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Fillable Form 433 F (2019)

Form 433-F is filled out by following the instructions attached the form and entering the information requested where indicated, according to the Internal Revenue Service.

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What is Form 433-F?

Form 433-F, formally known as the Collection Information Statement, is an Internal Revenue Service (IRS) form used to obtain financial information needed for determining how a wage earner or self-employed individual can satisfy an outstanding tax liability.

How to fill out Form 433-F?

Name(s) and Address
Enter your name(s) and address.

County of Residence
Enter your county of residence.

Your Social Security Number or Individual Taxpayer Identification Number
Provide your SSN or Individual TIN.

Your Spouse’s Social Security Number or Individual Taxpayer Identification Number
Enter your spouse’s SSN or Individual TIN.

Your telephone numbers
Provide your respective telephone numbers on the space provided.

Home
Enter your home telephone number.

Work
Enter your work telephone number.

Cell
Enter your cell number.

Spouse’s telephone numbers
Enter your spouse’s telephone numbers.

Home
Enter your spouse’s home telephone number.

Work
Enter your spouse’s work telephone number.

Cell
Enter your spouse’s cell number.

Enter the number of people in the household who can be claimed on this year’s tax return including you and your spouse.
Select whether the number of people in the household were under 65 or over 65.

If you or your spouse are self employed or have self employment income, provide the following information:
Enter information only on the succeeding fields if you and your spouse were self-employed.

Name of Business
Enter the name of your business.

Business EIN
Provide the EIN of your business.

Type of Business
Enter the type of business you have.

Number of Employees (not counting owner)
Enter the number of employees excluding you as the owner.

Section A- Accounts/Lines of Credit

Personal Bank Accounts
Enter all your bank information including checking, online, mobile (e.g., PayPal), savings accounts, and money market accounts.

Name and Address of Institution
Enter the name and address of the institution or bank account.

Account Number
Provide your account number.

Type of Account
Enter the type of account.

Current Balance/Value
Enter the current balance or value.

Check if Business Account
If the listed account is a business account, check the box.

Investments
Provide all the required information on your investments including Certificates of Deposit, Trusts, Individual Retirement Accounts (IRAs), Keogh Plans, Simplified Employee Pensions, 401(k) Plans, Profit Sharing Plans, Mutual Funds, Stocks, Bonds, Commodities (Silver, Gold, etc.), and other investments. If applicable, include business accounts.

Name and Address of Institution
Enter the name and address of the institution of your investments.

Account Number
Enter the account number.

Type of Account
Enter the type of account.

Current Balance/Value
Enter the current balance or value.

Check if Business Account
Check the box if the listed investment is a business account.

Virtual Currency (Cryptocurrency)
Enter all virtual currency you own or in which you have a financial interest (e.g., Bitcoin, Ethereum, Litecoin, Ripple, etc.).

Type of Virtual Currency
Enter the type of virtual currency you own.

Name of Virtual Currency Wallet, Exchange or Digital Currency Exchange (DCE)
Enter the name of the Virtual Currency Wallet, Exchange or Digital Currency Exchange (DCE).

Email Address Used to Set-up With the Virtual Currency Exchange or DCE
Enter the email address you used to set up your wallet or DCE locations.

Location(s) of Virtual Currency
Enter whether it is Mobile Wallet, Online, and/or External Hardware storage.

Virtual Currency Amount and Value in US dollars as of today
Enter the amount of virtual currency and value in US dollars as of today.

Section B- Real Estate
Provide all the required information on home, vacation property, timeshares, vacant land and other real estate you own.

Description/Location/County
Provide a description, location, and county of property and identify whether it is primary residence or other.

Monthly Payment(s)
Enter the amount of monthly payments for the property.

Financing
Enter the year the property was purchased, the year refinanced, the purchase price, and the refinance amount.

Current Value
Enter the current value of the property.

Balance Owed
Enter the owed balance.

Equity
Enter the equity of the property.

Section C- Other Assets
Provide all the required information ofyour other assets such as cars, boats, recreational vehicles, whole life policies, etc.

Section D- Credit Cards
Enter all credit cards and lines of credit.

Type
Enter the type of credit card you own.

Credit Limit
Enter the credit limit.

Balance Owed
Enter the owed balance. If none, leave blank.

Minimum Monthly Payment
Enter the minimum monthly payment.

Section E- Business Information
If you or your spouse are self-employed or have self-employment income, fill out this section.

E1. Accounts Receivable owed to you or your business
Enter all the Accounts Receivable owed to you or your business including federal, state and local grants and contracts.

Name
Enter the name.

Address
Enter the address.

Amount Owed
Enter the owed amount.

List total amount owed from additional sheets
Enter the total amount owed from additional sheets.

Total amount of accounts receivable available to pay to IRS now
Add everything and enter on the space provided.

E2. Name of individual or business on account
If you or your business accepts credit card payments (e.g., Visa, MasterCard, etc.) and/or virtual currency wallet, exchange or digital currency exchange, fill out this section.

Credit Card (Visa, Master Card, etc.) Issuing Bank Name and Address
Enter your credit card issuing bank’s name and address.

Merchant Account Number
Enter the account number.

Section F- Employment Information
If you or your spouse are wage earners, fill out this section.

Your current Employer (name and address)
Enter your current employer’s name and address.

How often are you paid (check one)
Select how you are paid (weekly,biweekly,semi-monthly, or monthly).

Gross per pay period
Enter the gross per pay period.

Taxes per pay period (Fed) (State) (Local)
Enter the taxes you pay per period on fed, state, and local.

How long at current employer
Enter how long you are working for the current employer.

Spouse’s current Employer (name and address)
Enter your spouse’s current employer’s name and address.

How often are you paid (check one)
Select how your spouse is paid (weekly,biweekly,semi-monthly, or monthly).

Gross per pay period
Enter your spouse’s gross per pay period.

Taxes per pay period (Fed) (State) (Local)
Enter the taxes your spouse pays per period on fed, state, and local.

How long at current employer
Enter how long your spouse is working for the current employer.

Section G- Non- Wage Household Income
Enter all the non-wage income you receive monthly.

Alimony Income
Enter your monthly alimony income.

Child Support Income
Enter your monthly child support income.

Net Self Employment Income
Enter your monthly net self-employment income.

Net Rental Income
Enter your monthly net rental income.

Unemployment Income
Enter your monthly unemployment income.

Pension Income
Enter your monthly pension income.

Interest/Dividends Income
Enter your monthly income from interest or dividends.

Social Security Income
Enter your monthly income from Social Security.

Other:
Enter other sources of income and the amount you receive monthly.

Section H- Monthly Necessary Living Expenses
Enter the monthly amounts for your expenses on the respective categories (Food/Personal Care, Transportation, Housing & Utilities, Medical, and Other).

Your signature
Provide your signature.

Spouse’s signature
Provide the signature of your spouse.

Date
Enter the date you submitted and completed the form.

Submission

Mail the completed form to:
Internal Revenue Service.
ACS Support.
PO Box 8208.
Philadelphia, PA 19101-8208

Tips

  • For Section C- Other Assets, include the make, model and year of vehicles and the name of life Insurance company in Description.
  • If you will attach a copy of your current pay stub, there is no need to complete Section F- Employment Information.

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