Form 433-A Generator by Jotform
When you owe back taxes, the IRS may ask wage earners and self-employed people to complete Form 433-A so it can review their finances. Fill out this collection information statement online for free with Jotform and download a completed PDF.
Keep your financial picture private
Form 433-A covers bank accounts, assets, debts, and monthly expenses. Jotform protects every entry with 256-bit SSL encryption and GDPR and CCPA friendly features, and you can enable encrypted forms for even more security.
Work through it on any device
Form 433-A is detailed, and you'll probably be looking up numbers as you go. Fill it out on a computer, tablet, or phone, whichever is easiest to use next to your statements and bills.
Organized sections, easy PDF download
Jotform walks you through the personal, employment, asset, and income sections with clear fields. When you're finished, download Form 433-A as a PDF to sign and send.
Printed in the IRS's own layout
Your answers flow into the original Form 433-A layout, so the IRS receives a statement that matches the official form.
FAQ
What is Form 433-A?
Form 433-A, Collection Information Statement for Wage Earners and Self-Employed Individuals, gives the IRS a detailed look at your income, living expenses, assets, and debts. The IRS uses it to figure out how much you can pay toward a tax balance and which collection options may fit, such as an installment agreement or currently not collectible status.
Who needs to fill out Form 433-A?
Individuals usually complete Form 433-A when the IRS asks for it during collection, for example when you're working with a revenue officer or asking for a payment plan that requires a financial review. Wage earners complete Sections 1 through 5, and self-employed individuals complete Sections 1 and 3 through 7.
Businesses such as corporations and partnerships use Form 433-B instead. If you're applying for an offer in compromise, the IRS uses a separate version called Form 433-A (OIC).
What documents should I gather before I start?
It helps to have recent pay stubs, bank and investment statements, retirement account statements, loan and mortgage balances, vehicle information, and records of monthly bills like rent, utilities, insurance, and child care. Some sections ask you to attach documentation, and the IRS may request more to verify what you report.
How do I fill out Form 433-A?
Section 1 covers personal information about you, your spouse, and your household. Section 2 asks about your and your spouse's employers, and Section 3 covers other financial information, such as lawsuits, bankruptcies, trusts, and time spent living abroad. Section 4 lists your personal assets, including bank accounts, investments, virtual currency, real estate, and vehicles.
Section 5 adds up your monthly household income and expenses. If you're self-employed, Sections 6 and 7 cover your business and your sole proprietorship's income and expenses. Answer every question or write N/A, then sign the certification.
Is it safe to enter my finances into Jotform?
Jotform uses 256-bit SSL encryption and offers encrypted forms for extra protection. You can fill out Form 433-A online for free, download the PDF, and decide how to deliver it to the IRS yourself. Jotform doesn't send your statement anywhere.
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