0626 Form 433-B (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f433b.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

Form

433-B¶

(June 2026)

Department of the Treasury Internal Revenue Service

Exceptions & meaning →

Collection Information Statement for Businesses¶

Note: Complete all entry spaces with the current data available or "N/A" (not applicable). Failure to complete all entry spaces may result in rejection of your request or significant delay in account resolution. Include attachments if additional space is needed to respond completely to any question.

Section 1: Business Information

1a Business Name 1b Business Street Address Mailing Address City State ZIP 1c County 1d Business Telephone ( ) 1e Type of Business 1f Business Website (web address)	2a Employer Identification No. (EIN) 2b Type of entity (Check appropriate box below) Partnership Corporation Other Limited Liability Company (LLC) classified as a corporation Other LLC - Include number of members 2c Date Incorporated/Established mmddyyyy
1a Business Name 1b Business Street Address Mailing Address City State ZIP 1d 1c Business Telephone ( ) 1e Type of Business 1f Business Website (web address) County	3a Number of Employees 3b 3c Frequency of Tax Deposits 3dIs the business enrolled in Electronic Federal Tax Payment System (EFTPS) Yes No Monthly Gross Payroll	3a Number of Employees 3b 3c Frequency of Tax Deposits 3dIs the business enrolled in Electronic Federal Tax Payment System (EFTPS) Yes No Monthly Gross Payroll	3a Number of Employees 3b 3c Frequency of Tax Deposits 3dIs the business enrolled in Electronic Federal Tax Payment System (EFTPS) Yes No Monthly Gross Payroll	3a Number of Employees 3b 3c Frequency of Tax Deposits 3dIs the business enrolled in Electronic Federal Tax Payment System (EFTPS) Yes No Monthly Gross Payroll	3a Number of Employees 3b 3c Frequency of Tax Deposits 3dIs the business enrolled in Electronic Federal Tax Payment System (EFTPS) Yes No Monthly Gross Payroll
1a Business Name 1b Business Street Address Mailing Address City State ZIP 1d 1c Business Telephone ( ) 1e Type of Business 1f Business Website (web address) County	3a Number of Employees 3b 3c Frequency of Tax Deposits 3dIs the business enrolled in Electronic Federal Tax Payment System (EFTPS) Yes No Monthly Gross Payroll
4 Does the business engage in e-Commerce_(Internet sales)_If yes, complete 5a and 5b.	4 Does the business engage in e-Commerce_(Internet sales)_If yes, complete 5a and 5b.		Yes		No

PAYMENT PROCESSOR (e.g., PayPal, Authorize.net, Google Checkout, etc.)

Name and Address (Street, City, State, ZIP code) Payment Processor Account Number

CREDIT CARDS ACCEPTED BY THE BUSINESS

Type of Credit Card (e.g., Visa, Mastercard, etc.)	Merchant Account Number	Issuing Bank Name and Address (Street, City, State, ZIP code)
6a		Phone
6b		Phone
6c		Phone

Section 2: Business Personnel and Contacts

PARTNERS, OFFICERS, LLC MEMBERS, MAJOR SHAREHOLDERS (Foreign and Domestic), ETC.

7a Full Name Title Home Address City State ZIP Responsible for Depositing Payroll Taxes Yes No	Taxpayer Identification Number Home Telephone ( ) Work/Cell Phone ( ) Ownership Percentage & Shares or Interest Annual Salary/Draw
7b Full Name Title Home Address City State ZIP Responsible for Depositing Payroll Taxes Yes No	Taxpayer Identification Number Home Telephone( ) Work/Cell Phone( ) Ownership Percentage & Shares or Interest Annual Salary/Draw
7c Full Name Title Home Address City State ZIP Responsible for Depositing Payroll Taxes Yes No	Taxpayer Identification Number Home Telephone( ) Work/Cell Phone( ) Ownership Percentage & Shares or Interest Annual Salary/Draw
7d Full Name Title Home Address City State ZIP Responsible for Depositing Payroll Taxes Yes No	Taxpayer Identification Number Home Telephone( ) Work/Cell Phone( ) Ownership Percentage & Shares or Interest Annual Salary/Draw

Catalog Number 16649P www.irs.gov Form 433-B (Rev. 6-2026 )

Form 433-B (Rev. 6-2026) Page 2 Section 3: Other Financial Information (Attach copies of all applicable documents)

8 Does the business use a Payroll Service Provider or Reporting Agent (If yes, answer the following) Yes No

Name and Address (Street, City, State, ZIP code) Effective dates (mmddyyyy)

9 Is the business a party to a lawsuit (If yes, answer the following) Yes No

10 Has the business ever filed bankruptcy (If yes, answer the following) Yes No

Date Filed (mmddyyyy) Date Dismissed (mmddyyyy) Date Discharged (mmddyyyy) Petition No. District of Filing

11 Do any related parties (e.g., officers, partners, employees) have outstanding amounts owed to the business ( If yes, answer the following) Yes No

Name and Address (Street, City, State, ZIP code) Date of Loan

Current Balance As of Payment Date Payment Amount

mmddyyyy

12 Have any assets been transferred, in the last 10 years, from this business for less than full value ( If yes, answer the following) Yes No

List Asset Value at Time of Transfer

Date Transferred (mmddyyyy) To Whom or Where Transferred

13 Does this business have other business affiliations (e.g., subsidiary or parent companies) (If yes, answer the following) Yes No

Related Business Name and Address (Street, City, State, ZIP code) Related Business EIN:

14 Any increase/decrease in income anticipated (If yes, answer the following) Yes No

Explain (Use attachment if needed) How much will it increase/decrease

When will it increase/decrease

15 Is the business a Federal Government Contractor (Include Federal Government contracts in #18, Accounts/Notes Receivable) Yes No

Section 4: Business Asset and Liability Information (Foreign and Domestic)

Include assets located in foreign countries or jurisdictions and add attachment(s) if additional space is needed to respond.

16a CASH ON HAND Include cash that is not in the bank Total Cash on Hand $

Contents

16b Is there a safe on the business premises Yes No

BUSINESS BANK ACOUNTS Include online and mobile accounts (e.g., PayPal), money market accounts, savings accounts, checking accounts and stored value cards (e.g., payroll cards, government benefit cards, etc.) List safe deposit boxes including location, box number and value of contents. Attach list of contents.

Account Balance

As of

mmddyyyy

Type of Account

Full Name and Address (Street, City, State, ZIP code) of Account Number Bank, Savings & Loan, Credit Union or Financial Institution

17a $

17b $

17c $

17d Total Cash in Banks (Add lines 17a through 17c and amounts from any attachments) $

Catalog Number 16649P www.irs.gov Form 433-B (Rev. 6-2026 )

Form 433-B (Rev. 6-2026) Page 3

ACCOUNTS/NOTES RECEIVABLE Include e-payment accounts receivable and factoring companies, and any bartering or online auction accounts. (List all contracts separately including contracts awarded, but not started). Include Federal, state and local government grants and contracts.

Invoice Number or Government

Amount Due Grant or Contract Number

Status (e.g., age, Name & Address (Street, City, State, ZIP code)

factored, other)

Date Due (mmddyyy)

18a

Contact Name Phone $ 18b

Contact Name Phone $ 18c

Contact Name Phone $ 18d

Contact Name Phone $ 18e

Contact Name Phone $

18f Outstanding Balance (Add lines 18a through 18e and amounts from any attachments) $

INVESTMENTS List all investment assets below. Include stocks, bonds, mutual funds, stock options, certificates of deposit, commodities (e.g., gold, silver, copper, etc.).

DIGITAL ASSETS List all digital assets such as virtual currency (cryptocurrency), non-fungible token (NFT), and smart contracts the business owns or in which the business has a financial interest have a financial interest (e.g., Bitcoin, Ethereum, Litecoin, Ripple, etc.) If applicable, attach a statement with each virtual currency’s public key. Include attachments if needed.

20a List the name(s) of individuals who have access to the private key(s) and/or digital wallets

Available Credit As of mmddyyyy

Full Name & Address (Street, City, State, ZIP code) Credit Limit

Amount Owed As of

mmddyyyy

21a

Account No. $ $ $ 21b

Account No. $ $ $

Catalog Number 16649P www.irs.gov Form 433-B (Rev. 6-2026 )

Form 433-B (Rev. 6-2026) Page 4

REAL PROPERTY Include all real property and land contracts the business owns/leases/rents.

VEHICLES, LEASED AND PURCHASED Include boats, RVs, motorcycles, all-terrain and off-road vehicles, trailers, mobile homes, etc.

Form 433-B (Rev. 6-2026) Page 5

BUSINESS EQUIPMENT AND INTANGIBLE ASSETS Include all machinery, equipment, merchandise inventory, and other assets in 24a through 24d. List intangible assets in 24e through 24g (licenses, patents, logos, domain names, trademarks, copyrights, software, mining claims, goodwill and trade secrets.)

	Purchase/ Lease Date (mmddyyyy)	Current Fair Market Value (FMV)		Current Loan Balance	Amount of Monthly Payment	Date of Final Payment (mmddyyyy)		Equity FMV Minus Loan
24a Asset Description		$	$	$	$			$
Location of asset_(Street, City, State, ZIP code)_ and County	Location of asset_(Street, City, State, ZIP code)_ and County	Location of asset_(Street, City, State, ZIP code)_ and County	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone
24b Asset Description		$	$	$	$			$
Location of asset_(Street, City, State, ZIP code)_ and County	Location of asset_(Street, City, State, ZIP code)_ and County	Location of asset_(Street, City, State, ZIP code)_ and County	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone
24c Asset Description		$	$	$	$			$
Location of asset_ (Street, City, State, ZIP code)_ and County	Location of asset_ (Street, City, State, ZIP code)_ and County	Location of asset_ (Street, City, State, ZIP code)_ and County	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone
24d Asset Description		$	$	$	$			$
Location of asset_ (Street, City, State, ZIP code)_ and County	Location of asset_ (Street, City, State, ZIP code)_ and County	Location of asset_ (Street, City, State, ZIP code)_ and County	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone	Lender/Lessor Name, Address,(Street, City, State, ZIP code) and Phone Phone
24e Intangible Asset Description	24e Intangible Asset Description	24e Intangible Asset Description	24e Intangible Asset Description	24e Intangible Asset Description	24e Intangible Asset Description	24e Intangible Asset Description	24e Intangible Asset Description	$
24f Intangible Asset Description	24f Intangible Asset Description	24f Intangible Asset Description	24f Intangible Asset Description	24f Intangible Asset Description	24f Intangible Asset Description	24f Intangible Asset Description	24f Intangible Asset Description	$
24g Intangible Asset Description	24g Intangible Asset Description	24g Intangible Asset Description	24g Intangible Asset Description	24g Intangible Asset Description	24g Intangible Asset Description	24g Intangible Asset Description	24g Intangible Asset Description	$
24h Total Equity(Add lines 24a through 24g and amounts from any attachments)	24h Total Equity(Add lines 24a through 24g and amounts from any attachments)	24h Total Equity(Add lines 24a through 24g and amounts from any attachments)	24h Total Equity(Add lines 24a through 24g and amounts from any attachments)	24h Total Equity(Add lines 24a through 24g and amounts from any attachments)	24h Total Equity(Add lines 24a through 24g and amounts from any attachments)	24h Total Equity(Add lines 24a through 24g and amounts from any attachments)	$	$

BUSINESS LIABILITIES Include notes and judgements not listed previously on this form.

Street Address City/State/ZIP code Phone 25b Description: Secured

Unsecured $ $ Name Street Address City/State/ZIP code Phone

25c Total Payments (Add lines 25a and 25b and amounts from any attachments) $

Catalog Number 16649P www.irs.gov Form 433-B (Rev. 6-2026 )

Form 433-B (Rev. 6-2026) Page 6

Section 5: Monthly Income/Expenses Statement for Business

Accounting Method Used: Cash Accrual Use the prior 3, 6, 9 or 12 month period to determine your typical business income and expenses.

Income and Expenses during the period (mmddyyyy) to (mmddyyyy)

Provide a breakdown below of your average monthly income and expenses, based on the period of time used above.

1 Materials Purchased: Materials are items directly related to the production of a product or service.

2 Inventory Purchased: Goods bought for resale.

3 Supplies: Supplies are items used to conduct business and are consumed or used up within one year. This could be the cost of books, office supplies, professional equipment, etc.

4 Utilities/Telephone: Utilities include gas, electricity, water, oil, other fuels, trash collection, telephone, cell phone and business internet.

5 Current Taxes: Real estate, state, and local income tax, excise, franchise, occupational, personal property, sales and the employer's portion of employment taxes.

Certification: Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities, and other

information is true, correct, and complete.

Signature Title Date

Print Name of Officer, Partner or LLC Member

After we review the completed Form 433-B, you may be asked to provide verification for the assets, encumbrances, income and expenses reported. Documentation may include previously filed income tax returns, profit and loss statements, bank and investment statements, loan statements, financing statements, bills or statements for recurring expenses, etc.

IRS USE ONLY (Notes)

Privacy Act : The information requested on this Form is covered under Privacy Acts and Paperwork Reduction Notices which have already been provided to the taxpayer.

Catalog Number 16649P www.irs.gov Form 433-B (Rev. 6-2026 )

Exceptions & meaning →