Fillable Form 433 F

What is Form 433-F?

IRS Form 433-F, Collection Information Statement, is used by residents of the United States to obtain current financial information necessary for determining how a wage earner or self-employed individual can satisfy an outstanding tax liability.

U.S. residents are required to retain a copy of their completed form and other supporting documentation. After the Internal Revenue Service (IRS) reviews their completed forms, the IRS may contact them for additional information.

How to fill out Form 433-F?

Residents of the United States can download and print a PDF copy of the 433-F Tax Form from the Internal Revenue Service (IRS) website that they can manually complete. They can also fill out Tax Form 433-F electronically on PDFRun.

To fill out the IRS 433-F Form, you must provide the following information:

Name and Address

Enter your full legal name and home or residential address.

Address Differentiation

Mark the box if the address you have provided above is different from the one you entered in your last filed return; otherwise, leave it blank.

Country of Residence

Enter the country where you reside.

Your Social Security Number (SSN) or Individual Taxpayer Identification Number (TIN)

Enter your social security number (SSN) or individual taxpayer identification number (TIN).

Your Spouse’s Social Security Number (SSN) or Individual Taxpayer Identification Number (TIN)

Enter the social security number (SSN) or individual taxpayer identification number (TIN) of your spouse.

Your telephone numbers

Enter all of your telephone numbers.

Home

Enter your home telephone number.

Work

Enter your work telephone number.

Cell

Enter your personal cell phone number.

Spouse’s telephone numbers

Enter all of the telephone numbers of your spouse.

Home

Enter the home telephone number of your spouse.

Work

Enter the work telephone number of your spouse.

Cell

Enter the cell phone number of your spouse.

Number of people in the household

Enter the number of people in the household who can be claimed on this year’s tax return including you and your spouse. You may select:

• Under 65
• 65 and over

Self Employment

Enter information about your self-employment.

Name of Business

Enter the full name of your business.

Business Employer Identification Number (EIN)

Enter the employer identification number (EIN) of your business.

Type of Business

Enter the type of your business.

Number of Employees

Enter the total number of employees not counting the owner.

Section A. Accounts/Lines of Credit

Personal Bank Accounts

The instructions stated below will apply to all of the rows in this section.

Your personal bank accounts may include checking, online, mobile, savings accounts, or money market accounts.

Name and Address of Institution

Enter the full name and address of the institution.

Account Number

Enter the account number assigned to your personal bank account.

Type of Account

Enter the type of your personal bank account.

Current Balance or Value

Enter the current balance or current value of your personal bank account.

Business Account

Mark the box if your personal bank account is a business account.

Investments

The instructions stated above will apply to all of the rows in this section.

Your investments may include certificates of deposit, trusts, individual retirement accounts (IRAs), Keogh plans, simplified employee pensions, 401(k) plans, profit-sharing plans, mutual funds, stocks, bonds, and commodities.

Virtual Currency

Enter all of the virtual currency you own.

Type of Virtual Currency

Enter the type of virtual currency.

Name of Virtual Currency Wallet, Exchange, or Digital Currency Exchange (DCE)

Enter the name of your virtual currency wallet, exchange, or digital currency exchange (DCE).

Email Address Used to Set-up With the Virtual Currency Exchange or DCE

Enter the email address you used to set up your virtual currency exchange or DCE.

Locations of Virtual Currency

Enter the location where your virtual currency is stored.

Virtual Currency Amount and Value

Enter the amount and value of your virtual currency.

Section B. Real Estate

Description/Location/County

Enter details about your real estate, where it is located, and which county it is in.

Type of Residence

Mark the appropriate box which corresponds to the type of your residence. You may select:

• Primary residence
• Other

Monthly Payment

Enter the amount of your monthly payment for your residence.

Financing

Enter information about your finances.

Year Purchased

Enter the year when your residence was purchased.

Purchase Price

Enter the purchase price of your residence in U.S. dollars.

Year Refinanced

Enter the year when your residence was refinanced.

Refinanced Amount

Enter the refinanced amount of your residence in U.S. dollars.

Current Value

Enter the current value of your residence in U.S. dollars.

Balance Owed

Enter the balance you currently owe for your residence.

Equity

Enter the equity for your residence.

Section C. Other Assets

Description

Enter the description for your other assets.

Monthly Payment

Enter the monthly payment for your other assets.

Year Purchased

Enter the year when you purchased your other assets.

Final Payment

Enter the final payment for your other assets in U.S. dollars.

Current Value

Enter the current value of your other assets in U.S. dollars.

Balance Owed

Enter the balance you currently owe for your other assets.

Equity

Enter the equity for your other assets.

Section D. Credit Cards

Type

Enter the type of your credit card.

Credit Limit

Enter the credit limit of your card.

Balance Owed

Enter the balance you owe.

Minimum Monthly Payment

Enter the minimum monthly payment for your credit card.

Section E. Business Information

E1. Accounts Receivable owed to you or your business

Enter information about your accounts receivable.

Name

Enter the full legal name connected to the account.

Address

Enter the address of the individual connected to the account.

Amount owed from additional sheets

Enter the amount owed from the additional sheets.

Total amount of accounts receivable

Enter the total amount of accounts receivable.

Section F. Employment Information

Your current employer

Enter the full legal name and home or residential address of your employer.

Payment

Mark the appropriate box which corresponds to how often you are paid. You may select:

• Weekly
• Biweekly
• Semi-monthly
• Monthly

Gross per pay period

Enter your gross per pay period.

Taxes per pay period

Enter your taxes per pay period and enter the amount for Fed, State, and Local.

How long at current employer

Enter the amount of time you have been working for your current employer.

Spouse’s current employer

Enter the full legal name and home or residential address of the employer of your spouse.

Payment

Mark the appropriate box which corresponds to how often your spouse is paid. You may select:

• Weekly
• Biweekly
• Semi-monthly
• Monthly

Gross per pay period

Enter your spouse’s gross per pay period.

Taxes per pay period

Enter your spouse’s taxes per pay period and enter the amount for Fed, State, and Local.

How long at current employer

Enter the amount of time your spouse has been working for his or her current employer.

Section G. Non-Wage Household Income

Alimony Income

Enter the amount of your alimony income.

Child Support Income

Enter the amount of your child support income.

Net Self Employment Income

Enter the amount of your net self-employment income.

Net Rental Income

Enter the amount of your net rental income.

Unemployment Income

Enter the amount of your unemployment income.

Pension Income

Enter the amount of your pension income.

Interests or Dividends Income

Enter the amount of your interests or dividends income.

Social Security Income

Enter the amount of your social security income.

Other

Enter the amount of your other income.

Section H. Monthly Necessary Living Expenses

Item 1. Food or Personal Care

Food

Enter your actual monthly and IRS-allowed food expenses.

Housekeeping Supplies

Enter your actual monthly and IRS-allowed housekeeping expenses.

Clothing and Clothing Services

Enter your actual monthly and IRS-allowed clothing and clothing services expenses.

Personal Care Products and Services

Enter your actual monthly and IRS-allowed personal care products and services expenses.

Miscellaneous

Enter your actual monthly and IRS-allowed miscellaneous expenses.

Total

Enter your total expenses.

Item 2. Transportation

Gas, Insurance, or Licenses

Enter your actual monthly and IRS-allowed gas, insurance, or licenses expenses.

Parking or Maintenance

Enter your actual monthly and IRS-allowed parking or maintenance expenses.

Public Transportation

Enter your actual monthly and IRS-allowed public transportation expenses.

Total

Enter your total expenses.

Item 3. Housing and Utilities

Rent

Enter your actual monthly and IRS-allowed rent expenses.

Electric, Oil or Gas, Water or Trash

Enter your actual monthly and IRS-allowed electric, oil or gas, and water or trash expenses.

Telephone, Cell, Cable, or Internet

Enter your actual monthly and IRS-allowed telephone, cell, cable, or internet expenses.

Real Estate Taxes and Insurance

Enter your actual monthly and IRS-allowed real estate taxes and insurance expenses.

Maintenance and Repairs

Enter your actual monthly and IRS-allowed maintenance and repairs expenses.

Total

Enter your total expenses.

Item 4. Medical

Health insurance

Enter your actual monthly and IRS-allowed health insurance expenses.

Out of pocket Health Care

Enter your actual monthly and IRS-allowed out-of-pocket health care expenses.

Expenses

Enter your medical expenses.

Total

Enter your total expenses.

Item 5. Other

Child or Dependent Care

Enter your actual monthly and IRS-allowed child or dependent care expenses.

Estimated Tax Payments

Enter your actual monthly and IRS-allowed estimated tax payment expenses.

Term Life Insurance

Enter your actual monthly and IRS-allowed term life insurance expenses.

Employer Required Retirement

Enter your actual monthly and IRS-allowed, employer-required retirement expenses.

Voluntary Retirement

Enter your actual monthly and IRS-allowed voluntary retirement expenses.

Union Dues

Enter your actual monthly and IRS-allowed union dues expenses.

Delinquent State and Local Taxes

Enter your actual monthly and IRS-allowed delinquent state and local tax expenses.

Student Loans

Enter your actual monthly and IRS-allowed student loan expenses.

Court Ordered Child Support

Enter your actual monthly and IRS-allowed, court-ordered child support expenses.

Court Ordered Alimony

Enter your actual monthly and IRS-allowed, court-ordered alimony expenses.

Other Court Ordered Payments

Enter your actual monthly and IRS-allowed, court-ordered payments.

Other

Enter other amounts of your actual monthly and IRS-allowed food expenses.

Total

Enter your total expenses.

Your signature

Affix your signature.

Spouse’s Signature

Have your spouse affix his or her signature.