Table of Contents
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.
If the address you provided on line 1a is new since you filed your last tax return, check the box on line 1b.
Show the name and employer identification number (EIN) of your business (must be no longer operating).
Enter the total amount you owe as shown on your tax return(s) (or notice(s)).
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.
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.
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.
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.
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.
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.
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.
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