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Federal Free Printable Form 433-B (OIC) (Rev. 3-2018) for 2019 Federal Collection Information Statement for Businesses

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Collection Information Statement for Businesses
Form 433-B (OIC) (Rev. 3-2018)

Form Department of the Treasury — Internal Revenue Service 433-B (OIC) Collection Information Statement for Businesses (March 2018) Complete this form if your business is a ► Corporation ► Limited Liability Company (LLC) classified as a corporation ► Partnership ► Other LLC Note: If your business is a sole proprietorship or was a disregarded single member LLC taxed as a sole proprietor (filing Schedule C, D, E, F, etc.) prior to 2009, do not use this form. Instead, complete Form 433-A (OIC) Collection Information Statement for Wage Earners and SelfEmployed Individuals. This form should only be used with the Form 656, Offer in Compromise. Include attachments if additional space is needed to respond completely to any question. Section 1 Business Information Business Name Employer Identification Number Business Physical Address (street, city, state, zip code) County of Business Location Description of Business and DBA or "Trade Name" Primary Phone ( Secondary Phone ) - ( ) Business Mailing Address (if different from above or Post Office Box number) - Business website address Fax Number ( ) - Federal Contractor Yes Does the business outsource its payroll processing and tax return preparation for a fee? Total Number of Employees Yes No If yes, list provider name and address in box below (Street, City, State, ZIP Code) No Frequency of Tax Deposits Average Gross Monthly Payroll $ Provide information about all partners, officers, LLC members, major shareholders (foreign and domestic), etc., associated with the business. Include attachments if additional space is needed. Last Name First Name Title Percent of Ownership and Annual Salary Social Security Number Primary Phone ( ) Secondary Phone - ( ) - Last Name First Name Percent of Ownership and Annual Salary Social Security Number Primary Phone Secondary Phone Title ( ) - ( ) - First Name Percent of Ownership and Annual Salary Social Security Number Title Primary Phone ) Home Address (Street, City, State, ZIP Code) - Last Name ( Home Address (Street, City, State, ZIP Code) - Home Address (Street, City, State, ZIP Code) - Secondary Phone - Catalog Number 55897B ( ) - www.irs.gov Form 433-B (OIC) (Rev. 3-2018) Page 2 of 6 Section 2 Business Asset Information Gather the most current statement from banks, lenders on loans, mortgages (including second mortgages), monthly payments, loan balances, and accountant's depreciation schedules, if applicable. Also, include make/model/year/mileage of vehicles and current value of business assets. To estimate the current value, you may consult resources like Kelley Blue Book (www.kbb.com), NADA (www.nada.com), local real estate postings of properties similar to yours, and any other websites or publications that show what the business assets would be worth if you were to sell them. Asset value is subject to adjustment by IRS. Enter the total amount available for each of the following (if additional space is needed, please include attachments). Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0". Cash and Investments (domestic and foreign) Cash Checking Savings Money Market Account/CD Bank Name Online Account Stored Value Card Virtual Currency Account Number (1a) $ Cash Checking Savings Money Market Account/CD Bank Name Online Account Stored Value Card Account Number (1b) $ Cash Checking Savings Money Market Account/CD Bank Name Online Account Stored Value Card Account Number (1c) $ Investment Account: Stocks Bonds Total bank accounts from attachment (1d) $ Add lines (1a) through (1d) = (1) $ Other Name of Financial Institution Account Number Current Market Value Minus Loan Balance $ X .8 = $ – $ = (2a) $ = (2b) $ Total investment accounts from attachment. [current market value X.8 minus loan balance(s)] (2c) $ Add lines (2a) through (2c) = (2) $ Investment Account: Stocks Bonds Other Name of Financial Institution Account Number Current Market Value $ Minus Loan Balance X .8 = $ – $ Notes Receivable Do you have notes receivable? Yes No If yes, attach current listing which includes name, age, and amount of note(s) receivable. Accounts Receivable Do you have accounts receivable, including e-payment, factoring companies, and any bartering or online auction accounts? Yes No If yes, you may be asked to provide a list of name, age, and amount of the account(s) receivable. Catalog Number 55897B www.irs.gov Form 433-B (OIC) (Rev. 3-2018) Page 3 of 6 Section 2 (Continued) Business Asset Information If the business owns more properties, vehicles, or equipment than shown in this form, please list on a separate attachment. Real Estate (Buildings, Lots, Commercial Property, etc.) Property Address (Street Address, City, State, ZIP Property Description Date Purchased Name of Creditor Date of Final Payment Code) County and Country Current Market Value Minus Loan Balance (mortgages, etc.) $ X .8 = $ – $ Property Address (Street Address, City, State, ZIP Total Value of Real Estate = Property Description Date Purchased Name of Creditor Date of Final Payment (3a) $ Code) County and Country Current Market Value Minus Loan Balance (mortgages, etc.) $ X .8 = $ – $ Total Value of Real Estate = (3b) $ Total value of property(s) listed from attachment [current market value X .8 minus any loan balance(s)] (3c) $ Add lines (3a) through (3c) = (3) $ Business Vehicles (cars, boats, motorcycles, trailers, etc.). If additional space is needed, list on an attachment. Vehicle Make & Model Year Lease Monthly Lease/Loan Amount Loan $ Current Market Value $ Vehicle Make & Model Name of Creditor Date of Final Payment Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = – $ Year Lease Monthly Lease/Loan Amount Loan $ Current Market Value Date Purchased Mileage or Use Hours Name of Creditor Date of Final Payment (4a) $ Minus Loan Balance X .8 = $ Vehicle Make & Model Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = – $ Year Lease Monthly Lease/Loan Amount Loan $ Current Market Value $ Mileage or Use Hours Minus Loan Balance X .8 = $ $ Date Purchased Date Purchased Mileage or Use Hours Name of Creditor Date of Final Payment (4b) $ Minus Loan Balance Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = (4c) $ Total value of vehicles listed from attachment [current market value X .8 minus any loan balance(s)] (4d) $ Add lines (4a) through (4d) = (4) $ X .8 = $ Catalog Number 55897B – $ www.irs.gov Form 433-B (OIC) (Rev. 3-2018) Page 4 of 6 Section 2 (Continued) Business Asset Information Other Business Equipment [If you have more than one piece of equipment, please list on a separate attachment and put the total of all equipment in box (5b)] Type of equipment Minus Loan Balance Current Market Value Total value of equipment (if leased or used in the production of income enter 0 as the total value) = (5a) $ Total value of equipment listed from attachment [current market value X .8 minus any loan balance(s)] (5b) $ $ X .8 = $ – $ Total value of all business equipment (5) $ Add lines (5a) and (5b) = Do not include amount on the lines with a letter beside the number. Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0" on that line. Box A Available Equity in Assets Add lines (1) through (5) and enter the amount in Box A = $ Section 3 Business Income Information Enter the average gross monthly income of your business. To determine your gross monthly income use the most recent 6-12 months documentation of commissions, invoices, gross receipts from sales/services, etc.; most recent 6-12 months earnings statements, etc., from every other source of income (such as rental income, interest and dividends, or subsidies); or you may use the most recent 6-12 months Profit and Loss (P&L) to provide the information of income and expenses. Note: If you provide a current profit and loss statement for the information below, enter the total gross monthly income in Box B below. Do not complete lines (6) - (10). Entire household income should also include income that is considered as not taxable and may not be included on your tax return. Gross receipts (6) $ Gross rental income (7) $ Interest income (8) $ Dividends (9) $ (10) $ Other income (Specify on attachment) Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0" on that line. Box B Total Business Income Add lines (6) through (10) and enter the amount in Box B = $ Section 4 Business Expense Information Enter the average gross monthly expenses for your business using your most recent 6-12 months statements, bills, receipts, or other documents showing monthly recurring expenses. Note: If you provide a current profit and loss statement for the information below, enter the total monthly expenses in Box C below. Do not complete lines (11) - (20). Materials purchased (e.g., items directly related to the production of a product or service) (11) $ Inventory purchased (e.g., goods bought for resale) (12) $ Gross wages and salaries (13) $ Rent (14) $ Supplies (items used to conduct business and used up within one year, e.g., books, office supplies, professional equipment, etc.) (15) $ Utilities/telephones (16) $ Vehicle costs (gas, oil, repairs, maintenance) (17) $ Insurance (other than life) (18) $ Current taxes (e.g., real estate, state, and local income tax, excise franchise, occupational, personal property, sales and employer's portion of employment taxes, etc.) (19) $ Other expenses (e.g., secured debt payments. Specify on attachment. Do not include credit card payments) (20) $ Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0" on that line. Box C Total Business Expenses Add lines (11) through (20) and enter the amount in Box C = $ Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0" on that line. Box D Remaining Monthly Income Subtract Box C from Box B and enter the amount in Box D = $ Catalog Number 55897B www.irs.gov Form 433-B (OIC) (Rev. 3-2018) Page 5 of 6 Section 5 Calculate Your Minimum Offer Amount The next steps calculate your minimum offer amount. The amount of time you take to pay your offer in full will affect your minimum offer amount. Paying over a shorter period of time will result in a smaller minimum offer amount. If you will pay your offer in 5 or fewer payments within 5 months or less, multiply "Remaining Monthly Income" (Box D) by 12 to get "Future Remaining Income." Do not enter a number less than zero. Note: The multipliers below (12 and 24) and the calculated offer amount do not apply if IRS determines you have the ability to pay your tax debt in full within the legal period to collect. Round to the nearest whole dollar. Enter the total from Box D Box E Future Remaining Income X 12 = $ $ If you will pay your offer in 6 to 24 months, multiply "Remaining Monthly Income" (Box D) by 24 to get "Future Remaining Income". Do not enter a number less than zero. Enter the total from Box D Box F Future Remaining Income X 24 = $ $ Determine your minimum offer amount by adding the total available assets from Box A to the amount in either Box E or Box F. Your offer amount must be more than zero. Enter the amount from Box A * Enter the amount from either Box E or Box F + $ Offer Amount = $ Your offer must be more than zero ($0). Do not leave blank. Use whole dollars only. $ You must offer an amount more than $0. *You may exclude any equity in income producing assets shown in Section 2 of this form. Section 6 Other Information Additional information IRS needs to consider settlement of your tax debt. If this business is currently in a bankruptcy proceeding, the business is not eligible to apply for an offer. Is the business currently in bankruptcy? Yes No Has the business ever filed bankruptcy? Yes No If yes, provide: Date Filed (mm/dd/yyyy) Petition No. Date Dismissed or Discharged (mm/dd/yyyy) Location Filed Does this business have other business affiliations (e.g., subsidiary or parent companies)? Yes No If yes, list the Name and Employer Identification Number: Do any related parties (e.g., partners, officers, employees) owe money to the business? Yes No Is the business currently, or in the past, a party to a lawsuit? Yes No If yes, date the lawsuit was resolved: Are you or have you been party to any lawsuits involving the IRS/United States (including any suits regarding tax matters)? Yes No If yes and the suit included tax debt, provide the types of tax and periods involved. In the past 10 years, has the business transferred any assets for less than their full value? Yes No If yes, provide date, value, and type of asset transferred: Catalog Number 55897B www.irs.gov Form 433-B (OIC) (Rev. 3-2018) Page 6 of 6 In the past 3 years have you transferred any real property (land, house, etc.)? Yes No If yes, list the type of property, value, and date of the transfer. Has the business been located outside the U.S. for 6 months or longer in the past 10 years? Yes No Do you have any assets or own any real property outside the U.S.? Yes No If yes, please provide description, location, and value. Does the business have any funds being held in trust by a third party? Yes No If yes, how much $ Where: Does the business have any lines of credit? Yes No If yes, credit limit $ Amount owed $ What property secures the line of credit? Section 7 Signatures Under penalties of perjury, I declare that I have examined this offer, including accompanying documents, and to the best of my knowledge it is true, correct, and complete. ► Signature of Taxpayer Title Date (mm/dd/yyyy) Remember to include all applicable attachments from list below. A current Profit and Loss statement covering at least the most recent 6–12 month period, if appropriate Copies of the six most recent bank statements for each business account and copies of the three most recent statements for each investment and retirement accounts If an asset is used as collateral on a loan, include copies of the most recent statement from lender(s) on loans, monthly payments, loan payoffs, and balances Copies of the most recent statement of outstanding notes receivable Copies of the most recent statements from lenders on loans, mortgages (including second mortgages), monthly payments, loan payoffs, and balances Copies of relevant supporting documentation of the special circumstances described in the “Explanation of Circumstances” on Form 656, if applicable Attach a Form 2848, Power of Attorney, if you would like your attorney, CPA, or enrolled agent to represent you and you do not have a current form on file with the IRS. Make sure the current tax year is included. Completed and signed Form 656 Catalog Number 55897B www.irs.gov Form 433-B (OIC) (Rev. 3-2018)
Extracted from PDF file 2018-federal-form-433-b-oic.pdf, last modified March 2018

More about the Federal Form 433-B (OIC) Other TY 2018

We last updated the Collection Information Statement for Businesses in December 2018, so this is the latest version of Form 433-B (OIC), fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 433-B (OIC) directly from TaxFormFinder. You can print other Federal tax forms here.


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Related Federal Other Forms:

TaxFormFinder has an additional 774 Federal income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Federal Form 433-B (OIC).

Form Code Form Name
Form 433-B Collection Information Statement for Businesses

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 433-B (OIC) from the Internal Revenue Service in December 2018.

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Historical Past-Year Versions of Federal Form 433-B (OIC)

We have a total of five past-year versions of Form 433-B (OIC) in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 433-B (OIC)

Form 433-B (OIC) (Rev. 3-2018)

2017 Form 433-B (OIC)

Form 433-B (OIC) (Rev. January 2014) Catalog Number 55897B

2016 Form 433-B (OIC)

Form 433-B (OIC) (Rev. January 2014) Catalog Number 55897B

Collection Information Statement for Businesses 2015 Form 433-B (OIC)

Form 433-B (OIC) (Rev. January 2014) Catalog Number 55897B

Collection Information Statement for Businesses 2012 Form 433-B (OIC)

Form 433-B (OIC) (Rev. May 2012)


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