Fillable Form 433-B

What is Form 433-B?

Form 433 B, officially titled Collection Information Statement for Business, is a tax form issued for businesses who owe federal taxes, but are unable to pay them immediately. The purpose of the 433 B tax form is to record the financial situation of a business for the IRS to review in order to implement taxes appropriate to the business' tax-paying capabilities.

The IRS Form 433 B is often filed along with Form 433 A, Collection Information Statement for Wage Earners and Self Employed Individuals, but the 433 B IRS Form can be filed by itself if the person who is filing is not the sole proprietor of the business.

The IRS Form 433 B contains specific information about assets and business expenses such as:

• Real estate
• Vehicle
• Utilities
• Salaries

Ensure that you have the specifics of this type of information before filling out the 433 B Form.

How to fill out Form 433-B?

For businesses that are required to submit IRS tax form 433 B, a PDF version of the form that is available for download, can be found on the official IRS government website. You may also fill out the form electronically on PDFRun.

Section 1: Business Information

Item 1a — Business Name

Input the registered name of your Business.

Item 1b — Business Street Address

Input the current Mailing Address of the business including the City, State, and ZIP Code.

Item 1c — County

Input the county where your business resides.

Item 1d — Business Telephone

Input the current serviceable telephone number of your business.

Item 1e — Type of Business

Input the type of Business that your business is classified as.

• Sole Proprietorship
• Partnership
• Corporation
• S Corporations
• Limited Liability Company

Item 1f — Business Website

Input the complete website address of your company.

Item 2a — Employer Identification Number

Input the EIN of your business.

Item 2b — Type of Entity

Identify the type of entity your business is by checking the appropriate box.

• Partnership
• Corporation
• Other (specify on the space)
• Limited Liability Company classified as a corporation
• Other LLC (include number of members)

Item 2c — Date Incorporated/Established

Input the date that your business was formed.

Item 3a — Number of Employees

Input the number of employees you currently have.

Item 3b — Monthly Gross Payroll

Input the gross pay for an employee.

Item 3c — Frequency of Tax Deposits

Indicate how often your business makes tax deposits.

Item 3d — EFTPS

If your business is enrolled in the Electronic Federal Tax Payment System, check yes. Otherwise, check no.

Item 4 — E-Commerce

If your business engages in e-commerce (internet sales), check “yes”. Otherwise, check no. If you have checked yes. Answer items 5a and 5b.

Payment Processor

Indicate here how the payment through e-commerce is processed (via Paypal, Google Checkout, etc). Include virtual currency wallet, exchange, or digital currency exchange.

Item 5a — 1st Payment Processor Name, Address, and Account number

Indicate the name of the payment processor, the address (street, city, state, and ZIP code), and the Payment Processor Account Number.

Item 5b — 2nd Payment Processor Name, Address, and Account number

Indicate the name of the second or alternative payment processor along with their address (street, city, state, and ZIP code). Input the Payment Processor Account Number.

Credit Cards Accepted By the Business

Items 6a, 6b, 6c — Type of Credit Card, Merchant Account Number, and Issuing Bank Name and Address

Enter the names of the acceptable credit card along with their appropriate merchant account number.

Input the name of the bank that issued the credit card, the address of the bank, and the bank’s business phone number.

Section 2: Business Personnel and Contacts

Items 7a - 7d

Indicate the following information about the major shareholders of your partners, officers, LLC Members, Major Shareholders.

• Full Name
• Title
• Home Address (along with City, State, and ZIP Code)
• Are they responsible for depositing payroll taxes? (check yes or no)
• Taxpayer Identification Number
• Home Telephone number
• Work Phone number
• Ownership Percentage and Shares of Interest
• Annual Salary or Draw

Section 3: Other Financial Information

In this section, you will answer by checking yes or no. If you have checked yes, you will need to provide additional information. However, if you check no you can leave the spaces for that information blank.

Item 8

If your business uses a Payroll Service Provider or Reporting Agent, check yes and enter the name of the Agent or Provider and their Address (Street, City, State). In addition, indicate the effective dates of the service.

If your business does not use a Payroll Service or Reporting Agent, check no and leave the spaces below blank.

Item 9

If your business is a party to a lawsuit, check yes and fill out the information required below. Otherwise, check no.

• Whether the business is the plaintiff or the defendant (check the appropriate box).
• Location of Filing of the Lawsuit
• Represented by (who represented the business)
• Docket or Case No.
• Amount of Suit
• Possible Completion Date of Lawsuit
• Subject of the Lawsuit

Item 10

If the business has ever filed bankruptcy before or currently, check yes and provide the required information below. Otherwise, check no:

• Date of Filing
• Date Dismissed
• Date Discharged
• Petition Number
• District Filing

Item 11

If any of the related parties (i.e. partners, employees, officers) have outstanding amounts owed to the business, check yes and provide the required information below. Otherwise, check no.

• Name and Address of the related party
• Date of Loan
• Current Balance as of (include value and date of balance)
• Payment Date
• Payment amount

Item 12

If any assets of the company have been transferred in the last 10 years, check yes and fill out the needed information below. Otherwise, check no.

• List Asset; mention the asset or assets that have been transferred
• Value of the asset at the time of the transfer
• Date transferred
• To whom or to where it was transferred.

Item 13

If your business has affiliations with other businesses, check yes and fill out the necessary information below. Otherwise, check no.

• Name and address of Related business
• The EIN of the related business

Item 14

Indicate if there has been an increase or decrease in the income anticipated. Check yes if this is the case and give the needed information below. Otherwise, check no.

• An explanation for the increase or decrease (if you need a larger space, you may attach it to the form.
• How much the value will decrease or increase.
• When the income decreases or increases.

Item 15

If your business is a Federal Government Contractor, check yes. Otherwise, check no.

Section 4: Business Asset and Liability Information

When filling out this section, you may make attachments to the form if there is not enough space for all the items you will list.

If you do end up using an attachment, indicate the item that it belongs to and follow the format given on that item.

Item 16a — CASH ON HAND

Input the current cash for spending that the business has. This includes money that is not in the bank yet.

Item 16b

If there is a safe in the business premises, check yes and input the contents of the safe. Otherwise, check no.

BUSINESS BANK ACCOUNTS

Items — 17a - 17c

Input the following information concerning all the business bank accounts:

• Type of Account
• Name and Address of Bank, Savings and Loan, Credit Union, or Financial Institution
• Account Number
• Account Balance as of (input date)

Item 17d

Input the total cash in all of the business bank accounts.

Accounts/ Notes Receivable

Include e-payment accounts, and bartering online accounts.

Items — 18a - 18e

List all contracts separately including contracts awarded, but not started. The list requires the following information.

• Name and Address
• Status
• Date Due
• Invoice Number or Government Grant or Contract Number
• Amount Due

Item 18f — Outstanding Balance

Input the total of all Amounts Due.

Investments

List all investments. Include stocks, bonds, mutual funds, stock options, commodities, certificates of deposit, and virtual currency.

Items 19a and 19b

Provide the following information concerning the investments:

• Name of Company and Address
• Can it be used as collateral on a loan (check yes or no)
• Current Value of investment
• Loan Balance
• Equity (Value minus Loan)

Item 19c — Total Investments

Add the equity of items 19a and 19b and all other attachments relating to it.

Available Credit

Items 20a - 20b

Provide the need information below on lines of credit and credit cards:

• Full Name and Address
• Account Number
• Credit Limit
• Amount Owed as of (input date)
• Available Credit as of (input date)

Item 20c — Total Credit Available

Input the total of the available credit of 20a, 20b, and all other attachments related to it.

Real Property

Items 21a - 21d

Provide needed information on all real property and land contracts below.

• Property Description
• Purchase or Lease Date
• Current Fair Market Value (FMV)
• Current Loan Balance
• Amount of Monthly Payment
• Date of Final Payment
• Equity (FMV minus Loan)
• Location of the property and County
• Lender, Lessor, or Landlord name, address, and phone number

Item 21e — Total Equity

Add all Equity values from 21a-21d and all other related attachments.

Vehicles Leased and Purchased

Items 22a - 22d

Provide the needed information on the vehicles that are leased or purchased by the business

• Year
• Make/Model
• Mileage
• License Tag/number
• Vehicle Identification Number
• Purchase/Lease Date
• Current Fair Market Value
• Current Loan Balance
• Amount of Monthly Payment
• Date of Final Payment
• Equity (FMV minus Loan)
• Lender/Lessor’s Name, address, and phone number

Item 22e — Total Equity

Add the Equity value of items 22a-22d as well as all the other related attachments.

Business Equipment and Intangible Assets

Items 23a - 23d

Provide the needed information on your business equipment and tangible assets.

• Asset Description
• Location of Asset and County
• Lender/Lessor’s Name, address, and phone number
• Purchase/Lease Date
• Current Fair Market Value
• Current Loan Balance
• Amount of Monthly Payment
• Date of Final Payment
• Equity (FMV minus Loan)

Items 23e - 23g

Provide the description for your Intangible asset and its value in Equity.

Item 23h — Total Equity

Input the total of the equity of 23a - 23g and other related attachments.

Business Liabilities

Items 24a - 24b

Provide the needed information on notes and judgments that were not included in this form prior to this part.

• Description of the Business Liability
• Whether or not it is secured or unsecured (check the appropriate box)
• Balance Owed
• Date of Final Payment
• Payment Amount
• Name of who the liability is for
• Street Address
• City/State/ZIP Code
• Phone Number

Item 24c — Total Payments

Input the total of the Payment Amount in items 24a and 24b along with any other related attachments.

Section 5: Monthly Income/ Expenses Statement for Business

Accounting Method Used

Indicate whether you are using Cash or Accrual methods of accounting by checking the appropriate box.

Income and Expenses during the period

Input the dates that will enclose the period of time wherein you will provide the average monthly income and expenses.

Total Monthly Business Income

Items 25 - 29

List down the Gross Value per month of each of the following:

• Gross Receipts from Sales and Services
• Gross Rental Income
• Interest Income
• Dividends
• Cash Receipts (that are not included in the previous ones)

Items 30 - 34

List down other sources of income of the business and their monthly gross value.

Item 35 — Total Income

Input the total of 25 - 34.

Total Monthly Business Expenses

Items 36 - 45

List down the monthly expenses of each of these items:

• Materials Purchased (directly related to the production or service)
• Inventory Purchased (goods bought for resale)
• Gross Wages and Salaries
• Rent
• Supplies (items for business that get consumed in a year)
• Utilities and Telephone (gas, water, electricity, oil, along with the internet, and telephone lines)
• Vehicle Gasoline or Oil
• Repairs and Maintenance
• Insurance
• Current Taxes
  • Real estate
  • State
  • Local income
  • Excise
  • Franchise
  • Occupational
  • Personal property
  • Sales and employer’s portion of employment taxes

Item 46 — Other Expenses

Specify other business expenses not included in the previous items and their monthly cost.

Items 47 - 49

This part of the section is not to be filled out by you and will be filled out by the IRS by calculating what you have inputted previously in this section.

Certification

Read the clause before signing. Signing will confirm that all the information you have written in this form is true, complete, and correct.

Signature

Affix your signature here.

Title

Enter your professional title.

Date

Input the date of signing.

Print Name of Officer, Partner, or LLC Member

Input your complete name.