How to Fill Out Form 433-A Collection Information Statement for Individuals

The following information is absolutely required to be attached to your Form 433-A when submitting an Offer in Compromise. Failure to include the information will automatically result in your Offer being returned to you for failure to meet the filing requirements. Some of the information may not pertain to you; for example, if you do not have any life insurance, then you will not be required to provide that information. If the information is not provided, then you must write "N/A" (not applicable) in the spaces of Form 433-A that do not apply.

Failure to complete all entry spaces on form 433-A may result in rejection or significant delay in the Offer process.

You may use this page as a checklist for the information you should provide.

If you have any doubt about whether or not to include a copy of any particular document, then go ahead and include it. It's better to send too much paperwork than not enough.

Do not send any original documents - send copies only.

Keep a complete copy (for your own records) of the entire package you send to IRS.

Section 1 Personal Information 
  • This should be pretty obvious. Just make sure you provide all the information that is required.

Section 2 Employment Information

  • If you have more than one employer, you should use additional pages

Section 3  Other Financial Information

  • This section is pretty easy to understand

Section 4 Personal Asset Information

  • Obviously, you should be as accurate as possible.
  • IRS will use this information to help them determine your "net worth."
  • If life insurance is currently borrowed against, include the loan amount and date of loan.
  • Page 4 of Form 433a is critical. It helps IRS calculate your Monthly Net Cash Flow. This cash flow amount helps them see how much money you will have available each month that you should be able to pay to IRS to pay off your old taxes.
  • Keep in mind that your own calculations of Total Income and Total Expenses probably will not agree with IRS's own determination of your Total Income and Total Expenses.
  • IRS has a very precise method of calculating Income minus Expenses that will result in Monthly Net Cash Flow. The more you study and learn this method, then the more accurate you can be in estimating what your outcome will be in this entire process.

Sections 5 Business Information

  • This section is needed only if you have a self-employed business

Section 6 Sole Proprietorship Information

  • This section is needed only if you have a self-employed business

Pay particular attention to the checklist at the bottom of Page 4, as it lists the info you are required to include with your Offer in Compromise if you are submitting form 656.

  • Include a copy of your last Form 1040 with all schedules.
  • include copies of at least your last month's pay check stubs with year-to-date totals
  • If you are providing this information in January through April, it would be a good idea to provide W-2 and 1099 forms from last year for all of your income sources
  • Include proof of all current expenses that you paid for the past 3 months, including:
  • rent or house payment
  • utilities
  • insurance
  • property taxes
  • other
  • Proof of all non-business transportation expenses for the last 3 months, including:
  • car payments
  • lease payments
  • fuel
  • oil
  • insurance
  • parking
  • registration
  • other
  • Proof of payments for health care for the last 3 months, including:
  • health insurance premiums
  • co-payments
  • other out-of-pocket expenses
  • Copies of any court orders requiring payment and proof of such payments for the last 3 months, including:
  • cancelled checks
  • money orders
  • earning statements showing such deductions