Federal Collection Information Statement for Businesses

Collection Information Statement for Businesses
Form  433-B (OIC) (Rev. 4-2023)
Form

Department of the Treasury — Internal Revenue Service

433-B (OIC)

Collection Information Statement for Businesses

(April 2023)
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 do not use this form. Instead, complete Form 433-A (OIC) Collection Information Statement for
Wage Earners and Self-Employed 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 (Domestic and Foreign)

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
(

)

Yes

Total number of employees

Federal contractor
Yes

Does the business outsource its payroll processing and tax return
preparation for a fee

-

No

No

If yes, list provider name and address in box below
(street, city, state, ZIP code)

Check here if you are the only employee

Frequency of tax deposits

Average gross monthly payroll
$

Provide information about all partners, officers, LLC members, major shareholders (domestic and foreign), 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

Primary phone

Secondary phone

Title

)

-

Catalog Number 55897B

(

)

Home address (street, city, state, ZIP code)

-

Last name

(

Home address (street, city, state, ZIP code)

-

Home address (street, city, state, ZIP code)

-

www.irs.gov

Form

433-B (OIC) (Rev. 4-2023)

Page 2

Section 2

Business Asset Information (Domestic and Foreign)

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 and country location

Online Account

Stored Value Card

Account number
(1a) $

Cash

Checking

Savings

Money Market Account/CD

Bank name and country location

Online Account

Stored Value Card

Account number
(1b) $

Cash

Checking

Savings

Money Market Account/CD

Bank name and country location

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 and country location

Account number

Current market value

Minus loan balance

$

X .8 = $

Investment Account:

Stocks

– $

Bonds

=

(2a) $

=

(2b) $

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

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) $

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, provide a list of name, age, and amount of the current accounts receivable

Catalog Number 55897B

www.irs.gov

Form

433-B (OIC) (Rev. 4-2023)

Page 3

Section 2 (Continued)

Business Asset Information (Domestic and Foreign)

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.)
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 address (street address, city,

Property description (indicate if rental property, vacant, etc.) Date purchased

state, ZIP code, county, and country)

Monthly mortgage payment

Date of final payment

Name of lender/contract holder

Current market value

Minus loan balance (mortgages, etc.)

$

X .8 = $

Property address (street address, city,

– $

Total value of real estate =

(3a) $

Property description (indicate if rental property, vacant, etc.) Date purchased

state, ZIP code, county, and country)

Monthly mortgage payment

Date of final payment

Name of lender/contract holder

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.). Include those located in foreign countries or jurisdictions. If additional space is needed, list on an
attachment
Vehicle make & model

Year

Lease

Monthly lease/loan amount

Own

$

Current market value
$

Vehicle make & model

Name of creditor

License/Tag number

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

Own

$

Current market value

Date purchased

Mileage or use hours

Name of creditor

(4a) $

License/Tag number

Date of final payment

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

Own

$

Current market value
$

Mileage or use hours

Minus loan balance
X .8 = $

$

Date purchased

Date purchased

Mileage or use hours

Name of creditor

(4b) $

License/Tag number

Date of final payment

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. 4-2023)

Page 4

Section 2 (Continued)

Business Asset Information (Domestic and Foreign)

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).

Period provided beginning

through

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. Deductions for non-cash expenses (e.g., depreciation, depletion, etc.) are not permitted as an expense for
offer purposes.
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).
Period provided beginning

through

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. 4-2023)

Page 5

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.
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.
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.
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.
Place your offer amount on Form 656
Section 4, Payment Terms.

=

$

$

*You may exclude any equity in income producing assets (except real estate) 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 filed bankruptcy in the past 10 years
Yes

No

If yes, provide
Date dismissed or discharged (mm/dd/yyyy)

Date filed (mm/dd/yyyy)
Petition no.

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, party to litigation
Yes

No

If yes, answer the following
Plaintiff

Location of filing

Represented by

Possible completion date (mmddyyyy)

Subject of litigation

Docket/Case number

Defendant
Amount in dispute
$
Are you or have you been party to 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.

Catalog Number 55897B

www.irs.gov

Form

433-B (OIC) (Rev. 4-2023)

Page 6

Section 6 (Continued)

Other Information

In the past 10 years, has the business transferred any asset with a fair market value of more than $10,000, including real property, for less than its full
value
Yes

No

If yes, provide date, value, and type of asset transferred
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 the 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 complete bank statements for each business account and copies of the three most recent
statements for each investment account.
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 accounts and 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. 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 current signed Form 656.

Catalog Number 55897B

www.irs.gov

Form

433-B (OIC) (Rev. 4-2023)