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Federal Free Printable Form 433-A (OIC) (Rev. 4-2023) for 2024 Federal Collection Information Statement for Wage Earners and Self-Employed Individuals

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Collection Information Statement for Wage Earners and Self-Employed Individuals
Form 433-A (OIC) (Rev. 4-2023)

Form 433-A (OIC) (April 2023) 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 who is personally responsible for a partnership liability (only if the partnership is submitting an offer) ● An individual who is submitting an offer on behalf of the estate of a deceased person ● 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. 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 Married Own your home If married, date of marriage (mm/dd/yyyy) - Do you Rent Other (specify e.g., share rent, live with relative, etc.) If you were married and lived in AZ, CA, ID, LA, NM, NV, TX, WA or WI within the last ten years check here County of residence Primary phone ( Secondary phone ( ) ) 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 Pay period Weekly Bi-weekly Monthly Other Employer’s address (street, city, state, ZIP code) Do you have an ownership interest in this business Yes (also complete and submit Form 433-B) No Your occupation How long with this employer Spouse’s employer's name Pay period (years) (months) Weekly Bi-weekly Monthly Other Employer’s address (street, city, state, ZIP code) Does your spouse have an ownership interest in this business Yes (also complete and submit Form 433-B) Spouse's occupation No How long with this employer (years) Catalog Number 55896Q (months) www.irs.gov Form 433-A (OIC) (Rev. 4-2023) Page 2 Section 3 Personal Asset Information (Domestic and Foreign) 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, retirement accounts (IRAs, Keogh, 401(k) plans, stocks, bonds, mutual funds, certificates of deposit) and digital assets such as virtual currency (cryptocurrency), non-fungible token (NFT), and smart contracts you own or in which you have a financial interest (e.g., Bitcoin, Ethereum, Litecoin, Ripple, etc.), life insurance policies that have a cash value, and safe deposit boxes including those located in foreign countries or jurisdictions. 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). Ensure you also include assets located in foreign countries or jurisdictions and add attachment(s) if additional space is needed to respond. 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 and country location Online Account Stored Value Card Account number (1a) $ Checking Savings Money Market Account/CD Bank name and country location 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 and country location Account number Current market value Minus loan balance $ X .8 = $ Investment account Stocks – $ Bonds = (2a) $ Other Name of Financial Institution and country location Account number Current market value Minus loan balance $ X .8 = $ – $ Name of digital asset such as virtual currency wallet, exchange or digital currency exchange (DCE) Digital asset Type of digital asset Name of individual who has access to the private key(s) and/or digital wallets = Email address used to set-up the digital asset such as virtual currency exchange or DCE (2b) $ Location(s) of digital asset (mobile wallet, online, and/or external hardware storage) Digital asset amount and value in US dollars as of today $ = (2c) $ Total investment accounts from attachment. [current market value minus loan balance(s)] (2d) $ Add lines (2a) through (2d) = (2) $ Retirement account 401K IRA Other Name of Financial Institution and country location Account number Current market value $ Minus loan balance X .8 = $ – $ = (3a) $ Total of retirement accounts from attachment. [current market value X .8 minus loan balance(s)] (3b) $ Add lines (3a) through (3b) = (3) $ 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. 4-2023) Page 3 Section 3 (Continued) Personal Asset Information (Domestic and Foreign) Real property (enter information about any house, condo, co-op, time share, etc. that you own or are buying including any assets owned by your spouse if you live in a community property state) Is your real property currently for sale or do you anticipate selling your real property to fund the offer amount Yes No (listing price) Property description (indicate if personal residence, rental property, vacant, etc.) Purchase date (mm/dd/yyyy) Amount of mortgage payment How title is held (joint tenancy, etc.) Date of final payment Location (street, city, state, ZIP code, county, and country) Lender/Contract holder name, address (street, city, state, ZIP code) and phone Minus loan balance (mortgages, etc.) Current market value $ X .8 = $ – $ (total value of real estate) = Property description (indicate if personal residence, rental property, vacant, etc.) Purchase date (mm/dd/yyyy) Amount of mortgage payment How title is held (joint tenancy, etc.) Date of final payment Location (street, city, state, ZIP code, county, and country) (5a) $ Lender/Contract holder name, address (street, city, state, ZIP code) and phone 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). Include those located in foreign countries or jurisdictions. If additional space is needed, list on an attachment. Vehicle make & model Lease Year Date purchased Name of creditor Mileage Date of final payment Monthly lease/loan amount Own $ Current market value $ Minus loan balance 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 Date purchased Name of creditor Mileage Date of final payment License/Tag number Monthly lease/loan amount Own $ Current market value $ License/Tag number Minus loan balance 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. 4-2023) Page 4 Section 3 (Continued) Personal Asset Information (Domestic and Foreign) 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(s) Current market value Minus loan balance $ X .8 = $ – $ = (7a) $ = (7b) $ Total value of valuable items listed from attachment [current market value X .8 minus any loan balance(s)] (7c) $ Value of remaining furniture and personal effects (not listed above) Description of asset Minus loan balance Current market value $ X .8 = $ – $ Add lines (7a) through (7c) minus IRS deduction of $10,810 = 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 = (7) $ Box A Available Individual Equity in Assets $ 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 address 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 Section 5 Corporation Other Business Asset Information (for Self-Employed) (Domestic and Foreign) List business assets such as bank accounts, digital assets (cryptocurrency), 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 and country location Online Account Stored Value Card Account number (8a) $ Cash Checking Savings Money Market Account/CD Bank name and country location Online Account Stored Value Card Account number (8b) $ Digital asset Type of digital asset Name of digital asset such as virtual currency wallet, exchange or digital currency exchange (DCE) Name of individual who has access to the private key(s) and/or digital wallets Email address used to set-up the digital asset such as virtual currency exchange or DCE Digital asset amount and value in US dollars as of today $ Catalog Number 55896Q Location(s) of digital asset (mobile wallet, online, and/or external hardware storage) = (8c) $ Total bank accounts from attachment (8d) $ Add lines (8a) through (8d) = (8) $ www.irs.gov Form 433-A (OIC) (Rev. 4-2023) Page 5 Section 5 (Continued) Business Asset Information (for Self-Employed) (Domestic and Foreign) 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 for individuals and sole-proprietors – Enter the value of line (9) minus line (10). If less than zero enter zero. = (9) $ (10) $ (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, provide a list of your current accounts receivable (include the age and amount) 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. Period provided beginning through 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. 4-2023) Page 6 Section 7 Monthly Household Income and Expense Information Enter your household's average gross monthly income. Gross monthly income includes wages, social security, pension, unemployment, and other income. Examples of other income include but are not limited to: agricultural subsidies, gambling income, oil credits, rent subsidies, sharing economy income from providing on-demand work, services or goods (e.g., Uber, Lyft, AirBnB, VRBO), income through digital platforms like an app or website, etc., and recurring capital gains from the sale of securities including cryptocurrency, non-fungible tokens, etc. 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 = (31) $ 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. List source(s) (32) $ Interest, dividends, and royalties (33) $ Distributions (e.g., income from partnerships, sub-S Corporations, etc.) (34) $ Net rental income (35) $ Net business income from Box C [Deductions for non-cash expenses on Schedule C (e.g., depreciation, depletion, etc.) are not permitted as an expense for offer purposes and must be added back in to the net income figure] (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. 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. For the other boxes input your actual expenses. 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, monthly rent payment 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 Public transportation costs (e.g., average monthly cost of fares for mass transit such as bus, train, ferry, etc.). A reasonable estimate of these expenses may be used Health insurance premiums (42) $ (43) $ (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) $ Life insurance policy amount Current monthly taxes (e.g., monthly cost of federal, state, and local tax, personal property tax, etc.) (49) $ Secured debts/Other (e.g., any loan where you pledged an asset as collateral not previously listed, government guaranteed student loan, employer required retirement or dues) List debt(s)/expense(s) (50) $ Enter the amount of your monthly delinquent state and/or local tax payment(s) . Total tax owed (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 = $ Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2023) Page 7 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 (which included the amount(s) allowed for vehicles and bank accounts) do not apply if the 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. = $ $ Place the offer amount shown above on the Form 656, Section 4, Payment Terms, unless you cannot pay that amount due to special circumstances. If you cannot pay that amount due to special circumstances, place the amount you can pay on the Form 656, Section 4, Payment Terms, and explain your special circumstances on the Form 656, Offer in Compromise, Section 3, Reason for Offer. 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 a party to or involved in litigation (if yes, answer the following) Plaintiff Yes Location of filing Represented by Possible completion date (mmddyyyy) Subject of litigation No Docket/Case number Defendant Amount of dispute $ Have you filed bankruptcy in the past 7 years (if yes, answer the following) Date filed (mmddyyyy) Date dismissed (mmddyyyy) Date discharged (mmddyyyy) Petition no. In the past 10 years, have you lived outside of the U.S. for 6 months or longer (if yes, answer the following) Dates lived abroad: From (mmddyyyy) Yes No Yes No Location filed To (mmddyyyy) Are you or have you ever been party to any litigation involving the IRS/United States (including any tax litigation) Yes No If yes and the litigation included tax debt, provide the types of tax and periods involved Yes Are you the beneficiary of a trust, estate, or life insurance policy, including those located in foreign countries or jurisdictions No (if yes, answer the following) Place where recorded Name of the trust, estate, or policy EIN Anticipated amount to be received When will the amount be received $ Are you a trustee, fiduciary, or contributor of a trust Name of the trust Yes No Yes No EIN Do you have a safe deposit box (business or personal) including those located in foreign countries or jurisdictions (if yes, answer the following) Location (name, address and box number(s)) Value Contents $ Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2023) Page 8 Section 9 (Continued) Other Information In the past 10 years, have you transferred any asset with a fair market value of more than $10,000 including real property, for less than their full value (if yes, answer the following) Value at time of transfer List asset(s) Date transferred (mmddyyyy) Yes No To whom or where was it transferred $ Do you have any assets or own any real property outside the U.S. Yes No Yes No If yes, provide description, location, and value Do you have any funds being held in trust by a third party 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, royalties, agricultural subsidies, gambling income, oil credits, rent subsidies, sharing economy income from providing on-demand work, services or goods (e.g., Uber, Lyft, AirBnB, VRBO), income through digital platforms like an app or website, etc., and recurring capital gains from the sale of securities including cryptocurrency, non-fungible tokens. Copies of individual complete bank statements for the three most recent months. If you operate a business, copies of the six most recent complete statements for each business bank account. Completed Form 433-B (Collection Information Statement for Businesses) if you or your spouse have an interest in a business entity other than a sole-proprietorship. 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 Accounts Receivable or Notes Receivable, if applicable. Verification of delinquent State/Local Tax Liability showing total delinquent state/local taxes and amount of monthly payments, if applicable. Copies of court orders for child support/alimony payments claimed in monthly expense section. Copies of Trust documents if applicable per Section 9. 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. Ensure all years and forms involved in your offer are listed on Form 2848 and include the current tax year. Check the appropriate box to ensure copies of communications are sent to your representative. Completed and signed current Form 656. Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2023)
Extracted from PDF file 2023-federal-form-433-a-oic.pdf, last modified December 2022

More about the Federal Form 433-A (OIC) Other TY 2023

We last updated the Collection Information Statement for Wage Earners and Self-Employed Individuals in January 2024, so this is the latest version of Form 433-A (OIC), fully updated for tax year 2023. You can download or print current or past-year PDFs of Form 433-A (OIC) 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-A (OIC).

Form Code Form Name
Form 433-A Collection Information Statement for Wage Earners

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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-A (OIC) from the Internal Revenue Service in January 2024.

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

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


2023 Form 433-A (OIC)

Form 433-A (OIC) (Rev. 4-2023)

2022 Form 433-A (OIC)

Form 433-A (OIC) (Rev. 4-2022)

2021 Form 433-A (OIC)

Form 433-A (OIC) (Rev. 4-2021)

2020 Form 433-A (OIC)

Form 433-A (OIC) (Rev. 4-2020)

2019 Form 433-A (OIC)

Form 433-A (OIC) (Rev. 3-2019)

2018 Form 433-A (OIC)

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

2017 Form 433-A (OIC)

Form 433-A; Collection Information Statement for Wage Earners and Self-Employed Individuals (Rev. January 2014) Catalog Number 55896Q

2016 Form 433-A (OIC)

Form 433-A; Collection Information Statement for Wage Earners and Self-Employed Individuals (Rev. January 2014) Catalog Number 55896Q

Collection Information Statement for Wage Earners and Self-Employed Individuals 2015 Form 433-A (OIC)

Form 433-A; Collection Information Statement for Wage Earners and Self-Employed Individuals (Rev. January 2014) Catalog Number 55896Q

Collection Information Statement for Wages Earners and Self-Employed Individuals 2012 Form 433-A (OIC)

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


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