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Section 7 Monthly Household Income and Expense Information
Enter your household's average gross monthly income. Gross monthly income includes wages, social security, pension, unemployment, and other
income. Examples of other income include but are not limited to: agricultural subsidies, gambling income, oil credits, rent subsidies, sharing economy
income from providing on-demand work, services or goods (e.g., Uber, Lyft, DoorDash, AirBnB, VRBO), income through digital platforms like an app or
website, etc., and recurring capital gains from the sale of securities or other property such as digital assets. Include the below information for yourself,
your spouse, and anyone else who contributes to your household’s income. This is necessary for the IRS to accurately evaluate your offer.
Monthly Household Income
Note: Entire household income should also include income that is considered not taxable and may not be included on your tax return.
Round to the nearest whole dollar.
Primary taxpayer
Gross wages Social Security Pension(s) Other income (e.g. unemployment)
$ + $ + $ + $ Total primary
taxpayer income = (30) $
Spouse
Gross wages Social Security Pension(s) Other Income (e.g. unemployment)
$ + $ + $ + $ Total spouse (31) $
income =
Additional sources of income used to support the household, e.g., non-liable spouse, or anyone else who may
contribute to the household income, etc. List source(s) (32) $
Interest, dividends, and royalties (33) $
Distributions (e.g., income from partnerships, sub-S Corporations, etc.) (34) $
Net rental income (35) $
Net business income from Box C [Deductions for non-cash expenses on Schedule C (e.g., depreciation, depletion, etc.) are (36) $
not permitted as an expense for offer purposes and must be added back in to the net income figure]
Child support received (37) $
Alimony received (38) $
Round to the nearest whole dollar. Box D
Do not enter a negative number. If any line item is a negative, enter "0" on that line. Total Household Income
Add lines (30) through (38) and enter the amount in Box D = $
Monthly Household Expenses
Enter your average monthly expenses.
Note: For expenses claimed in boxes (39) and (45) only, you should list the full amount of the allowable standard even if the
actual amount you pay is less. For the other boxes input your actual expenses. You may find the allowable standards at
IRS.gov/Businesses/Small-Businesses-&-Self-Employed/Collection-Financial-Standards.
Round to the nearest whole dollar.
Food, clothing, and miscellaneous (e.g., housekeeping supplies, personal care products, minimum payment on credit card).
A reasonable estimate of these expenses may be used (39) $
Housing and utilities (e.g., rent or mortgage payment and average monthly cost of property taxes, home insurance,
maintenance, dues, fees and utilities including electricity, gas, other fuels, trash collection, water, cable television and internet,
telephone, and cell phone) monthly rent payment (40) $
Vehicle loan and/or lease payment(s) (41) $
Vehicle operating costs (e.g., average monthly cost of maintenance, repairs, insurance, fuel, registrations, licenses,
inspections, parking, tolls, etc.). A reasonable estimate of these expenses may be used (42) $
Public transportation costs (e.g., average monthly cost of fares for mass transit such as bus, train, ferry, etc.). A reasonable
estimate of these expenses may be used (43) $
Health insurance premiums (44) $
Out-of-pocket health care costs (e.g. average monthly cost of prescription drugs, medical services, and medical supplies like
eyeglasses, hearing aids, etc.) (45) $
Court-ordered payments (e.g., monthly cost of any alimony, child support, etc.) (46) $
Child/dependent care payments (e.g., daycare, etc.) (47) $
Life insurance premiums Life insurance policy amount (48) $
Current monthly taxes (e.g., monthly cost of federal, state, and local tax, personal property tax, etc.) (49) $
Secured debts/Other (e.g., any loan where you pledged an asset as collateral not previously listed, government guaranteed
student loan, employer required retirement or dues) List debt(s)/expense(s) (50) $
Enter the amount of your monthly delinquent state and/or local tax payment(s) . Total tax owed (51) $
Round to the nearest whole dollar. Box E
Do not enter a negative number. If any line item is a negative, enter "0" on that line. Total Household Expenses
Add lines (39) through (51) and enter the amount in Box E = $
Round to the nearest whole dollar. Box F
Do not enter a negative number. If any line item is a negative, enter "0" on that line. Remaining Monthly Income
Subtract Box E from Box D and enter the amount in Box F = $
Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 4-2024)
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