Form 433-F: Collection Information Statement
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Form 433-F (Rev. 7-2024), Collection Information Statement, is the financial statement the IRS requests when you owe tax and cannot pay in full. It lists your accounts, assets, debts, income and monthly expenses so the IRS can see what you can pay, or find you currently not collectible. Attach it to Form 9465 if you owe over $50,000 or offer less than the balance divided by 72; otherwise send it to the address or fax on your IRS notice. JustFill makes the blank IRS PDF fillable so you can type your figures; the first clean completed download is included at no charge.
Form 433-F is the shorter Collection Information Statement the IRS (and its Automated Collection System) uses to evaluate a taxpayer's ability to pay a tax debt. Its sections A–H cover bank and investment accounts, digital assets such as cryptocurrency, real estate, vehicles and other assets, credit cards, business receivables, employment, non-wage income and monthly living expenses. The expense table has an "Actual" and an "IRS Allowed" column: for food/personal care and medical you enter the IRS Collection Financial Standards (currently effective June 29, 2026) unless you pay more and can prove it, and housing and transportation are limited to the local standard or what you actually spend, whichever is less. The IRS compares your income to those allowed expenses to set an installment amount or determine that you are currently not collectible. Because the numbers determine your monthly payment, clarity counts. JustFill lets you complete the 433-F online so every income, expense and asset figure is legible before you send it.
The official Form 433-F (Rev. 7-2024) PDF, with its instructions on pages 3–4, is free at irs.gov/pub/irs-pdf/f433f.pdf. If the IRS asked you for one, open the blank in JustFill to type your accounts, income and expenses cleanly, then download it and send it the way your notice or Form 9465 directs — the first clean completed download is included at no charge.
Get the official Form 433-F PDF from IRSWhat each section of Form 433-F 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.
Name, address, SSN or ITIN for you and your spouse, phone numbers, county of residence, how many household members can be claimed on this year's return (under 65 and 65 and over), and, if self-employed, the business name, EIN, type and number of employees.
Section A: every checking, savings, online or mobile (PayPal-type) account and every investment (CDs, IRAs, 401(k)s, stocks, bonds, mutual funds), even at a zero balance, with institution, account number, type and current balance. Digital assets need the wallet or exchange, the email used to open it, where they are held and today's U.S.-dollar value. Bank loans do not go here.
Sections B and C: each property (primary residence or other) with monthly payment, purchase and refinance years and amounts, current value, balance owed and equity; then vehicles (make, model, year — write "lease" if leased), boats, whole-life policies and business assets. Equity is current market value minus what you owe.
Section F asks for employer, pay frequency, gross pay and tax withheld per pay period for you and your spouse — or skip it and attach a current pay stub. Section G lists monthly non-wage income: net self-employment (attach Schedule C or a current profit-and-loss statement), net rental, alimony, child support, unemployment, pension, Social Security, interest and dividends.
Section H: food/personal care, transportation, housing and utilities, medical, and other (child care, estimated taxes, term life, required and voluntary retirement, union dues, delinquent state taxes, student loans, court-ordered payments). Convert bills you do not pay monthly: weekly × 4.3, biweekly × 2.17, semimonthly × 2, quarterly ÷ 3. Rent goes here; a mortgage payment belongs in Section B.
Section D lists every credit card and line of credit, even with no balance, with its limit, balance owed and minimum monthly payment. Section E, for the self-employed, lists accounts receivable owed to you and any merchant accounts that take card or digital-asset payments.
You (and your spouse) sign under penalty of perjury and date the form. Keep a copy plus your paperwork: the IRS may ask for pay statements, bank and investment statements, loan statements, court orders and bills to substantiate any figure, and it must see proof for any expense above the standard.
A fictional single renter in Columbus, Ohio, owes about $31,000 for tax years 2023 and 2024. Form 9465 line 10 (the balance divided by 72) comes to $431 a month, but they can only offer $250, so Form 9465 tells them to check the box on line 11b and attach Form 433-F.
1 person under 65 · County: Franklin · address box unchecked · business lines: N/A
Count only people who can be claimed on this year's return. Tick the address box only if you have moved since your last return; the business lines are for the self-employed.
Sample Community Bank, 100 Main St, Columbus OH — checking ••••4321, $1,240 · savings ••••8765, $0
List every account even at a zero balance. Bank loans do not go in this section; they show up as the balance owed on the asset they financed.
Employer 401(k) — $18,500 · digital assets: N/A
Retirement plans count as investments. Write N/A rather than leaving the crypto table blank, so the IRS does not come back to ask.
N/A (renting; no rental, pension, unemployment or other income)
Blank lines look like omissions and trigger follow-up requests; N/A shows the section was considered.
2019 Honda Civic — payment $310/mo — purchased 2021 — final payment 05/2028 — value $14,000 — owed $6,200 — equity $7,800
Give make, model and year; equity is current market value minus the loan balance. Write "lease" in the year-purchased column for a leased car.
Visa — limit $5,000 — balance $3,100 — minimum payment $95
Every card and line of credit, even with nothing owed. Card payments are not a separate allowed expense; they fall under the miscellaneous allowance.
Sample Logistics LLC — biweekly — gross $2,150 per pay period — withheld: federal $245, state $70, local $50 — 3 years
Or skip this section entirely and attach a current pay stub, which the instructions allow.
Rent $1,150 · electric, gas, water $160 · phone and internet $95 · total $1,405
Rent goes here; a mortgage payment belongs with the property in Section B. Only list utilities and taxes that are not already inside the rent.
Gas, insurance, licence, maintenance $380 · public transportation $0 · total $380
Operating costs only; the $310 car payment is already in Section C. The IRS allows the local standard or the actual amount, whichever is less.
Food/personal care: Total line only, the one-person national standard from the IRS Collection Financial Standards · medical: health insurance $0 (deducted from pay), out-of-pocket $45
If you do not spend more than the standard for your family size, the form says to fill in the Total only. Claim more than the standard only if you can prove it.
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-F has to be your own.
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Form 9465, Installment Agreement Request
Form 433-A: Collection Information Statement for Wage Earners and Self-Employed Individuals
Form 433-D: Installment Agreement
Form 1040, U.S. Individual Income Tax Return
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Official source: Form 433-F on IRS’s website
Edition checked: Rev. 7-2024 (July 2024), Catalog Number 62053J. Verified against the official source on .
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