Catalog Number 62053J www.irs.gov
433-F (Rev. 1-2017)
Page 3 of 4
Instructions for Form 433-F, Collection Information Statement
What is the purpose of Form 433F?
Form 433-F is used to obtain current financial information
necessary for determining how a wage earner or self-employed
individual can satisfy an outstanding tax liability.
Note: You may be able to establish an Online Payment
Agreement on the IRS web site. To apply online, go to
https://www.irs.gov, click on “I need to pay my taxes,” and select
“Installment Agreement” under the heading “What if I can't pay
If you are requesting an Installment Agreement, you should
submit Form 9465, Installment Agreement Request, along with
Form 433-F. (A large down payment may streamline the
installment agreement process, pay your balance faster and
reduce the amount of penalties and interest.
Please retain a copy of your completed form and supporting
documentation. After we review your completed form, we may
contact you for additional information. For example, we may ask
you to send supporting documentation of your current income or
substantiation of your stated expenditures.
If any section on this form is too small for the information
you need to supply, please use a separate sheet.
Section A – Accounts / Lines of Credit
List all accounts, even if they currently have no balance.
However, do not enter bank loans in this section. Include
business accounts, if applicable. If you are entering information
for a stock or bond, etc. and a question does not apply, enter N/A.
Section B – Real Estate
List all real estate you own or are purchasing including your
home. Include insurance and taxes if they are included in your
monthly payment. The county/description is needed if different
than the address and county you listed above. To determine
equity, subtract the amount owed for each piece of real estate
from its current market value.
Section C – Other Assets
List all cars, boats and recreational vehicles with their make,
model and year. If a vehicle is leased, write “lease” in the “year
purchased” column. List whole life insurance policies with the
name of the insurance company. List other assets with a
description such as “paintings”, “coin collection”, or “antiques”. If
applicable, include business assets, such as tools, equipment,
inventory, and intangible assets such as domain names, patents,
copyrights, etc. To determine equity, subtract the amount owed
from its current market value. If you are entering information for
an asset and a question does not apply, enter N/A.
List all credit cards and lines of credit, even if there is no balance
Section D – Credit Cards
Section E – Business Information
Complete this section if you or your spouse are self-employed, or
have self-employment income. This includes self-employment
income from online sales.
E1: List all Accounts Receivable owed to you or your business.
Include federal, state and local grants and contracts.
E2: Complete if you or your business accepts credit card
payments (e.g., Visa, MasterCard, etc.).
Section F – Employment Information
Complete this section if you or your spouse are wage earners.
If attaching a copy of current pay stub, you do not need to
complete this section.
Section G – Non-Wage Household Income
List all non-wage income received monthly.
Net Self-Employment Income is the amount you or your
spouse earns after you pay ordinary and necessary monthly
business expenses. This figure should relate to the yearly net
profit from Schedule C on your Form 1040 or your current year
profit and loss statement. Please attach a copy of Schedule C or
your current year profit and loss statement. If net income is a loss,
Net Rental Income is the amount you earn after you pay
ordinary and necessary monthly rental expenses. This figure
should relate to the amount reported on Schedule E of your Form
Do not include depreciation expenses. Depreciation is a non-cash
expense. Only cash expenses are used to determine ability to
If net rental income is a loss, enter “0”.
Other Income includes distributions from partnerships and
subchapter S corporations reported on Schedule K-1, and from
limited liability companies reported on Form 1040, Schedule C, D
or E. It also includes agricultural subsidies, gambling income, oil
credits, and rent subsidies. Enter total distributions from IRAs if
not included under Pension Income.
Section H – Monthly Necessary Living
Enter monthly amounts for expenses. For any expenses not paid
monthly, convert as follows:
If a bill is paid …
Calculate the monthly
amount by …
Quarterly Dividing by 3
Weekly Multiplying by 4.3
Biweekly (every two
Multiplying by 2.17
Multiplying by 2