Line 1b
If the address you provided on line 3 is new since you filed your last
tax return, check the box on line 1b.
Line 7
Enter the total amount you owe as shown on your tax return(s) (or
notice(s)).
Note: Electronic filing of Form 9465 is not available if the
amount you owe is greater than $50,000.
If you do not agree to make your payments by direct debit or payroll deduction,
complete Form 433-F, Collection Information Statement, and file it with this
form.
If the amount you owe is greater than $50,000, you must complete Form 433-F, and
file it with this form. You can download Form 433-F at
IRS.gov or order it by calling 1-800-TAX-FORM (1-800-829-3676).
TIP: If the total amount you owe is not more than $50,000
(including any amounts you owe from prior years), you do not need to file Form
9465; you can request an installment agreement online. For more information see
Applying online for a payment agreement.
Line 8
Even if you cannot pay
the full amount you owe now, you
should pay as much as possible
to limit penalty and interest
charges. If you are filing this
form with your tax return, make
the payment with your return. For details on how to pay,
see your tax return
instructions.
If you are filing
this form by itself, such as in
response to a notice, attach a
check or money order payable to
“United States Treasury.” Do not
send cash. Be sure to include:
- Your name, address, SSN/EIN, and daytime phone
number.
- The tax year and tax return (for example, “2012 Form
1040”) for which you are making this request.
Line 10
Enter on line 10 the amount you can pay each month.
Make your payments as large as possible to limit interest
and penalty charges. The charges will continue until you
pay in full. If no payment amount is listed on line 10, a
payment will be determined for you by dividing the
balance due by 72 months.
Line 12
You can choose the day
of each month your payment is
due. This can be on or after the
1st of the month, but no later
than the 28th of the month. For
example, if your rent or
mortgage payment is due on the
1st of the month, you may want
to make your installment
payments on the 15th. When we
approve your request, we will
tell you the month and day that
your first payment is due.If we
have not replied by the date you
chose for your first payment,
you can send the first payment
to the Internal Revenue Service
Center at the address shown
earlier that applies to you. See
the instructions for line 8
above for details on what to
write on your payment.
Line 13
TIP:
Making your payments by direct
debit will help ensure that your
payments are made timely and
that you are not in default of
this agreement.
To pay by direct debit from
your checking account at a bank
or other financial institution
(such as a mutual fund,
brokerage firm, or credit
union), fill in lines 13a and
13b. Check with your financial
institution to make sure that a
direct debit is allowed and to
get the correct routing and
account numbers.
Line 13a.
The routing number must be nine
digits. The first two digits of
the routing number must be 01
through 12 or 21 through 32. Use
a check to verify the routing
number. On the sample check on
this page, the routing number is
250250025. But if your check is
payable through a financial
institution different from the
one at which you have your
checking account, do not use the
routing number on that check.
Instead, contact your financial
institution for the correct
routing number.
Line 13b.
The account number can be up to
17 characters (both numbers and
letters). Include hyphens but
omit spaces and special symbols.
Enter the number from left to
right and leave any unused boxes
blank. On the sample check
below, the account number is
20202086. Do not include the
check number.
Note. We may have filed a Notice of Federal Tax Lien against your property. If
so, you may be able to get the notice of lien withdrawn. To learn more about
lien withdrawals and to see if you qualify, visit IRS.gov and enter "lien
withdrawal" in the search box.
TIP: The
direct debit from your checking
account will not be approved
unless you (and your spouse if
filing a joint return) sign Form
9465.
Line 14
If you want to make your
payments by payroll deduction,
check the box on line 14 and
attach a completed and signed
Form 2159. Ask your employer to
complete and sign their portion
of Form 2159.
Applying online for a payment
agreement
If your balance due is not more
than $50,000, you can apply
online for a payment agreement
instead of filing Form 9465. To
do that, go to IRS.gov and enter
“Online Payment Agreement” in
the “Search” box.