Department of the Treasury - Internal Revenue Service
Offer in Compromise - Periodic Payment Voucher
If you filed an offer in compromise and the offered amount is to be paid within 6 to 24 months (Periodic Payment Offer) in accordance
with the Tax Increase Prevention and Reconciliation Act of 2005, you must continue to make the payments during the investigation
of the offer until you receive a decision letter (accepted, rejected, returned, or withdrawn). Mail this voucher with your check or money
order payable to the "United States Treasury." Write your social security number or employer identification number on the check or
money order. Do not send cash. You may designate a specific tax liability to apply the payments.
Note: You may also make your payment(s) through the
Electronic Federal Tax Payment System (EFTPS)
https:// Select "Offer in Compromise - Subsequent Periodic Payment".
If you qualified for the Low Income Certification in Section 1 of Form 656, Offer in Compromise, no payments are required; however,
any payments made will be applied to your tax debt.
(Print or Type)
Your first name and middle initial
Your last name
(number, street, and room or suite no., city, state, ZIP code)
Your Social Security Number (SSN) or Employer Identification Number (EIN)
Offer in Compromise Number
Amount of Your Payment
If you want your payment to be applied to a specific tax year and a specific tax debt, such as
a Trust Fund Recovery Penalty, tell us the form number or name (i.e., 1040 or Individual Tax
and tax year/quarter
If you do not designate a preference, we will apply any money you send to the government's
Note: Round up to the nearest
whole dollar. Do not include cents.
Enclose your payment with this voucher and mail to:
If you reside in AK, AL, AR, AZ, CO, FL, GA, HI, ID, KY, LA, MS, NC, NM, NV, OK, OR, TN, TX, UT, WA, WI, enclose your payment
with this voucher and mail to: Memphis IRS Center COIC Unit, AMC-Stop 880, P.O. Box 30834, Memphis, TN 38130-0834. If you have
questions, please call toll-free 1-866-790-7117.
If you reside in CA, CT, DE, IA, IL, IN, KS, MA, MD, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, PA, RI, SC, SD, VT, VA, WY, WV;
DC, PR, or a foreign address enclose your payment with this voucher and mail to: Brookhaven IRS Center COIC Unit, P.O. Box 9011,
Holtsville, NY 11742. If you have questions, please call 1-844-805-4980.
Catalog Number 31131Y