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IRS Department of the Treasury Internal Revenue Service Form 433-B (Rev. 5-2001) Business Information Complete all entry spaces with the most current data available. Important! Write ''N/A'' (not
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How to fill out a collection information statement:

01
Begin by gathering all necessary documents and information. This may include bank statements, pay stubs, tax returns, and any other relevant financial records.
02
Fill in your personal information, such as your full name, address, and contact details. Make sure to provide accurate and up-to-date information.
03
Provide details about your income, including your employer's name, job title, and the amount you earn. If you have multiple sources of income, make sure to include all of them.
04
List all your monthly expenses, including rent or mortgage payments, utilities, groceries, transportation costs, and any other regular expenses. Be as thorough as possible to provide an accurate representation of your financial situation.
05
Declare any assets you own, such as real estate, vehicles, investments, or valuable personal belongings. Include their estimated value as well.
06
Disclose any outstanding debts or liabilities you have, such as credit card debt, student loans, or medical bills. Provide the names of the creditors and the amounts owed.
07
If applicable, include information about any dependents you have, such as children or elderly parents who rely on your financial support.
08
Make sure to sign and date the statement to certify its accuracy and completeness.
09
Submit the completed collection information statement to the relevant party, whether it is a court, creditor, or a financial institution.

Who needs a collection information statement?

01
Individuals going through a debt collection process may be required to fill out a collection information statement. This typically happens when a creditor or a collections agency is seeking payment for outstanding debts.
02
People applying for certain types of debt relief or bankruptcy may also need to provide a collection information statement as part of the application process. This helps determine their eligibility and assists in creating a repayment or restructuring plan.
03
In some legal cases, a collection information statement may be required to assess an individual's ability to pay fines, penalties, or restitution as ordered by the court. This assists in understanding the person's financial circumstances and determining an appropriate outcome.
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The collection information statement is used to gather financial information about a taxpayer to determine their ability to pay back taxes.
Taxpayers who owe back taxes and are unable to pay them in full may be required to file a collection information statement.
Taxpayers must provide detailed information about their income, expenses, assets, and liabilities on the collection information statement form.
The purpose of the collection information statement is to help the IRS assess a taxpayer's financial situation and determine the appropriate course of action for collecting back taxes.
Taxpayers must report their income, expenses, assets, liabilities, and any other relevant financial information on the collection information statement form.
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