Form 9465, Installment Agreement Request Instructions

Check this box if your current address is different from the one on your most recently filed tax return.

Check this box if you have health insurance to proceed to the follow-up question about whether your insurance premiums are deducted from your paycheck.

Required. Enter the number and street of your current mailing address. If you have a P.O. box and no home delivery, enter your P.O. box number here.

Enter the apartment, suite, or unit number associated with your Current address (number and street). If you have no apartment, suite, or unit number, leave this field blank.

Enter the name of your city, town, or post office; your U.S. state using a two-letter postal abbreviation (for example, CA); and your five-digit ZIP code. If you have a foreign address, also complete Foreign country name, Foreign province/state/county, and Foreign postal code below.

Enter the full name of the foreign country for the address entered in “City, town or post office, state, and ZIP code.” Required only if you provided a non-U.S. address; leave blank if your address is in the United States.

If you entered a value in “Foreign country name,” type the full name of the province, state, or county for that address. Complete this field only for foreign addresses; leave it blank for U.S. addresses. Use the full local name without abbreviations.

Enter the postal code for your foreign address (numeric or alphanumeric, as used in your country) if you provided a non-U.S. address. Complete this field only when you have entered a value in the “Foreign country name” field. Leave it blank if you are using a U.S. address and entered a U.S. ZIP code in the “City, town or post office, state, and ZIP code” field.

Enter the time of day or time range when you prefer the IRS to call you at your home phone number. Use AM and PM notation (for example, 9:00 AM to 5:00 PM). Leave blank if you have no preference or did not provide a home phone number.

Enter your work phone number, including the three-digit area code and seven-digit number, in the format 123-456-7890. If you have a phone extension, enter it in the “Ext.” field. Leave blank if you do not have a work phone number.

Enter the extension for Your work phone number. If your work phone has no extension, leave this field blank. Use digits only (no spaces, hyphens, or other characters).

Enter the preferred time of day when the IRS can call you at the number entered in Your work phone number. Provide a specific time or time range (for example, 8 AM–12 PM). Complete only if you entered Your work phone number.

Check this box if your court-ordered payments are taken directly out of your paycheck.

Check this box when your court-ordered payments are not deducted from your paycheck.

Check this box when you cannot adjust your proposed monthly payment to meet or exceed the required amount and must complete Form 433-F to provide additional financial information.

Check this box when you elect to have your installment payments collected through payroll deduction and will attach the completed Form 2159.

Check this box when you elect to have your installment agreement payments made by payroll deduction and will submit a completed Form 2159

Check this box if you are paid on a weekly basis when reporting your pay frequency for the installment agreement request.

Check this box if you receive your pay on a biweekly schedule to ensure your installment agreement reflects your payment frequency.

Check this box if you receive your pay once a month.

Check this box if you are paid two times per month for your net income pay period.

Check this box if you do not have health insurance to skip the next health insurance question and proceed to the following question.

Enter in whole dollars any additional tax balances you owe that aren’t included on line 5 (“Enter the total amount you owe as shown on your tax return(s) or notice(s)”). Include amounts even if they are covered by an existing installment agreement. If you have no additional balances, enter 0. Omit cents.

Enter the amount of any payment you are submitting with this installment agreement request in dollars and cents. If you are not enclosing a payment with this request, enter 0. Use numerals only; omit the dollar sign and commas (for example, 250.00).

Enter the full name of the county in which your primary residence is located, including the word “County” (for example, “Orange County”). Do not use abbreviations. Complete this field only if you are filling out Part II “Additional Information” of Form 9465 (i.e., you defaulted on an installment agreement in the past 12 months, owe more than $25,000 but not more than $50,000, and the amount on line 11a (or 11b, if applicable) is less than line 10). Leave blank if Part II does not apply.

Enter the amount of net income (your take-home pay) you receive each pay period in US dollars. Round to the nearest whole dollar and omit cents. Fill in this field only if you are completing Part II – Additional Information of Form 9465.

Enter the total number of car loan or lease payments you make each month as a whole number (no decimals).

Enter the total monthly amount you pay for health insurance premiums in U.S. dollars. Complete this field only if you answered “Yes” to Do you have health insurance? (question 25a) and “No” to Are your health insurance premiums deducted from your paycheck? (question 25b). Round to the nearest dollar; omit the dollar sign and commas.

Check this box if you are unmarried so that you do not need to provide spouse information and can proceed to the next part of the form.

Check this box if you are currently married so that you can complete the follow-up questions about household expenses and spousal information.

Select this box if, as a married filer, you and your spouse share household living expenses.

Check this box if you do not share household expenses with your spouse when completing your installment agreement request.

Check this box if your health insurance premiums are deducted directly from your paycheck, which skips question 25c and advances to question 26a.

Check this box if your health insurance premiums are not deducted from your paycheck.

Enter the full legal name of the business that has ceased operations. Complete this field only if you are reporting a business that is no longer operating.

Enter your home telephone number, including a three-digit area code and seven-digit number (10 digits total). Format as 555-123-4567. If you do not have a home phone, leave this field blank.

Enter the total amount you owe as shown on your tax return(s) or notice(s). Required. Enter the amount in whole U.S. dollars; do not include commas or dollar signs.

Add the amounts from line 5 ("Enter the total amount you owe as shown on your tax return(s) (or notice(s))") and line 6 ("If you have any additional balances due that aren’t reported on line 5, enter the amount here"). Enter the result in whole dollars; do not include dollar signs, commas, or decimal points.

Enter the total U.S. dollar amount of any payment you are submitting with this Installment Agreement Request (Form 9465). If you are not enclosing a payment, enter 0. Use only numbers and a decimal point; include two decimal places (for example, 250.00). Do not include a dollar sign or commas.

Enter the result of dividing the amount on Line 9 by 72.0, in U.S. dollars and cents (for example, 1,234.56). Required.

Enter the dollar amount you can pay each month as your proposed installment payment. Include only digits and a decimal point (for example, 150.00); do not enter the $ symbol or commas. This field is optional—if you leave it blank, a payment will be determined for you by dividing the balance due on line 9 by 72 months.

Enter the amount of your revised monthly payment in U.S. dollars and cents (for example, 150.00). Only complete this field if the amount on line 11a is less than the amount on line 10 and you can increase your payment to an amount equal to or greater than the amount on line 10; otherwise leave this field blank.

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.

Check this box if your spouse is paid once every two weeks.

Check this box if your spouse is paid once a month.

Check this box when your spouse is paid twice a month to report their pay frequency for the installment agreement request.

Enter your spouse’s net take-home pay per pay period based on the frequency selected in How often is your spouse paid?. Only complete this field if you have a spouse and meet the conditions in the Note above How often is your spouse paid?; if you don’t have a spouse, go to How many vehicles do you own?. Enter the amount in U.S. dollars as a whole number, omitting the dollar sign and commas.

Enter the total number of vehicles you own. Provide a whole number (for example, enter 0 if you own none).

Enter the total number of dependents you will claim on your federal income tax return for the current tax year. If you have no dependents, enter 0. Use a whole number. Only complete this field when filling out Part II: Additional Information.

Enter the total count of people in your household who are age 65 or older. Provide a whole number with no decimals. Complete this field only when filling out Part II Additional Information.

Enter the total dollar amount of court-ordered payments you make each month in whole dollars (omit cents). Complete this field only if you answered “Yes” to “Do you make court-ordered payments?” and answered “No” to “Are your court-ordered payments deducted from your paycheck?”.

Enter the IRS form designation(s) (for example, Form 1040 or Form 941) for which you are requesting an installment agreement. If you request more than one form, separate each form with a comma. Required.

Enter the tax year(s) or tax period(s) to which this Installment Agreement Request applies. For calendar years, list each year separated by “and” (for example, 2018 and 2019). For a specific period less than a year, enter the start and end dates in Month Day, Year format separated by “to” (for example, January 1, 2019, to June 30, 2019).

Enter your legal first name and, if applicable, your middle initial exactly as shown on your tax return. Do not include periods or other punctuation. If you have no middle name or initial, enter only your first name.

Enter your legal last name (surname) exactly as shown on your Social Security card. Use only letters; if you have a suffix (for example, Jr., Sr., III), include it immediately after your last name with a space. This field is required for all filers.

Enter your nine-digit Social Security Number as issued by the Social Security Administration. Include all nine digits without dashes or spaces (for example, 123456789). This field is required for all filers.

Enter your spouse’s first name followed by middle initial exactly as shown on their Social Security card. Complete only if filing a joint return; leave blank if not filing jointly.

Enter your spouse’s full last name exactly as shown on their Social Security card. Complete this field only if you are filing a joint return (the spouse’s first name goes in “If a joint return, spouse’s first name and initial”). Use your legal surname, including any hyphens or apostrophes, and do not include generational suffixes (for example, Jr. or Sr.).

Enter your spouse’s nine-digit Social Security number if filing a joint return. Format as XXX-XX-XXXX (for example, 123-45-6789). Only complete this field when filing jointly.

Enter the nine-digit Employer Identification Number assigned by the IRS in 00-0000000 format. Only complete this field if you entered a business name in Name of your business (must no longer be operating); otherwise, leave this field blank.

Enter the numeric day of the month you want your installment payment made each month. Use a whole number between 1 and 28 (for example, 15). Do not enter a date later than the 28th.

If you want to make payments by direct debit from your checking account, enter the nine-digit routing transit number of your financial institution as shown on your checks. Enter only digits, with no spaces or hyphens.

Enter the bank account number from which you want your monthly installment payments to be debited. Only enter digits—do not include spaces, hyphens, or other characters. Complete this field if you are making payments by direct debit and have provided a Routing number in the Routing number field.

Check this box if you make court-ordered payments so that you can answer the follow-up about paycheck deductions.

Check this box if you do not make court-ordered payments and then proceed to the next question.

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.