Form 656 Booklet - Offer In Compromise Page 12
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28Page 6 of 7
Section 6
Monthly Household Income and Expense Information
Monthly Household Expenses
Enter your average monthly expenses. Note: Expenses may be adjusted based on IRS Collection Financial Standards.
Food, clothing, and miscellaneous
. A reasonable estimate of
(e.g., housekeeping supplies, personal care products)
these expenses may be used.
(41) $
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, telephone, and cell
(42) $
phone).
Vehicle loan and/or lease payment(s)
(43) $
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.)
(44) $
Public transportation costs
. A
(e.g., average monthly cost of fares for mass transit such as bus, train, ferry, taxi, etc.)
reasonable estimate of these expenses may be used.
(45) $
Health insurance premiums
(46) $
Out-of-pocket heath care costs
(e.g. average monthly cost of prescription drugs, medical services, and medical supplies like
(47) $
eyeglasses, hearing aids, etc.)
Court-ordered payments
(48) $
(e.g., monthly cost of any alimony, child support, etc.)
Child/dependent care payments
(49) $
(e.g., daycare, etc.)
Life insurance premiums
(50) $
Taxes
(51) $
(e.g., monthly cost of federal, state, and local tax, personal property tax, etc.)
Other secured debts
. Do not include
(e.g., any loan where you pledged an asset as collateral not previously listed)
unsecured debt such as credit cards.
(52) $
Box 4 Household Expenses
$
Add lines (41) through (52) and enter the amount in Box 4 =
Box 5 Remaining Monthly Income
$
Subtract Box 4 from Box 3 and enter the amount in Box 5 =
Section 7
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 months or less (Payment Option 1), multiply "Remaining Monthly Income" (Box 5) by 48 to get "Future Remaining Income"
(Box 6).
Enter the total from Box 5 here
Box 6 Future Remaining Income
X 48 =
$
$
If you will pay your offer in more than 5 months (Payment Option 2), multiply "Remaining Monthly Income"
by 60 to get "Future Remaining
(Box 5)
Income" (Box 7).
Enter the total from Box 5 here
Box 7 Future Remaining Income
X 60 =
$
$
Determine your minimum offer amount by adding the total available assets from Box 1 to amount in either Box 6 or Box 7.
Enter the amount from Box 1 here
Enter the amount from either Box 6 or Box 7
Minimum Offer Amount
+
=
Must be more than zero
$
$
$
If you have special circumstances that would hinder you from paying this amount, explain them on Form 656,
Offer in Compromise, page 2, "Explanation of Circumstances."
433-A (OIC)
Catalog Number 55896Q
Form
(3-2011)
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