Fillable Form 9465 (Installment Agreement Request)

What is Form 9465?

Form 9465, officially the Installment Agreement Request, is an Internal Revenue Service (IRS) document used to request a monthly installment payment plan if you can’t pay the full amount you owe on your tax return.

Use Form 9465 if:

• You have an indebted income tax.
• You are or might be the one who is responsible for a trust fund recovery penalty
• You are indebted to employment taxes.
• You owe an individual shared responsibility payment under the Affordable Care Act.

Don’t use Form 9465 if:

• You are capable of paying the full amount of tax in 120 days.
• You are interested in requesting an online payment agreement.
• Your business is still running and owes unemployment and employment taxes.

How to fill out Form 9465?

Form 9465 is a two-page form divided into two parts.

Part I

Line 1a

Check the order of the names and social security numbers (SSNs) on your tax return and fill the information in with the same order. Enter your address on the appropriate line.

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

Line 2
Provide the name and employer identification number (EIN) of your business that is no longer operating.

Line 3
Provide your home phone number and preferred time for a call.

Line 4
Provide your office phone number and preferred time for the IRS to call.

Line 5
Enter the total amount you owe as reflected on your tax return.

Line 6
List the total amount of any additional balances or charges that are not reported on the tax return or notice.

Line 7
Add lines 5 and 6 and enter the result.

Line 8
If you’re filing this form with your tax return, enter the amount of the payment you’re making with this request.

Line 9
Subtract line 8 from line 7 and enter the result.

Line 10
Divide the amount on line 9 by 72 and enter the result.

Line 11a
Enter the amount you can pay each month. If you have an existing installment agreement, this amount should represent your total proposed monthly payment. If nothing is listed here, payment will be determined for you by dividing the balance due by 72 months.

Line 11b
The IRS sets the minimum monthly payment at tax debt divided by 72. If the amount you entered on line 11a is less than this minimum monthly payment and you’re able to increase your payment to an amount that is equal to or greater than the said amount, you have to enter your revised monthly payment proposal here.

Line 12
Enter the date you want to make your payment each month. Don’t enter a date later than the 28th.

Line 13a
Enter the routing number.

Line 13b
Enter the account number including hyphens, but omit spaces and special symbols.

Line 13c
If you’re a low-income taxpayer, check this box and your user fee will be reimbursed. If you don’t check this box and don’t provide the information on lines 13a and 13b, you’re indicating that you’re able but you choose not to make electronic payments.

Line 14
Check this box and attach a completed and signed Form 2159, if you want to make your payments by payroll deduction.

Part II

Complete this part only if all three conditions apply:
1. you defaulted on an installment agreement in the past 12 months,
2. you owe more than $25,000 but not more than $50,000, and
3. the amount on line 11a (or 11b, if applicable) is less than line 10

Line 15
Provide your country of primary residence.

Line 16a
Check your Marital status.

Line 16b
Select “Yes” if you share household expenses with your spouse. If not, select “No”.

Line 17
Provide the number of dependents you will claim on this year’s tax return.

Line 18
Provide the number of people in your household who are 65 or older.

Line 19
Select how often you are paid.

Line 20
Provide your net income per pay period.

Complete lines 21 and 22 only if you have a spouse and meet either of the following conditions:

• You live with and share household expenses with your spouse.
• You live in a community property state.

If you don’t have a spouse, go to line 23.

Line 21
Select how often your spouse is paid.

Line 22
Provide your spouse’s net income per pay period.

Line 23
Provide how many vehicles you own.

Line 24
Enter the number of car payments you have each month.

Line 25a
Select “Yes” if you have health insurance and go to question 25b. If you don’t have health insurance, select “No” and skip question 25b and go to question 26a.

Line 25b
Select “Yes” if your health insurance premiums are deducted from your paycheck and skip question 25c and go to question 26a. Select “No” if your health insurance premiums are not deducted from your paycheck and go to question 25c.

Line 25c
Provide the amount of your monthly health insurance premiums.

Line 26a
Select “Yes” if you make court-ordered payments and go to question 26b. If not, select “No” and go to question 27.

Line 26b
Select “Yes” if your court-ordered payments are deducted from your paycheck and go to question 27. If not, select “No” and go to question 26c.

Line 26c
Provide the amount of your court-ordered payments each month.

Line 27
Provide the amount of money you pay for child or dependent care each month, not including any court-ordered payments for child and dependent support.

Submission

You may file your Form 9465 online or by mail.
If the amount you owe on line 9 is greater than $50,000, you cannot file Form 9465 electronically and you must complete Form 433-F, Collection Information Statement, and file it with this form.
If you choose to make your payments by payroll deduction, you won’t be able to file Form 9465 electronically.
If you’ll file by mail, send your installment agreement request to the address shown in your tax return booklet.