Form 433-B (Oic) - Collection Information Statement For Businesses
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6Department of the Treasury — Internal Revenue Service
433-B (OIC)
Form
Collection Information Statement for Businesses
(Rev. January 2014)
Complete this form if your business is a
If your business is a sole proprietorship (filing Schedule C, D, E, F,
Corporation
etc.), do not use this form. Instead, complete Form 433-A (OIC)
Partnership
Collection Information Statement for Wage Earners and Self-
Limited Liability Company (LLC) classified as a corporation
Employed Individuals.
Other multi-owner/multi-member LLC
Single member LLC
Include attachments if additional space is needed to respond completely to any question.
Section 1
Business Information
Business Name
Employer Identification Number
Business Address
(street, city, state, zip code)
County of Business Location
Description of Business and dba or "Trade Name"
Primary Phone
Secondary Phone
Mailing Address
(if different from above or Post Office Box number)
(
)
(
)
-
-
Business website address
Fax Number
Does the business outsource its payroll processing and tax
return preparation for a fee?
(
)
-
If yes, list provider name and address in box below
Yes
No
Federal Contractor
Total Number of Employees
(Street, City, State, ZIP Code)
Yes
No
Frequency of Tax Deposits
Average Gross Monthly Payroll
$
Provide information about all partners, officers, LLC members, major shareholders (foreign and domestic), etc., associated with the
business. Include attachments if additional space is needed.
Title
Last Name
First Name
Percent of Ownership and Annual Salary Social Security Number
Home Address
(Street, City, State, ZIP Code)
Primary Phone
Secondary Phone
(
)
-
(
)
-
Last Name
First Name
Title
Percent of Ownership and Annual Salary Social Security Number
Home Address
(Street, City, State, ZIP Code)
Primary Phone
Secondary Phone
(
)
-
(
)
-
Last Name
First Name
Title
Percent of Ownership and Annual Salary Social Security Number
Home Address
(Street, City, State, ZIP Code)
Primary Phone
Secondary Phone
(
)
-
(
)
-
433-B (OIC)
Catalog Number 55897B
Form
(Rev. 1-2014)
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