Pennsylvania Offer in Compromise

Offer in Compromise
Offer in Compromise (REV-567)
(ET) 02-21

REV-567

OFFICIAL USE ONLY

Case Number

PA DEPArTmEnT of rEvEnuE
Po BoX 281041
HArrisBurg PA 17128-1041

OFFER IN
COMPROMISE

Entity Number

THIS FORM MUST BE COMPLETED PRIOR TO YOUR OFFER BEING REVIEWED BY THE DEPARTMENT.
FAILURE TO RETURN THIS COMPLETED FORM IN A TIMELY MANNER MAY RESULT IN DELAY OR DENIAL OF YOUR OFFER.
ALL SECTIONS MUST BE COMPLETELY FILLED OUT IN ORDER FOR AN OFFER TO BE CONSIDERED.
PLEASE PRINT OR TYPE ALL ANSWERS. ATTACH ADDITIONAL SHEETS WHEN NECESSARY.

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APPLICANT INFORMATION

SECTION I
Applicant Name

SSN or FEIN

Mailing Address

Phone Number

City

State

Co-applicant Name (if necessary)

SSN or FEIN

Mailing Address

Phone Number

City

State

➜

Applicant Structure

Individual

Corporation

Partnership

Proprietorship

Trust/Estate

Other (specify)

ZIP Code

ZIP Code

Corporation Officer(s)

SETTLEMENT INFORMATION

SECTION II
Amount of Offer

Amount Attached

Method of Payment

Description of Tax Liabilities to be Settled
TAX TYPE

SECTION III

ACCOUNT NUMBER

PERIODS

ATTORNEY, ACCOUNTANT, OR AGENT INFORMATION

Name (attach Power of Attorney if necessary)

Phone Number

Street Address
City

State

SECTION IV
Reason for offer

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ZIP Code

REASON FOR OFFER
Doubt as to Liability (“I don’t believe I owe this tax”)

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Doubt as to Collectibility (“I can’t pay”)

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SECTION IV

REASON FOR OFFER (cont.)

Summary Statement Supporting Reason for Offer

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SECTION V

CERTIFICATION

By submitting this offer, I/we understand and agree to the Pennsylvania
Department of Revenue's TERMS AND CONDITIONS as follows:
a) I/we voluntarily submit all payments made on this offer.
b) The Pennsylvania Department of Revenue will apply payments made
under the terms of this offer in the best interests of the commonwealth.
c) If the department rejects the offer or the offer is withdrawn, the
department will treat any amount paid with the offer per my/our
direction, as given on Page 4 of the offer, as to refund or application
of funds. If my/our directions are to apply the payment, the date of
payment will be the date these funds are received by the department.
I/we understand that the department will not pay interest on any
amount I/we submit with the offer.
d) I/we will remain in compliance with all provisions of the Pennsylvania
Revenue Code relating to the filing/payment of my/our required taxes
during the pendency of this offer; additionally, I/we will comply with all
said provisions for a period of five years from the date of notification
of acceptance of this offer.
e) The offer is pending starting with the date it is acknowledged by the
department. The offer remains pending until the department gives
notification in writing of acceptance or rejection, or until withdrawn
by me/us.
f) I/we understand that, although collection activity is normally stayed
while an offer is pending, such a stay is not required by law. I/we
further understand that collection activity may continue if it is found
that the stay would jeopardize the commonwealth's interest, or if it is
determined that the offer is a subterfuge or stall.
g) The department will keep all payments and credits made, received or
applied to the amount being compromised before this offer was
submitted. The department will also keep any payments made under
the terms of an installment agreement, any credits applied due to
refund offsets and any collections made through continued enforced
collection activity while this offer is pending.

h) The total amount the department can collect under this offer cannot
be more than the full amount of the tax liability, including fees,
interest, penalties, etc.
i) I/we understand that I/we remain responsible for the full amount of
the tax liability unless and until the offer is accepted in writing and
I/we have met all terms and conditions. The department will not
remove the original amount of the tax liability from its records until
I/we have met all terms and conditions.
j) I/we understand that the tax I/we offer to compromise is and will
remain a tax liability until I/we meet all terms and conditions. If I/we
file bankruptcy before the terms and conditions of this offer are
completed, any claim the department files in a bankruptcy
proceeding will be a tax claim.
k) Once the department accepts the offer in writing, I/we have no right
to contest, in court or otherwise, the amount of the tax liability.
l) If I/we fail to meet any of the offer's terms and conditions, including
making payment(s) within the time frame mutually agreed upon as a
condition of acceptance, the offer is then determined to be in default.
The department will continue to add interest and applicable
penalties, as required by the Revenue Code, on the amount due to
the department. Interest and applicable penalties will continue to be
added as though no offer had been made, until I/we completely
satisfy the amount owed. Additionally the department may:
i)

immediately issue and record any tax liens (if not already issued
and recorded) necessary to protect the commonwealth's position;

ii) proceed with enforced collection activity on the original tax
liability without further notice of any kind;
iii) disregard the amount of the offer and apply all amounts already
paid under the offer against the original of tax liability.

I/We understand that the Pennsylvania Department of Revenue will immediately deposit any payment tendered with this offer, to be held pending a final
decision by the Department or my/our withdrawal of the offer. I further understand that the Department’s deposit of this payment constitutes neither a
waiver of any of its rights, nor an acceptance of the offer. In the event the Department rejects the offer or it is withdrawn, I/we wish that the amount be
tendered be:
Returned to Me/Us

Applied to My/Our Tax Liability

Under penalties of perjury, I/we declare that I/we have examined this offer including accompanying schedules and statements, and to the best of my/our
knowledge and belief it is true, correct and complete. I/We further understand and agree to the terms and conditions set forth on Page 3 of the application form.
Taxpayer Name (please print)

Taxpayer Signature

Taxpayer Name (please print)

Taxpayer Signature

Attorney or Accountant Name (please print)

Attorney or Accountant Signature
SIGN AFTER PRINTING

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Date MM/DD/YYYY
Date
Date

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rEv-567 (ET) 02-21

SECTION VI

DISCLOSURE AGREEMENT

To be completed only if an offer is presently pending with, has been recently acted upon by or is contemplated to be filed with the IRS.
Separate signature(s) required for this section.
By my/our signature(s) below, I/we authorize the Pennsylvania Department of Revenue and the Internal Revenue Service to exchange information from
their respective files regarding my/our pending or completed Offer in Compromise. The status of my offer with the IRS is:
To Be Filed Date
IRS Agent Assigned

Pending (date filed)
Tax Period(s) Covered

Completed Date
Tax Type(s)

Taxpayer Name

Taxpayer Signature

Taxpayer Name

Taxpayer Signature

Accepted
Rejected
FEIN

SIGN AFTER PRINTING

SIGN AFTER PRINTING

Date MM/DD/YYYY
Date

If you have recently prepared IRS Form 433-A and/or 433-B, you may attach a copy of the same to this application in lieu of completing the attached
financial statement form(s). In either event, the department will most likely request verification of some or all of the information provided or in some
instances may request additional information.

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Instructions for Form REV-567
offer in Comprimise

rEv-567 in (ET) 02-21

GENERAL INFORMATION
REASONS FOR COMPROMISE
The Department of Revenue can compromise the amount
owed for the following reasons:
•

•

Doubt as to liability, i.e., doubt as to whether you
owe the amount ("I don’t believe I owe this tax")
and/or
Doubt as to collectibility i.e., doubt that we can
collect the full amount owed ("I can’t pay").

We cannot accept a compromise based on doubt as to
collectibility when there is no doubt that we can collect the
full amount owed. We also cannot accept a compromise
based on doubt as to liability when the amount owed has
already been rendered due by a court or an administrative
law judge.
If you submit an offer based on doubt as to liability, you must
include a written statement describing in detail why you don’t
believe you owe the liability.
REVENUE DEPARTMENT POLICY
We will accept an offer in compromise when it is unlikely that
we can collect the full amount owed and the amount you
offered reasonably reflects collection potential. An offer in
compromise is an alternative to declaring a case currently
uncollectible or to a long-term installment agreement. Our
goal is to collect what we can at the earliest possible time
with the least cost to the state.
In delinquent tax cases where an offer in compromise
appears to be a workable solution, a revenue agent will
discuss the compromise alternative with you and help you
prepare the forms, if necessary. You are responsible for
making the first specific proposal for compromise.
Our offer in compromise process will be successful only if you
make an adequate compromise proposal consistent with your
ability to pay and we make prompt and reasonable decisions.
Taxpayers are expected to provide adequate documentation
to verify their ability to pay. The goal is a compromise which
is in the best interest of both the taxpayer and Revenue.
Acceptance of an offer also creates a fresh start for the
taxpayer regarding future filing and payment requirements.
HOW TO DETERMINE AN ACCEPTABLE OFFER
An acceptable offer must include all amounts available
from the following sources. You may use the spaces
provided to calculate the minimum amount you must offer.

(1) The liquidating value of your assets (value if you
are forced to sell) minus debts against specific
assets that have priority over Revenue.
Liquidating value of assets

$

Minus: Debts with priority

$

Value of available assets

$

NOTE: The following examples are debts which you
should NOT subtract because Revenue has priority
over them:
•

amounts you owe on credit cards;

•

loans you secured without pledging assets as security;

•

any amount you borrowed after we recorded a state
tax lien.

(2) The amount we could collect from your present and
future income. Generally, the collectable amount is
your income minus necessary living expenses. We
usually consider what we can collect over five
years. Calculate the amount as follows:
Average monthly income

$

Minus: Necessary
living expenses

$

Multiply the difference
of above by 60

$

(3) Assets or income that are available to you but may
not be available to Revenue for direct collection
action (e.g., property outside the state of
Pennsylvania). Show the value of any income or
assets to which you have access.
$
(4) Minimum Offer (total items 1 through 3)
$
If your offer is less than the minimum offer amount from Item
(4), we can’t process your offer. If the total of Items (1)
through (3) exceeds the amount owed, we cannot process
your offer; you must pay the full amount owed. We will return
this form to you. If the total of Items (1) through (3) exceeds
the amount owed, you may wish to consider an installment
agreement, if so contact your nearest regional office.
OFFER INVESTIGATION
The Department of Revenue will investigate your offer to
determine if the offered amount is the maximum you can

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pay. This means that we may ask for information to verify
your financial statement (Form REV-488, REV-484). We
may ask you to increase the amount of your offer or to
change the terms of payment, or we may find that we can’t
accept your offer.
QUESTIONS REVENUE WILL CONSIDER
The Department of Revenue’s goal is to reach a
compromise that is in the best interest of both the
commonwealth and the taxpayer. It is your responsibility to
show us why it would be in the commonwealth’s best interest
to accept your proposal. When we consider your offer we
must ask the following questions:
(1) Could we collect the entire amount owed through
liquidation of your assets or through an installment
agreement based on your present and future
income? If the answer is "yes", we can’t accept
your offer.
(2) Could we collect more from your assets and future
income than you offered? If the answer is "yes",
you must offer a larger amount or we will reject
your offer.

FINANCIAL STATEMENT
If you submit your offer on the basis of doubt as to
collectibilty, you must also submit Form REV-488, Collection
Information Statement for Individuals, or Form REV-484,
Collection Information Statement for Businesses. If you are
an individual and you operate a business, you must submit
both forms.
You must complete all blocks on these forms. Write N/A (not
applicable) in any blocks that don’t affect you. Please pay
particular attention to Line 24, “Other Assets”, on Form REV484 and Line 33, “Other Assets” on Form REV-488. You
should list pension plans, profit sharing plans and individual
retirement accounts on those lines. When you send Form
REV-484 and/or Form REV-488, you should include
documentation to verify values of assets, encumbrances
and income and expense information. When you determine
the "Current Market Value" of assets on Forms REV-484 and
REV-488, use the "quick sale" or "liquidating value".
RETURNING YOUR OFFER
We will return your offer to you for clarification if we can’t
process it because it contains any of the following problems.

(3) Would we be better off waiting until a future date
because it appears that collection in the future
would result in more money than you now offer? If
the answer is "yes", you must offer a larger amount
or we will reject your offer.

(1) the taxpayer isn’t adequately identified;

(4) Would the taxpaying public believe that acceptance
of your offer was a reasonable action? If the answer
is "no", we will reject your offer.

(5) financial statements aren’t submitted; or

(2) the liabilities to compromise aren’t identified;
(3) no amount is offered;
(4) appropriate signatures aren’t present;
(6) the amount offered doesn’t equal the minimum offer
amount required.

The fact that you currently have no assets or income doesn’t
mean that Revenue should simply accept anything that you
offer because that is all we can collect now. It is usually
better for us to reject a nominal offer and wait to see what
collection potential arises during the remainder of our
collection time.

OFFER REJECTION
If you should submit an offer based on doubt that we can
collect the full amount owed and we find that you can pay
more than you offered, we will reject your offer. We will also
reject an offer based on your doubt that you owe the liability,
if we still believe that you owe it.

As we stated in our policy, we will accept your offer only if you
submit a legitimate proposal that is in the State’s best interest.

LINE INSTRUCTIONS

TAX COMPLIANCE
We won’t accept your offer if you haven’t filed all required
returns. In addition, we will expect you to have paid all
estimated tax payments due as of the date you file the offer.
Please note that the acceptance of an offer is contingent
upon your future compliance (i.e., filing and paying) for five
years after acceptance.
SUSPENDING COLLECTION
Submitting an offer doesn’t automatically suspend our
collection activity. If there is any indication that you filed the
offer only to delay collection of the tax or to delay our ability
to collect the tax, we will continue collection efforts. If you
agreed to make installment payments before you submitted
your offer, you should continue to make those payments.
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SECTION I
APPLICANT INFORMATION
APPLICANT
Include name, SSN or FEIN mailing address and phone
number. Also inlcude for co-applicant if necessary.
APPLICANT STRUCTURE
Fill in the appropriate oval. Specify if “other” is selected.

SECTION II
SETTLEMENT INFORMATION
Write the amount of offer, amount attached, and method of
payment. List the descriptions of tax liabilities to be settled

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including tax type, account number and periods. Attach
additional sheets if necessary.

SECTION III
ATTORNEY, ACCOUNTANT OR AGENT INFORMATION
Include Name, phone number and address. Attach power of
attorney if necessay.

SECTION IV
REASON FOR OFFER
Fill in the appropriate oval. Include a summary statement

SECTION V
CERTIFICATION
TERMS AND CONDITIONS
Carefully read all terms and conditions as set by the
Department of Revenue. Fill in the oval to specify how the
amount is to be tendered in the event the offer is rejected
or withdrawn.
Print the taxpayers’ names, attorney or accountant’s name
and sign and date after printing.

SECTION VI
DISCLOSURE AGREEMENT
If an offer is pending, recently acted upon by, or is
contemplated to be filed with the IRS, you must complete the
disclosure agreement. If not, mark the appropriate block. Be
sure all parties making the offer sign and date this section.
NOTE: Only to be completed if an offer is presently
pending with, has been recently acted upon by, or is
contemplated to be filed with the IRS.

FILING YOUR OFFER
Submit your offer to the representative presently working on
your case. If you do not know the name of the assigned
representative, mail your application to:
PA DEPARTMENT OF REVENUE
BUREAU OF ENFORCEMENT AND TAXPAYER
ASSISTANCE, COMPROMISE UNIT
327 WALNUT STREET
HARRISBURG PA 17128
Or submit electronically via
[email protected]

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