Form 433-F (Rev. 7-2024), Collection Information Statement Instructions

Enter the full name of the individual or business that owes you or your business money for this accounts receivable entry.

Enter the mailing or billing address for the individual or business listed in this accounts receivable entry.

Enter the total amount currently owed to you or your business by the individual or business listed on this row.

Enter the full name of the individual or business that owes accounts receivable for this second row entry.

Provide the mailing or business address for the debtor listed in row 2 (street address, city, state, and ZIP as applicable).

Enter the total amount currently owed to you or your business from the account listed on row 2.

Enter the total dollar amount of accounts receivable listed on any additional E1 sheets.

Enter the total dollar amount of accounts receivable currently available to pay the IRS.

Enter the legal or trade name of the self‑employed business.

Enter the business Employer Identification Number (EIN) as assigned by the IRS, including any hyphen if used (for example, 12-3456789).

Provide a short description of the business activity or industry (for example: retail, consulting, construction).

Enter the number of employees working for this business, not including the owner, using numerals (for example: 0, 1, 12).

Enter the name or type of the credit card (for example, Visa, MasterCard, American Express, or store card).

Enter the credit limit for this credit card as reported by the card issuer.

Enter the current outstanding balance owed on this credit card.

Enter the minimum monthly payment required for this credit card.

Enter the name or type of the credit card account (for example, Visa, MasterCard, American Express, or the store/issuer name).

Enter the total credit limit available on this card as a numeric value.

Enter the current outstanding balance you owe on this card as a numeric value.

Enter the current minimum monthly payment required for this card as a numeric value.

Enter the name or symbol of the digital currency you own for Digital Asset 1 (for example, Bitcoin or BTC).

Enter the name of the digital assets wallet, exchange, or Digital Currency Exchange (DCE) where this asset is held or was transacted for Digital Asset 1.

Enter the email address you used to set up or register the account with the digital currency wallet or exchange for Digital Asset 1.

Describe the location(s) where the digital asset is stored or accessible (for example, mobile wallet, online exchange account, or external hardware storage) for Digital Asset 1.

Provide the quantity of the digital asset you own and its total value in U.S. dollars as of today for Digital Asset 1.

Enter the name of the digital currency for this second asset (for example, Bitcoin, Ethereum, Litecoin).

Enter the name of the digital assets wallet, exchange, or digital currency exchange (DCE) where this asset is held.

Enter the email address you used to register or set up the wallet or exchange account associated with this digital asset.

Describe where the digital asset is stored (for example: mobile wallet, online exchange account, external hardware wallet, or other storage location).

Enter the quantity of the digital asset and its current value in U.S. dollars as of today (for example: 10 Bitcoins $64,600 USD).

Enter the full name of the individual or business that appears on the account.

Enter the credit card brand or type used for this account (for example, Visa, MasterCard, Discover).

Provide the full name and mailing address of the bank or financial institution that issued the card for this account.

Enter the merchant account number associated with this credit-card account as shown in your records.

Enter the name of the credit card brand or type used on this account (for example, Visa, MasterCard, Discover, AMEX).

Provide the full name and mailing address of the bank or financial institution that issued the credit card on this account.

Enter the merchant account number associated with this credit card account as shown on your records.

Enter the name or type of the credit card used on this account (for example, Visa, MasterCard, AmEx).

Enter the full name and mailing address of the bank or financial institution that issued the credit card on this account.

Enter the merchant account number associated with this credit card account as provided by the merchant or processor.

Enter the total amount you actually spend each month on clothing and clothing-related services.

Enter the IRS-allowed monthly amount for clothing and clothing-related services (the standard allowable figure to use for this expense).

Enter the total amount you actually spend on food each month to report your household's monthly food expenses.

Enter the IRS-allowed monthly food expense amount (standard allowance) for your household size if applicable.

Enter the total amount you actually spend each month on housekeeping supplies.

Enter the IRS-allowed monthly amount for housekeeping supplies as applicable to your household.

Enter the total actual monthly dollars you spend on miscellaneous food and personal care items for your household.

Enter the IRS-allowed monthly amount for miscellaneous food and personal care for your household as shown in the instructions or IRS table.

Enter the total monthly amount you actually spend on personal care products and services.

Enter the monthly amount allowed by the IRS for personal care products and services.

Enter the total actual monthly dollar amount your household spends on food and personal care (sum of food, housekeeping supplies, clothing/services, personal care products/services, and miscellaneous).

Enter the IRS-allowed monthly dollar amount for food and personal care for your household as specified by the form's allowance table.

Enter the number of people in your household who can be claimed on this year’s tax return (including you and your spouse) who are under age 65.

Enter the number of people in your household who can be claimed on this year’s tax return (including you and your spouse) who are age 65 or older.

Enter the total actual monthly amount you pay for electricity, oil, gas, water and trash combined.

Enter the IRS-allowed monthly amount (if any) for your combined electric, oil/gas, water and trash expenses.

Enter the dollar amount your household actually spends per month for maintenance and repairs on your housing (enter the total monthly expense).

Enter the IRS‑allowed monthly amount for maintenance and repairs for your housing as shown or calculated per IRS guidelines.

Enter the total actual monthly amount you pay for real estate taxes and property insurance (combined) for the residence.

Enter the IRS-allowed monthly amount for real estate taxes and insurance per the form’s allowance rules.

Enter the total actual rent you pay each month for your primary residence.

Enter the IRS-allowed monthly rent amount for your household as applicable for this form.

Enter the total actual monthly amount you pay for telephone, cell, cable and internet services.

Enter the IRS-allowed monthly amount for telephone, cell, cable and internet that you are claiming.

Enter the total actual monthly dollar amount you pay for all housing and utilities line items (sum of Rent, Electric/Oil/Gas/Water/Trash, Telephone/Cell/Cable/Internet, Real Estate Taxes and Insurance, Maintenance and Repairs, and other housing-related expenses).

Enter the total IRS‑allowed monthly amount for the Housing & Utilities section as shown or as calculated per instructions.

Enter the full name and mailing address of the financial institution or investment company where this investment is held.

Enter the account number or identifying reference for this investment as it appears on your statement or account records.

Enter the type or category of the investment account (for example, IRA, brokerage, mutual fund, certificate of deposit, etc.).

Enter the current total balance or market value of this investment.

Check this box if the investment listed on this Investments row is held as a business account (rather than an individual/personal account).

Enter the name and full mailing address of the financial institution or entity that holds this investment.

Enter the account, policy, or reference number assigned to this investment by the institution.

Enter the type of account or investment (for example, IRA, mutual fund, brokerage, certificate of deposit, stock, bond, or cryptocurrency).

Enter the current balance or estimated market value of this investment.

Check this box if the listed investment account is a business account (i.e., the account is owned by a business rather than an individual).

Enter the total monthly amount you actually pay out of pocket for health insurance premiums.

Enter the monthly amount allowed by IRS guidelines for your health insurance that should be used on this form.

Enter the total actual monthly out-of-pocket health care expenses for you and your dependents to report under Medical.

Enter the IRS-allowed monthly amount for out-of-pocket health care expenses for your household to be used for calculations.

Enter the total actual monthly medical expenses (sum of Health Insurance and Out-of-Pocket Health Care expenses) for your household.

Enter the total IRS-allowed monthly medical expense amount for your household as calculated per the form instructions.

Enter your full name or names and your complete mailing address including street address, city, state, and ZIP code.

Check this box if the address you entered in the Name(s) and Address section is different from the address shown on your most recently filed tax return.

Enter the name of the county where you currently reside.

Enter the monthly alimony (spousal support) amount you receive, reported as the net amount after any related expenses or taxes.

Enter the monthly child support amount you receive, reported as the net amount after any related expenses or taxes.

Enter the monthly net income from self-employment after business expenses and taxes.

Enter the monthly net rental income you receive after property expenses and applicable taxes.

Enter the monthly unemployment benefits amount you receive after any withholdings.

Enter the monthly pension or retirement income amount you receive after any applicable deductions.

Enter the monthly interest and dividends income you receive after any applicable taxes or fees.

Enter the monthly Social Security benefits amount you receive after any applicable withholdings.

Enter the monthly amount for any other non-wage income not listed (Other 1), reported after expenses or taxes.

Enter the monthly amount for any additional non-wage income not listed (Other 2), reported after expenses or taxes.

Enter the total actual monthly amount you pay for child or dependent care.

Enter the IRS-allowed monthly amount for child or dependent care as shown or calculated under IRS rules.

Enter the actual monthly amount you currently pay for court-ordered alimony (monthly outflow).

Enter the monthly alimony amount the IRS allows for calculation purposes (allowable expense).

Enter the actual monthly dollar amount you pay for court-ordered child support.

Enter the monthly dollar amount of court-ordered child support that is allowed by the IRS.

Enter the monthly amount you currently pay toward delinquent state and local taxes (minimum payment) as a numeric value.

Enter the IRS‑allowed monthly amount for delinquent state and local taxes (minimum payment) as a numeric value.

Enter the total monthly amount you actually pay for estimated tax payments (the out‑of‑pocket monthly expense for estimated federal/state taxes).

Enter the IRS‑allowed monthly amount for estimated tax payments as used for allowable expenses.

Enter a short label or description naming this 'Other' expense (for example: lawn care, pet expenses, or subscription).

Enter the actual monthly dollar amount you currently pay for the expense you named on the corresponding 'Other (specify)' line.

Enter the monthly dollar amount allowed by IRS guidelines for the same expense you named on the corresponding 'Other (specify)' line.

Enter a brief description or label for the 'Other' expense being reported in this row.

Enter the monthly dollar amount for the 'Other' expense described in the adjacent field.

Enter the dollar amount of the monthly expense for the third 'Other (specify)' item listed under Other/Other (specify).

Provide a short description or label identifying the third 'Other (specify)' expense item (e.g., category or purpose).

Enter the total actual monthly dollar amount for all items listed under Other (specify) 4, summing every individual expense in that column.

Enter the total IRS-allowed monthly dollar amount for the items listed under Other (specify) 4, summing every individual IRS-allowed amount in that column.

Enter a short description identifying the other court‑ordered payment (for example, name of the order or purpose of the payment).

Enter the monthly dollar amount of the other court‑ordered payment owed (include cents or decimals if applicable).

Enter the monthly amount your employer is required to contribute or withhold for a retirement plan (employer-required retirement deduction) from your pay.

Enter the monthly amount you voluntarily contribute or have withheld for a retirement plan (employee voluntary retirement deduction) from your pay.

Enter the monthly amount you voluntarily contribute to retirement (actual out‑of‑pocket) that you pay each month.

Enter the IRS‑allowed monthly amount for voluntary retirement contributions to be used for allowance calculations.

Enter the total monthly minimum payment you currently make toward all student loans.

Enter the monthly student loan amount allowed by IRS guidelines for this expense (if different from your actual payment).

Enter the actual monthly amount you pay for term life insurance.

Enter the IRS-allowed monthly amount for term life insurance (if different from your actual monthly payment).

Enter the total actual monthly dollar amount for all items listed in the 'Other' expenses column.

Enter the total IRS-allowed monthly dollar amount for all items listed in the 'Other' expenses column.

Enter the actual monthly amount you pay for union dues.

Enter the IRS-allowed monthly amount for union dues (if different from the actual amount).

Provide a brief description or identifying details of the asset (for example, make and model, policy name, or other identification) you are listing as Other Asset 1.

Enter the monthly payment amount associated with this asset (for example, loan or insurance payment).

Enter the year you purchased this asset (for example, 2019).

Enter the month of the asset's final payment (use a numeric month 1–12 or the month name).

Enter the year of the asset's final payment (for example, 2028).

Enter the current estimated dollar value of this asset.

Enter the current outstanding balance owed on this asset.

Enter the equity in this asset (current value minus any balance owed).

Provide a brief description of the asset (make, model, year, policy name, or other identifying details).

Enter the monthly payment amount for this asset.

Enter the year the asset was purchased.

Enter the month when the final payment is due for this asset.

Enter the year when the final payment is due.

Enter the current value of this asset.

Enter the current outstanding balance owed on this asset.

Enter the equity you have in this asset (current value minus balance owed).

Enter the full name and mailing address of the bank or financial institution where this personal account is held.

Enter the account number or identifier exactly as it appears on your statements for this personal account.

Specify the type of account (for example, checking, savings, money market, online wallet, etc.) for this personal account.

Provide the current balance or estimated value of this account.

Check this box if the bank account listed on this row is a business account (the account is owned/used by a business rather than an individual).

Enter the full name and mailing address of the financial institution that holds this personal bank account.

Enter the account number for this bank account exactly as it appears on your bank records or statement.

Enter the account type (for example: checking, savings, money market, online/PayPal, etc.).

Enter the current balance or value of this account.

Check this box if the account listed on the second personal bank account row is actually a business account.

Enter a short description and the property location, including street address, city/state and county (e.g., vacation home, parcel, or primary residence). Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Check this box if the real estate described in this Property 1 entry is your primary residence.

Check this box if the real estate described in this Property 1 entry is an other (non-primary) property such as a vacation home, rental, or vacant land.

Enter the monthly mortgage or other recurring payment amount for this property. Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Enter the year the property was purchased. Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Enter the original purchase price paid for the property. Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Enter the year the property was refinanced, if applicable. Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Enter the amount of the refinance loan taken against the property, if applicable. Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Enter the current market value of the property. Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Enter the outstanding mortgage or other loan balance currently owed on the property. Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Enter the owner's equity in the property (current value minus outstanding balance). Fill only if 'Real Estate Property 1 - Primary Residence', 'Real Estate Property 1 - Other' is 'Yes' (any).

Enter the property description and full location for Property 2, including street address, city, state and county. Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Check this box if the second listed real estate property is your primary residence.

Check this box if the second listed real estate property is not your primary residence (e.g., a rental, vacation home, timeshare, or other real estate).

Enter the total monthly payment(s) for Property 2 (for example mortgage and any related recurring payments). Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Enter the year Property 2 was purchased (e.g., 2015). Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Enter the original purchase price paid for Property 2. Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Enter the year Property 2 was refinanced, if applicable. Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Enter the refinance loan amount associated with Property 2. Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Enter the current market value of Property 2. Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Enter the total outstanding balance currently owed on loans secured by Property 2. Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Enter the owner’s equity in Property 2 (current value minus balance owed). Fill only if 'Real Estate Property 2 — Primary Residence', 'Real Estate Property 2 — Other' is 'Yes' (any).

Enter the primary filer’s handwritten or typed signature exactly as they wish it to appear on the form.

Enter the spouse’s handwritten or typed signature if applicable; leave blank if not required.

Enter the date when the signature(s) were signed.

Enter the primary taxpayer’s Social Security Number or Individual Taxpayer Identification Number that identifies the person filing this form.

Enter the spouse’s Social Security Number or Individual Taxpayer Identification Number if applicable.

Enter the spouse's employer name and full mailing address where they work (street, city, state, ZIP).

Check this box if your spouse is paid weekly by their current employer.

Check this box if your spouse is paid every two weeks (biweekly) by their current employer.

Check this box if your spouse is paid semi-monthly (twice a month) by their current employer.

Check this box if your spouse is paid once a month (monthly) by their current employer.

Enter the spouse's gross pay amount received for one pay period. Fill only if 'Spouse: Weekly', 'Spouse: Biweekly', 'Spouse: Semi-monthly', 'Spouse: Monthly' is 'Yes' (any).

Enter the federal income tax withheld from the spouse's pay each pay period. Fill only if 'Spouse: Weekly', 'Spouse: Biweekly', 'Spouse: Semi-monthly', 'Spouse: Monthly' is 'Yes' (any).

Enter the state income tax withheld from the spouse's pay each pay period. Fill only if 'Spouse: Weekly', 'Spouse: Biweekly', 'Spouse: Semi-monthly', 'Spouse: Monthly' is 'Yes' (any).

Enter the local taxes (city/county) withheld from the spouse's pay each pay period. Fill only if 'Spouse: Weekly', 'Spouse: Biweekly', 'Spouse: Semi-monthly', 'Spouse: Monthly' is 'Yes' (any).

Enter how long the spouse has worked for the current employer (for example, years and months).

Enter your home telephone number where you can be reached.

Enter your work (office) telephone number where you can be reached.

Enter your mobile or cell phone number where you can be reached.

Enter your spouse's home telephone number where they can be reached. Fill only if 'Spouse Social Security Number or ITIN' is provided.

Enter your spouse's work (office) telephone number where they can be reached. Fill only if 'Spouse Social Security Number or ITIN' is provided.

Enter your spouse's mobile or cell phone number where they can be reached. Fill only if 'Spouse Social Security Number or ITIN' is provided.

Enter the total actual monthly amount you pay for transportation-related costs such as gas, vehicle insurance, licenses, parking, and maintenance.

Enter the IRS-allowed monthly amount for transportation (the deductible or allowable figure to be used for this expense category).

Enter the total monthly out-of-pocket transportation expenses (e.g., gas, insurance, licenses, parking, maintenance, and public transportation) that you actually pay each month.

Enter the IRS-allowed monthly amount for transportation expenses to be used for this form.

Enter the total actual monthly amount you pay for transportation expenses (including gas, insurance, licenses, parking, maintenance and public transportation).

Enter the IRS‑allowed monthly amount for transportation (the allowable deduction/standard amount used for this form) corresponding to the transportation category.

Enter the full name and mailing address of your current employer.

Check this box if your current employer pays you weekly.

Check this box if your current employer pays you every two weeks (biweekly).

Check this box if your current employer pays you semi-monthly (twice a month).

Check this box if your current employer pays you monthly.

Enter the total gross pay you receive for each pay period. Fill only if 'Your current employer — Weekly', 'Your current employer — Biweekly', 'Your current employer — Semi-monthly', 'Your current employer — Monthly' is 'Yes' (any).

Enter the amount of federal taxes withheld from each pay period. Fill only if 'Your current employer — Weekly', 'Your current employer — Biweekly', 'Your current employer — Semi-monthly', 'Your current employer — Monthly' is 'Yes' (any).

Enter the amount of state taxes withheld from each pay period. Fill only if 'Your current employer — Weekly', 'Your current employer — Biweekly', 'Your current employer — Semi-monthly', 'Your current employer — Monthly' is 'Yes' (any).

Enter the amount of local taxes withheld from each pay period. Fill only if 'Your current employer — Weekly', 'Your current employer — Biweekly', 'Your current employer — Semi-monthly', 'Your current employer — Monthly' is 'Yes' (any).

Enter how long you have worked for this employer (for example: '3 years', '18 months', or a start date and 'to present').