Fillable Form 433-F

What is Form 433-F?

Form 433-F, Collection Information Statement, is a form by the Internal Revenue Service (IRS). The IRS uses it to figure out a taxpayer’s eligibility for payment plants of non-collectible status. Wage-earners and self-employed professionals use it to determine their financial status to check if they can satisfy an outstanding tax liability.

How to fill out Form 433-F?

Form 433-F is a two-page form. Answer it accurately and correctly to avoid any problems with the IRS.

Name and Address 

Enter your full legal name and address.

County of Residence

Enter your county of residence.

Your Social Security Number or Individual Taxpayer Identification Number

Enter your nine-digit Social Security Number (SSN) or Individual Taxpayer Identification Number (TIN).

Your Spouse’s Social Security Number or Individual Taxpayer Identification Number

Enter your spouse’s nine-digit Social Security Number (SSN) or Individual Taxpayer Identification Number (TIN).

Your telephone numbers

Enter your telephone numbers on the space provided, such as your Home, Work, and Cell numbers.

Spouse’s telephone numbers

Enter your spouse’s telephone numbers on the space provided, such as your Home, Work, and Cell numbers.

Enter the number of people in the household who can be claimed on this year’s tax return including you and your spouse. Enter the number based on two categories: Under 65 or 65 and Over.

If you or your spouse are self-employed or have self-employment income, enter the following information:

Enter information only on the succeeding fields if you and your spouse were self-employed.

Name of Business

Enter the legal name of your business.

Business EIN

Enter the Employer Identification Number (EIN) of your business.

Type of Business

Enter the type of business you have.

Number of Employees (not counting owner)

Enter the number of employees, excluding you as the owner.

Section A — Accounts/Lines of Credit

Personal Bank Accounts

Enter all your bank information including checking, online, mobile (e.g., PayPal), savings accounts, and money market accounts.

Name and Address of Institution

Enter the name and address of the financial institution or bank account.

Account Number

Enter your bank account number.

Type of Account

Enter the type of bank account you have.

Current Balance/Value

Enter the current balance or value in your account.

Check if Business Account

Mark the box if the account is a business account

Investments

Enter all the required information on your investments including Certificates of Deposit, Trusts, Individual Retirement Accounts (IRAs), Keogh Plans, Simplified Employee Pensions, 401(k) Plans, Profit Sharing Plans, Mutual Funds, Stocks, Bonds, Commodities (Silver, Gold, etc.), and other investments. If applicable, include business accounts.

Name and Address of Institution

Enter the name and address of the institution you have investments in.

Account Number

Enter your investment account number.

Type of Account

Enter the type of investment account you have.

Current Balance/Value

Enter the current balance or value of your investments.

Check if Business Account

Mark the box if the listed investment is a business account.

Virtual Currency (Cryptocurrency)

Enter all virtual currency you own or in which you have a financial interest (e.g., Bitcoin, Ethereum, Litecoin, Ripple, etc.).

Type of Virtual Currency

Enter the type of virtual currency you own.

Name of Virtual Currency Wallet, Exchange or Digital Currency Exchange (DCE)

Enter the name of the Virtual Currency Wallet, Exchange, or Digital Currency Exchange.

Email Address Used to Set-up With the Virtual Currency Exchange or DCE

Enter the email address you used to set up your wallet or DCE locations.

Location(s) of Virtual Currency

Enter whether it is Mobile Wallet, Online, and/or External Hardware storage.

Virtual Currency Amount and Value in US dollars as of today

Enter the amount of virtual currency and value in US dollars as of today.

Section B — Real Estate

Enter all the required information about the home, vacation property, timeshares, vacant land, and other real estates you own.

Description/Location/County

Enter the description, location, and county of each real estate and identify whether it is a primary residence or other.

Monthly Payment(s)

Enter the amount of monthly payment for the property.

Financing

Enter the year the property was purchased, the year refinanced, the purchase price, and the refinance amount.

Current Value

Enter the current value of the property.

Balance Owed

Enter the owed balance.

Equity

Enter the equity of the property.

Section C — Other Assets

Enter all the required information of your other assets such as cars, boats, recreational vehicles, whole life policies, etc.

Description

Enter the description of the listed asset.

Monthly Payment

Enter the amount of monthly payment for the asset.

Year Purchased

Enter the year the asset was purchased.

Final Payment

Enter the date — month and year — of the final payment.

Current Value

Enter the current value of the asset.

Balance Owed

Enter the balance owed, if there is any.

Equity

Enter the equity of the asset.

Section D — Credit Cards

Enter all credit cards and lines of credit.

Type

Enter the type of credit card you own.

Credit Limit

Enter the credit limit.

Balance Owed

Enter the owed balance. If none, leave it blank.

Minimum Monthly Payment

Enter the minimum monthly payment.

Section E — Business Information

If you or your spouse are self-employed or have self-employment income, fill out this section.

Complete E1 for Accounts Receivable owed to you or your business. Complete E2 if you or your business accepts credit card payment.

E1. Accounts Receivable owed to you or your business

Enter all the Accounts Receivable owed to you or your business including federal, state, and local grants and contracts.

Name

Enter the name of the debtor.

Address

Enter the address of the debtor.

Amount Owed

Enter the owed amount.

List total amount owed from additional sheets

Enter the total amount owed from additional sheets.

Total amount of accounts receivable available to pay to IRS now

Add everything and enter in the space provided.

E2. Name of individual or business on account

If you or your business accepts credit card payments (e.g., Visa, MasterCard, etc.) and/or virtual currency wallet, exchange, or digital currency exchange, fill out this section.

Credit Card (Visa, Master Card, etc.) Issuing Bank Name and Address

Enter your credit card issuing bank’s name and address.

Issuing Bank Name and Address

Enter the name of the issuing bank and its address.

Merchant Account Number

Enter the merchant account number.

Section F — Employment Information

If you or your spouse are wage earners, fill out this section.

Your current Employer (name and address)

Enter your current employer’s name and address.

How often are you paid (check one)

Mark the box to determine how you are paid. You may select Weekly, Biweekly, Semi-monthly, or Monthly.

Gross per pay period

Enter the gross per pay period.

Taxes per pay period (Fed) (State) (Local)

Enter the taxes you pay per period to Fed, State, and Local.

How long at current employer

Enter how long you are working for your current employer.

Spouse’s current Employer (name and address)

Enter your spouse’s current employer’s name and address.

How often are you paid (check one)

Mark the box to determine how your spouse is paid. You may select Weekly, Biweekly, Semi-monthly, or Monthly.

Gross per pay period

Enter your spouse’s gross per pay period.

Taxes per pay period (Fed) (State) (Local)

Enter the taxes your spouse pays per period to Fed, State, and Local.

How long at current employer

Enter how long your spouse is working for his or her current employer.

Section G — Non-Wage Household Income

Enter all the non-wage income you receive monthly.

Alimony Income

Enter your monthly alimony income.

Child Support Income

Enter your monthly child support income.

Net Self Employment Income

Enter your monthly net self-employment income.

Net Rental Income

Enter your monthly net rental income.

Unemployment Income

Enter your monthly unemployment income.

Pension Income

Enter your monthly pension income.

Interest/Dividends Income

Enter your monthly income from interest or dividends.

Social Security Income

Enter your monthly income from Social Security.

Other:

Enter other sources of income and the amount you receive monthly. Also, specify your other source of income.

Section H — Monthly Necessary Living Expenses

Enter the Actual Monthly Expenses and IRS Allowed amount for each category: Food/Personal Care, Transportation, Housing & Utilities, Medical, Other. After listing the amounts, compute for the Total.

Your signature

Affix your signature.

Spouse’s signature

Affix the signature of your spouse.

Date

Enter the date you submitted and completed the form.

Where to submit Form 433-F?

Submit the form to:

Internal Revenue Service

ACS Support

P.O. Box 8209

Philadelphia, PA 19101-8208