IRS · Official form

Form 433-F, Collection Information Statement

Form 433-F is the short financial statement the IRS uses to review what you can pay toward a tax balance. Fill in the official PDF below and download it.

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This is the genuine IRS PDF, unmodified. Source: IRS official page.

What is 433-F?

Form 433-F, Collection Information Statement, is a condensed financial disclosure used mainly by the IRS Automated Collection System (ACS). It collects your accounts, lines of credit, real estate, vehicles, employment and business income, and monthly living expenses on two pages, so the IRS can decide how much you can pay each month.

It is shorter than Forms 433-A and 433-B, which revenue officers use for more detailed reviews. If you are dealing with ACS by phone or mail about a payment plan or hardship status, the 433-F is usually the form they want.

Who files 433-F?

Individuals who owe federal tax and are asked by the IRS for a financial statement before a payment plan is approved
Taxpayers requesting an installment agreement above the streamlined limits, or one based on ability to pay
People asking the IRS to mark their account currently not collectible because of financial hardship
Self-employed taxpayers whose case is being handled by ACS rather than a revenue officer

How to fill out 433-F

Fill in your name, address, SSN (and spouse’s if you file jointly), and contact information at the top.
List bank accounts, investments, credit cards, real estate, and vehicles with current balances and values.
Report your employment information and any self-employment income, along with how often you are paid.
Complete the monthly income and expense section using realistic figures; the IRS compares expenses to its collection financial standards.
Download the finished PDF, sign and date it, and send it to the IRS address or fax number the notice or ACS representative gave you.

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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 93 fields

Page 1. Name(s) and Address.

If address provided above is different than last return filed, please check here.

County of Residence.

Your Social Security Number or Individual Taxpayer Identification Number.

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

Your telephone numbers. Home.

Work.

Cell.

Spouse's telephone numbers. Home.

Work.

Cell.

The number of people in the household who can be claimed on this year’s tax return including you and your spouse. Under 65.

65 and over.

If you or your spouse are self employed or have self employment income, provide the following information: Name of Business.

Business EIN

Type of Business.

Number of Employees (not counting owner).

INVESTMENTS Include Certificates of Deposit, Trusts, Individual Retirement Accounts (IRAs), Keogh Plans, Simplified Employee Pensions,

Row: 1. Column: Account Number.

Row: 1. Column: Type of Account.

Row: 1. Column: Current Balance/Value.

Row: 1. Column: Check if Business Account .

Row: 2. Column: Name and Address of Institution.

Row: 2. Column: Account Number.

Row: 2. Column: Type of Account.

Row: 2. Column: Current Balance/Value.

Row: 2. Column: Check if Business Account .

A. ACCOUNTS / LINES OF CREDIT. PERSONAL BANK ACCOUNTS Include checking, online, mobile (e.g., PayPal), savings accounts, money market

Row: 1. Column: Account Number.

Row: 1. Column: Type of Account.

Row: 1. Column: Current Balance/Value.

Row: 1. Column: Check if Business Account .

Row: 2. Column: Name and Address of Institution.

Row: 2. Column: Account Number.

Row: 2. Column: Type of Account.

Row: 2. Column: Current Balance/Value.

Row: 2. Column: Check if Business Account .

B. REAL ESTATE Include home, vacation property, timeshares, vacant land and other real estate. (Use additional sheets if necessary.). Row:

Row: 1. Column: Description/Location/County. Primary Residence.

Row: 1. Column: Description/Location/County. Other.

Row: 1. Column: Monthly Payment(s).

Row: 1. Column: Financing. Year Purchased.

Row: 1. Column: Financing. Purchase Price.

Row: 1. Column: Financing. Year Refinanced.

Row: 1. Column: Financing. Refinance Amount.

Row: 1. Column: Current Value.

Row: 1. Column: Balance Owed.

Row: 1. Column: Equity.

Row: 2. Column: Description/Location/County.

Row: 2. Column: Description/Location/County. Primary Residence.

Row: 2. Column: Description/Location/County. Other.

Row: 2. Column: Monthly Payment(s).

Row: 2. Column: Financing. Year Purchased.

Row: 2. Column: Financing. Purchase Price.

Row: 2. Column: Financing. Year Refinanced.

Row: 2. Column: Financing. Refinance Amount.

Row: 2. Column: Current Value.

Row: 2. Column: Balance Owed.

Row: 2. Column: Equity.

C. OTHER ASSETS Include cars, boats, recreational vehicles, whole life policies, etc. Include make, model and year of vehicles and name of

Row: 1. Column: Monthly Payment.

Row: 1. Column: Year Purchased.

Row: 1. Column: Final Payment (mo/yr). Month.

Row: 1. Column: Final Payment (mo/yr). Year.

Row: 1. Column: Current Value.

Row: 1. Column: Balance Owed.

Row: 1. Column: Equity.

Row: 2. Column: Description.

Row: 2. Column: Monthly Payment.

Row: 2. Column: Year Purchased.

Row: 2. Column: Final Payment (mo/yr). Month.

Row: 2. Column: Final Payment (mo/yr). Year.

Row: 2. Column: Current Value.

Row: 2. Column: Balance Owed.

Row: 2. Column: Equity.

D. CREDIT CARDS (Visa, MasterCard, American Express, Department Stores, etc.). Row: 1. Column: Type.

Row: 1. Column: Credit Limit.

Row: 1. Column: Balance Owed.

Row: 1. Column: Minimum Monthly Payment.

Row: 2. Column: Type.

Row: 2. Column: Credit Limit.

Row: 2. Column: Balance Owed.

Row: 2. Column: Minimum Monthly Payment.

DIGITAL ASSETS (CRYPTOCURRENCY) List all digital assets you own or in which you have a financial interest (e.g., Bitcoin, Ethereum,

Row: 1. Column: Name of Digital Assets Wallet, Exchange or Digital Currency Exchange (D C E).

Row: 1. Column: Email Address Used to Set-up With the Digital Currency Exchange or D C E.

Row: 1. Column: Location(s) of Digital Assets (Mobile Wallet, Online, and/or External Hardware storage).

Row: 1. Column: Digital Assets Amount and Value in U S dollars as of today (e.g., 10 Bitcoins $64,600 U S D).

Row: 2. Column: Type of Digital Currency.

Row: 2. Column: Name of Digital Assets Wallet, Exchange or Digital Currency Exchange (D C E).

Row: 2. Column: Email Address Used to Set-up With the Digital Currency Exchange or D C E.

Row: 2. Column: Location(s) of Digital Assets (Mobile Wallet, Online, and/or External Hardware storage).

Row: 2. Column: Digital Assets Amount and Value in U S dollars as of today (e.g., 10 Bitcoins $64,600 U S D).

Page 2 120 fields

Page 2. E. BUSINESS INFORMATION Complete E1 for Accounts Receivable owed to you or your business. (Use additional sheets if necessary.)

Row: 1. Column: Address.

Row: 1. Column: Amount Owed.

Row: 2. Column: Name.

Row: 2. Column: Address.

Row: 2. Column: Amount Owed.

List total amount owed from additional sheets.

Total amount of accounts receivable available to pay to I R S now.

E2. Name of individual or business on account.

Row: 1. Column: Credit Card (Visa, Master Card, etc.).

Row: 1. Column: Issuing Bank Name and Address.

Row: 1. Column: Merchant Account Number.

Row: 2. Column: Credit Card (Visa, Master Card, etc.).

Row: 2. Column: Issuing Bank Name and Address.

Row: 2. Column: Merchant Account Number.

Row: 3. Column: Credit Card (Visa, Master Card, etc.).

Row: 3. Column: Issuing Bank Name and Address.

Row: 3. Column: Merchant Account Number.

F. EMPLOYMENT INFORMATION If you have more than one employer, include the information on another sheet of paper. (If attaching a copy of

How often are you paid (check one). Weekly.

Biweekly.

Semi-monthly.

Monthly.

Gross per pay period

Taxes per pay period (Fed).

(State)

(Local)

How long at current employer.

Spouse’s current Employer (name and address).

How often are you paid (check one). Weekly.

Biweekly.

Semi-monthly.

Monthly.

Gross per pay period.

Taxes per pay period (Fed).

(State).

(Local).

How long at current employer

G. NON-WAGE HOUSEHOLD INCOME List monthly amounts. For Self-Employment and Rental Income, list the monthly amount received after expenses

Child Support Income

Net Self Employment Income.

Net Rental Income

Unemployment Income

Pension Income

Interest/Dividends Income.

Social Security Income

Other

Other Income.

1. Food / Personal Care See instructions. If you do not spend more than the standard allowable amount for your family size, fill in the

Row: Food. Column: I R S Allowed.

Row: Housekeeping Supplies. Column: Actual Monthly Expenses.

Row: Housekeeping Supplies. Column: I R S Allowed.

Row: Clothing and Clothing Services. Column: Actual Monthly Expenses.

Row: Clothing and Clothing Services. Column: I R S Allowed.

Row: Personal Care Products & Services. Column: Actual Monthly Expenses.

Row: Personal Care Products & Services. Column: I R S Allowed.

Row: Miscellaneous. Column: Actual Monthly Expenses.

Row: Miscellaneous. Column: I R S Allowed.

Row: Total. Column: Actual Monthly Expenses.

Row: Total. Column: I R S Allowed.

2. Transportation. Row: Gas / Insurance / Licenses / Parking / Maintenance etc.. Column: Actual Monthly Expenses.

Row: Gas / Insurance / Licenses / Parking / Maintenance etc.. Column: I R S Allowed.

Row: Public Transportation. Column: Actual Monthly Expenses.

Row: Public Transportation. Column: I R S Allowed.

Row: Total. Column: Actual Monthly Expenses.

Row: Total. Column: I R S Allowed.

3. Housing & Utilities. Row: Rent. Column: Actual Monthly Expenses.

Row: Rent. Column: I R S Allowed.

Row: Electric, Oil/Gas, Water/Trash. Column: Actual Monthly Expenses.

Row: Electric, Oil/Gas, Water/Trash. Column: I R S Allowed.

Row: Telephone/Cell/Cable/Internet. Column: Actual Monthly Expenses.

Row: Telephone/Cell/Cable/Internet. Column: I R S Allowed.

Row: Real Estate Taxes and Insurance (if not included in B above). Column: Actual Monthly Expenses.

Row: Real Estate Taxes and Insurance (if not included in B above). Column: I R S Allowed.

Row: Maintenance and Repairs. Column: Actual Monthly Expenses.

Row: Maintenance and Repairs. Column: I R S Allowed.

Row: Total. Column: Actual Monthly Expenses.

Row: Total. Column: I R S Allowed.

4. Medical. Row: Health Insurance. Column: Actual Monthly Expenses.

Row: Health Insurance. Column: I R S Allowed.

Row: Out of Pocket Health Care Expenses. Column: Actual Monthly Expenses.

Row: Out of Pocket Health Care Expenses. Column: I R S Allowed.

Row: Total. Column: Actual Monthly Expenses.

Row: Total. Column: I R S Allowed.

5. Other. Row: Child / Dependent Care. Column: Actual Monthly Expenses.

Row: Child / Dependent Care. Column: I R S Allowed.

Row: Estimated Tax Payments. Column: Actual Monthly Expenses.

Row: Estimated Tax Payments. Column: I R S Allowed.

Row: Term Life Insurance. Column: Actual Monthly Expenses.

Row: Term Life Insurance. Column: I R S Allowed.

Row: Retirement (Employer Required). Column: Actual Monthly Expenses.

Row: Retirement (Employer Required). Column: I R S Allowed.

Row: Retirement (Voluntary). Column: Actual Monthly Expenses.

Row: Retirement (Voluntary). Column: I R S Allowed.

Row: Union Dues. Column: Actual Monthly Expenses.

Row: Union Dues. Column: I R S Allowed.

Row: Delinquent State & Local Taxes (minimum payment). Column: Actual Monthly Expenses.

Row: Delinquent State & Local Taxes (minimum payment). Column: I R S Allowed.

Row: Student Loans (minimum payment). Column: Actual Monthly Expenses.

Row: Student Loans (minimum payment). Column: I R S Allowed.

Row: Court Ordered Child Support. Column: Actual Monthly Expenses.

Row: Court Ordered Child Support. Column: I R S Allowed.

Row: Court Ordered Alimony. Column: Actual Monthly Expenses.

Row: Court Ordered Alimony. Column: I R S Allowed.

Row: Other Court Ordered Payments. Column: Actual Monthly Expenses.

Row: Other Court Ordered Payments. Column: I R S Allowed.

Row: 1. Column: Other (specify).

Row: 1. Column: Actual Monthly Expenses.

Row: 1. Column: I R S Allowed.

Row: 2. Column: Other (specify).

Row: 2. Column: Actual Monthly Expenses.

Row: 2. Column: I R S Allowed.

Row: 3. Column: Other (specify).

Row: 3. Column: Actual Monthly Expenses.

Row: 3. Column: I R S Allowed.

Row: Total. Column: Actual Monthly Expenses.

Row: Total. Column: I R S Allowed.

Your signature

Spouse’s signature

Date.

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Frequently asked questions

When does the IRS ask for Form 433-F instead of 433-A?

The 433-F is the shorter statement used by the Automated Collection System for phone and mail cases. Form 433-A is longer and is typically requested by a revenue officer working a case directly.

Do both spouses complete one 433-F?

If the balance is from a joint return, one form covering both spouses’ finances is normal. Include both incomes and shared household expenses.

Will the IRS accept my actual expenses?

The IRS compares your claimed expenses to its national and local collection financial standards. Amounts above the standards may need documentation showing they are necessary.

Form 433-F, Collection Information Statement

What is 433-F?

Who files 433-F?

How to fill out 433-F

Quick fill 433-F on this page

Frequently asked questions

Related forms

Form 433-B, Collection Information Statement for Businesses

Form 433-D, Installment Agreement

Form 9465, Installment Agreement Request