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Form 433-A

Collection Information Statement for Wage Earners and Self-Employed Individuals

The detailed financial statement used for larger balances and in-depth collection cases.

What it does

Form 433-A collects detailed information on household income, expenses, property, accounts and business interests. Businesses use a separate form, Form 433-B.

When people use it

  • A revenue officer or the IRS requests a full financial statement.
  • You are asking for a collection alternative that needs detailed financial proof.

Before you file

  • Collect bank, retirement, loan and vehicle statements, plus income records for every household member whose income is counted.
  • If you are applying for an offer in compromise, the offer package uses its own version, Form 433-A (OIC).

What to watch for

  • Leaving out an asset or account can cause serious problems. Disclose everything the form asks for.
  • The IRS may verify what you report against its own records.
Get the current Form 433-A and instructions from the IRS

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This guide is general education, not tax or legal advice. Form requirements and fees change, so confirm details on the IRS page above before you file.