U.S. Individual Income Tax Return Forms

Instructions for Form 9465

Department of the Treasury
Internal Revenue Service

(Rev. November 2023)

Installment Agreement Request
(For use with Form 9465 (Rev. September 2020))
Section references are to the Internal Revenue Code
unless otherwise noted.

General Instructions

Future Developments

For the latest developments related to Form 9465 and its
instructions, such as legislation enacted after they were
published, go to IRS.gov/Form9465.

What's New
Clarification of types of installment agreements.
Additional text has been added for streamlined and partial
payment installment agreements. See Streamlined
installment agreement and Partial payment installment
agreement, later, for more information.
Installment agreement request. Additional text has
been added clarifying that a request for an installment
agreement may prolong or extend the time the IRS can
collect. See How the Installment Agreement Works, later.

Reminders
Reduced user fees for certain installment agreements. The user fee is $10 for installment agreements
reinstated or restructured through an online payment
agreement (OPA). You must have established the
reinstatement or restructuring of the installment
agreement through an OPA to qualify for the reduced user
fee. Low-income taxpayers may be reimbursed this fee
under certain conditions. See Requests to modify or
terminate an installment agreement, later.
Apply online at reduced fee. If the total amount you
owe isn't more than $50,000 (including any amounts you
owe from prior years), you may not need to file Form 9465;
you can request an installment agreement online for a
reduced fee. For more information, see Applying online for
an installment agreement and other payment plans, later.
Waiver and reimbursement of user fees for low-income taxpayers. For installment agreements entered
into by taxpayers with adjusted gross income, for the most
recent tax year available, at or below 250% of the federal
poverty guidelines, the IRS will waive or reimburse user
fees if certain conditions are met. For details, see
Low-income taxpayer user fee waivers and
reimbursements, later.
Financial statement may be required. See Line 11b,
later, for more information about when a Form 433-F is
required. A Form 433-F, Collection Information Statement,
may be downloaded at IRS.gov/Forms-Instructions.

Purpose of Form

Use Form 9465 to request a monthly installment
agreement (payment plan) if you can’t pay the full amount
you owe shown on your tax return (or on a notice we sent
you). Most installment agreements meet our streamlined
installment agreement criteria. See Streamlined
installment agreement, later, for more information. In
certain circumstances, you can have longer to pay or you
can establish an agreement for an amount that is less than
the amount of tax you owe.
However, before requesting a payment plan, you should
consider other alternatives, such as getting a bank loan or
using available credit, which may be less costly. If you
have any questions about this request, call 800-829-1040.
Who should use this form? Use Form 9465 if you’re an
individual:

• Who owes income tax on Form 1040 or 1040-SR;
• Who is or may be responsible for a trust fund recovery

penalty;
• Who owes employment taxes (for example, as reported
on Forms 941, 943, or 940) related to a sole proprietor
business that is no longer in operation; or
• Who owes an individual shared responsibility payment
under the Affordable Care Act (this payment isn’t
assessed for months beginning after December 31,
2018). See section 5000A.
Who should not use this form? Don’t use Form 9465 if:

• You can pay the full amount you owe within 180 days (if
you plan to pay the taxes, interest, and penalties due in full
within 180 days, you can save the cost of the user
fee—see Can you pay in full within 180 days? next);
• You want to request a payment plan online, including an
installment agreement (see Applying online for an
installment agreement and other payment plans, later); or
• Your business is still operating and owes employment or
unemployment taxes. Instead, call the telephone number
on your most recent notice to request an installment
agreement.
Can you pay in full within 180 days? If you can pay the
full amount you owe within 180 days, you can avoid paying
the fee to set up an installment agreement by calling the
IRS at 800-829-1040. If you owe $100,000 or less, you
can apply for a short-term payment plan, if you can pay in
full within 180 days, by using the OPA application at
IRS.gov/OPA.
Applying online for an installment agreement and
other payment plans. If your balance due isn’t more
than $50,000, you can apply online for a payment plan
instead of filing Form 9465. To do that, go to IRS.gov/OPA.

Oct 13, 2023

Cat. No. 58607N

How the Installment Agreement
Works

If you establish your installment agreement using the OPA
application, the user fee that you pay will be lower than it
would be otherwise.

Requesting an installment agreement. 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 user fee.

Guaranteed installment agreement. You’re eligible for
a guaranteed installment agreement if the tax you owe
isn’t more than $10,000 and:
• 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 haven’t entered into an
installment agreement for the payment of income tax;
• 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; and
• You’re financially unable to pay the liability in full when
due.

Note. When you request an installment agreement, with
certain exceptions the IRS is generally prohibited from
levying and the IRS's time to collect is suspended or
prolonged while the installment agreement is pending.
See IRS.gov/filing/time-irs-can-collect-tax and Tax Topic
No. 202, Tax Payment Options, at IRS.gov/TaxTopics/
TC202 for additional information.

Streamlined installment agreement. Generally, you're
eligible for a streamlined installment agreement if:
• Your assessed tax liability is $25,000 or less (for an
individual, in-business with income tax only, or an
out-of-business taxpayer); or
• Your assessed tax liability is $25,001 to $50,000 (for an
individual or an out-of-business sole proprietorship) and
you agree to pay by direct debit or payroll deduction.
Your proposed payment amount must pay in full the
assessed tax liability within 72 months or satisfy the
liability in full by the Collection Statute Expiration Date
(CSED), whichever is less. The CSED is normally 10
years from the date of the assessment. However, it may
be suspended or extended for various reasons. For more
information on the CSED, go to IRS.gov/filing/time-irs-cancollect-tax.
Generally, a streamlined installment agreement, does
not require a financial statement or a Notice of Federal Tax
Lien to be filed.

After approving your request. Each month, 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 (also known as a
direct debit), you won’t receive a notice. Your checking
account statement is your record of payment. We will 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.
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. In return, you agree
to make your monthly payments on time. You also agree to
meet all your future tax obligations. This means that you
must have enough withholding or estimated tax payments
so that your tax obligation for future years is paid in full
when you timely file your return. Your request for an
installment agreement will be denied if any required tax
returns haven’t been filed. Any refund will be applied
against the amount you owe even if you have an
installment agreement. If your refund is applied to your
balance, you’re still required to make your regular monthly
installment payment.

Partial payment installment agreement (PPIA). An
installment agreement that will not pay in full the entire
balance before the CSED is called a PPIA. You will be
required to complete a financial statement and provide
supporting financial information for a PPIA. If a PPIA is
approved, your agreement is subject to future reviews to
confirm if your financial situation has changed. You may
be required to provide a new financial statement and
supporting financial information during this review. The
financial information you provide may result in a reduction,
an increase, or no change to your monthly installment
agreement amount.

Installment agreement user fees. We charge a user
fee to set up an installment agreement. The amount of the
user fee can vary depending on whether you use the
online payment application and how you propose to make
your monthly payments. For details, see the table below.

More on types of installment agreements and payment options. For more information about types of
installment agreements, see Tax Topic No. 202, Tax
Payment Options, at IRS.gov/TaxTopics/TC202. Also go to
IRS.gov/Payments for more information on payment
options.

Applicable Fee
Payment Method

Bankruptcy or offer in compromise. If you’re in
bankruptcy or have a pending or accepted offer in
compromise, don’t file this form. Instead, call
800-829-1040 to get the number of your local IRS
Insolvency function for bankruptcy or to get the number of
the office to contact regarding your offer in compromise.

Using the online
payment application

Not using the online
payment application

Direct debit

$31*

$107*

Check, money order,
credit card, or debit
card

$130*

$225*

* Low-income taxpayers should see Low-income taxpayer reduced
installment agreement user fee and Low-income taxpayer user fee waivers
and reimbursements, later.

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Instructions for Form 9465 (Rev. 11-2023)

for months beginning after December 31, 2018. However,
even after that date, you may continue to owe the SRP
assessed for months that began before December 31,
2018. The SRP amount that you owe isn’t subject to
penalties or to Notice of Federal Tax Lien (NFTL) or levy
enforcement actions. However, interest will continue to
accrue until you pay the total SRP balance due. We may
apply your federal tax refunds to the SRP amount that you
owe until it’s paid in full.

Note. If you request a payroll deduction agreement using
Form 2159, Payroll Deduction Agreement, your user fee
will be $225. If you’re a low-income taxpayer, see
Low-income taxpayer reduced installment agreement user
fee next for more details.
Low-income taxpayer reduced installment agreement
user fee. If you establish an installment agreement that is
not paid by direct debit, you may qualify to pay a reduced
fee of $43 or for a reimbursement of your fee if you are a
low-income taxpayer, as defined below. See Low-income
taxpayer user fee waivers and reimbursements next. The
IRS will let you know whether you qualify for the reduced
fee. If the IRS doesn’t say you qualify for the reduced fee,
you can request that the IRS consider you for
“low-income” status using Form 13844, Application For
Reduced User Fee For Installment Agreements.

Payment methods. You can make your payments by
direct debit, check or money order, credit card, debit card,
or one of the other accepted payment methods. To be
charged a lower fee, you may want to set up an OPA
and/or agree to make your payments by direct debit. For
more information on the accepted payment methods, go
to IRS.gov/Payments, see your tax return instructions, or
call 800-829-1040.

Low-income taxpayer user fee waivers and reimbursements. For installment agreements entered into on
or after April 10, 2018, by low-income taxpayers, defined
next, the IRS will waive or reimburse the user fees if
certain conditions are met. If you’re a low-income taxpayer
and you agree to make electronic payments through a
debit instrument by entering into a direct debit installment
agreement (DDIA), the IRS will waive the user fees for the
installment agreement. See Lines 13a, 13b, and 13c, later,
for further details. If you’re a low-income taxpayer and
you’re unable to make electronic payments through a debit
instrument by entering into a DDIA, the IRS will reimburse
the reduced $43 user fee that you paid for the installment
agreement upon completion of the installment agreement.
See Line 13c, later, for more details.
Definition of low-income taxpayer. A low-income
taxpayer is a taxpayer with adjusted gross income, for the
most recent tax year available, at or below 250% of the
federal poverty guidelines. For more information on how to
determine if your adjusted gross income is at or below
250% of the federal poverty guidelines, see the
instructions for Form 13844.

Requests to modify or terminate an installment
agreement. After an installment agreement is approved,
you may submit a request to modify or terminate your
installment agreement. You may modify your payment
amount or due date by going to IRS.gov/OPA. You may
also call 800-829-1040 to modify or terminate your
agreement.
Generally, the fee is $89 to modify your installment
agreement ($43 if you are a low-income taxpayer).
However, the user fee is $10 for installment agreements
reinstated or restructured through an OPA. This user fee
applies only if the reinstatement or restructuring of the
installment agreement is completed through an OPA.
The IRS will waive or reimburse the fee for low-income
taxpayers if certain conditions are met. See Low-income
taxpayer user fee waivers and reimbursements, earlier.
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. In return, you agree
to make your monthly payments on time. You agree to
provide updated financial information when requested.
You also agree to meet all your future tax obligations.
This means that you must have enough withholding or
estimated tax payments so that your tax obligation for
future years is paid in full when payment is due. And you
agree to timely file your return.

The only payment option that will qualify the
low-income taxpayer for a waiver of the installment
CAUTION agreement user fee is their agreement to make
electronic payments through a debit instrument by
entering into a DDIA. See Lines 13a, 13b, and 13c, later,
for more details.

!

What happens if the taxpayer doesn’t comply with
the terms of the installment agreement? If you don’t
make your payments on time or don’t pay a balance due
on a return you file later, you will be in default on your
agreement and we may terminate the agreement. Before
we terminate the agreement, you may be entitled to file an
appeal under the Collection Appeals Program (CAP). We
may take enforcement actions, such as filing an NFTL or
issuing an IRS levy, to collect the entire amount you owe.
To ensure that your payments are made timely, you should
consider making them by direct debit. See Lines 13a, 13b,
and 13c, later.

Other costs. You will be charged interest and 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. But see Topic 653, IRS Notices and
Bills, Penalties, and Interest Charges, at IRS.gov/
TaxTopics/TC653 for additional information. 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. All payments received under the installment
agreement will be applied to your account in the best
interests of the United States.
What happens if the taxpayer owes a shared responsibility payment (SRP)? The SRP amount that you owe
is the assessed payment for not having minimum essential
health coverage for you and, if applicable, your
dependents per section 5000A. The SRP isn’t assessed
Instructions for Form 9465 (Rev. 11-2023)

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An installment agreement may be terminated if
you provide materially incomplete or inaccurate
CAUTION information in response to an IRS request for a
financial update or if you provide such information to
obtain the installment agreement. For more information
about what you need to do if your installment agreement is
terminated, go to IRS.gov/CP523.

For all taxpayers except those filing Form 1040 or 1040-SR with
Schedule(s) C, E, or F for any tax year for which this installment
agreement is being requested

!

IF you live in . . .

THEN use this address . . .

Alaska, Arizona, Colorado,
Connecticut, Delaware, District of
Columbia, Hawaii, Idaho, Illinois,
Maine, Maryland, Massachusetts,
Montana, Nevada, New
Hampshire, New Jersey, New
Mexico, North Dakota, Oregon,
Rhode Island, South Dakota,
Tennessee, Utah, Vermont,
Washington, Wisconsin, Wyoming

Note. We may have filed an NFTL against your property.
If so, you may be able to get the notice of lien withdrawn.
To learn more about lien withdrawals and to see if you
qualify, go to IRS.gov/businesses/small-businesses-selfemployed/understanding-a-federal-tax-lien.
An NFTL may be filed to protect the government’s
interests until you pay in full. However, an NFTL
CAUTION generally isn’t filed with a guaranteed installment
agreement or streamlined installment agreement, but can
be in certain situations. We won’t file an NFTL for the
individual shared responsibility payment under the
Affordable Care Act.

Alabama, Florida, Georgia,
Kentucky, Louisiana, Mississippi,
North Carolina, South Carolina,
Texas, Virginia

!

Arkansas, California, Indiana,
Iowa, Kansas, Michigan,
Minnesota, Missouri, Nebraska,
New York, Ohio, Oklahoma,
Pennsylvania, West Virginia

You may be entitled to file an appeal through the CAP
before and after the NFTL is filed. You are entitled to file
an appeal regarding an NFTL filing through Collection Due
Process (CDP) only for the first filing of an NFTL for the
unpaid tax liabilities shown on that NFTL.
IRS collection process and taxpayer rights. For
additional information on the IRS collection process and
what to do if you cannot pay your taxes in full, see Pub.
594, The IRS Collection Process. You can find more
information about the collection process, taxpayer rights,
and appealing a collection decision at IRS.gov/
businesses/small-businesses-self-employed/collectionprocedures-for-taxpayers-filing-and-or-paying-late.

Department of the Treasury
Internal Revenue Service
310 Lowell St.
Stop 830
Andover, MA 01810

Department of the Treasury
Internal Revenue Service
P.O. Box 47421
Stop 74
Doraville, GA 30362
Department of the Treasury
Internal Revenue Service
Stop P-4 5000
Kansas City, MO 64999-0250

For taxpayers filing Form 1040 or 1040-SR with Schedule(s) C,
E, or F for any tax year for which this installment agreement is
being requested
IF you live in . . .

THEN use this address . . .

Connecticut, Maine,
Massachusetts, New Hampshire,
New York, Rhode Island, Vermont

Taxpayer Advocate Service (TAS). TAS is an
independent organization within the IRS that helps
taxpayers and protects taxpayer rights. TAS strives to
ensure that every taxpayer is treated fairly and that you
know and understand your rights under the Taxpayer Bill
of Rights. TAS can help you if your tax problem is causing
a financial difficulty; you've tried and been unable to
resolve your issue with the IRS; or you believe an IRS
system, process, or procedure isn’t working as it should.
The service is free. Your local advocate’s number is
atTaxpayerAdvocate.IRS.gov/Contact-Us and in your local
directory. You can also call TAS toll free at 877-777-4778.
For more information about TAS and your rights under the
Taxpayer Bill of Rights, go to TaxpayerAdvocate.IRS.gov.

Where To File

Alabama, Arkansas, Georgia,
Illinois, Indiana, Iowa, Kansas,
Kentucky, Louisiana, Michigan,
Minnesota, Mississippi, Missouri,
Nebraska, New Jersey, North
Dakota, Ohio, Oklahoma,
Pennsylvania, South Dakota,
Tennessee, Texas, West Virginia,
Wisconsin

Department of the Treasury
Internal Revenue Service
P.O. Box 69
Stop 811
Memphis, TN 38101-0069

Alaska, Arizona, California,
Colorado, Hawaii, Idaho,
Montana, Nevada, New Mexico,
Oregon, Utah, Washington,
Wyoming

Department of the Treasury
Internal Revenue Service
P.O. Box 9941
Stop 5500
Ogden, UT 84409

District of Columbia, Delaware,
Florida, Maryland, North Carolina,
South Carolina, Virginia

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’re filing this form in
response to a notice, file Form 9465 by itself with the
Internal Revenue Service Center using the address in the
table below that applies to you.

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Department of the Treasury
Internal Revenue Service
P.O. Box 480
Stop 660
Holtsville, NY 11742-0480

Department of the Treasury
Internal Revenue Service
Stop 4-N31.142
Philadelphia, PA 19255-0030

Instructions for Form 9465 (Rev. 11-2023)

“United States Treasury.” Don’t send cash. Be sure to
include the following.
• Your name, address, SSN/EIN, and daytime phone
number.
• The tax year and tax return (for example, “2022 Form
1040”) for which you’re making this request.

For all taxpayers living outside the 50 states, for any tax year for
which the installment agreement is being requested
IF you live in . . .
A foreign country, U.S. territory*,
or use an APO or FPO address,
or file Form 2555 or 4563, or are a
dual-status alien

THEN use this address . . .
Department of the Treasury
Internal Revenue Service
3651 South I-H 35
5501AUSC
Austin, TX 78741

Line 9

Subtract line 8 from line 7 and enter the result.

* For all taxpayers who are bona fide residents of American Samoa, Puerto
Rico, Guam, the U.S. Virgin Islands, or the Northern Mariana Islands, see
Pub. 570, Tax Guide for Individuals With Income From U.S. Territories.

Generally, to qualify for a streamlined installment
agreement, if the total amount you owe is greater
CAUTION than $25,000 but not more than $50,000, you
must either (1) complete lines 13a and 13b and agree to
make payments by direct debit; or (2) check box 14 to
make your payments by payroll deduction and attach a
completed, signed Form 2159.

!

Specific Instructions
Part I

If the total amount you owe isn’t more than

TIP $50,000 (including any amounts you owe from

Line 1a

prior years), you don’t need to file Form 9465; you
can request an installment agreement online. For more
information, see Applying online for an installment
agreement and other payment plans, earlier.

If you’re making this request for a joint tax return, show the
names and social security numbers (SSNs) in the same
order as they appear on your tax return.
If you have a foreign address, enter the city name on
the appropriate line. Don’t enter any other information on
that line, but also complete the spaces below that line.
Don’t abbreviate the country name. Follow the country’s
practice for entering the postal code and the name of the
province, county, or state.

Line 11a

Enter on line 11a the amount you can pay each month.
Make your payments as large as possible to limit interest
and penalty charges. The charges will continue to apply
until you pay them in full. If you have an existing
installment agreement, this amount should represent your
total proposed monthly payment amount for all your
liabilities. If no payment amount is listed on line 11a (or
11b), a payment will be determined for you by dividing the
balance due by 72 months. If the proposed payment
amount entered does not pay in full the amount of tax
owed by the CSED, your request may be considered for a
PPIA. See Partial payment installment agreement, earlier,
for more information.

Line 1b

If the address you provided on line 1a is new since you
filed your last tax return, check the box on line 1b.

Line 2

Show the name and employer identification number (EIN)
of your business (which must no longer be operating).

Line 5

Enter the total amount you owe as shown on your tax
return(s) or notice(s). The amount you owe could include
amounts from more than 1 tax year.

After we review your completed form, we may contact
you for additional information. For example, we may
request a Form 433-F to be completed.

Line 6

Line 11b

Follow the steps in the bullet below that applies to you.
• If the amount on line 11a is less than the amount on
line 10 and you’re able to increase your payment to an
amount that is equal to or greater than the amount on
line 10, enter your revised monthly payment proposal on
line 11b.
• If the amount on line 11a is less than the amount on
line 10 and you’re unable to increase your payment to the
amount on line 10, check the box below line 11b and
complete and attach Form 433-F.
• If the amount on line 11a is equal to or greater than the
amount on line 10 but the amount you owe (line 9) is
greater than $25,000 but not more than $50,000, you must
complete either line 13 or 14 if you don’t want to complete
Form 433-F.
• If you have defaulted on an installment agreement
within the last 12 months, the amount you owe is greater
than $25,000 but not more than $50,000, and the amount

If you have additional balances due that are not reflected
on line 5, list the total here (even if they are included in an
existing installment agreement). Any adjustments or other
charges that are not reported on a tax return or notice
should be listed on this line.

Line 7

Add lines 5 and 6 and enter the result.

Line 8

Even if you can’t pay the full amount you owe now, you
should pay as much as possible to limit the penalty and
interest charges. If you’re 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’re filing this form by itself, such as in response to
a notice, attach a check or money order made payable to
Instructions for Form 9465 (Rev. 11-2023)

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Sample Check—Lines 13a and 13b

on line 11a (11b, if applicable) is less than the amount on
line 10, you must complete Part II on page 2 of Form 9465.
• If the amount on line 9 is greater than $50,000,
complete and attach Form 433-F.

Paul Maple
Roberta Maple
123 Pear Lane
Anyplace, VA 20000

Line 12

PAY TO THE
ORDER OF

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.

ANYPLACE BANK
Anyplace, VA 20000

|:250250025 |

Account
number
(line 13b)

$
DOLLARS

Don’t include
the check number.
:202020"'86".

1234

The routing and account numbers may be in

TIP different places on your check.

Line 13c. Low-income taxpayers who are unable to make
electronic payments through a DDIA by providing their
information on lines 13a and 13b are eligible to receive
reimbursement of their installment agreement user fees. If
you’re a low-income taxpayer and you checked the box on
line 13c, your installment agreement user fee will be
reimbursed upon completion of your installment
agreement. See Low-income taxpayer user fee waivers
and reimbursements, earlier, for more information.
If you don’t check the box on line 13c (and don’t
provide the information on lines 13a and 13b), you’re
indicating that you’re able but choosing not to make
electronic payments by establishing a DDIA. As such, your
user fee is not eligible for reimbursement upon completion
of your installment agreement.

Lines 13a, 13b, and 13c

To pay by direct debit from your checking account at a
bank or other financial institution (such as a mutual fund,
brokerage firm, or credit union), fill in lines 13a and 13b.
Check with your financial institution to make sure that a
direct debit is allowed and to get the correct routing and
account numbers.
Making your payments by direct debit will help

TIP ensure that your payments are made timely and
you don’t default on this installment agreement.

Line 14

If you want to make your payments by payroll deduction,
check the box on line 14 and attach a completed and
signed Form 2159. Ask your employer to complete and
sign the employer’s portion of your Form 2159.

Low-income taxpayers who complete lines 13a and
13b will receive a waiver of their installment agreement
user fees. See Low-income taxpayer user fee waivers and
reimbursements, earlier, for more information.

Part II

Line 13a. 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, later, the routing number
is 250250025. But, if your check is payable through a
financial institution different from the one at which you
have your checking account, don’t use the routing number
on that check. Instead, contact your financial institution for
the correct routing number.

If you have defaulted on an installment agreement within
the last 12 months, the amount you owe is greater than
$25,000 but not more than $50,000, and the amount on
line 11a (line 11b, if applicable) is less than line 10,
complete Part II on page 2 of Form 9465.

Lines 21 and 22

Complete lines 21 and 22 relating to income earned by
your spouse if you are married and meet either of the
following conditions.
• You live with and share household expenses with your
spouse. Even if only one spouse is liable for the taxes
owed, the total household income and expenses are
relevant in determining the liable spouse’s ability to pay
the taxes owed.
• You live in a community property state. In a community
property state, the income of a non-liable spouse may be
factored into the other spouse’s ability to pay the taxes
owed.
You should complete lines 21 and 22 whether your filing
status is married filing jointly or married filing separately.

Line 13b. 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, later, the account number is
20202086. Don’t include the check number.

!

Routing
number
(line 13a)

15-0000/0000

For

If we haven’t 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 earlier that
applies to you. See Line 8, earlier, for details on what to
write on your payment. Or you can submit this payment
electronically. Go to IRS.gov/Payments for payment
options.

CAUTION

1234

SAMPLE

The direct debit from your checking account won’t
be approved unless you (and your spouse if filing
a joint return) sign Form 9465.

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
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Instructions for Form 9465 (Rev. 11-2023)

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 aren’t required to request an
installment agreement. If you do request an installment
agreement, you’re 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 and/or penalties.

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, the District
of Columbia, and U.S. commonwealths and territories 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.

You aren’t 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

Instructions for Form 9465 (Rev. 11-2023)

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.

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