Form 433-B (Oic) - Collection Information Statement For Businesses Page 5
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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 months or less, multiply "Remaining Monthly Income" (Box D) by 12 to get "Future Remaining Income." Do not enter a
number less than zero.
Round to the nearest whole dollar.
Enter the amount from Box D
Box E Future Remaining Income
X 12 =
$
$
If you will pay your offer in more than 5 months, multiply "Remaining Monthly Income" (from Box D) by 24 to get "Future Remaining Income." Do not
enter a number less than zero.
Box F Future Remaining Income
Enter the amount from Box D
$
$
X 24 =
Determine your minimum offer amount by adding the total available assets from Box A to 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.
$
$
$
If you cannot pay the offer amount due to special circumstances, explain on the Form 656, Offer in Compromise, Section 3. You must offer
something.
*You may exclude any equity in income producing assets shown in Section 2 of this form.
Section 6
Other Information
Is the business currently in bankruptcy?
Additional information IRS needs to
consider settlement of your tax debt. If this
Yes
No
business is currently in a bankruptcy
proceeding, the business is not eligible to
Has the business ever filed bankruptcy?
apply for an offer.
Yes
No
If yes, provide:
Date Filed
Date Dismissed or Discharged
(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:
In the past 10 years, has the business transferred any assets for less than their full value?
Yes
No
If yes, provide date and type of asset transferred:
Has the business been located outside the U.S. for 6 months or longer in the past 10 years?
Yes
No
Does the business have any funds being held in trust by a third party?
No If yes, how much $
Where:
Yes
Does the business have any lines of credit?
Yes
No
If yes, credit limit $
Amount owed $
What property secures the line of credit?
433-B (OIC)
Catalog Number 55897B
Form
(Rev. 1-2014)
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