Specific Instructions

Line 1a

If you are making this request for a joint tax return, show the names and social security numbers (SSNs) in the same order as they appear on your tax return.

Line 1b

If the address you provided on line 1a is new since you filed your last tax return, check the box on line 1b.

Line 2

Show the name and employer identification number (EIN) of your business (must be no longer operating).

Line 7

Enter the total amount you owe as shown on your tax return(s) (or notice(s)).

If the total amount you owe is greater than $25,000 but not more than $50,000, you must either: (1) Complete lines 13a and 13b and agree to make your payments by direct debit, or (2) Check box 14 to agree to make your payments by payroll deduction, and attach a completed, signed Form 2159, Payroll Deduction Agreement. A payroll deduction agreement is not available if you file Form 9465 electronically.

Note: Electronic filing of Form 9465 is not available if the amount you owe is greater than $50,000.

If you do not agree to make your payments by direct debit or payroll deduction, complete Form 433-F, Collection Information Statement, and file it with this form.

If the amount you owe is greater than $50,000, you must complete Form 433-F, and file it with this form. You can download Form 433-F at IRS.gov or order it by calling 1-800-TAX-FORM (1-800-829-3676).

If the total amount you owe is not more than $50,000 (including any amounts you owe from prior years), you do not need to file Form 9465; you can request an installment agreement online. For more information see Applying online for a payment agreement, earlier.

Line 8

Even if you cannot pay the full amount you owe now, you should pay as much as possible to limit penalty and interest charges. If you are filing this form with your tax return, make the payment with your return. For details on how to pay, see your tax return instructions.

If you are filing this form by itself, such as in response to a notice, attach a check or money order payable to “United States Treasury.” Do not send cash. Be sure to include:

  • Your name, address, SSN/EIN, and daytime phone number.

  • The tax year and tax return (for example, “2012 Form 1040”) for which you are making this request.

Line 9

Subtract line 8 from line 7 and enter the result.

Line 10

Enter on line 10 the amount you can pay each month. Make your payments as large as possible to limit interest and penalty charges. The charges will continue until you pay in full. If no payment amount is listed on line 10, a payment will be determined for you by dividing the balance due by 72 months.

Line 11

Divide the amount on line 9 by 72 and enter the result.

  • If the amount on line 10 is less than the amount on line 11 and you are unable to increase your payment to the amount on line 11, complete and attach Form 433-F, Collection Information Statement.

  • If the amount on line 10 is equal to or greater than the amount on line 11 but the amount you owe is greater than $25,000 but not more than $50,000, you must complete either line 13 or 14, if you do not want to complete Form 433-F. If you have defaulted on an installment agreement within the last 12 months, and the amount you owe is greater than $25,000 but not more than $50,000, you must complete Part II on page 2 of Form 9465.

  • If the amount on line 9 is greater than $50,000, complete and attach Form 433-F.

Line 12

You can choose the day of each month your payment is due. This can be on or after the 1st of the month, but no later than the 28th of the month. For example, if your rent or mortgage payment is due on the 1st of the month, you may want to make your installment payments on the 15th. When we approve your request, we will tell you the month and day that your first payment is due.

If we have not replied by the date you chose for your first payment, you can send the first payment to the Internal Revenue Service Center at the address shown earlier that applies to you. See the instructions for line 8 above for details on what to write on your payment.

Lines 13a and 13b

Making your payments by direct debit will help ensure that your payments are made timely and that you are not in default of this agreement.

To pay by direct debit from your checking account at a bank or other financial institution (such as a mutual fund, brokerage firm, or credit union), fill in lines 13a and 13b. Check with your financial institution to make sure that a direct debit is allowed and to get the correct routing and account numbers.

Line 13a.   The routing number must be nine digits. The first two digits of the routing number must be 01 through 12 or 21 through 32. Use a check to verify the routing number. On the sample check on this page, the routing number is 250250025. But if your check is payable through a financial institution different from the one at which you have your checking account, do not use the routing number on that check. Instead, contact your financial institution for the correct routing number.

Line 13b.   The account number can be up to 17 characters (both numbers and letters). Include hyphens but omit spaces and special symbols. Enter the number from left to right and leave any unused boxes blank. On the sample check below, the account number is 20202086. Do not include the check number.

Note.

We may have filed a Notice of Federal Tax Lien against your property. If so, you may be able to get the notice of lien withdrawn. To learn more about lien withdrawals and to see if you qualify, visit IRS.gov and enter "lien withdrawal" in the “Search” box.

  
The direct debit from your checking account will not be approved unless you (and your spouse if filing a joint return) sign Form 9465.

  

Sample Check—Lines 13a and 13b

Sample Check - Lines 13a and 13b

  
The routing and account numbers may be in different places on your check.

Line 14

If you want to make your payments by payroll deduction, check the box on line 14 and attach a completed and signed Form 2159. Ask your employer to complete and sign their portion of Form 2159.

If you choose to make your payments by payroll deduction, you will not be able to file Form 9465 electronically.

Part II

If you have defaulted on an installment agreement within the last 12 months, and the amount you owe is greater than $25,000 but not more than $50,000, complete Part II on page 2 of Form 9465.


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