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that allows you to have monthly payments automatically withdrawn from a savings or checking account.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

City

State

ZIP

(

)

(

)

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

City

State

ZIP

(

)

Person responsible for remitting payments

Phone

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)