0426 Form 433-A (OIC) (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f433aoi.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(April 2026)

Department of the Treasury — Internal Revenue Service

Use this form if you are

• An individual who owes income tax on a Form 1040, U.S.

Individual Income Tax Return

• An individual with a personal liability for Excise Tax

• An individual responsible for a Trust Fund Recovery Penalty

• An individual who is self-employed or has self-employment

income. You are considered to be self-employed if you are in business for yourself, or operate a trade or business.

• An individual who is personally responsible for a partnership liability (only if the partnership is submitting an offer)

• An individual who is submitting an offer on behalf of the estate of a deceased person

Note: Include attachments if additional space is needed to respond completely to any question. This form should only be used with the Form 656, Offer in Compromise.

Section 1 Personal and Household Information

Provide information about your spouse.

Spouse's last name Spouse's first name Date of birth (mm/dd/yyyy) Social Security Number

Provide information for all other persons in the household or claimed as a dependent.

Section 2 Employment Information for Wage Earners

Complete this section if you or your spouse are wage earners and receive a Form W-2. If you or your spouse have self-employment income (that is you file a Schedule C, E, F, etc.) instead of, or in addition to wage income, you must also complete Business Information in Sections 4, 5, and 6.

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2026)

Page 2

Section 3 Personal Asset Information (Domestic and Foreign)

Use the most current statement for each type of account, such as checking, savings, money market and online accounts, stored value cards (such as a payroll card from an employer), investment, retirement accounts (IRAs, Keogh, 401(k) plans, stocks, bonds, mutual funds, certificates of deposit) and digital assets, or financial interests in digital assets, such as non-fungible tokens (NFTs) and virtual currencies, such as cryptocurrencies and stablecoins, life insurance policies that have a cash value, or may be sold on a secondary market, a life settlement, and safe deposit boxes including those located in foreign countries or jurisdictions. Asset value is subject to adjustment by IRS based on individual circumstances. Enter the total amount available for each of the following (if additional space is needed include attachments). Ensure you also include assets located in foreign countries or jurisdictions and add attachment(s) if additional space is needed to respond.

Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0". Cash and Investments (domestic and foreign)

Note: Your reduction from current market value may be greater than 20% due to potential tax consequences/withdrawal penalties.

Cash value of Life Insurance Policies

Name of Insurance Company Policy number

Current cash value

$

Total cash value of life insurance policies from attachment

$

Minus loan balance

– $ = (4a) $

Minus loan balance(s)

– $ = (4b) $

Add lines (4a) through (4b) = (4) $

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2026)

Page 3

Section 3 (Continued) Personal Asset Information (Domestic and Foreign)

Real property – Enter information about any house, condo, co-op, time share, etc. that you own (or have interest in through a life estate), or that your spouse owns if you live in a community property state.

Is your real property currently for sale or do you anticipate selling your real property to fund the offer amount

Yes (listing price) No

Property description (indicate if personal residence, rental property, vacant, etc.) Purchase date (mm/dd/yyyy)

Amount of mortgage payment Date of final payment How title is held (joint tenancy, etc.)

Location (street, city, state, ZIP code, county, and country) Lender/Contract holder name, address (street, city, state, ZIP code) and phone

Current market value

$ X .8 = $

Minus loan balance (mortgages, etc.)

– $ (total value of real estate) = (5a) $

Property description (indicate if personal residence, rental property, vacant, etc.) Purchase date (mm/dd/yyyy)

Amount of mortgage payment Date of final payment How title is held (joint tenancy, etc.)

Location (street, city, state, ZIP code, county, and country) Lender/Contract holder name, address (street, city, state, ZIP code) and phone

Current market value

$ X .8 = $

Minus loan balance (mortgages, etc.)

– $ (total value of real estate) = (5b) $

Total value of property(s) from attachment [current market value X .8 minus any loan balance(s)] (5c) $

Add lines (5a) through (5c) = (5) $

Vehicles (enter information about any cars, boats, motorcycles, etc. that you own or lease). Include those located in foreign countries or jurisdictions. If additional space is needed, list on an attachment.

Vehicle make & model Year Date purchased Mileage License/Tag number

Lease

Own

Name of creditor Date of final payment Monthly lease/loan amount

$

Current market value

$ X .8 = $

Minus loan balance

– $

Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = (6a) $

Subtract $3,450 from line (6a) (6b) $ (If line (6a) minus $3,450 is a negative number, enter "0")

Vehicle make & model Year Date purchased Mileage License/Tag number

Lease

Own

Name of creditor Date of final payment Monthly lease/loan amount

$

Current market value

$ X .8 = $

Minus loan balance

– $

Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = (6c) $

If you are filing a joint offer, subtract $3,450 from line (6c) (If line (6c) minus $3,450 is a negative number, enter "0") If you are not filing a joint offer, enter the amount from line (6c)

(6d) $

Total value of vehicles listed from attachment [current market value X .8 minus any loan balance(s)] (6e) $

Total lines (6b), (6d), and (6e) = (6) $

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2026)

Page 4 Section 3 (Continued) Personal Asset Information (Domestic and Foreign)

Other valuable items (artwork, collections, jewelry, items of value in safe deposit boxes, interest in a company or business that is not publicly traded, etc.)

Description of asset(s)

NOTE: If you or your spouse are self-employed, Sections 4, 5, and 6 must be completed before continuing with Sections 7 and 8. Section 4 Self-Employed Information

If you or your spouse are self-employed (e.g., files Schedule(s) C, E, F, etc.), complete this section.

Partnership LLC Corporation Other Section 5 Business Asset Information (for Self-Employed) (Domestic and Foreign)

List business assets including bank accounts, digital assets (such as cryptocurrency), tools, books, machinery, equipment, business vehicles and real property that is owned/leased/rented. If additional space is needed, attach a list of items. Do not include personal assets listed in Section 3.

Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative number, enter "0".

Page 5 Section 5 (Continued) Business Asset Information (for Self-Employed) (Domestic and Foreign)

Description of asset

If you provide a current profit and loss (P&L) statement for the information below, enter the total gross monthly income on line 17 and your monthly expenses on line 29 below. Do not complete lines (12) - (16) and (18) - (28). You may use the amounts claimed for income and expenses on your most recent Schedule C; however, if the amount has changed significantly within the past year, a current P&L should be submitted to substantiate the claim.

Period provided beginning through

Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative number, enter "0".

Business income (you may average 6-12 months income/receipts to determine your gross monthly income/receipts)

Gross receipts (12) $

Gross rental income (13) $

Interest income (14) $

Dividends (15) $

Other income (16) $

Add lines (12) through (16) = (17) $

Business expenses ( you may average 6-12 months expenses to determine your average expenses)

Page 6 Section 7 Monthly Household Income and Expense Information

Enter your household's average gross monthly income. Gross monthly income includes wages, social security, pension, unemployment, and other income. Examples of other income include but are not limited to: agricultural subsidies, gambling income, oil credits, rent subsidies, sharing economy income from providing on-demand work, services or goods (e.g., Uber, Lyft, DoorDash, AirBnB, VRBO), income through digital platforms like an app or website, etc., and recurring capital gains from the sale of securities or other property such as digital assets. Include the below information for yourself, your spouse, and anyone else who contributes to your household’s income. This is necessary for the IRS to accurately evaluate your offer.

Monthly Household Expenses Enter your average monthly expenses. Note: For expenses claimed in boxes (39) and (45) only, you should list the full amount of the allowable standard even if the actual amount you pay is less. For the other boxes input your actual expenses. You may find the allowable standards at IRS.gov/Businesses/Small-Businesses-&-Self-Employed/Collection-Financial-Standards.

Page 7 Section 8 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.

Note: The multipliers below (12 and 24) and the calculated offer amount (which included the amount(s) allowed for vehicles and bank accounts) do not apply if the IRS determines you have the ability to pay your tax debt in full within the legal period to collect.

Round to the nearest whole dollar.

If you will pay your offer in 5 or fewer payments within 5 months or less, multiply "Remaining Monthly Income" (Box F) by 12 to get "Future Remaining Income" (Box G). Do not enter a number less than $0.

Enter the total from Box F

$ X 12 =

Box G Future Remaining Income

$

If you will pay your offer in 6 to 24 months, multiply "Remaining Monthly Income" (Box F) by 24 to get "Future Remaining Income" (Box H). Do not enter a number less than $0.

Enter the total from Box F

$ X 24 =

Box H Future Remaining Income

$

Determine your minimum offer amount by adding the total available assets from Box A and Box B (if applicable) to the amount in either Box G or Box H.

Enter the amount from Box A plus Box B (if applicable)

$ +

Enter the amount from either Box G or Box H

$ =

Offer Amount Your offer must be more than zero ($0). Do not leave blank. Use whole dollars only.

$

Place the offer amount shown above on the Form 656, Section 4, Payment Terms, unless you cannot pay that amount due to special circumstances. If you cannot pay that amount due to special circumstances, place the amount you can pay on the Form 656, Section 4, Payment Terms, and explain your special circumstances on the Form 656, Section 3, Reason for Offer.

If you or your business are currently in a bankruptcy proceeding, you are not eligible to apply for an offer.

If yes and the litigation included tax debt, provide the types of tax and periods involved

Are you the beneficiary of a trust, estate, or life insurance policy, including those located in foreign countries or jurisdictions (if yes, answer the following)

Yes No

the following)

Location (name, address and box number(s)) Contents Value

$

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2026)

Page 8 Section 9 (Continued) Other Information

In the past 10 years, have you transferred any asset with a fair market value of more than $10,000 including real property, for less than their full value (if yes, answer the following)

Yes No

List asset(s) Value at time of transfer

$

Date transferred (mmddyyyy) To whom or where was it transferred

Do you have any assets or own any real property outside the U.S. Yes No

If yes, provide description, location, and value

Do you have any funds being held in trust by a third party Yes No

If yes, how much $ Where Section 10 Signatures

Under penalties of perjury, I declare that I have examined this offer, including accompanying documents, and to the best of my knowledge it is true, correct, and complete.

Signature of Taxpayer Date (mm/dd/yyyy)

Signature of Spouse Date (mm/dd/yyyy)

Remember to include all applicable attachments listed below.

Copies of the most recent pay stub, earnings statement, etc., from each employer.

Copies of the most recent statement for each investment and retirement account.

Copies of all documents and records showing currently held digital assets.

Copies of the most recent statement, etc., from all other sources of income such as pensions, Social Security, rental income, interest and dividends (including any received from a related partnership, corporation, LLC, LLP, etc.), court order for child support, alimony, royalties, agricultural subsidies, gambling income, oil credits, rent subsidies, sharing economy income from providing on-demand work, services or goods (e.g., Uber, Lyft, AirBnB, VRBO), income through digital platforms like an app or website, etc., and recurring capital gains from the sale of securities or other property such as digital assets.

Copies of individual complete bank statements for the three most recent months. If you operate a business, copies of the six most recent complete statements for each business bank account.

Completed Form 433-B (Collection Information Statement for Businesses) if you or your spouse have an interest in a business entity other than a sole-proprietorship.

Copies of the most recent statement from lender(s) on loans such as mortgages, second mortgages, vehicles, etc., showing monthly payments, loan payoffs, and balances.

List of Accounts Receivable or Notes Receivable, if applicable.

Verification of delinquent State/Local Tax Liability showing total delinquent state/local taxes and amount of monthly payments, if applicable.

Copies of court orders for child support/alimony payments claimed in monthly expense section.

Copies of Trust documents if applicable per Section 9.

Documentation to support any special circumstances described in the “Explanation of Circumstances” on Form 656, if applicable.

Attach a Form 2848, Power of Attorney and Declaration of Representative, if you would like your attorney, CPA, or enrolled agent to represent you and you do not have a current form on file with the IRS. Ensure all years and forms involved in your offer are listed on Form 2848 and include the current tax year.

Completed and signed current Form 656.

Privacy Act Statement

We ask for the information on this form to carry out the internal revenue laws of the United States. Our authority to request this information is section § 7801 of the Internal Revenue Code. Our purpose for requesting the information is to determine if it is in the best interests of the IRS to accept an offer. You are not required to make an offer; however, if you choose to do so, you must provide all of the taxpayer information requested. Failure to provide all of the information may prevent us from processing your request. If you are a paid preparer and you prepared the Form 656 for the taxpayer submitting an offer, we request that you complete and sign Section 9 on Form 656, and provide identifying information. Providing this information is voluntary. This information will be used to administer and enforce the internal revenue laws of the United States and may be used to regulate practice before the Internal Revenue Service for those persons subject to Treasury Department Circular No. 230, Regulations Governing the Practice of Attorneys, Certified Public Accountants, Enrolled Agents, Enrolled Actuaries, and Appraisers before the Internal Revenue Service. Information on this form may be disclosed to the Department of Justice for civil and criminal litigation. We may also disclose this information to cities, states and the District of Columbia for use in administering their tax laws and to combat terrorism. Providing false or fraudulent information on this form may subject you to criminal prosecution and penalties.

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2026)