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Section 5
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.
If you will pay your offer in 5 or fewer payments within 5 months or less, multiply "Remaining Monthly Income" (Box D) by 12 to get "Future Remaining
Income." Do not enter a number less than zero.
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.
Enter the total from Box D
Box E Future Remaining Income
X 12 =
$
$
If you will pay your offer in 6 to 24 months, multiply "Remaining Monthly Income" (Box D) by 24 to get "Future Remaining Income". Do not enter a
number less than zero.
Enter the total from Box D
Box F Future Remaining Income
X 24 =
$
$
Determine your minimum offer amount by adding the total available assets from Box A to the amount in either Box E or Box F. Your offer amount must
be more than zero.
Enter the amount from Box A *
Enter the amount from either
Offer Amount
Box E or Box F
Your offer must be more than zero ($0).
+
=
Do not leave blank. Use whole dollars only.
$
$
$
You must offer an amount more than $0.
*You may exclude any equity in income producing assets shown in Section 2 of this form.
Section 6
Other Information
Additional information IRS needs to consider settlement of your tax debt. If this business is currently in a bankruptcy proceeding, the
business is not eligible to apply for an offer.
Is the business currently in bankruptcy?
Yes
No
Has the business ever filed bankruptcy?
Yes
No
If yes, provide:
Date Dismissed or Discharged
Date Filed
(mm/dd/yyyy)
(mm/dd/yyyy)
Petition No.
Location Filed
Does this business have other business affiliations (e.g., subsidiary or parent companies)?
Yes
No
If yes, list the Name and Employer Identification Number:
Do any related parties (e.g., partners, officers, employees) owe money to the business?
Yes
No
Is the business currently, or in the past, a party to a lawsuit?
Yes
No
If yes, date the lawsuit was resolved:
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, has the business transferred any assets for less than their full value?
Yes
No
If yes, provide date, value, and type of asset transferred:
433-B (OIC)
Form
(Rev. 3-2017)
Catalog Number 55897B