IRS · Official form

Form 433-B, Collection Information Statement for Businesses

Form 433-B gives the IRS a full financial picture of a business that owes federal tax. Fill in the official PDF below and download it for your collection case.

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What is 433-B?

Form 433-B, Collection Information Statement for Businesses, is the financial disclosure the IRS requests when a business owes tax and is working out how to pay it. It asks for the business structure, bank and investment accounts, accounts receivable, real and personal property, income, and monthly operating expenses so the IRS can judge what the business can realistically pay.

An IRS revenue officer typically uses the completed 433-B to evaluate an installment agreement, a temporary delay in collection, or another payment alternative. A separate version, Form 433-B (OIC), exists specifically for businesses applying for an offer in compromise.

Who files 433-B?

Corporations, partnerships, and LLCs that owe federal tax and are asked for financial information by an IRS revenue officer
Businesses requesting an installment agreement that requires full financial disclosure
Businesses asking the IRS to report their account as currently not collectible
Sole proprietors are usually asked for Form 433-A instead; confirm with the IRS employee handling your case

How to fill out 433-B

Fill in Section 1 with the business name, address, EIN, type of entity, and contact details.
List the people responsible for the business (partners, officers, major shareholders) in Section 2.
Report all bank accounts, lines of credit, accounts receivable, and business assets, using current values and loan balances.
Complete the monthly income and expense statement with figures you can back up with records.
Download the finished PDF, attach the documentation the form lists, sign it, and send it to the IRS office or revenue officer that requested it.

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These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to IRS.

Page 1 103 fields

Page 2 64 fields

Page 3 82 fields

Page 3. Section 4: Business Asset and Liability Information. ACCOUNTS / NOTES RECEIVABLE. Include e-payment accounts receivable and

Row: 18a. Column: Name and Address (Street, City, State, Z I P code). Contact Name.

Row: 18a. Column: Name and Address (Street, City, State, Z I P code). Phone.

Row: 18a. Column: Status (for example, age, factored, other).

Row: 18a. Column: Date Due (m m d d y y y y).

Row: 18a. Column: Invoice Number or Government Grant or Contract Number.

Row: 18a. Column: Amount Due.

Row: 18b. Column: Name and Address (Street, City, State, Z I P code).

Row: 18b. Column: Name and Address (Street, City, State, Z I P code). Contact Name.

Row: 18b. Column: Name and Address (Street, City, State, Z I P code). Phone.

Row: 18b. Column: Status (for example, age, factored, other).

Row: 18b. Column: Date Due (m m d d y y y y).

Row: 18b. Column: Invoice Number or Government Grant or Contract Number.

Row: 18b. Column: Amount Due.

Row: 18c. Column: Name and Address (Street, City, State, Z I P code).

Row: 18c. Column: Name and Address (Street, City, State, Z I P code). Contact Name.

Row: 18c. Column: Name and Address (Street, City, State, Z I P code). Phone.

Row: 18c. Column: Status (for example, age, factored, other).

Row: 18c. Column: Date Due (m m d d y y y y).

Row: 18c. Column: Invoice Number or Government Grant or Contract Number.

Row: 18c. Column: Amount Due.

Row: 18d. Column: Name and Address (Street, City, State, Z I P code).

Row: 18d. Column: Name and Address (Street, City, State, Z I P code). Contact Name.

Row: 18d. Column: Name and Address (Street, City, State, Z I P code). Phone.

Row: 18d. Column: Status (for example, age, factored, other).

Row: 18d. Column: Date Due (m m d d y y y y).

Row: 18d. Column: Invoice Number or Government Grant or Contract Number.

Row: 18d. Column: Amount Due.

Row: 18e. Column: Name and Address (Street, City, State, Z I P code).

Row: 18e. Column: Name and Address (Street, City, State, Z I P code). Contact Name.

Row: 18e. Column: Status (for example, age, factored, other).

Row: 18e. Column: Date Due (m m d d y y y y).

Row: 18e. Column: Invoice Number or Government Grant or Contract Number.

Row: 18e. Column: Amount Due.

18f. Outstanding Balance (Add lines 18a through 18e and amounts from any attachments).

INVESTMENTS. List all investment assets below. Include stocks, bonds, mutual funds, stock options, certificates of deposit, commodities

Row: 19a. Column: Name of Company and Address (Street, City, State, Z I P code). Phone.

Row: 19a. Column: Used as collateral on loan. Yes.

Row: 19a. Column: Used as collateral on loan. No.

Row: 19a. Column: Current Value.

Row: 19a. Column: Loan Balance.

Row: 19a. Column: Equity. Value Minus Loan.

Row: 19b. Column: Name of Company and Address (Street, City, State, Z I P code).

Row: 19b. Column: Name of Company and Address (Street, City, State, Z I P code). Phone.

Row: 19b. Column: Used as collateral on loan. Yes.

Row: 19b. Column: Used as collateral on loan. No.

Row: 19b. Column: Current Value.

Row: 19b. Column: Loan Balance.

Row: 19a. Column: Equity. Value Minus Loan.

19c. Total Investments (Add lines 19a, 19b, and amounts from any attachments).

20a. List the name(s) of individuals who have access to the private key(s) and/or digital wallets.

Digital Asset Amount and Value in US dollars as of (mmddyyyy).

Row: 14d. Column: Type of Digital Asset.

Row: 14d. Column: Name of Digital Asset such as Virtual Currency Wallet, Exchange or Digital Currency Exchange (D C E).

Row: 14d. Column: Email Address Used to Set-up With the Digital Assets such as Virtual Currency Exchange or D C E.

Yes

Row: 14d. Column: Digital Asset Amount and Value in U S dollars (e.g., 1 Bitcoins $38,000.00 U S D). $.

Row: 14e. Column: Type of Digital Asset.

Row: 14e. Column: Name of Digital Asset such as Virtual Currency Wallet, Exchange or Digital Currency Exchange (D C E).

Row: 14e. Column: Email Address Used to Set-up With the Digital Assets such as Virtual Currency Exchange or D C E.

Yes

Row: 14e. Column: Digital Asset Amount and Value in U S dollars (e.g., 1 Bitcoins $38,000.00 U S D). $.

14f. Total Equity (Add lines 14a, 14b, 14d and 14e. Also include any amounts from any attachments to your total equity). $.

Available Credit. Include all lines of credit and credit cards. Amount Owed as of (m m d d y y y y).

Available Credit as of (m m d d y y y y).

Row: 21a. Column: Full Name and Address (Street, City, State, Z I P code).

Row: 21a. Column: Full Name and Address (Street, City, State, Z I P code). Account number.

Row: 21a. Column: Credit Limit.

Row: 21a. Column: Amount Owed.

Row: 21a. Column: Available Credit.

Row: 21b. Column: Full Name and Address (Street, City, State, Z I P code).

Row: 21b. Column: Full Name and Address (Street, City, State, Z I P code). Account number.

Row: 21b. Column: Credit Limit.

Row: 21b. Column: Amount Owed.

Row: 21b. Column: Available Credit.

Page 4 94 fields

Business Asset and Liability Information. Real Property. Include all real property and land contracts the business owns / leases / rents.

22a. Purchase/Lease Date (m m d d y y y y).

22a. Current Fair Market Value (F M V).

22a. Current Loan Balance.

22a. Amount of Monthly Payment.

22a. Date of Final Payment(m m d d y y y y).

22a. Equity. F M V Minus Loan.

22a. Location (Street, City, State, ZIP code) and County.

22a. Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone.

22a. Phone.

22b. Property Description.

22b. Purchase/Lease Date (m m d d y y y y).

22b. Current Fair Market Value (F M V).

22b. Current Loan Balance.

22b. Amount of Monthly Payment.

22b. Date of Final Payment(m m d d y y y y).

22b. Equity. F M V Minus Loan.

22b. Location (Street, City, State, ZIP code) and County.

22b. Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone.

22b. Phone.

22c. Property Description.

22c. Purchase/Lease Date (m m d d y y y y).

22c. Current Fair Market Value (F M V).

22c. Current Loan Balance.

22c. Amount of Monthly Payment.

22c. Date of Final Payment(m m d d y y y y).

22c. Equity. F M V Minus Loan.

22c. Location (Street, City, State, ZIP code) and County.

22c. Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone.

22c. Phone.

22d. Property Description.

22d. Purchase/Lease Date (m m d d y y y y).

22d. Current Fair Market Value (F M V).

22d. Current Loan Balance.

22d. Amount of Monthly Payment.

22d. Date of Final Payment(m m d d y y y y).

22d. Equity. F M V Minus Loan.

22d. Location (Street, City, State, ZIP code) and County.

22d. Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone.

22d. Phone.

22e. Total Equity (add lines 22a through 22d and amounts from any attachments).

Section 4. Vehicle, Leased and Purchased. Include boats, R V's motorcycles, all-terrain and off-road vehicles, trailers, mobile homes,

23a. Mileage.

23a. Make / Model.

23a. License / Tag Number.

23a. Vehicle Identification Number (V I N).

23a. Purchase / Lease Date (m m d d y y y y).

23a. Current Fair Market Value (F M V).

23a. Current Loan Balance.

23a. Amount of Monthly Payment.

23a. Date of Final Payment (m m d d y y y y).

23a. Equity. F M V Minus Loan.

23a. Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone.

23a. Phone.

23b. Year.

23b. Mileage.

23b. Make / Model.

23b. License / Tag Number.

23b. Vehicle Identification Number (V I N).

23b. Purchase / Lease Date (m m d d y y y y).

23b. Current Fair Market Value (F M V).

23b. Current Loan Balance.

23b. Amount of Monthly Payment.

23b. Date of Final Payment (m m d d y y y y).

23b. Equity. F M V Minus Loan.

23b. Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone.

23b. Phone.

23c. Year.

23c. Mileage.

23c. Make / Model.

23c. License / Tag Number.

23c. Vehicle Identification Number (V I N).

23c. Purchase / Lease Date (m m d d y y y y).

23c. Current Fair Market Value (F M V).

23c. Current Loan Balance.

23c. Amount of Monthly Payment.

23c. Date of Final Payment (m m d d y y y y).

23c. Equity. F M V Minus Loan.

23c. Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone.

23c. Phone.

23d. Year.

23d. Mileage.

23d. Make / Model.

23d. License / Tag Number.

23d. Vehicle Identification Number (V I N).

23d. Purchase / Lease Date (m m d d y y y y).

23d. Current Fair Market Value (F M V).

23d. Current Loan Balance.

23d. Amount of Monthly Payment.

23d. Date of Final Payment (m m d d y y y y).

23d. Equity. F M V Minus Loan.

23d. Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone.

23d. Phone.

23e. Total Equity (add lines 23a through 23d and amounts from any attachments).

Page 5 70 fields

Page 5. Section 4. Business Asset and Liability Information. BUSINESS EQUIPMENT AND INTANGIBLE ASSETS. Include all machinery, equipment,

24a. Purchase / Lease Date (m m d d y y y y).

24a. Current Fair Market Value (F M V).

24a. Current Loan Balance.

24a. Amount of Monthly Payment.

24a. Date of Final Payment (m m d d y y y y).

24a. Equity. F M V Minus Loan.

24a. Location of asset (Street, City, State, ZIP code) and County.

24a. Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone.

24a. Phone.

24b. Asset Description.

24b. Purchase / Lease Date (m m d d y y y y).

24b. Current Fair Market Value (F M V).

24b. Current Loan Balance.

24b. Amount of Monthly Payment.

23b. Date of Final Payment (m m d d y y y y).

24b. Equity. F M V Minus Loan.

24b. Location of asset (Street, City, State, ZIP code) and County.

24b. Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone.

24b. Phone.

24c. Asset Description.

24c. Purchase / Lease Date (m m d d y y y y).

24c. Current Fair Market Value (F M V).

24c. Current Loan Balance.

24c. Amount of Monthly Payment.

24c. Date of Final Payment (m m d d y y y y).

24c. Equity. F M V Minus Loan.

24c. Location of asset (Street, City, State, ZIP code) and County.

24c. Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone.

24c. Phone.

24d. Asset Description.

24d. Purchase / Lease Date (m m d d y y y y).

24d. Current Fair Market Value (F M V).

24d. Current Loan Balance.

24d. Amount of Monthly Payment.

24d. Date of Final Payment (m m d d y y y y).

24d. Equity. F M V Minus Loan.

24d. Location of asset (Street, City, State, ZIP code) and County.

24d. Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone.

24d. Phone.

24e. Intangible Asset Description.

24e. Dollar amount.

24f. Intangible Asset Description.

24f. Dollar amount.

24g. Intangible Asset Description.

24g. Dollar amount.

24h. Total Equity (add lines 24a through 24g and amounts from any attachments).

Section 4. Business Liabilities. Include notes and judgements not listed on this form. 25a. Description.

25a. Secured.

25a. Unsecured.

25a. Date Pledged (m m d d y y y y).

25a. Balance Owed.

25a. Date of Final Payment (m m d d y y y y).

25a. Payment Amount.

25a. Name.

25a. Street Address.

25a. City/State/ZIP code.

25a. Phone.

25b. Description.

25b. Secured.

25b. Unsecured.

25b. Date Pledged (m m d d y y y y).

25b. Balance Owed.

25b. Date of Final Payment (m m d d y y y y).

25b. Payment Amount.

25b. Name.

25b. Street Address.

25b. City/State/ZIP code.

25b. Phone.

25c. Total Payments (Add lines 25a and 25b and amounts from any attachments).

Page 6 31 fields

Page 6. Section 5. Monthly Income / Expenses Statement for Business. Account Method Used. Cash.

Section 5. Account Method Used. Accrual.

Section 5. Income and Expenses during the period (enter m m d d y y y y) to (m m d d y y y y).

Section 5. Income and Expenses during the period (m m d d y y y y) to (enter m m d d y y y y).

Section 5. Total Monthly Business Income. Source. 26. Income Source. Gross Receipts from Sales/Services. Gross Monthly. $.

27. Gross Rental Income. Gross Monthly. $.

28. Interest Income. Gross Monthly. $.

29. Dividends. Gross Monthly. $.

30. Cash Receipts (Not Included in lines 26-29). Gross Monthly. $.

31. Other Income (Specify).

31. Other Income. Gross Monthly. $.

32. Other Income (Specify).

32. Other Income. Gross Monthly. $.

33. Other Income (Specify).

33. Other Income. Gross Monthly. $.

34. Other Income (Specify).

34. Other Income. Gross Monthly. $.

35. Other Income (Specify).

35. Other Income. Gross Monthly. $.

36. Total Income (Add lines 26 through 35). Gross Monthly. $.

Total Monthly Business Expenses. 37. Materials Purchased. Materials Purchased: Materials are items directly related to the production of a

38. Inventory Purchased. Inventory Purchased: Goods bought for resale. Actual Monthly. $.

39. Gross Wages and Salaries. Actual Monthly. $.

40. Rent. Actual Monthly. $.

41. Supplies. Supplies: Supplies are items used to conduct business and are consumed or used up within one year. This could be the cost of

42. Utilities / Telephone. Utilities/Telephone: Utilities include gas, electricity, water, oil, other fuels, trash collection, telephone,

43. Vehicle Gasoline / Oil. Actual Monthly. $.

44. Repairs and Maintenance. Actual Monthly. $.

45. Insurance. Actual Monthly. $.

46. Current Taxes. Current Taxes: Real estate, state, and local income tax, excise, franchise, occupational, personal property, sales and

47. Other Expenses (Specify). Actual Monthly. $.

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Frequently asked questions

Do I file Form 433-B with my tax return?

No. The 433-B goes to the IRS collection employee or office that asked for it, usually as part of resolving a balance due. It is not attached to any tax return.

What is the difference between Form 433-B and 433-B (OIC)?

The standard 433-B supports installment agreements and other collection decisions. Form 433-B (OIC) is a separate version filed with Form 656 when the business applies for an offer in compromise.

Do I need to attach documents?

Usually yes. The IRS generally asks for support such as bank statements, loan statements, and proof of expenses. The form and your revenue officer will tell you exactly what to include.

Form 433-B, Collection Information Statement for Businesses

What is 433-B?

Who files 433-B?

How to fill out 433-B

Quick fill 433-B on this page

Frequently asked questions

Related forms

Form 433-F, Collection Information Statement

Form 433-D, Installment Agreement

Form 656, Offer in Compromise