Fillable Form Ftb 3567 - Installment Agreement Request printable pdf download

State of California

Franchise Tax Board

Installment Agreement Request

We will always ask you to immediately pay your tax liability (including interest and penalties) in full. We encourage you to

borrow from private sources to immediately pay your liability in full. If you do not have the financial ability to immediately

pay in full, you may be eligible to make payments in installments over time. We recommend you make the largest monthly

payment possible because your tax liability continues to accrue interest and applicable penalties until paid in full.

Eligibility

You may be eligible for an installment agreement if the following conditions apply:

• The tax liability you owe does not exceed $25,000.

• The installment period for payment does not exceed 60 months.

• You have filed all required valid personal income tax returns.

• You are not in an existing installment agreement.

Taxpayer Installment Agreement Conditions

You agree to:

• Make timely monthly payments until your tax liability is paid in full.

• Maintain adequate funds in your bank account.

• File all required valid personal income tax returns timely.

• Pay all future income tax liabilities timely.

• Pay a $34 installment agreement fee, which we will add to your tax liability. The fee amount is subject to change without

further notice.

• If the tax liability you owe exceeds $10,000 or the installment agreement period for payment exceeds 36 months, or

both, then you must certify that you have a financial hardship. In cases of financial hardship, installment agreements are

subject to periodic review.

• Confirm that the withholding rates for Employment Development Department Form DE 4 and Internal Revenue Service

W-4 on file with your employer will withhold enough state income tax to pay your state income tax liability for your next

state income tax return. If the withholding rates are insufficient, make changes to the forms accordingly.

• Make any required estimated payments if you receive income from sources other than wages.

We approve or reject your request based on your ability to pay and your compliance history. We may file a lien and/or

request a financial statement as a condition for approval. If you fail to prove or if you misrepresent your financial condition,

we may reject your installment agreement request.

Electronic Funds Transfer (EFT)

To authorize electronic funds withdrawal from your bank account, you must complete and sign the EFT Authorization

on PAGE 3 of FTB 3567. Your authorization allows us to automatically withdraw the agreed-upon funds from your bank

account monthly on a date you specify. You must select an automatic withdrawal date that is no later than the 28th day of

the month. If you select a date after the 28th, we will withdraw the amount on the 28th of each month. Failure to select a

date will delay processing your installment agreement request.

Insufficient Funds

To avoid any dishonored payment penalties and possible termination of your installment agreement, maintain adequate

funds in your bank account to cover each monthly payment until you pay your tax liability in full.

State Tax Liens

We may file a state tax lien to protect the state’s interest until you pay off your tax liability (Government Code

Sections 7170-7173). This can affect your credit report.

Franchise Tax Board Privacy Notice

Get FTB 1131, Franchise Tax Board Privacy Notice, at ftb.ca.gov or call us at 800.338.0505. If outside the United States,

call 916.845.6500.

FTB 3567 (REV 08-2013) C2 PAGE 1

Form Ftb 3567 - Installment Agreement Request

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