This form contains 66 fields organized into 26 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Address Change Notification
New Address	Checkbox	Check this box if the current address is different from the address provided on your last tax return.
Amount Owed Calculation
Total Amount Owed	Number	Enter the total amount you owe as displayed on your tax return(s) or any notices you have received.
Additional Balances Due	Number	Enter any additional amounts you owe that are not already included in line 5, even if these amounts are part of an existing installment agreement.
Combined Balance Due	Number	Enter the sum of the amounts from line 5 and line 6.
Payment with Request	Number	Enter the amount of any payment you are submitting with this installment agreement request.
Net Amount Owed	Number	Enter the remaining balance after subtracting the payment amount on line 8 from the combined balance on line 7.
Business Information
Business Name	Text	Enter the full name of your business, especially if it is no longer operating.
Employer Identification Number (EIN)	Text	Enter your Employer Identification Number (EIN). Max length: 10 characters
City, State, and ZIP Code
City, State, and ZIP Code	Text	Provide the city, town or post office, state, and ZIP code for your current address.
Court-Ordered Payment Details
Yes	Checkbox	Check this box if you make court-ordered payments.
No	Checkbox	Check this box if you do not make court-ordered payments.
Yes	Checkbox	Check this box if your court-ordered payments are deducted directly from your paycheck. Fill only if 'Yes' is 'Yes'. Depends on: Yes
No	Checkbox	Check this box if your court-ordered payments are not deducted directly from your paycheck. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Monthly Court-Ordered Payment Amount	Number	Please provide the total amount of your court-ordered payments each month. Fill only if 'Yes', 'No' is 'Yes' and 'No' respectively. Depends on: Yes, No
Current Address
Street Address or P.O. Box	Text	Please provide your current street address, including the number and street name. If you have a P.O. box and do not receive home delivery, enter your P.O. box number here.
Apartment Number	Text	Enter your apartment, suite, unit, or building number, if applicable.
Direct Debit Information
Routing Number	Text	Enter the routing number of the financial institution from which payments will be debited. Max length: 9 characters
Account Number	Text	Enter the account number of the financial institution from which payments will be debited. Max length: 17 characters
Foreign Address
Foreign Country Name	Text	Enter the full name of the foreign country for the foreign address. Fill only if 'City, State, and ZIP Code' is a foreign address. Depends on: City, State, and ZIP Code
Foreign Province/State/County	Text	Enter the province, state, or county for the foreign address. Fill only if 'City, State, and ZIP Code' is a foreign address. Depends on: City, State, and ZIP Code
Foreign Postal Code	Text	Enter the postal code for the foreign address. Fill only if 'City, State, and ZIP Code' is a foreign address. Depends on: City, State, and ZIP Code
Health Insurance Details
Yes	Checkbox	Check this box if you have health insurance.
No	Checkbox	Check this box if you do not have health insurance.
Yes	Checkbox	Check this box if your health insurance premiums are deducted directly from your paycheck. Fill only if 'Yes' is 'Yes'. Depends on: Yes
No	Checkbox	Check this box if your health insurance premiums are not deducted directly from your paycheck. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Monthly Health Insurance Premiums	Number	Enter the total amount of your monthly health insurance premiums. Fill only if 'Yes', 'No' is 'Yes' and 'No' respectively. Depends on: Yes, No
Home Phone Number
Home Phone Number	Text	Provide your primary home telephone number.
Best Time to Call (Home)	Time	Indicate the most suitable time of day for us to contact you at your home phone number.
Marital and Household Expense Status
Single	Checkbox	Check this box if your marital status is single. If checked, skip question 16b and go to question 17.
Married	Checkbox	Check this box if your marital status is married. If checked, proceed to question 16b.
Yes	Checkbox	Check this box if you share household expenses with your spouse. Fill only if 'Married' is selected. Depends on: Married
No	Checkbox	Check this box if you do not share household expenses with your spouse. Fill only if 'Married' is selected. Depends on: Married
Monthly Child or Dependent Care Payments
Monthly Child or Dependent Care Payments	Text	Enter the total dollar amount you pay each month for child or dependent care, excluding any court-ordered payments for child or dependent support. Enter in dollars and cents (for example, 250.00), without commas.
Monthly Payment Calculation
Line 9 divided by 72	Number	Enter the result of dividing the amount on line 9 by 72.0.
Proposed Monthly Payment	Number	Enter the amount you can pay each month.
Revised Monthly Payment	Number	Enter your revised monthly payment if you can increase the amount on line 11a to be equal to or greater than the amount on line 10. Fill only if 'Line 9 divided by 72', 'Proposed Monthly Payment' amount on line 11a is less than the amount on line 10 and you're able to increase your payment. Depends on: Proposed Monthly Payment, Line 9 divided by 72
Unable to Increase Monthly Payment	Checkbox	Check this box if you are unable to increase your payment on line 11b to an amount that is more than or equal to the amount shown on line 10. You will also need to complete and attach Form 433-F, Collection Information Statement. Fill only if 'Line 9 divided by 72', 'Revised Monthly Payment' you can't increase your payment on line 11b to more than or equal to the amount shown on line 10. Depends on: Revised Monthly Payment, Line 9 divided by 72
Monthly Payment Date
Payment Day	Text	Enter the day of the month you want to make your payment, ensuring it is not later than the 28th.
Number of Dependents
Number of Dependents	Text	Enter the total number of dependents you will claim on this year's tax return.
Number of Household Members 65 or Older
Household Members 65 or Older	Text	Enter the total number of people in your household who are 65 years old or older.
Number of Monthly Car Payments
Number of Car Payments	Text	Enter the total number of car payments you make each month.
Number of Vehicles Owned
Number of vehicles you own	Text	Enter the total number of vehicles you own. Provide a whole number (for example, enter 0 if you own none).
Payment Method Options
Low-income taxpayer unable to make electronic payments	Checkbox	Check this box if you are a low-income taxpayer unable to make electronic payments via debit instrument and wish to have your user fee reimbursed.
Payroll deduction payments	Checkbox	Check this box if you want to make payments by payroll deduction and will attach a completed Form 2159.
Personal Payment Information
Once a week	Checkbox	Check this box if you receive your payment once a week.
Once every 2 weeks	Checkbox	Check this box if you receive your payment once every two weeks.
Once a month	Checkbox	Check this box if you receive your payment once a month.
Twice a month	Checkbox	Check this box if you receive your payment twice a month.
Net Income Per Pay Period	Number	Provide your net income received per pay period (take home pay).
Primary Residence County
Primary Residence County	Text	Enter the county in which your primary residence is located.
Primary Taxpayer Information
Primary Taxpayer First Name and Initial	Text	Please provide the primary taxpayer's first name and initial.
Primary Taxpayer Last Name	Text	Please provide the primary taxpayer's last name.
Primary Taxpayer Social Security Number	Text	Please provide the primary taxpayer's social security number. Max length: 11 characters
Spouse's Information
Spouse's First Name and Initial	Text	Provide your spouse's first name and middle initial if you are filing a joint return.
Spouse's Last Name	Text	Provide your spouse's last name if you are filing a joint return.
Spouse's Social Security Number	Text	Enter your spouse's Social Security Number if you are filing a joint return. Max length: 11 characters
Spouse's Payment Information
Once a week.	Checkbox	Check this box if you have a spouse and your spouse is paid once a week when reporting pay frequency for the installment agreement request. Fill only if 'Married' is selected. Depends on: Married
Once every 2 weeks.	Checkbox	Check this box if your spouse is paid once every two weeks. Fill only if 'Married' is selected. Depends on: Married
Once a month.	Checkbox	Check this box if your spouse is paid once a month. Fill only if 'Married' is selected. Depends on: Married
Twice a month	Checkbox	Check this box when your spouse is paid twice a month to report their pay frequency for the installment agreement request. Fill only if 'Married' is selected. Depends on: Married
Spouse's Net Income Per Pay Period	Number	Enter the total net income your spouse receives per pay period after taxes and other deductions. Fill only if 'Married' is selected. Depends on: Married
Tax Form and Period Information
Requested Form(s)	Text	Provide the tax form number(s) for which this installment agreement is requested.
Tax Year(s) or Period(s)	Text	Enter the tax year(s) or period(s) that are involved in this installment agreement request.
Work Phone Number
Work Phone Number	Text	Please provide your work phone number.
Extension	Text	Please enter your work phone extension, if applicable.
Best Time to Call	Time	Please indicate the best time for us to call you at your work phone number.

Form 9465, Installment Agreement Request Instructions