Form 656-B - Offer In Compromise Booklet Page 14
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32Page 6 of 8
Section 7
Monthly Household Income and Expense Information
Enter your household's gross monthly income. The information below is for yourself, your spouse, and anyone else who contributes to
your household's income. The entire household includes spouse, non-liable spouse, significant other, children, and others who
contribute to the household. This is necessary for the IRS to accurately evaluate your offer.
Monthly Household Income
Note: Entire household income should also include income that is considered not taxable and may not be included on your
tax return.
Round to the nearest whole dollar.
Primary taxpayer
Gross Wages
Social Security
Pension(s)
Other Income
(e.g. unemployment)
Total primary
$
+ $
+ $
+ $
(30) $
taxpayer income =
Spouse
Gross Wages
Social Security
Pension(s)
Other Income
(e.g. unemployment)
Total spouse
$
+ $
+ $
+ $
(31) $
income =
Additional sources of income used to support the household, e.g., non-liable spouse, or anyone else who may
contribute to the household income, etc.
(32) $
Interest and dividends
(33) $
Distributions
(34) $
(e.g., income from partnerships, sub-S Corporations, etc.)
Net rental income
(35) $
Net business income from Box C
(36) $
Child support received
(37) $
Alimony received
(38) $
Box D
Round to the nearest whole dollar.
Total Household Income
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
$
Add lines (30) through (38) and enter the amount in Box D =
Monthly Household Expenses
Enter your average monthly expenses.
Note: For expenses claimed in boxes (39) and (45) only, you should list the full amount of the allowable standard even if the
actual amount you pay is less. You may find the allowable standards at
Self-Employed/Collection-Financial-Standards.
Round to the nearest whole dollar.
Food, clothing, and miscellaneous
(e.g., housekeeping supplies, personal care products , minimum payment on credit card).
A reasonable estimate of these expenses may be used.
(39) $
Housing and utilities
(e.g., rent or mortgage payment and average monthly cost of property taxes, home insurance,
maintenance, dues, fees and utilities including electricity, gas, other fuels, trash collection, water, cable television and internet,
telephone, and cell phone).
(40) $
Vehicle loan and/or lease payment(s)
(41) $
Vehicle operating costs
(e.g., average monthly cost of maintenance, repairs, insurance, fuel, registrations, licenses,
. A reasonable estimate of these expenses may be used.
inspections, parking, tolls, etc.)
(42) $
Public transportation costs
(e.g., average monthly cost of fares for mass transit such as bus, train, ferry, taxi, etc.). A
reasonable estimate of these expenses may be used.
(43) $
Health insurance premiums
(44) $
Out-of-pocket health care costs
(e.g. average monthly cost of prescription drugs, medical services, and medical supplies like
eyeglasses, hearing aids, etc.)
(45) $
Court-ordered payments
(46) $
(e.g., monthly cost of any alimony, child support, etc.)
Child/dependent care payments
(47) $
(e.g., daycare, etc.)
Life insurance premiums
(48) $
Current monthly taxes
(49) $
(e.g., monthly cost of federal, state, and local tax, personal property tax, etc.)
433-A (OIC)
Form
(Rev. 3-2017)
Catalog Number 55896Q
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