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Federal Free Printable Form 656-B (Rev. 3-2018) for 2019 Federal Offer in Compromise Booklet

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Offer in Compromise Booklet
Form 656-B (Rev. 3-2018)

Form 656 Booklet Offer in Compromise CONTENTS ■ What you need to know................................................................................. 1 ■ Paying for your offer ..................................................................................... 3 ■ How to apply ................................................................................................ 4 ■ Completing the application package ............................................................ 5 ■ Important information ................................................................................... 6 ■ Removable Forms - Form 433-A (OIC), Collection Information Statement for Wage Earners and Self-Employed; Form 433-B (OIC), Collection Information Statement for Businesses; Form 656, Offer in Compromise ..... 7 ■ Application Checklist .................................................................................... 29 IRS contact information If you want to see if you qualify for an offer in compromise before filling out the paperwork, you may use the Offer in Compromise Pre-Qualifier tool. The questionnaire format assists in gathering the information needed and provides instant feedback as to your eligibility based on the information you provided. The tool will also assist you in determining a preliminary offer amount for consideration of an acceptable offer. The Pre-Qualifier tool is located on our website at www.irs.gov. If you have questions regarding qualifications for an offer in compromise, please call our toll-free number at 1-800-829-1040. You can get forms and publications by calling 1-800-TAX-FORM (1-800-829-3676), by visiting your local IRS office, or at www.irs.gov. Taxpayer resources The Taxpayer Advocate Service (TAS) is an independent organization within the Internal Revenue Service that helps taxpayers and protects taxpayer rights. TAS helps taxpayers whose problems with the IRS are causing financial difficulties, who've tried but haven't been able to resolve their problems with the IRS, or believe an IRS system or procedure isn't working as it should. And the service is free. Your local advocate's number is in your local directory and at taxpayeradvocate.irs.gov. You can also call us at 1-877-777-4778. For more information about TAS and your rights under the Taxpayer Bill of Rights, go to taxpayeradvocate.irs.gov. TAS is your voice at the IRS. Low-Income Taxpayer Clinics (LITCs) are independent from the IRS. LITCs serve individuals whose income is below a certain level and who need to resolve a tax problem with the IRS. LITCs provide professional representation before the IRS or in court on audits, appeals, tax collection disputes, and other issues for free or for a small fee. For more information and to find a LITC near you, see the LITC page at www.taxpayeradvocate.irs.gov/litcmap or IRS Publication 4134, Low-Income Taxpayer Clinic List. This Publication is also available by calling the IRS toll-free at 1-800-829-3676 or visiting your local IRS office. WHAT YOU NEED TO KNOW What is an Offer? An Offer in Compromise (offer) is an agreement between you (the taxpayer) and the IRS that settles a tax debt for less than the full amount owed. The offer program provides eligible taxpayers with a path toward paying off their tax debt and getting a fresh start. The ultimate goal is a compromise that suits the best interest of both the taxpayer and the IRS. To be considered, generally you must make an appropriate offer based on what the IRS considers your true ability to pay. Submitting an application does not ensure that the IRS will accept your offer. It begins a process of evaluation and verification by the IRS, taking into consideration any special circumstances that might affect your ability to pay. This booklet will lead you through a series of steps to help you calculate an appropriate offer based on your assets, income, expenses, and future earning potential. The application requires you to describe your financial situation in detail, so before you begin, make sure you have the necessary information and documentation. Are You Eligible? Before your offer can be considered, you must (1) file all tax returns you are legally required to file, (2) have received a bill for at least one tax debt included on your offer, (3) make all required estimated tax payments for the current year, and (4) make all required federal tax deposits for the current quarter if you are a business owner with employees. Your offer will be immediately returned without consideration if you have not filed all tax returns you are legally required to file. Note: If it is determined you have not filed all tax returns, any initial payment sent with your offer will be applied to your tax debt and your offer will be returned along with your application fee. You cannot appeal this decision. Bankruptcy, Open Audit or Innocent Spouse Claim If you or your business is currently in an open bankruptcy proceeding, you are not eligible to apply for an offer. Any resolution of your outstanding tax debts generally must take place within the context of your bankruptcy proceeding. If you are not sure of your bankruptcy status, contact the Centralized Insolvency Operation at 1-800-973-0424. Be prepared to provide your bankruptcy case number and/or Taxpayer Identification Number. If you currently have any open audit or outstanding innocent spouse claim, wait for those issues to be resolved before you submit an offer. For any additional questions see www.irs.gov. Offer in Compromise FAQs. Can You Pay in Full? Generally, the IRS will not accept an offer if you can pay your tax debt in full or through an installment agreement and/or equity in assets. Note: Adjustments or exclusions, such as allowance of $1,000 to a bank balance or $3,450 against the value of a car, are only applied after it is determined that you cannot pay your tax debt in full. Your Future Tax Refunds The IRS will keep any refund, including interest, for tax periods extending through the calendar year that the IRS accepts the offer. For example, if your offer is accepted in 2018 and you file your 2018 Form 1040 on April 15, 2019 showing a refund, IRS will apply your refund to your tax debt. The refund is not considered as a payment toward your offer. 1 Doubt as to Liability If you have a legitimate doubt that you owe part or all of the tax debt, complete and submit a Form 656-L, Offer in Compromise (Doubt as to Liability). The Form 656-L is not included as part of this package. To request a Form 656-L, visit www. irs.gov or a local IRS office or call toll-free 1-800-TAX-FORM (1-800-829-3676). Note: Do not submit both a Doubt as to Liability offer and an offer under Doubt as to Collectibility or Effective Tax Administration at the same time. Any doubt you owe part or all of the tax debt must be resolved before sending in an offer based on your ability to pay. Notice of Federal Tax Lien A lien is a legal claim against all your current and future property. When you don’t pay your first bill for taxes due, a lien is created by law and attaches to your property. A Notice of Federal Tax Lien (NFTL) provides public notice to creditors and is filed to establish priority of the IRS claim versus the claims of other creditors. The IRS may file a NFTL while your offer is being considered. You may be entitled to file an appeal under the Collection Appeal Program (CAP) before this occurs. Note: A Notice of Federal Tax Lien (NFTL) will not be filed on any individual shared responsibility payment under the Affordable Care Act. Trust Fund Taxes If your business owes trust fund taxes, responsible individuals may be held liable for the trust fund portion of the tax. Trust fund taxes are the money withheld from an employee's wages, such as income tax, Social Security, and Medicare taxes. You are not eligible for consideration of an offer unless the trust fund portion of the tax is paid or the Trust Fund Recovery Penalty determination(s) has/have been made on all potentially responsible individual(s). However, if you are submitting the offer as a victim of payroll service provider fraud or failure, the trust fund assessment discussed above is not required prior to submitting the offer. Your Rights as a Taxpayer Each and every taxpayer has a set of fundamental rights they should be aware of when dealing with the IRS. Explore your rights and our obligations to protect them. For more information on your rights as a taxpayer, go to http://www.irs.gov/ Taxpayer-Bill-of-Rights. Other Important Facts Penalties and interest will continue to accrue during consideration of your offer. After you file your offer, you must continue to timely file and pay all required tax returns, estimated tax payments, and federal tax payments. Failure to meet your filing and payment responsibilities during consideration of your offer will result in your offer being returned. If your offer is accepted, you must continue to stay current with all tax filing and payment obligations through the fifth year after your offer is accepted (including any extensions). Note: If you have filed your tax returns but you have not received a bill for at least one tax debt included on your offer, your offer and application fee may be returned and any initial payment sent with your offer will be applied to your tax debt. Include a complete copy of any tax return filed within 60 days prior to this offer submission. An offer cannot be accepted for processing if the IRS has referred your case, or cases, involving all of the liabilities identified in the offer to the Department of Justice (DOJ). In addition, the IRS cannot compromise any restitution amount ordered by a court or a tax debt that has been reduced to judgment. The law requires the IRS to make certain information from accepted offers available for public inspection and review. These public inspection files are located in designated IRS Area Offices. 2 The IRS may levy your assets up to the time the IRS official signs and acknowledges your offer as pending. In addition, the IRS may keep any proceeds received from the levy. If your assets are levied after your offer is submitted and pending evaluation, immediately contact the IRS person whose name and phone number are listed on the levy. If you currently have an approved installment agreement, you will not be required to make your installment agreement payments while your offer is being considered. If your offer is not accepted and you have not incurred any additional tax debt, your installment agreement with the IRS will be reinstated with no additional fee. PAYING FOR YOUR OFFER Application Fee Offers require a $186 application fee. Exception: If you are an individual and meet the Low-Income Certification guidelines, you are not required to send any money with your offer. You are considered an individual if you are seeking compromise of a liability for which you are personally responsible, including any liability you incurred as a sole proprietor or any Form 941 liability incurred prior to January 1, 2009 as a disregarded single member LLC. Payment Options You must select a payment option and include the payment with your offer. The amount of the initial payment and subsequent payments will depend on the total amount of your offer and which of the following payment options you choose: Lump Sum Cash: This option requires 20% of the total offer amount to be paid with the offer and the remaining balance paid in 5 or fewer payments within 5 or fewer months of the date your offer is accepted. Periodic Payment: This option requires the first payment to be paid with the offer and the remaining balance paid in monthly payments within 6 to 24 months, in accordance with your proposed offer terms. Note: Under this option, you must continue to make monthly payments while the IRS is evaluating your offer. Failure to make these payments will cause your offer to be returned. There is no appeal. Total payments must equal the total offer amount. Exception: If you are an individual and meet the Low-Income Certification guidelines, you will not be required to send the initial payment or make the required monthly payments while your offer is being considered. Generally, payments made on an offer will not be returned. You, however, may make a deposit, as described in Form 656, Section 5. Deposits may be returned. If your offer is accepted, your payments made during the offer process, including any money designated as a deposit, will be applied to your offer amount. If you do not have sufficient cash to pay for your offer, you may need to consider borrowing money from a bank, friends, and/or family. Other options may include borrowing against or selling other assets. Note: You may not pay your offer amount with an expected or current tax refund, money already paid, funds attached by any collection action, or anticipated benefits from a capital or net operating loss. If you are planning to use your retirement savings from an IRA or 401k plan, you may have future tax debt as a result. Contact the IRS or your tax advisor before taking this action. 3 HOW TO APPLY Application Process The application must include: • Form 656, Offer in Compromise • Completed Form 433-A (OIC), Collection Information Statement for Wage Earners and Self-Employed Individuals, if applicable • Completed Form 433-B (OIC), Collection Information Statement for Businesses, if applicable • $186 application fee, unless you meet Low-Income Certification • Initial offer payment, unless you meet Low-Income Certification Note: Your offer(s) cannot be considered without the completed and signed Collection Information Statement(s), Form 433-A (OIC) and/or 433-B (OIC). If You and Your Spouse Owe Joint and Separate Tax Debts If you and your spouse have joint tax debt(s) and you and/or your spouse are also responsible for separate tax debt(s), you will each need to send in a separate Form 656. You will complete one Form 656 for yourself listing all your joint and any separate tax debts and your spouse will complete one Form 656 listing all his or her joint tax debt(s) plus any separate tax debt(s), for a total of two Forms 656. If you and your spouse or ex-spouse have a joint tax debt and your spouse or exspouse does not want to be part of the offer, you on your own may submit a Form 656 to compromise your responsibility for the joint tax debt. Each Form 656 will require the $186 application fee and initial payment unless you are an individual and meet the Low-Income Certification guidelines. You are considered an individual if you are seeking compromise of a liability for which you are personally responsible, including any liability you incurred as a sole proprietor, or any Form 941 liability incurred prior to January 1, 2009 as a disregarded single member LLC. If You Owe Individual and Business Tax Debt If you have individual and business tax debt that you wish to compromise, you will need to send in two Forms 656. Complete one Form 656 for your individual tax debts and one Form 656 for your business tax debts. Each Form 656 will require the $186 application fee and initial payment. Note: A business is defined as a corporation, partnership, or any business that is operated as other than a sole-proprietorship. An individual's share of a partnership debt will not be compromised. The partnership must submit its own offer based on the partnership's and partners' ability to pay. If You Have Tax Debt From a Limited Liability Company (LLC) Individuals or individuals operating as a disregarded single member LLC taxed as a sole proprietor with tax debts (including employment taxes) incurred before January 1, 2009 may be included on your individual Form 656. However, in those instances where an LLC incurred employment taxes on or after January 1, 2009 or excise taxes on or after January 1, 2008, two Forms 656 must be sent with a separate application fee and initial payment for each offer, even if the tax debts were reported under the same Tax Identification Number. One Form 656 will be for the individual tax debts while the second Form 656 will be for the LLC employment tax debts incurred on or after January 1, 2009 and excise tax debts on or after January 1, 2008. 4 COMPLETING THE APPLICATION PACKAGE Step 1 – Gather Your Information To calculate an offer amount, you will need to gather information about your financial situation, including cash, investments, available credit, assets, income, and debt. You will also need to gather information about your average household's gross monthly income and expenses. The entire household includes all those in addition to yourself who contribute money to pay expenses relating to the household such as, rent, utilities, insurance, groceries, etc. This is necessary for the IRS to accurately evaluate your offer. In general, the IRS will not consider expenses for tuition for private schools, college expenses, charitable contributions, and other unsecured debt payments as part of the expense calculation. Step 2 – Fill out Form 433-A (OIC), Collection Information Statement for Wage Earners and Self-Employed Individuals Fill out Form 433-A (OIC) if you are an individual wage earner and operate or operated as a sole proprietor, a disregarded single member LLC taxed as a sole proprietor prior to 2009 or are submitting an offer on behalf of a deceased individual. If you are married but living separately from your spouse then you each must submit a Form 433-A(OIC). This will be used to calculate an appropriate offer amount based on your assets, income, expenses, and future earning potential. You will have the opportunity to provide a written explanation of any special circumstances that affect your financial situation. Step 3 – Fill out Form 433-B (OIC), Collection Information Statement for Businesses Fill out Form 433-B (OIC) if the business is a Corporation, Partnership, LLC classified as a corporation, single member LLC taxed as a corporation, or other multi-owner/multi-member LLC. This will be used to calculate an appropriate offer amount based on the business assets, income, expenses, and future earning potential. If the business has assets that are used to produce income (for example, a tow truck used in the business for towing vehicles), the business may be allowed to exclude equity in these assets. Step 4 – Attach Required Documentation You will need to attach supporting documentation with Form(s) 433-A (OIC) and 433-B (OIC). A list of the documents required will be found at the end of each form. Include copies of all required attachments. Do not send original documents. Step 5 – Fill out Form 656, Offer in Compromise Fill out Form 656. The Form 656 identifies the tax years and type of tax you would like to compromise. It also identifies your offer amount and the payment terms. Step 6 – Include Initial Payment and $186 Application Fee Include a personal check, cashier's check, or money order for your initial payment based on the payment option you selected (20% of the offer amount for a lump sum cash offer or the first month's payment for a periodic payment offer). Generally, initial payments will not be returned but will be applied to your tax debt. If you meet the Low-Income Certification guidelines DO NOT send any money with your offer since the initial payment and application fee are not required. Include a separate personal check, cashier's check, or money order for the application fee ($186). Make both payments payable to the “United States Treasury.” All payments must be made in U.S. dollars. Step 7 – Mail the Application Package Make a copy of your application package and keep it for your records. Mail the completed application package to the appropriate IRS facility. See page 29, Application Checklist, for details. Note: If you are working with an IRS employee, let him or her know you are sending or have sent an offer to compromise your tax debt(s). 5 IMPORTANT INFORMATION After You Mail Your Application: We will contact you after we receive and review your offer application. Promptly reply to any requests for additional information within the time frame specified. If you selected the Periodic Payment option, you must continue to make the payments during consideration of your offer, unless you meet the Low-Income Certification. Failure to reply timely to requests for additional information or make monthly payments may result in the return of your offer without appeal rights. If your offer is accepted, you must continue to timely file all required tax returns and timely pay all estimated tax payments and federal tax payments that become due in the future. If you fail to timely file and timely pay any tax obligations that become due within the five years after your offer is accepted (including any extensions) your offer may be defaulted. If your offer is defaulted, you will be liable for the original tax debt, less payments made, and all accrued interest and penalties. An offer does not stop the accrual of interest and penalties. Please note that if your final payment is more than the agreed amount by $50 or less the money will not be returned but will be applied to your tax debt. If your final payment is more than $50 over the agreed amount then the overpayment will be returned to you. In addition, your offer may be defaulted if you fail to promptly pay any tax debts assessed after acceptance of your offer for any tax years prior to acceptance that were not included in your original offer. 6 Form 433-A (OIC) (March 2018) Department of the Treasury — Internal Revenue Service Collection Information Statement for Wage Earners and Self-Employed Individuals Use this form if you are ► An individual who owes income tax on a Form 1040, U.S. Individual Income Tax Return ► An individual with a personal liability for Excise Tax ► An individual responsible for a Trust Fund Recovery Penalty ► An individual who is self-employed or has self-employment income. You are considered to be self-employed if you are in business for yourself, or carry on a trade or business. ► An individual who is personally responsible for a partnership liability (only if the partnership is submitting an offer) ► An individual who operated as a disregarded single member Limited Liability Company (LLC) taxed as a sole proprietor prior to 2009 ► An individual who is submitting an offer on behalf of the estate of a deceased person Note: Include attachments if additional space is needed to respond completely to any question. This form should only be used with the Form 656, Offer in Compromise. Section 1 Personal and Household Information Last Name First Name Social Security Number Date of Birth (mm/dd/yyyy) Marital status Home Physical Address (Street, City, State, ZIP Code) Unmarried Own your home Rent Other (specify e.g., share rent, live with relative, etc.) Married County of Residence Primary Phone ( Secondary Phone ( - Do you: ) ) Home Mailing Address (if different from above or Post Office Box number) - Fax Number - ( ) - Provide information about your spouse. Spouse's Last Name Spouse's First Name Date of Birth (mm/dd/yyyy) Social Security Number - - Provide information for all other persons in the household or claimed as a dependent. Name Section 2 Age Relationship Claimed as a dependent on your Form 1040? Contributes to household income? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Employment Information for Wage Earners Complete this section if you or your spouse are wage earners and receive a Form W-2. If you or your spouse have self-employment income (that is you file a Schedule C, E, F, etc.) instead of, or in addition to wage income, you must also complete Business Information in Sections 4, 5, and 6. Your Employer’s Name Do you have an ownership interest in this business? Yes No Your Occupation Employer’s Address (street, city, state, zip code) If yes, check the business interest that applies: Partner Officer Sole proprietor How long with this employer (years) (months) Spouse’s Employer's Name Does your spouse have an ownership interest in this business? Yes No Spouse's Occupation Employer’s Address (street, city, state, zip code) If yes, check the business interest that applies: Partner Officer Sole proprietor How long with this employer (years) Catalog Number 55896Q www.irs.gov (months) Form 433-A (OIC) (Rev. 3-2018) Page 2 of 8 Section 3 Personal Asset Information Use the most current statement for each type of account, such as checking, savings, money market and online accounts, stored value cards (such as, a payroll card from an employer), investment and retirement accounts (IRAs, Keogh, 401(k) plans, stocks, bonds, mutual funds, certificates of deposit, and virtual currency such as Bitcoin, Ripple and Litecoin), life insurance policies that have a cash value, and safe deposit boxes. Asset value is subject to adjustment by IRS based on individual circumstances. Enter the total amount available for each of the following (if additional space is needed 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) $ Checking Savings Money Market Account/CD Bank Name Online Account Stored Value Card Account Number (1b) $ Investment Account: Stocks Bonds Total of bank accounts from attachment (1c) $ Add lines (1a) through (1c) minus ($1,000) = (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 = $ Retirement Account: 401K IRA – $ Other Name of Financial Institution Account Number Current Market Value Minus Loan Balance $ X .8 = $ – $ = (3a) $ = (3b) $ Total of retirement accounts from attachment. [current market value X .8 minus loan balance(s)] (3c) $ Add lines (3a) through (3c) = (3) $ Retirement Account: 401K IRA Other Name of Financial Institution Account Number Current Market Value $ Minus Loan Balance X .8 = $ – $ Note: Your reduction from current market value may be greater than 20% due to potential tax consequences/withdrawal penalties. Cash Value of Life Insurance Policies Name of Insurance Company Current Cash Value $ Total cash value of life insurance policies from attachment $ Catalog Number 55896Q Policy Number Minus Loan Balance – $ = (4a) $ = (4b) $ Add lines (4a) through (4b) = (4) $ Minus Loan Balance(s) – $ www.irs.gov Form 433-A (OIC) (Rev. 3-2018) Page 3 of 8 Section 3 (Continued) Personal Asset Information Real Estate (Enter information about any house, condo, co-op, time share, etc. that you own or are buying) Property Address (Street Address, City, State, ZIP Code) Primary Residence Yes No Date Purchased County and Country Date of Final Payment How title is held (joint tenancy, etc.) Description of Property Minus Loan Balance (Mortgages, etc.) Current Market Value $ X .8 = $ – $ Property Address (Street Address, City, State, ZIP Code) (Total Value of Real Estate) = Primary Residence Yes (5a) $ No Date Purchased County and Country Date of Final Payment How title is held (joint tenancy, etc.) Description of Property Minus Loan Balance (Mortgages, etc.) Current Market Value $ X .8 = $ – $ (Total Value of Real Estate) = (5b) $ Total value of property(s) from attachment [current market value X .8 minus any loan balance(s)] (5c) $ Add lines (5a) through (5c) = (5) $ Vehicles (Enter information about any cars, boats, motorcycles, etc. that you own or lease) Vehicle Make & Model Lease Year Name of Creditor Date Purchased Mileage Date of Final Payment Monthly Lease/Loan Amount Loan $ Current Market Value $ Minus Loan Balance (Mortgages, etc.) X .8 = $ Vehicle Make & Model Lease Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = (6a) $ Subtract $3,450 from line (6a) (If line (6a) minus $3,450 is a negative number, enter "0") (6b) $ – $ Year Name of Creditor Date Purchased Mileage Date of Final Payment Monthly Lease/Loan Amount Loan $ Current Market Value $ Minus Loan Balance (Mortgages, etc.) Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = (6c) $ If you are filing a joint offer, subtract $3,450 from line (6c) (If line (6c) minus $3,450 is a negative number, enter "0") If you are not filing a joint offer, enter the amount from line (6c) (6d) $ Total value of vehicles listed from attachment [current market value X .8 minus any loan balance(s)] (6e) $ X .8 = $ – $ Total lines (6b), (6d), and (6e) = Catalog Number 55896Q www.irs.gov (6) $ Form 433-A (OIC) (Rev. 3-2018) Page 4 of 8 Section 3 (Continued) Personal Asset Information Other valuable items (artwork, collections, jewelry, items of value in safe deposit boxes, interest in a company or business that is not publicly traded, etc.) Description of asset: Current Market Value Minus Loan Balance $ X .8 = $ – $ = (7a) $ = (7b) $ Description of asset: Current Market Value Minus Loan Balance $ X .8 = $ – $ Value of remaining furniture and personal effects (not listed above) Description of asset: Minus Loan Balance Current Market Value $ X .8 = $ – $ = (7c) $ Total value of valuable items listed from attachment [current market value X .8 minus any loan balance(s)] (7d) $ Add lines (7a) through (7d) = (7) $ Box A Available Individual Equity in Assets Do not include amount on the lines with a letter beside the number. Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line. Add lines (1) through (7) and enter the amount in Box A = $ NOTE: If you or your spouse are self-employed, Sections 4, 5, and 6 must be completed before continuing with Sections 7 and 8. Section 4 Self-Employed Information If you or your spouse are self-employed (e.g., files Schedule(s) C, E, F, etc.), complete this section. Is your business a sole proprietorship? Yes Address of Business (If other than personal residence) No Name of Business Business Telephone Number ( ) Employer Identification Number Business Website Total Number of Employees Frequency of Tax Deposits - Description of Business Do you or your spouse have any other business interests? Include any interest in an LLC, LLP, corporation, partnership, etc. Yes Trade Name or DBA (Percentage of ownership: Average Gross Monthly Payroll $ Business Address (Street, City, State, ZIP code) ) Title: No Business Name Employer Identification Number Business Telephone Number ( ) - Type of business (Select one) Partnership LLC Corporation Section 5 Other Business Asset Information (for Self-Employed) List business assets such as bank accounts, tools, books, machinery, equipment, business vehicles and real property that is owned/leased/rented. If additional space is needed, attach a list of items. Do not include personal assets listed in Section 3. Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative number, enter "0". Cash Checking Savings Money Market Account/CD Bank Name Online Account Stored Value Card Account Number (8a) $ Cash Checking Savings Money Market Account/CD Bank Name Online Account Stored Value Card Account Number (8b) $ Catalog Number 55896Q www.irs.gov Total bank accounts from attachment (8c) $ Add lines (8a) through (8c) = (8) $ Form 433-A (OIC) (Rev. 3-2018) Page 5 of 8 Section 5 (Continued) Business Asset Information (for Self-Employed) Description of asset: Total Value (if leased or used in the production of income, enter 0 as the total value) = (9a) $ Total Value (if leased or used in the production of income, enter 0 as the total value) = (9b) $ Total value of assets listed from attachment [current market value X .8 minus any loan balance(s)] (9c) $ Current Market Value $ Minus Loan Balance X .8 = $ – $ Description of asset: Current Market Value $ Minus Loan Balance X .8 = $ – $ Add lines (9a) through (9c) = IRS allowed deduction for professional books and tools of trade – Enter the value of line (9) minus line (10). If less than zero enter zero. = (9) $ (10) $ [4,690] (11) $ Notes Receivable Do you have notes receivable? Yes No If yes, attach current listing that includes name(s) 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 your account(s) receivable. Do not include amounts from the lines with a letter beside the number [for example: (9c)]. Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line. Box B Available Business Equity in Assets Add lines (8) and (11) and enter the amount in Box B = $ Section 6 Business Income and Expense Information (for Self-Employed) If you provide a current profit and loss (P&L) statement for the information below, enter the total gross monthly income on line 17 and your monthly expenses on line 29 below. Do not complete lines (12) - (16) and (18) - (28). You may use the amounts claimed for income and expenses on your most recent Schedule C; however, if the amount has changed significantly within the past year, a current P&L should be submitted to substantiate the claim. Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative number, enter "0". Business Income (You may average 6-12 months income/receipts to determine your Gross monthly income/receipts.) Gross receipts (12) $ Gross rental income (13) $ Interest income (14) $ Dividends (15) $ Other income (16) $ Add lines (12) through (16) = (17) $ Business Expenses (You may average 6-12 months expenses to determine your average expenses.) Materials purchased (e.g., items directly related to the production of a product or service) (18) $ Inventory purchased (e.g., goods bought for resale) (19) $ Gross wages and salaries (20) $ Rent (21) $ Supplies (items used to conduct business and used up within one year, e.g., books, office supplies, professional equipment, etc.) (22) $ Utilities/telephones (23) $ Vehicle costs (gas, oil, repairs, maintenance) (24) $ Business Insurance (25) $ Current Business Taxes (e.g., Real estate, excise, franchise, occupational, personal property, sales and employer's portion of employment taxes) (26) $ Secured debts (not credit cards) (27) $ Other business expenses (include a list) (28) $ Add lines (18) through (28) = (29) $ Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line. Box C Net Business Income Subtract line (29) from line (17) and enter the amount in Box C = $ Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 3-2018) Page 6 of 8 Section 7 Monthly Household Income and Expense Information Enter your household's gross monthly income. The information below is for yourself, your spouse, and anyone else who contributes to your household's income. The entire household includes spouse, non-liable spouse, significant other, children, and others who contribute to the household. This is necessary for the IRS to accurately evaluate your offer. Monthly Household Income Note: Entire household income should also include income that is considered not taxable and may not be included on your tax return. Round to the nearest whole dollar. Primary taxpayer Gross Wages $ Social Security Pension(s) + $ + $ + Other Income (e.g. unemployment) Total primary $ taxpayer income = (30) $ Spouse Gross Wages Social Security Pension(s) Other Income (e.g. unemployment) Total spouse $ + $ + $ + $ income = Additional sources of income used to support the household, e.g., non-liable spouse, or anyone else who may contribute to the household income, etc. (31) $ Interest and dividends (33) $ Distributions (e.g., income from partnerships, sub-S Corporations, etc.) (34) $ Net rental income (35) $ Net business income from Box C (36) $ Child support received (37) $ Alimony received (38) $ Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line. (32) $ Box D Total Household Income Add lines (30) through (38) and enter the amount in Box D = $ Monthly Household Expenses Enter your average monthly expenses. Note: For expenses claimed in boxes (39) and (45) only, you should list the full amount of the allowable standard even if the actual amount you pay is less. You may find the allowable standards at http://www.irs.gov/Businesses/Small-Businesses-&Self-Employed/Collection-Financial-Standards. Round to the nearest whole dollar. Food, clothing, and miscellaneous (e.g., housekeeping supplies, personal care products , minimum payment on credit card). A reasonable estimate of these expenses may be used. (39) $ Housing and utilities (e.g., rent or mortgage payment and average monthly cost of property taxes, home insurance, maintenance, dues, fees and utilities including electricity, gas, other fuels, trash collection, water, cable television and internet, telephone, and cell phone). (40) $ Vehicle loan and/or lease payment(s) (41) $ Vehicle operating costs (e.g., average monthly cost of maintenance, repairs, insurance, fuel, registrations, licenses, inspections, parking, tolls, etc.). A reasonable estimate of these expenses may be used. (42) $ Public transportation costs (e.g., average monthly cost of fares for mass transit such as bus, train, ferry, taxi, etc.). A reasonable estimate of these expenses may be used. (43) $ Health insurance premiums (44) $ Out-of-pocket health care costs (e.g. average monthly cost of prescription drugs, medical services, and medical supplies like eyeglasses, hearing aids, etc.) (45) $ Court-ordered payments (e.g., monthly cost of any alimony, child support, etc.) (46) $ Child/dependent care payments (e.g., daycare, etc.) (47) $ Life insurance premiums (48) $ Current monthly taxes (e.g., monthly cost of federal, state, and local tax, personal property tax, etc.) (49) $ Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 3-2018) Page 7 of 8 Section 7 Monthly Household Income and Expense Information (Continued) Secured debts (e.g., any loan where you pledged an asset as collateral not previously listed, government guaranteed Student Loan) (50) $ Enter the amount of your monthly delinquent State and/or Local Tax payment(s) (51) $ Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line. Box E Total Household Expenses Add lines (39) through (51) and enter the amount in Box E = $ Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line. Box F Remaining Monthly Income Subtract Box E from Box D and enter the amount in Box F = $ Section 8 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. 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. If you will pay your offer in 5 or fewer payments within 5 months or less, multiply "Remaining Monthly Income" (Box F) by 12 to get "Future Remaining Income" (Box G). Do not enter a number less than $0. Enter the total from Box F Box G Future Remaining Income $ X 12 = $ If you will pay your offer in 6 to 24 months, multiply "Remaining Monthly Income" (Box F) by 24 to get "Future Remaining Income" (Box H). Do not enter a number less than $0. Enter the total from Box F Box H Future Remaining Income $ X 24 = $ Determine your minimum offer amount by adding the total available assets from Box A and Box B (if applicable) to the amount in either Box G or Box H. Enter the amount from Box A plus Box B (if applicable) $ Enter the amount from either Box G or Box H + $ Offer Amount Your offer must be more than zero ($0). Do not leave blank. Use whole dollars only. = $ If you cannot pay the Offer Amount shown above due to special circumstances, explain on the Form 656, Offer in Compromise, Section 3, Reason for Offer, Explanation of Circumstances. You must offer an amount more than $0. Section 9 Other Information Additional information IRS needs to consider settlement of your tax debt. If you or your business are currently in a bankruptcy proceeding, you are not eligible to apply for an offer. Are you the beneficiary of a trust, estate, or life insurance policy? Yes No Are you currently in bankruptcy? Yes No Discharge/Dismissal Date (mm/dd/yyyy) Have you filed bankruptcy in the past 10 years? Yes No Location Filed Are you or have you been party to a lawsuit? Yes No If yes, date the lawsuit was resolved: (mm/dd/yyyy) 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. Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 3-2018) Page 8 of 8 In the past 10 years, have you transferred any assets for less than their full value? Yes No If yes, provide date, value, and type of asset transferred: (mm/dd/yyyy) 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. Have you lived 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, provide description, location, and value. Do you have any funds being held in trust by a third party? Yes No If yes, how much $ Section 10 Where: 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 Date (mm/dd/yyyy) Signature of Spouse Date (mm/dd/yyyy) Remember to include all applicable attachments listed below. Copies of the most recent pay stub, earnings statement, etc., from each employer Copies of the most recent statement for each investment and retirement account Copies of the most recent statement, etc., from all other sources of income such as pensions, Social Security, rental income, interest and dividends (including any received from a related partnership, corporation, LLC, LLP, etc.), court order for child support, alimony, and rent subsidies Copies of individual bank statements for the three most recent months. If you operate a business, copies of the six most recent statements for each business bank account. Copies of the most recent statement from lender(s) on loans such as mortgages, second mortgages, vehicles, etc., showing monthly payments, loan payoffs, and balances List of Notes Receivable, if applicable Verification of delinquent State/Local Tax Liability, if applicable Documentation to support any 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. Completed and signed Form 656 Catalog Number 55896Q www.irs.gov Form 433-A (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) Form Department of the Treasury — Internal Revenue Service 656 Offer in Compromise (March 2018) ► To: Commissioner of Internal Revenue Service IRS Received Date In the following agreement, the pronoun "we" may be assumed in place of "I" when there are joint liabilities and both parties are signing this agreement. I submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and additional amounts required by law for the tax type and period(s) marked in Section 1 or Section 2 below. Did you use the Pre-Qualifier tool located on our website at http://irs.treasury.gov/oic_pre_qualifier/ prior to filling out this form? Yes No Note: The use of the Pre-Qualifier tool is not mandatory before sending in your offer. However, it is recommended. Include the $186 application fee and initial payment (personal check, cashier's check, or money order) with your Form 656. You must also include the completed Form 433-A (OIC) and/or 433-B (OIC) and supporting documentation. You should fill out either Section 1 or Section 2, but not both, depending on the tax debt you are offering to compromise. Section 1 Individual Information (Form 1040 filers) If you are a 1040 filer, an individual with personal liability for Excise tax, individual responsible for Trust Fund Recovery Penalty, self-employed individual, individual personally responsible for partnership liabilities, and/or an individual who operated as a disregarded single member Limited Liability Company (LLC) taxed as a sole proprietor prior to 2009 you should fill out Section 1. Your First Name, Middle Initial, Last Name Social Security Number (SSN) If a Joint Offer, Spouse's First Name, Middle Initial, Last Name Social Security Number (SSN) - - - - Your Home Physical Address (Street, City, State, ZIP Code, County of Residence) Your Home Mailing Address (if different from above or Post Office Box number) Is this a new address? Yes No If yes, would you like us to update our records to this address? Yes No Your Employer Identification Number (if applicable) - Individual Tax Periods (If Your Offer is for Individual Tax Debt Only) 1040 Income Tax-Year(s) Trust Fund Recovery Penalty as a responsible person of (enter business name) for failure to pay withholding and Federal Insurance Contributions Act taxes (Social Security taxes), for period(s) ending 941 Employer's Quarterly Federal Tax Return - Quarterly period(s) 940 Employer's Annual Federal Unemployment (FUTA) Tax Return - Year(s) Other Federal Tax(es) [specify type(s) and period(s)] Note: If you need more space, use attachment and title it “Attachment to Form 656 dated attachment. Catalog Number 16728N www.irs.gov .” Make sure to sign and date the Form 656 (Rev. 3-2018) Page 2 of 7 Low-Income Certification (Individuals and Sole Proprietors Only) Do you qualify for Low-Income Certification? You qualify if your gross monthly household income is less than or equal to the amount shown in the chart below based on your family size and where you live. If you qualify, you are not required to submit any payments or the application fee upon submission or during the consideration of your offer. If your business is other than a sole proprietor or disregarded single member LLC taxed as a sole proprietor and you owe employment taxes on or after January 1, 2009, you cannot qualify for the waiver. IRS will determine whether the household income (at the time of the offer submission or at the time the offer is processed, whichever is lower) and family size support the decision not to pay the application fee. Check this box if your household's gross monthly income is equal to or less than the monthly income shown in the table below. Note: By checking this box you are certifying that your total household income and size of your family qualify you for the Low-Income Certification. IF YOU QUALIFY FOR THE LOW-INCOME CERTIFICATION DO NOT INCLUDE ANY PAYMENTS WITH YOUR OFFER. However, if you elect to send in money and the Low-Income Certification box is checked, you MUST check ONE of the options listed below. Payment - By checking this box I am requesting all money to be applied to my tax debt. Deposit - By checking this box I am requesting all money to be treated as a deposit and returned if my offer is not accepted. Please note that failure to check either box or checking both boxes above will result in all payments being applied to your tax debt and not returned to you. Size of family unit 48 contiguous states and D.C. Hawaii Alaska 1 $2,529 $2,908 $3,163 2 $3,429 $3,944 $4,288 3 $4,329 $4,979 $5,413 4 $5,229 $6,015 $6,538 5 $6,129 $7,050 $7,663 6 $7,029 $8,085 $8,788 7 $7,929 $9,121 $9,913 8 $8,829 $10,156 $11,038 For each additional person, add $900 $1,035 $1,125 Section 2 Business Information (Form 1120, 1065, etc., filers) If your business is a Corporation, Partnership, LLC, or LLP and you want to compromise those tax debts, you must complete this section. You must also include all required documentation including the Form 433-B (OIC), and a separate $186 application fee, and initial payment. Business Name Business Physical Address (Street, City, State, ZIP Code) Business Mailing Address (Street, City, State, ZIP Code) Employer Identification Number Name and Title of Primary Contact Telephone Number (EIN) - ( ) - Business Tax Periods (If Your Offer is for Business Tax Debt Only) 1120 Income Tax-Year(s) 941 Employer's Quarterly Federal Tax Return - Quarterly period(s) 940 Employer's Annual Federal Unemployment (FUTA) Tax Ret
Extracted from PDF file 2018-federal-form-656-b.pdf, last modified March 2018

More about the Federal Form 656-B Other TY 2018

We last updated the Offer in Compromise Booklet in December 2018, so this is the latest version of Form 656-B, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 656-B directly from TaxFormFinder. You can print other Federal tax forms here.


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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 656-B from the Internal Revenue Service in December 2018.

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Historical Past-Year Versions of Federal Form 656-B

We have a total of six past-year versions of Form 656-B in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 656-B

Form 656-B (Rev. 3-2018)

2017 Form 656-B

Form 656-B (Rev. 3-2017)

2016 Form 656-B

Form 656-B (Rev. 3-2017)

Form 656 Booklet Offer in Compromise 2015 Form 656-B

Form 656-B (Rev. 1-2015)

Form 656 Booklet Offer in Compromise 2012 Form 656-B

Form 656-B (Rev. 5-2012)

Form 656 Booklet Offer in Compromise 2011 Form 656-B

Form 656-B (Rev. 3-2011)


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