Instructions For Form 9465 - Installment Agreement Request (Page 5 of 5) in pdf

the sample check below, the account number is

Privacy Act and Paperwork Reduction Act Notice.

20202086. Don’t include the check number.

Our legal right to ask for the information on this form is

sections 6001, 6011, 6012(a), 6109, and 6159 and their

Note. We may have filed a Notice of Federal Tax Lien

regulations. We will use the information to process your

against your property. If so, you may be able to get the

request for an installment agreement. The reason we

notice of lien withdrawn. To learn more about lien

need your name and social security number is to secure

withdrawals and to see if you qualify, visit IRS.gov and

proper identification. We require this information to gain

enter "lien withdrawal" in the “Search” box.

access to the tax information in our files and properly

The direct debit from your checking account won’t

respond to your request. You aren’t required to request an

be approved unless you (and your spouse if filing

installment agreement. If you do request an installment

TIP

a joint return) sign Form 9465.

agreement, you’re required to provide the information

requested on this form. Failure to provide this information

Sample Check—Lines 13a and 13b

may prevent processing your request; providing false

information may subject you to fines or penalties.

Paul Maple

1234

SAMPLE

Roberta Maple

123 Pear Lane

15-0000/0000

You aren’t required to provide the information

Anyplace, VA 20000

requested on a form that is subject to the Paperwork

PAY TO THE

Reduction Act unless the form displays a valid OMB

ORDER OF

Routing

Account

control number. Books or records relating to a form or its

number

DOLLARS

instructions must be retained as long as their contents

(line 13a)

(line 13b)

ANYPLACE BANK

Don’t include

Anyplace, VA 20000

may become material in the administration of any Internal

the check number.

Revenue law. Generally, tax returns and return

For

information are confidential, as required by section 6103.

:250250025

:202020"'86".

1234

However, we may give this information to the Department

The routing and account numbers may be in

of Justice for civil and criminal litigation, and to cities,

different places on your check.

states, the District of Columbia, and U.S. commonwealths

TIP

and possessions to carry out their tax laws. We may also

disclose this information to other countries under a tax

Line 14

treaty, to federal and state agencies to enforce federal

If you want to make your payments by payroll deduction,

nontax criminal laws, or to federal law enforcement and

check the box on line 14 and attach a completed and

intelligence agencies to combat terrorism.

signed Form 2159. Ask your employer to complete and

The average time and expenses required to complete

sign the employer’s portion of Form 2159.

and file this form will vary depending on individual

If you choose to make your payments by payroll

circumstances. For the estimated averages, see the

deduction, you won’t be able to file Form 9465

instructions for your income tax return.

electronically.

CAUTION

If you have suggestions for making this form simpler,

we would be happy to hear from you. See the instructions

Part II

for your income tax return.

If you have defaulted on an installment agreement within

the last 12 months, and the amount you owe is greater

than $25,000 but not more than $50,000, complete Part II

on page 2 of Form 9465.

-5-

Instructions For Form 9465 - Installment Agreement Request Page 5

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