Form Cpp-1 - Payment Installment Plan Request

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Illinois Department of Revenue
CPP-1 Payment Installment Plan Request
Read this information first
Quick - Easy - Automatic
Please read the instructions before completing this form.
We now offer you the ACH debit
Everyone must complete Steps 1, 3, 4, and 6. Complete Step 2
program. It makes monthly payments
if you are a business requesting a payment installment plan for a
automatic. Never chance being
debt other than Individual Income Tax. Complete Step 5 if you wish to
late again.
take advantage of the new Automated Clearing House (ACH) debit program
that allows you to have monthly payments automatically withdrawn from a savings or checking account.
Note: You must complete a Form EG-13-I, Financial and Other Information Statement for Individuals,
or a Form EG-13-B, Financial Statement for Businesses, if the payment agreement amount that you are
applying for, including penalty and interest, is over $5,000.
Step 1: Personal Information
(including your spouse, if applicable)
____ ____ ____—____ ____—____ ____ ____ ____
____ ____ ____—____ ____—____ ____ ____ ____
Your Social Security number
Your spouse’s Social Security number
Your first name and middle initial
Your last name
Your spouse’s first name and middle initial
Your spouse’s last name (if different)
Mailing address
Your home phone number
Spouse’s work phone number
Your work phone number
Step 2: Identify your business and the person responsible for remitting payments
(businesses only)
____ ____—____ ____ ____ ____ ____ ____ ____
____ ____ ____ ____—____ ____ ____ ____
Federal employer identification number (FEIN)
Illinois Business Tax (IBT) number
Excise Tax Number
Business name
Mailing address
Person responsible for remitting payments
Department use only
Approved by assignee
Approved by supervisor
This form is authorized as outlined by the Illinois Income Tax Act and the Retailers’ Occupation and related occupation taxes and fees acts. Disclosure of this
information is REQUIRED. Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-4231.
CPP-1 front (R-12/05)


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