Form 433-B: Collection Information Statement for Businesses
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JustFill is not affiliated with Internal Revenue Service (IRS). This is an independent third-party tool to help you complete Form 433-B. Always download the current blank form from the official source and verify your completed copy before signing or submitting. Official Form 433-B from Internal Revenue Service (IRS)
IRS Form 433-B, Collection Information Statement for Businesses, is the 6-page financial disclosure partnerships, corporations, and LLCs submit to the IRS to negotiate an installment agreement, request Currently Not Collectible status, or resolve unpaid payroll and corporate tax debt. Open Form 433-B in JustFill to complete all 6 pages of assets, liabilities, and monthly cash flow online.
Stop re-typing Name, SSN/EIN, and Street Address across separate forms. Launch a pre-built JustFill B2B Packet to enter shared fields once and download a ZIP or merged PDF.
Enter contractor and payer details once to fill the W-9 and the 1099-NEC copy for the recipient.
Shared fields: Contractor Name, Address, TIN, Payer Details, Box 1a Compensation
IRS Form W-4 + USCIS Form I-9
IRS Form W-9 + IRS Form 1099-NEC (Copy B)
IRS Form 2848 (POA) + Form 8821 + Form 4506-T Transcript
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Combine Form 433-B with companion documents (e.g. W-9 + Direct Deposit Authorization + NDA, or I-9 + W-4 + State Withholding, or 2848 + 8821 + Tax Organizer) or batch-generate hundreds of copies from Excel/CSV.
Form 433-B (Collection Information Statement for Businesses) is the comprehensive 6-page financial statement that an IRS Revenue Officer or the IRS Automated Collection System (ACS) requires from an operating business — a C corporation, S corporation, partnership, or multi-member/employer LLC — that owes delinquent federal taxes (most commonly unpaid Form 941 payroll taxes or corporate income taxes) and cannot pay the balance in full immediately. Across its 6 pages, Form 433-B requires a complete inventory of the business's officers, partners, or LLC members, bank accounts, payment processors, accounts receivable, real estate, vehicles, machinery, intangible assets, business liabilities, and a 3- to 12-month gross monthly income and expense cash-flow statement so the IRS can determine the business's monthly ability to pay under an Installment Agreement or Currently Not Collectible (CNC) hardship determination. Note: businesses submitting a formal Offer in Compromise on Form 656 use the companion Form 433-B (OIC) booklet, whereas sole proprietors use Form 433-A. Open the 6-page IRS Form 433-B PDF in JustFill to fill every schedule cleanly in your browser.
The official 6-page IRS Form 433-B PDF (Rev. February 2019) is free to download in the public domain at irs.gov/forms-pubs/about-form-433-b. Upload the 6-page Form 433-B PDF in JustFill to complete every asset table, accounts receivable schedule, and monthly cash-flow line online and export a clean PDF.
What each section of Form 433-B asks for. JustFill’s AI will detect these fields automatically when you upload the PDF — review the breakdown below so you know what to enter.
Business legal name, DBA/trade name, street and mailing address, county, EIN, entity type (Partnership, Corporation, S-Corp, LLC), date established, website, merchant card processor details, and every partner, officer, LLC member, or major shareholder (with title, masked/full SSN, ownership percentage, and annual salary/draws).
Total number of employees, gross monthly payroll, payroll frequency, whether the business uses a third-party payroll service or PEO, pending lawsuits, bankruptcies, IRS litigation, related-party transfers over $10,000, and lines of credit.
All business checking, savings, money market, and online/merchant accounts (Item 17), investment accounts (Item 18), available credit lines (Item 19), and a detailed aging schedule of Accounts and Notes Receivable (0–30, 31–60, 61–90, and 90+ days past due) with customer contact information (Item 20).
Real property owned by the business, leased/financed vehicles, business machinery, equipment, inventory, and intangible assets showing Current Fair Market Value, Quick Sale Value (typically 80% of FMV), loan balance, lender info, and net realizable equity.
Actual gross monthly business receipts (cash/credit sales, rental income, other income) over the selected accounting period (cash or accrual) less actual monthly operating expenses (materials purchased, inventory, gross wages, rent, supplies, utilities, vehicle expenses, insurance, current-period taxes, and secured debt payments) to compute Net Monthly Business Income.
Signatures under penalties of perjury of an authorized corporate officer, partner, or LLC member, plus the checklist of mandatory attachments (last 3 months of bank statements, profit and loss statement, current balance sheet, and current payroll tax deposit receipts).
An HVAC mechanical contracting LLC in Columbus, Ohio that fell behind on two quarters of Form 941 payroll taxes completes the 6-page Form 433-B with its CPA to propose a $2,800/month business installment agreement to the assigned IRS Revenue Officer. All names and numbers are fictional.
Sample Buckeye Mechanical Services LLC · EIN: 98-•••5190 · 1840 Sample Industrial Pkwy, Columbus, OH 43228 · Entity: ☑ LLC (Taxed as S-Corp) · Member: Thomas A. Sample, Managing Member (100% owner, SSN •••-••-4108)
Identifies the operating business entity, EIN, and responsible officer/member.
Item 17: Sample First National Bank Operating Checking (Acct ••••3910): $18,400; Payroll Checking (Acct ••••3928): $6,200 · Item 20 Accounts Receivable (0–30 days): $34,500 across 3 commercial contracts
Discloses current operating liquidity and short-term collectible commercial receivables.
3 Service Vans (FMV $65,000 × 80% QSV = $52,000 − Loan Balance $49,200 = Net Equity $2,800) · HVAC Tools & Diagnostic Equipment (FMV $22,000 × 80% QSV = $17,600, Loan $0)
Calculates Net Realizable Equity at 80% Quick Sale Value less secured equipment encumbrances.
Accounting Method: ☑ Cash · Period: 07/01/2026–09/30/2026 · Item 32 Total Monthly Income: $58,400 − Item 44 Total Monthly Expenses: $55,600 = Item 45 Net Monthly Income: $2,800 · Signed by Thomas A. Sample on 10/23/2026
Establishes $2,800/month in net disposable business cash flow to fund the proposed installment agreement.
These values are made up. They are here to show what belongs on each line, not to be copied — every name, number, and address on your own Form 433-B has to be your own.
Form 433-B is submitted directly to the IRS Revenue Officer assigned to your business or to the IRS Automated Collection System (ACS) unit listed on your collection notice (such as Notice CP504B or Letter 1058).
Use this if the address is in: Businesses responding to an IRS Revenue Officer request, Letter 1058, LT11, or Notice CP504B
Use this if the address is in: Businesses located in eastern states submitting financial disclosures with an Offer in Compromise
Always check the upper-right corner of your latest IRS notice or your Revenue Officer's Form 9297 (Summary of Taxpayer Contact) for the exact direct fax number or local field office mailing address.
Checked against the official Internal Revenue Service (IRS) instructions on 2026-10-23. Destinations change — confirm on the Internal Revenue Service (IRS) page before you send anything.
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Form 433-A: Collection Information Statement for Wage Earners and Self-Employed Individuals
Form 656: Offer in Compromise (IRS Booklet Form 656-B)
Form 2848: Power of Attorney and Declaration of Representative
Form 8821: Tax Information Authorization
Form 941, Employer's Quarterly Federal Tax Return
Form 843: Claim for Refund and Request for Abatement
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Official source: Form 433-B on Internal Revenue Service (IRS)’s website
Edition checked: Rev. February 2019 (6 pages; Catalog No. 16649P). Verified against the official source on · Verified in our Government Forms Fillability Study.
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