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Federal Free Printable Form 433-B (Rev. 2-2019) for 2024 Federal Collection Information Statement for Businesses

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Collection Information Statement for Businesses
Form 433-B (Rev. 2-2019)

Form 433-B Collection Information Statement for Businesses (February 2019) Department of the Treasury Internal Revenue Service Note: Complete all entry spaces with the current data available or "N/A" (not applicable). Failure to complete all entry spaces may result in rejection of your request or significant delay in account resolution. Include attachments if additional space is needed to respond completely to any question. Section 1: Business Information 1a Business Name 2a Employer Identification No. (EIN) 2b Type of entity (Check appropriate box below) Partnership Corporation Other Limited Liability Company (LLC) classified as a corporation Other LLC - Include number of members 2c Date Incorporated/Established mmddyyyy 1b Business Street Address Mailing Address City 1c County 1d Business Telephone 1e Type of Business State ( ZIP ) 3a 3b 3c 3d Number of Employees Monthly Gross Payroll Frequency of Tax Deposits 1f Business Website (web address) Is the business enrolled in Electronic Federal Tax Payment System (EFTPS) 4 Does the business engage in e-Commerce (Internet sales) If yes, complete 5a and 5b. Yes Yes No No PAYMENT PROCESSOR (e.g., PayPal, Authorize.net, Google Checkout, etc.) Include virtual currency wallet, exchange or digital currency exchange. Name and Address (Street, City, State, ZIP code) Payment Processor Account Number 5a 5b CREDIT CARDS ACCEPTED BY THE BUSINESS Type of Credit Card Merchant Account Number (e.g., Visa, Mastercard, etc.) Issuing Bank Name and Address (Street, City, State, ZIP code) 6a Phone 6b Phone 6c Phone Section 2: Business Personnel and Contacts PARTNERS, OFFICERS, LLC MEMBERS, MAJOR SHAREHOLDERS (Foreign and Domestic), ETC. Taxpayer Identification Number 7a Full Name ) Title Home Telephone ( ) Home Address Work/Cell Phone ( Ownership Percentage & Shares or Interest City State ZIP Responsible for Depositing Payroll Taxes Yes No Annual Salary/Draw Taxpayer Identification Number 7b Full Name ) Title Home Telephone ( ) Home Address Work/Cell Phone ( Ownership Percentage & Shares or Interest City State ZIP Responsible for Depositing Payroll Taxes Yes No Annual Salary/Draw Taxpayer Identification Number 7c Full Name ) Title Home Telephone ( ) Home Address Work/Cell Phone ( City State Responsible for Depositing Payroll Taxes Yes ZIP No 7d Full Name Title Home Address City State Responsible for Depositing Payroll Taxes Yes ZIP No Catalog Number 16649P www.irs.gov Ownership Percentage & Shares or Interest Annual Salary/Draw Taxpayer Identification Number ) Home Telephone ( ) Work/Cell Phone ( Ownership Percentage & Shares or Interest Annual Salary/Draw Form 433-B (Rev. 2-2019) Form 433-B (Rev. 2-2019) Page 2 Section 3: Other Financial Information (Attach copies of all applicable documents) 8 Does the business use a Payroll Service Provider or Reporting Agent (If yes, answer the following) Yes Name and Address (Street, City, State, ZIP code) 9 Effective dates (mmddyyyy) Is the business a party to a lawsuit (If yes, answer the following) Plaintiff Amount of Suit $ 10 Yes Location of Filing Represented by Possible Completion Date (mmddyyyy) Subject of Suit Date Filed (mmddyyyy) Docket/Case No. Date Dismissed (mmddyyyy) Yes Date Discharged (mmddyyyy) Petition No. Date of Loan Current Balance As of Name and Address (Street, City, State, ZIP code) mmddyyyy Yes $ Have any assets been transferred, in the last 10 years, from this business for less than full value (If yes, answer the following) 13 Value at Time of Transfer $ Date Transferred (mmddyyyy) Yes Related Business Name and Address (Street, City, State, ZIP code) Yes No Related Business EIN: Any increase/decrease in income anticipated (If yes, answer the following) Yes How much will it increase/decrease Explain (Use attachment if needed) No To Whom or Where Transferred Does this business have other business affiliations (e.g., subsidiary or parent companies) (If yes, answer the following) 14 No Payment Date Payment Amount $ List Asset No District of Filing Do any related parties (e.g., officers, partners, employees) have outstanding amounts owed to the business (If yes, answer the following) 12 No Defendant Has the business ever filed bankruptcy (If yes, answer the following) 11 No No When will it increase/decrease $ 15 Is the business a Federal Government Contractor (Include Federal Government contracts in #18, Accounts/Notes Receivable) Yes No Section 4: Business Asset and Liability Information (Foreign and Domestic) 16a CASH ON HAND Include cash that is not in the bank Total Cash on Hand $ Contents 16b Is there a safe on the business premises Yes No BUSINESS BANK ACOUNTS Include online and mobile accounts (e.g., PayPal), money market accounts, savings accounts, checking accounts and stored value cards (e.g., payroll cards, government benefit cards, etc.) List safe deposit boxes including location, box number and value of contents. Attach list of contents. Type of Account Full Name and Address (Street, City, State, ZIP code) of Bank, Savings & Loan, Credit Union or Financial Institution Account Balance Account Number As of mmddyyyy 17a $ 17b $ 17c $ 17d Total Cash in Banks (Add lines 17a through 17c and amounts from any attachments) $ Catalog Number 16649P www.irs.gov Form 433-B (Rev. 2-2019) Form 433-B (Rev. 2-2019) Page 3 ACCOUNTS/NOTES RECEIVABLE Include e-payment accounts receivable and factoring companies, and any bartering or online auction accounts. (List all contracts separately including contracts awarded, but not started). Include Federal, state and local government grants and contracts. Name & Address (Street, City, State, ZIP code) Status (e.g., age, factored, other) Date Due (mmddyyy) Invoice Number or Government Grant or Contract Number Amount Due 18a Contact Name Phone 18b $ Contact Name Phone 18c $ Contact Name Phone 18d $ Contact Name Phone 18e $ Contact Name Phone $ 18f Outstanding Balance (Add lines 18a through 18e and amounts from any attachments) $ INVESTMENTS List all investment assets below. Include stocks, bonds, mutual funds, stock options, certificates of deposit, commodities (e.g., gold, silver, copper, etc.) and virtual currency (e.g., Bitcoin, Ripple and Litecoin). Name of Company & Address (Street, City, State, ZIP code) Used as collateral on loan Equity Value Minus Loan Loan Balance Current Value 19a Yes No Phone $ $ $ $ $ $ 19b Yes Phone No 19c Total Investments (Add lines 19a, 19b, and amounts from any attachments) AVAILABLE CREDIT Include all lines of credit and credit cards. $ Available Credit Amount Owed Full Name & Address (Street, City, State, ZIP code) Credit Limit As of As of mmddyyyy mmddyyyy 20a Account No. $ $ $ Account No. $ $ $ 20b 20c Total Credit Available (Add lines 20a, 20b, and amounts from any attachments) Catalog Number 16649P www.irs.gov $ Form 433-B (Rev. 2-2019) Form 433-B (Rev. 2-2019) Page 4 REAL PROPERTY Include all real property and land contracts the business owns/leases/rents. Purchase/ Lease Date (mmddyyyy) Current Fair Market Value (FMV) Current Loan Balance Amount of Monthly Payment Date of Final Payment (mmddyyyy) Equity FMV Minus Loan 21a Property Description $ Location (Street, City, State, ZIP code) and County $ $ $ Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone Phone 21b Property Description $ Location (Street, City, State, ZIP code) and County $ $ $ Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone Phone 21c Property Description $ Location (Street, City, State, ZIP code) and County $ $ $ Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone Phone 21d Property Description $ Location (Street, City, State, ZIP code) and County $ $ $ Lender/Lessor/Landlord Name, Address, (Street, City, State, ZIP code) and Phone Phone 21e Total Equity (Add lines 21a through 21d and amounts from any attachments) $ VEHICLES, LEASED AND PURCHASED Include boats, RVs, motorcycles, all-terrain and off-road vehicles, trailers, mobile homes, etc. Purchase/ Lease Date (mmddyyyy) 22a Year Mileage Current Fair Market Value (FMV) Current Loan Balance Amount of Monthly Payment Date of Final Payment (mmddyyyy) Equity FMV Minus Loan Make/Model License/Tag Number $ $ $ Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone $ Vehicle Identification Number (VIN) Phone 22b Year Mileage Make/Model License/Tag Number $ $ $ Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone $ Vehicle Identification Number (VIN) Phone 22c Year Mileage Make/Model License/Tag Number $ $ $ Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone $ Vehicle Identification Number (VIN) Phone 22d Year Mileage Make/Model License/Tag Number $ $ $ Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone $ Vehicle Identification Number (VIN) Phone 22e Total Equity (Add lines 22a through 22d and amounts from any attachments) Catalog Number 16649P www.irs.gov $ Form 433-B (Rev. 2-2019) Form 433-B (Rev. 2-2019) Page 5 BUSINESS EQUIPMENT AND INTANGIBLE ASSETS Include all machinery, equipment, merchandise inventory, and other assets in 23a through 23d. List intangible assets in 23e through 23g (licenses, patents, logos, domain names, trademarks, copyrights, software, mining claims, goodwill and trade secrets.) Purchase/ Lease Date (mmddyyyy) Current Fair Market Value (FMV) Current Loan Balance Amount of Monthly Payment Date of Final Payment (mmddyyyy) Equity FMV Minus Loan 23a Asset Description $ Location of asset (Street, City, State, ZIP code) and County $ $ $ Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone Phone 23b Asset Description $ Location of asset (Street, City, State, ZIP code) and County $ $ $ Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone Phone 23c Asset Description $ Location of asset (Street, City, State, ZIP code) and County $ $ $ Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone Phone 23d Asset Description $ Location of asset (Street, City, State, ZIP code) and County $ $ $ Lender/Lessor Name, Address, (Street, City, State, ZIP code) and Phone Phone 23e Intangible Asset Description $ 23f Intangible Asset Description $ 23g Intangible Asset Description $ 23h Total Equity (Add lines 23a through 23g and amounts from any attachments) BUSINESS LIABILITIES Include notes and judgements not listed previously on this form. Business Liabilities 24a Description: Secured/ Unsecured Date Pledged (mmddyyyy) Date of Final Payment (mmddyyyy) Payment Amount $ $ Phone Secured Unsecured Name Street Address City/State/ZIP code $ $ Phone 24c Total Payments (Add lines 24a and 24b and amounts from any attachments) Catalog Number 16649P Balance Owed Secured Unsecured Name Street Address City/State/ZIP code 24b Description: $ www.irs.gov $ Form 433-B (Rev. 2-2019) Form 433-B (Rev. 2-2019) Page 6 Section 5: Monthly Income/Expenses Statement for Business Accounting Method Used: Cash Accrual Use the prior 3, 6, 9 or 12 month period to determine your typical business income and expenses. Income and Expenses during the period (mmddyyyy) to (mmddyyyy) Provide a breakdown below of your average monthly income and expenses, based on the period of time used above. Total Monthly Business Income 25 26 27 28 29 Income Source Gross Receipts from Sales/Services Gross Rental Income Interest Income Dividends Cash Receipts (Not included in lines 25-28) Other Income (Specify below) 30 31 32 33 34 35 Total Income (Add lines 25 through 34) Total Monthly Business Expenses Gross Monthly 36 37 38 39 40 41 42 43 44 45 46 47 48 49 $ $ $ $ $ $ $ $ $ $ $ Expense items Materials Purchased 1 Inventory Purchased 2 Gross Wages & Salaries Rent Supplies 3 Utilities/Telephone 4 Vehicle Gasoline/Oil Repairs & Maintenance Insurance Current Taxes 5 Other Expenses (Specify) IRS Use Only-Allowable Installment Payments Total Expenses (Add lines 36 through 47) Net Income (Line 35 minus Line 48) Actual Monthly $ $ $ $ $ $ $ $ $ $ $ $ $ $ 1 Materials Purchased: Materials are items directly related to the production of a product or service. 4 Utilities/Telephone: Utilities include gas, electricity, water, oil, other fuels, trash collection, telephone, cell phone and business internet. 2 Inventory Purchased: Goods bought for resale. 5 Current Taxes: Real estate, state, and local income tax, excise, franchise, occupational, personal property, sales and the employer's portion of employment taxes. 3 Supplies: Supplies are items used to conduct business and are consumed or used up within one year. This could be the cost of books, office supplies, professional equipment, etc. Certification: Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities, and other information is true, correct, and complete. Signature Title Date Print Name of Officer, Partner or LLC Member After we review the completed Form 433-B, you may be asked to provide verification for the assets, encumbrances, income and expenses reported. Documentation may include previously filed income tax returns, profit and loss statements, bank and investment statements, loan statements, financing statements, bills or statements for recurring expenses, etc. IRS USE ONLY (Notes) Privacy Act: The information requested on this Form is covered under Privacy Acts and Paperwork Reduction Notices which have already been provided to the taxpayer. Catalog Number 16649P www.irs.gov Form 433-B (Rev. 2-2019)
Extracted from PDF file 2023-federal-form-433-b.pdf, last modified February 2019

More about the Federal Form 433-B Other TY 2023

We last updated the Collection Information Statement for Businesses in February 2024, so this is the latest version of Form 433-B, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form 433-B directly from TaxFormFinder. You can print other Federal tax forms here.

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.

Form Code Form Name
Form 433-B (OIC) 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 from the Internal Revenue Service in February 2024.

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Historical Past-Year Versions of Federal Form 433-B

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


2023 Form 433-B

Form 433-B (Rev. 2-2019)

2022 Form 433-B

Form 433-B (Rev. 2-2019)

2021 Form 433-B

Form 433-B (Rev. 2-2019)

2020 Form 433-B

Form 433-B (Rev. 2-2019)

2019 Form 433-B

Form 433-B (Rev. 2-2019)

2018 Form 433-B

Form 433B (Rev. December 2012)

2017 Form 433-B

Form 433B (Rev. December 2012)

2016 Form 433-B

Form 433B (Rev. December 2012)

Collection Information Statement for Businesses 2015 Form 433-B

Form 433B (Rev. December 2012)

Collection Information Statement for Businesses 2012 Form 433-B

Form 433B (Rev. December 2012)

Collection Information Statement for Businesses 2011 Form 433-B

Form 433-B (Rev. January 2008)


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