing, within 24 months of the date my offer was received by IRS. I also understand that if any tax
debt that is included in the offer is in dispute in any judicial proceeding it/they will not be included in determining
the expiration of the 24-month period.
c) I voluntarily submit the payments made on this offer and understand that they will not be returned even if I
withdraw the offer or the IRS rejects or returns the offer except as otherwise provided in subpart (h) of this section
(regarding “deposit” amounts) or subpart (i) of this section. Unless I designate how to apply each required
payment in Section 5, the IRS will apply my payment in the best interest of the government, choosing which tax
years and tax debts to pay off. The IRS will also keep my application fee unless the offer is not accepted for
processing.
IRS will keep my payments,
fees, and some refunds.
d) I understand that if I checked the Low-Income Certification in Section 1, then no payments are required. If I
qualify for the Low-Income Certification and voluntarily submit payments, all money will be applied to my tax debt
and will not be returned to me unless l designate it as a deposit. In making my deposit I do not have to designate
any amounts to the application fee and my first month’s payment.
e) The IRS will keep any refund, including interest, that I might be due for tax periods extending through the
calendar year in which the IRS accepts my offer. I cannot designate that the refund be applied to estimated tax
payments for the following year or the accepted offer amount. If I receive a refund after I submit this offer for any
tax period extending through the calendar year in which the IRS accepts my offer, I will return the refund within 30
days of notification. The refund offset does not apply to offers accepted under the provisions of Effective Tax
Administration or Doubt as to Collectibility with special circumstances based on public policy/equity
considerations.
f) I understand that the amount I am offering may not include part or all of an expected or current tax refund,
money already paid, funds attached by any collection action, or anticipated benefits from a capital or net operating
loss.
g) The IRS will keep any monies it has collected prior to this offer. Under section 6331(k) the IRS may levy up to
the time that the IRS official signs and acknowledges my offer as pending, which is accepted for processing and
the IRS may keep any proceeds arising from such a levy. No levy will be issued on individual shared responsibility
payments. However, if the IRS served a continuous levy on wages, salary, or certain federal payments under
sections 6331(e) or (h), then the IRS could choose to either retain or release the levy.
h) The IRS will keep any payments that I make related to this offer. I agree that any funds submitted with this offer
will be treated as a payment unless I checked the box to treat any amount more than the required initial payment
as a deposit. For other than Low-Income taxpayers, only amounts that exceed the mandatory payments can be
treated as a deposit. A Low-Income taxpayer who has checked the deposit box is not required to make payments
with the offer. I also agree that any funds submitted with periodic payments made after the submission of this offer
and prior to the acceptance, rejection, or return of this offer will be treated as payments, unless I identify the
amount more than the required payment as a deposit on the check submitted with the corresponding periodic
payment. A deposit will be returned if the offer is rejected, returned, or withdrawn. I understand that the IRS will
not pay interest on any deposit. If the IRS attempts to return a deposit once and it comes back as undeliverable
then the IRS will apply the funds to my tax liability.
i) If my offer is accepted and my final payment is more than the agreed amount by $50 or less, the IRS will not
return the difference, but will apply the entire payment to my tax debt. If my final payment exceeds the agreed
amount by more than $50, the IRS will return the excess payment to me.
j) Once an authorized IRS official signs this form, my offer is considered pending as of that signature date and it
remains pending until the IRS accepts, rejects, returns, or I withdraw my offer. An offer is also considered pending
for 30 days after any rejection of my offer by the IRS, and during the time that any rejection of my offer is being
considered by the Appeals Office. An offer will be considered withdrawn when the IRS receives my written
notification of withdrawal by personal delivery or certified mail or when I inform the IRS of my withdrawal by other
means and the IRS acknowledges in writing my intent to withdraw the offer.
Pending status of an offer and
right to appeal
k) I waive the right to an Appeals hearing if I do not request a hearing in writing within 30 days of the date the IRS
notifies me of the decision to reject the offer.
Catalog Number 16728N www.irs.gov
Form
656 (Rev. 8-2019)
Page 6
Section 7 (Continued) Offer Terms
l) I will comply with all provisions of the internal revenue laws, including requirements to timely file tax returns and
timely pay taxes for the five year period beginning with the date of acceptance of this offer and ending through the
fifth year, including any extensions to file and pay. I agree to promptly pay any liabilities assessed after
acceptance of this offer for tax years ending prior to acceptance of this offer that were not otherwise identified in
Section 1 or Section 2 of this agreement. I also understand that during the five year period I cannot request an
installment agreement for unpaid taxes incurred before or after the accepted offer. If this is an offer being
submitted for joint tax debt, and one of us does not comply with future obligations, only the non-compliant
taxpayer will be in default of this agreement. An accepted offer will not be defaulted solely due to the assessment
of an individual shared responsibility payment.
I must comply with my future
tax obligations and understand
I remain liable for the full
amount of my tax debt until all
terms and conditions of this
offer have been met.
m) I agree that I will remain liable for the full amount of the tax liability, accrued penalties and interest, until I have
met all of the terms and conditions of this offer. Penalty and interest will continue to accrue until all payment terms
of the offer have been met. If I file for bankruptcy before the terms and conditions of the offer are met, I agree that
the IRS may file a claim for the full amount of the tax liability, accrued penalties and interest, and that any claim
the IRS files in the bankruptcy proceeding will be a tax claim.
n) Once the IRS accepts my offer in writing, I have no right to challenge the tax debt(s) in court or by filing a
refund claim or refund suit for any liability or period listed in Section 1 or Section 2, even if the IRS defaults the
offer.
o) If I fail to meet any of the terms of this offer, the IRS may revoke the certificate of release of federal tax lien and
file a new notice of federal tax lien; levy or sue me to collect any amount ranging from one or more missed
payments to the original amount of the tax debt (less payments made) plus penalties and interest that have
accrued from the time the underlying tax liability arose. The IRS will continue to add interest, as required by
section 6601 of the Internal Revenue Code, on the amount the IRS determines is due after default. Shared
responsibility payments are excluded from levy.
I understand what will happen if
I fail to meet the terms of my
offer (e.g., default).
p) To have my offer considered, I agree to the extension of the time limit provided by law to assess my tax debt
(statutory period of assessment). I agree that the date by which the IRS must assess my tax debt will now be the
date by which my debt must currently be assessed plus the period of time my offer is pending plus one additional
year if the IRS rejects, returns, or terminates my offer or I withdraw it. (Paragraph (j) of this section defines
pending and withdrawal.) I understand that I have the right not to waive the statutory period of assessment or to
limit the waiver to a certain length or certain periods or issues. I understand, however, that the IRS may not
consider my offer if I refuse to waive the statutory period of assessment or if I provide only a limited waiver. I also
understand that the statutory period for collecting my tax debt will be suspended during the time my offer is
pending with the IRS, for 30 days after any rejection of my offer by the IRS, and during the time that any rejection
of my offer is being considered by the Appeals Office.
I agree to waive time limits
provided by law.
q) The IRS may file a Notice of Federal Tax Lien during consideration of the offer or for offers that will be paid
over time. If the offer is accepted, the tax lien will be released within 30 days of when the payment terms have
been satisfied and the payment has been verified. The time it takes to transfer funds to the IRS from commercial
institutions varies based on the form of payment. The IRS will not file a Notice of Federal Tax Lien on any
individual shared responsibility debt.
I understand the IRS may file a
Notice of Federal Tax Lien on
my property.
r) I authorize the IRS, to correct any typographical or clerical errors or make minor modifications to my/our Form
656 that I signed in connection to this offer.
Correction Agreement
s) By authorizing the IRS to contact third parties, I understand that I will not be notified of which third parties the
IRS contacts as part of the offer application process, including tax periods that have not been assessed, as stated
in §7602 (c ) of the Internal Revenue Code. In addition, I authorize the IRS to request a consumer report on me
from a credit bureau.
I authorize the IRS to contact
relevant third parties in order to
process my offer.
t) I understand if the liability sought to be compromised is the joint and individual liability of myself and my co-
obligor(s) and I am submitting this offer to compromise my individual liability only, then if this offer is accepted, it
does not release or discharge my co-obligor(s) from liability. The United States still reserves all rights of collection
against the co-obligor(s).
I am submitting an offer as an
individual for a joint liability.
u) If your offer includes any shared responsibility payment (SRP) amount that you owe for not having minimum
essential health coverage for you and, if applicable, your dependents per Internal Revenue Code Section 5000A
- Individual shared responsibility payment, it is not subject to penalties (except applicable bad check penalty) or to
lien and levy enforcement actions. However, interest will continue to accrue until you pay the total SRP balance
due. We may apply your federal tax refunds to the SRP amount that you owe until it is paid in full.
I understand the IRS Shared
Responsibility Payment (SRP).
v) The IRS is required to make certain information, such as taxpayer name, city/state/zip, liability amount, and
offer terms, available for public inspection and review for one year after the date of offer acceptance.
I understand the IRS is required
to make certain information
public.
Catalog Number 16728N www.irs.gov
Form
656 (Rev. 8-2019)
Page 7
Section 8 Signatures
Under penalties of perjury, I declare that I have examined this offer, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct and complete.
►
Signature of Taxpayer/Corporation Name
Phone number
Today's date (mm/dd/yyyy)
By checking this box you are authorizing the IRS to contact you at the telephone number listed above and leave detailed messages concerning
this offer on your voice mail or answering machine.
►
Signature of Spouse/Authorized Corporate Officer
Phone number Today's date (mm/dd/yyyy)
By checking this box you are authorizing the IRS to contact you at the telephone number listed above and leave detailed messages concerning
this offer on your voice mail or answering machine.
Section 9
Paid Preparer Use Only
Signature of Preparer Phone number Today's date (mm/dd/yyyy)
By checking this box you are authorizing the IRS to contact you at the telephone number listed above and leave detailed messages concerning
this offer on your voice mail or answering machine.
Name of Paid Preparer Preparer's CAF no. or PTIN
Firm's name (or yours if self-employed), address, and ZIP code
If you would like to have someone represent you during the offer investigation, attach a valid, signed Form 2848 with this application or a
copy of a previously filed form. Form 2848 allows for representation and receipt of confidential information. You should also include the
current tax year on the form, in the list of applicable years or periods.
We ask for the information on this form to carry out the internal revenue laws of the United States. Our authority to request this information is section §
7801 of the Internal Revenue Code.
Our purpose for requesting the information is to determine if it is in the best interests of the IRS to accept an offer. You are not required to make an offer;
however, if you choose to do so, you must provide all of the taxpayer information requested. Failure to provide all of the information may prevent us from
processing your request.
If you are a paid preparer and you prepared the Form 656 for the taxpayer submitting an offer, we request that you complete and sign Section 9 on Form
656, and provide identifying information. Providing this information is voluntary. This information will be used to administer and enforce the internal
revenue laws of the United States and may be used to regulate practice before the Internal Revenue Service for those persons subject to Treasury
Department Circular No. 230, Regulations Governing the Practice of Attorneys, Certified Public Accountants, Enrolled Agents, Enrolled Actuaries, and
Appraisers before the Internal Revenue Service. Information on this form may be disclosed to the Department of Justice for civil and criminal litigation.
We may also disclose this information to cities, states and the District of Columbia for use in administering their tax laws and to combat terrorism.
Providing false or fraudulent information on this form may subject you to criminal prosecution and penalties.
Privacy Act Statement
Form 8821 allows a third party to receive confidential information but they cannot represent you before the IRS in a Collection matter. If you
would like a third party to receive confidential information on your behalf attach a copy if previously filed and include the current tax year on
the form.
IRS Use Only. I accept the waiver of the statutory period of limitations on assessment for the Internal Revenue Service, as described in Section 7(p).
Signature of Authorized Internal Revenue Service Official Title Date (mm/dd/yyyy)
APPLICATION CHECKLIST
Review the entire application using the Application Checklist below. Include this checklist with your application.
Forms 433-A (OIC),
433-B (OIC), and 656
Did you complete all fields and sign all forms
Did you make an offer amount that is equal to the offer amount calculated on
the Form 433-A (OIC) or Form 433-B (OIC)? If not, did you describe the
special circumstances that are leading you to offer less than the minimum in
the “Explanation of Circumstances” Section 3 of Form 656, and did you
provide supporting documentation of the special circumstances
Have you filed all required tax returns and received a bill or notice of balance
due
Did you include a complete copy of any tax return filed within 60 days prior to
this offer submission
Did you select a payment option on Form 656
Did you sign and attach the Form 433-A (OIC), if applicable
Did you sign and attach the Form 433-B (OIC), if applicable
Did you sign and attach the Form 656
If you are making an offer that includes business and individual tax debts, did
you prepare a separate Form 656 package (including separate financial
statements, supporting documentation, application fee, and initial payment)
Supporting documentation
and additional forms
Did you include photocopies of all required supporting documentation
If you want a third party to represent you and receive confidential information
during the offer process, did you include a Form 2848? If you want a third
party to only receive confidential information on your behalf did you include
valid Form 8821? Does it include the current tax year
Did you provide a letter of testamentary or other verification of person(s)
authorized to act on behalf of the estate or deceased individual
Payment
Did you include a check or money order made payable to the “United States
Treasury” for the initial payment? (Waived if you meet Low-Income
Certification guidelines—see Form 656)
Did you include a separate check or money order made payable to the
“United States Treasury” for the $186 application fee? (Waived if you meet
Low-Income Certification guidelines—see Form 656)
Mail your application package to
the appropriate IRS facility
Mail the Form 656, 433-A (OIC) and/or 433-B (OIC), and related financial
document(s) to the appropriate IRS processing office for your state. You may wish
to send it by Certified Mail so you have a record of the date it was mailed.
If you reside in: Mail your application to:
AL, AR, FL, GA, HI, ID, KY, LA, MS, NC, NM, NV, OK, OR,
TN, TX, WA, WI
Memphis IRS Center COIC Unit
P.O. Box 30803, AMC
Memphis, TN 38130-0803
1-844-398-5025
AK, AZ, CA, CO, CT, DE, IA, IL, IN, KS, MA, MD, ME, MI,
MN, MO, MT, ND, NE, NH, NJ, NY, OH, PA, RI, SC, SD,
UT, VT, VA, WY, WV; DC, PR, or a foreign address
Brookhaven IRS Center COIC Unit
P.O. Box 9007
Holtsville, NY 11742-9007
1-844-805-4980
29
Form 656-B (Rev. 8-2019)
Catalog Number 52133W www.irs.gov Department of the Treasury - Internal Revenue Service
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IRS - Form 656B Offer in Compromise

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Completed 24 May 2020

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