Form 656-B - Offer In Compromise Booklet Page 15
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32Page 7 of 8
Section 7
Monthly Household Income and Expense Information
(Continued)
Secured debts
(e.g., any loan where you pledged an asset as collateral not previously listed, government guaranteed Student
(50) $
Loan)
Enter the amount of your monthly delinquent State and/or Local Tax payment(s)
(51) $
Box E
Round to the nearest whole dollar.
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
Total Household Expenses
Add lines (39) through (51) and enter the amount in Box E =
$
Round to the nearest whole dollar.
Box F
Do not enter a negative number. If any line item is a negative, enter "0" on that line.
Remaining Monthly Income
Subtract Box E from Box D and enter the amount in Box F =
$
Section 8
Calculate Your Minimum Offer Amount
The next steps calculate your minimum offer amount. The amount of time you take to pay your offer in full will affect your minimum offer amount. Paying
over a shorter period of time will result in a smaller minimum offer amount.
Note: The multipliers below (12 and 24) and the calculated offer amount do not apply if IRS determines you have the ability to pay your tax
debt in full within the legal period to collect.
Round to the nearest whole dollar.
If you will pay your offer in 5 or fewer payments within 5 months or less, multiply "Remaining Monthly Income" (Box F) by 12 to get "Future Remaining
Income" (Box G). Do not enter a number less than $0.
Enter the total from Box F
Box G Future Remaining Income
$
$
X 12 =
If you will pay your offer in 6 to 24 months, multiply "Remaining Monthly Income" (Box F) by 24 to get "Future Remaining Income" (Box H). Do not enter
a number less than $0.
Enter the total from Box F
Box H Future Remaining Income
$
$
X 24 =
Determine your minimum offer amount by adding the total available assets from Box A and Box B (if applicable) to the amount in either Box G or Box H.
Enter the amount from Box A
Enter the amount from either
Offer Amount
plus Box B (if applicable)
Box G or Box H
Your offer must be more than zero ($0). Do
not leave blank. Use whole dollars only.
$
$
+
=
$
If you cannot pay the Offer Amount shown above due to special circumstances, explain on the Form 656, Offer in
Compromise, Section 1, Low Income Certification. You must offer an amount more than $0.
Section 9
Other Information
Additional information IRS needs to consider settlement of your tax debt. If you or your business are currently in a bankruptcy proceeding,
you are not eligible to apply for an offer.
Are you the beneficiary of a trust, estate, or life insurance policy?
Yes
No
Are you currently in bankruptcy?
Have you filed bankruptcy in the past 10 years?
Yes
No
Yes
No
Location Filed
Discharge/Dismissal Date
(mm/dd/yyyy)
Are you or have you been party to a lawsuit?
Yes
No
If yes, date the lawsuit was resolved:
(mm/dd/yyyy)
Are you or have you been party to any lawsuits involving the IRS/United States (including any suits regarding tax matters)?
Yes
No
If yes and the suit included tax debt, provide the types of tax and periods involved.
In the past 10 years, have you transferred any assets for less than their full value?
Yes
No
If yes, provide date, value, and type of asset transferred:
(mm/dd/yyyy)
433-A (OIC)
Form
(Rev. 3-2017)
Catalog Number 55896Q
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