9465 I nstallment Agreement Request

9465

Form
(Rev. December 2008)

Department of the Treasury
Internal Revenue Service

Installment Agreement Request
OMB No. 1545-0074

© If you are filing this form with your tax return, attach it to the

front of the return. Otherwise, see instructions.

Caution: Do not file this form if you are currently making payments on an installment agreement or can pay your balance due in full
within 120 days. Instead, call 1-800-829-1040. If you are in bankruptcy or we have accepted your offer-in-compromise, see
Bankruptcy or offer-in-compromise on page 2.
This request is for Form(s) (for example, Form 1040) ©

1

and for tax year(s) (for example, 2007 and 2008) ©

Your first name and initial

Last name

Your social security number

If a joint return, spouse’s first name and initial

Last name

Spouse’s social security number

Current address (number and street). If you have a P.O. box and no home delivery, enter your box number.

Apt. number

City, town or post office, state, and ZIP code. If a foreign address, enter city, province or state, and country. Follow the country’s practice for entering the
postal code.

2

If this address is new since you filed your last tax return, check here

3

(

)
Your home phone number

5

7
8
9
10
11
©
©

4
6

Your employer’s name:

Best time for us to call

Name of your bank or other financial institution:

©

(

)
Your work phone number

Address

Address

City, state, and ZIP code

City, state, and ZIP code

Ext.

Enter the total amount you owe as shown on your tax return(s) (or notice(s))
Enter the amount of any payment you are making with your tax return(s) (or notice(s)). See instructions
Enter the amount you can pay each month. Make your payments as large as possible to limit
interest and penalty charges. The charges will continue until you pay in full
Enter the day you want to make your payment each month. Do not enter a day later than the 28th ©

Best time for us to call

7
8
9

If you want to make your payments by electronic funds withdrawal from your checking account, see the instructions and fill
in lines 11a and 11b. This is the most convenient way to make your payments and it will ensure that they are made on time.
a Routing number
b Account number
I authorize the U.S. Treasury and its designated Financial Agent to initiate a monthly ACH electronic funds withdrawal
entry to the financial institution account indicated for payments of my federal taxes owed, and the financial institution to
debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial
Agent to terminate the authorization. To revoke payment, I must contact the U.S. Treasury Financial Agent at
1-800-829-1040 no later than 9 business days prior to the payment (settlement) date. I also authorize the financial
institutions involved in the processing of the electronic payments of taxes to receive confidential information necessary
to answer inquiries and resolve issues related to the payments.

Your signature

Date

General Instructions
Section references are to the Internal Revenue Code.

Purpose of Form
Use Form 9465 to request a monthly installment plan if you
cannot pay the full amount you owe shown on your tax return
(or on a notice we sent you). Generally, you can have up to 60
months to pay. In certain circumstances, you can have longer
to pay or your agreement can be approved for an amount that
is less than the amount of tax you owe. However, before
requesting an installment agreement, you should consider
other less costly alternatives, such as getting a bank loan or
using available credit on a credit card. If you have any
questions about this request, call 1-800-829-1040.
Do not use Form 9465 if:
● You can pay the full amount you owe within 120 days (see
page 2), or
For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Spouse’s signature. If a joint return, both must sign.

Date

● You want to request an online payment agreement. See
Applying online for a payment agreement on page 2.
Guaranteed installment agreement. Your request for an
installment agreement cannot be turned down if the tax you
owe is not more than $10,000 and all three of the following
apply.
● During the past 5 tax years, you (and your spouse if filing a
joint return) have timely filed all income tax returns and paid
any income tax due, and have not entered into an installment
agreement for payment of income tax.
● The IRS determines that you cannot pay the tax owed in
full when it is due and you give the IRS any information
needed to make that determination.
● You agree to pay the full amount you owe within 3 years
and to comply with the tax laws while the agreement is in
effect.

Cat. No. 14842Y

Form

9465

(Rev. 12-2008)

Form 9465 (Rev. 12-2008)

CAUTION

Page

A Notice of Federal Tax Lien may be filed to protect
the government’s interests until you pay in full.

Can you pay in full within 120 days? If you can pay the full
amount you owe within 120 days, call 1-800-829-1040 to
establish your request to pay in full. If you can do this, you
can avoid paying the fee to set up an installment agreement.
Instead of calling, you can apply online.
Applying online for a payment agreement. Instead of filing
Form 9465, you can apply online for a payment agreement.
To do that, go to www.irs.gov, use the pull-down menu
under “I need to . . .” and select “Set Up a Payment Plan.”
Bankruptcy or offer-in-compromise. If you are in
bankruptcy or we have accepted your offer-in-compromise,
do not file this form. Instead, call 1-800-829-1040 to get the
number of your local IRS Insolvency function for bankruptcy
or Technical Support function for offer-in-compromise.

How the Installment Agreement Works
We will usually let you know within 30 days after we receive
your request whether it is approved or denied. However, if
this request is for tax due on a return you filed after March
31, it may take us longer than 30 days to reply. If we
approve your request, we will send you a notice detailing the
terms of your agreement and requesting a fee of $105 ($52 if
you make your payments by electronic funds withdrawal).
However, you may qualify to pay a reduced fee of $43 if your
income is below a certain level. The IRS will let you know
whether you qualify for the reduced fee. If the IRS does not
say you qualify for the reduced fee, you can request the
reduced fee using Form 13844, Application For Reduced
User Fee For Installment Agreements.
You will also be charged interest and may be charged a
late payment penalty on any tax not paid by its due date,
even if your request to pay in installments is granted. Interest
and any applicable penalties will be charged until the balance
is paid in full. To limit interest and penalty charges, file your
return on time and pay as much of the tax as possible with
your return (or notice).
By approving your request, we agree to let you pay the tax
you owe in monthly installments instead of immediately
paying the amount in full. All payments received will be
applied to your account in the best interests of the United
States. In return, you agree to make your monthly payments
on time. You also agree to meet all your future tax liabilities.
This means that you must have enough withholding or
estimated tax payments so that your tax liability for future
years is paid in full when you timely file your return. Your
request for an installment agreement will be denied if all
required tax returns have not been filed. Any refund due you
in a future year will be applied against the amount you owe.
If your refund is applied to your balance, you are still
required to make your regular monthly installment payment.
Payment methods. You can make your payments by check,
money order, credit card, or one of the other payment
methods shown next. The fee for each payment method is
also shown.
Payment method

Applicable fee

Check, money order, or credit card

$105

Electronic funds withdrawal

$ 52

Payroll deduction installment agreement

$105

For details on how to pay, see your tax return instructions,
visit www.irs.gov, or call 1-800-829-1040.

2

After we receive each payment, we will send you a notice
showing the remaining amount you owe, and the due date
and amount of your next payment. But if you choose to have
your payments automatically withdrawn from your checking
account, you will not receive a notice. Your bank statement
is your record of payment. We will also send you an annual
statement showing the amount you owed at the beginning of
the year, all payments made during the year, and the amount
you owe at the end of the year.
If you do not make your payments on time or do not pay
any balance due on a return you file later, you will be in
default on your agreement and we may take enforcement
actions, such as the filing of a Notice of Federal Tax Lien or
an IRS levy action, to collect the entire amount you owe. To
ensure that your payments are made timely, you should
consider making them by electronic funds withdrawal (see
the instructions for lines 11a and 11b).
For additional information on the IRS collection process, see
Pub. 594, The IRS Collection Process.

Where To File
Attach Form 9465 to the front of your return and send it to
the address shown in your tax return booklet. If you have
already filed your return or you are filing this form in
response to a notice, file Form 9465 by itself with the Internal
Revenue Service Center at the address below that applies to
you. No street address is needed.
IF you live in . . .

THEN use this address . . .

Alabama, Florida, Georgia, North
Carolina, South Carolina, Virginia

Department of the Treasury
Internal Revenue Service Center
Atlanta, GA 39901

District of Columbia, Maine,
Maryland, Massachusetts,
New Hampshire, Vermont

Department of the Treasury
Internal Revenue Service Center
Andover, MA 05501

Kentucky, Louisiana, Mississippi,
Tennessee, Texas, APO, FPO

Department of the Treasury
Internal Revenue Service Center
Austin, TX 73301

Alaska, Arizona, California, Colorado,
Hawaii, Idaho, Illinois, Iowa, Kansas,
Minnesota, Montana, Nebraska,
Department of the Treasury
Nevada, New Mexico, North
Internal Revenue Service Center
Dakota, Oklahoma, Oregon, South
Fresno, CA 93888
Dakota, Utah, Washington,
Wisconsin, Wyoming
Arkansas, Connecticut, Delaware,
Indiana, Michigan, Missouri, New
Jersey, New York, Ohio,
Pennsylvania, Rhode Island,
West Virginia

Department of the Treasury
Internal Revenue Service Center
Kansas City, MO 64999

If you live in American Samoa or Puerto Rico (or exclude income
under section 933); are a nonpermanent resident of Guam or the
Virgin Islands*, have a foreign address; are a dual-status alien; or file
Form 2555, 2555-EZ, or 4563, use this address: Department of the
Treasury, Internal Revenue Service Center, Austin, TX 73301, USA
* Permanent residents of Guam or the Virgin Islands cannot use
Form 9465.

Form 9465 (Rev. 12-2008)

Line 8

1234

DWAINE MAPLE
ROBYN MAPLE
123 Pear Lane
Anyplace, VA 20000

15-0000/0000

PAY TO THE
ORDER OF

ANYPLACE BANK
Anyplace, VA 20000

$

Routing
number

Account
number

(line 11a)

(line 11b)

For

|:250250025| :202020"’86".

TIP

1234

DOLLARS

Do not include
the check number.

Ä

Even if you cannot pay the full amount you owe now, you
should pay as much as possible to limit penalty and interest
charges. If you are filing this form with your tax return, make
the payment with your return. For details on how to pay, see
your tax return instructions.
If you are filing this form by itself, such as in response to a
notice, attach a check or money order payable to the “United
States Treasury.” Do not send cash. Be sure to include:
● Your name, address, SSN, and daytime phone number.
● The tax year and tax return (for example, “2008 Form
1040”) for which you are making this request.

Sample Check—Lines 11a and 11b

E

Enter the total amount you owe as shown on your tax return
(or notice).
If the total amount you owe is more than $25,000
(including any amounts you owe from prior years),
CAUTION
complete and attach Form 433-F, Collection
Information Statement. You can get Form 433-F by visiting
the IRS website at www.irs.gov.

PL

Line 7

Line 11b. The account number can be up to 17 characters
(both numbers and letters). Include hyphens but omit spaces
and special symbols. Enter the number from left to right and
leave any unused boxes blank. On the sample check on this
page, the account number is 20202086. Do not include the
check number.
The electronic funds withdrawal from your checking
TIP
account will not be approved unless you (and your
spouse if a joint return) sign Form 9465.

M

If you are making this request for a joint tax return, show the
names and social security numbers (SSNs) in the same order
as on your tax return.

institution different from the one at which you have your
checking account, do not use the routing number on that
check. Instead, contact your financial institution for the
correct routing number.

SA

Line 1

3

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Specific Instructions

Page

The routing and account numbers may be in
different places on your check.

Line 9
You should try to make your payments large enough so that
your balance due will be paid off as quickly as possible
without causing you a financial burden.

Line 10
You can choose the day of each month your payment is due.
This can be on or after the 1st of the month, but no later
than the 28th of the month. For example, if your rent or
mortgage payment is due on the 1st of the month, you may
want to make your installment payments on the 15th. When
we approve your request, we will tell you the month and day
that your first payment is due.
If we have not replied by the date you chose for your first
payment, you can send the first payment to the Internal
Revenue Service Center at the address shown on page 2
that applies to you. See the instructions for line 8 above for
details on what to write on your payment.

Lines 11a and 11b
Making your payments by electronic funds withdrawal
will help ensure that your payments are made timely
and that you are not in default of this agreement.
To pay by electronic funds withdrawal from your checking
account at a bank or other financial institution (such as
mutual fund, brokerage firm, or credit union), fill in lines 11a
and 11b. Check with your financial institution to make sure
that an electronic funds withdrawal is allowed and to get the
correct routing and account numbers.
Note. We will send you a bill for the first payment and the
fee. You must send us your first payment. All other payments
will be electronically withdrawn.
Line 11a. The routing number must be nine digits. The first
two digits of the routing number must be 01 through 12 or
21 through 32. Use a check to verify the routing number. On
the sample check on this page, the routing number is
250250025. But if your check is payable through a financial
TIP

Privacy Act and Paperwork Reduction Act Notice. Our
legal right to ask for the information on this form is sections
6001, 6011, 6012(a), 6109, and 6159 and their regulations.
We will use the information to process your request for an
installment agreement. The reason we need your name and
social security number is to secure proper identification. We
require this information to gain access to the tax information
in our files and properly respond to your request. You are not
required to request an installment agreement. If you do
request an installment agreement, you are required to
provide the information requested on this form. Failure to
provide this information may prevent processing your
request; providing false information may subject you to fines
or penalties.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be
retained as long as their contents may become material in
the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
section 6103. However, we may give this information to the
Department of Justice for civil and criminal litigation, and to
cities, states, and the District of Columbia to carry out their
tax laws. We may also disclose this information to other
countries under a tax treaty, to federal and state agencies to
enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism.
The average time and expenses required to complete and
file this form will vary depending on individual circumstances.
For the estimated averages, see the instructions for your
income tax return.
If you have suggestions for making this form simpler, we
would be happy to hear from you. See the instructions for
your income tax return.