Department of the Treasury — Internal Revenue Service 
Form  433-B (OIC) 
        (April 2023)                      Collection Information Statement for Businesses 
Complete this form if your business is a 
      ●   Corporation                                           ●   Limited Liability Company (LLC) classified as a corporation 
      ●   Partnership                                           ●   Other LLC 

Note: If your business is a sole proprietorship do not use this form. Instead, complete Form 433-A (OIC) Collection Information Statement for 
Wage Earners and Self-Employed Individuals. This form should only be used with the Form 656, Offer in Compromise. 
Include attachments if additional space is needed to respond completely to any question. 
Section 1                 Business Information (Domestic and Foreign)
Business name                                                                            Employer Identification Number 

Business physical address (street, city, state, ZIP code)              County of business location 

                                                                       Description of business and DBA or "Trade Name" 

Primary phone                            Secondary phone               Business mailing address (if different from above or post office box number) 
(     )            -                   (  )               -
Business website address 

FAX number                                                             Does the business outsource its payroll processing and tax return  
                                                                       preparation for a fee
(     )            -
Federal contractor    Total number of employees                        Yes          No      If yes, list provider name and address in box below 
                                                                                            (street, city, state, ZIP code) 
  Yes         No          Check here if you are the only employee
Frequency of tax deposits                Average gross monthly payroll 
                                         $
Provide information about all partners, officers, LLC members, major shareholders (domestic and foreign), etc., associated with the business. 
Include attachments if additional space is needed. 
Last name                                First name                           Title 

Percent of ownership and annual salary   Social Security Number        Home address (street, city, state, ZIP code)
                                          -                -
Primary phone                            Secondary phone 
(     )            -                   (  )               -
Last name                                First name                           Title 

Percent of ownership and annual salary   Social Security Number        Home address (street, city, state, ZIP code)
                                          -                -
Primary phone                            Secondary phone 
( )           -                        (  )               -
Last name                                First name                           Title 

Percent of ownership and annual salary   Social Security Number        Home address (street, city, state, ZIP code)
                                          -                -
Primary phone                            Secondary phone 
( )           -                        (  )               -

Catalog Number 55897B                                           www.irs.gov                        Form  433-B (OIC) (Rev. 4-2023) 

                                                                                                                                              Page 2 
Section 2                    Business Asset Information (Domestic and Foreign)
Gather the most current statement from banks, lenders on loans, mortgages (including second mortgages), monthly payments, loan balances, and  
accountant's depreciation schedules, if applicable. Also, include make/model/year/mileage of vehicles and current value of business assets. To estimate 
the current value, you may consult resources like Kelley Blue Book (www.kbb.com), NADA (www.nada.com), local real estate postings of properties similar 
to yours, and any other websites or publications that show what the business assets would be worth if you were to sell them. Asset value is subject to 
adjustment by IRS. Enter the total amount available for each of the following (if additional space is needed, please include attachments). 

                               Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0".
Cash and investments (domestic and foreign) 
  Cash          Checking       Savings             Money Market Account/CD        Online Account           Stored Value Card
Bank name and country location                                     Account number 
                                                                                                            (1a)  $ 
  Cash          Checking       Savings             Money Market Account/CD        Online Account           Stored Value Card
Bank name and country location                                     Account number 
                                                                                                            (1b)  $ 
  Cash          Checking       Savings             Money Market Account/CD        Online Account           Stored Value Card
Bank name and country location                                     Account number 
                                                                                                            (1c)  $ 
                                                                   Total bank accounts from attachment  (1d)  $ 

                                                                              Add lines (1a) through (1d) = (1) $ 
Investment account    Stocks   Bonds                 Other
Name of Financial Institution and country location                 Account number 

Current market value                                               Minus loan balance 
$                              X .8 =  $                           –  $                                    =  (2a)  $ 
Investment Account:   Stocks   Bonds                 Other
Name of Financial Institution and country location                 Account number 

Current market value                                               Minus loan balance
$                              X .8 =  $                           –  $                                    =  (2b)  $ 
  Digital asset              Name of digital asset such as virtual Email address used to set-up the digital Location(s) of digital asset (mobile 
                             currency wallet, exchange or digital  asset such as virtual currency exchange  wallet, online, and/or external 
Type of digital asset        currency exchange (DCE)               or DCE                                   hardware storage)

Name of individual who has access to the private   Digital asset amount and value in US dollars as of today
key(s) and/or digital wallets
                                                   $                                                       =  (2c)  $ 
                      Total investment accounts from attachment. [current market value minus loan balance(s)]  (2d)  $ 

                                                                              Add lines (2a) through (2d) =  (2)  $ 

Notes Receivable 
Do you have notes receivable   Yes                 No
If yes, attach current listing which includes name, age, and amount of note(s) receivable
Accounts Receivable 
Do you have accounts receivable, including e-payment, factoring 
companies, and any bartering or online auction accounts                       Yes        No
If yes, provide a list of name, age, and amount of the current accounts receivable

Catalog Number 55897B                                              www.irs.gov                              Form  433-B (OIC) (Rev. 4-2023) 

                                                                                                                                        Page 3 
Section 2 (Continued)     Business Asset Information (Domestic and Foreign)
If the business owns more properties, vehicles, or equipment than shown in this form, please list on a separate attachment. 
Real estate (buildings, lots, commercial property, etc.) 
Is your real property currently for sale or do you anticipate selling your real property to fund the offer amount
  Yes     (listing price)                    No
Property address (street address, city, Property description (indicate if rental property, vacant, etc.) Date purchased 
state, ZIP code, county, and country) 

                                        Monthly mortgage payment                      Date of final payment

                                        Name of lender/contract holder

Current market value                                        Minus loan balance (mortgages, etc.)
$                         X .8 =  $                         –  $               Total value of real estate =              (3a)  $ 
Property address (street address, city, Property description (indicate if rental property, vacant, etc.) Date purchased 
state, ZIP code, county, and country)

                                        Monthly mortgage payment                      Date of final payment

                                        Name of lender/contract holder

Current market value                                        Minus loan balance (mortgages, etc.)
$                         X .8 =  $                         –  $               Total value of real estate =              (3b)  $ 
      Total value of property(s) listed from attachment [current market value X .8  minus any loan balance(s)]  (3c)  $ 
                                                                               Add lines (3a) through (3c) =  (3)  $ 
Business vehicles (cars, boats, motorcycles, trailers, etc.). Include those located in foreign countries or jurisdictions. If additional space is needed, list on an 
attachment
Vehicle make & model                    Year Date purchased      Mileage or use hours           License/Tag number

  Lease     Monthly lease/loan amount        Name of creditor                                   Date of final payment 
  Own       $
Current market value                                     Minus loan balance
                                                                               Total value of vehicle (if the vehicle 
$                    X .8 =  $                           –  $                  is leased, enter 0 as the total value)  = (4a) $ 
Vehicle make & model                    Year Date purchased      Mileage or use hours           License/Tag number

  Lease     Monthly lease/loan amount        Name of creditor                                   Date of final payment 
  Own       $
Current market value                                     Minus loan balance
                                                                               Total value of vehicle (if the vehicle 
$                    X .8 =  $                           –  $                  is leased, enter 0 as the total value)  = (4b) $ 
Vehicle make & model                    Year Date purchased      Mileage or use hours           License/Tag number

  Lease     Monthly lease/loan amount        Name of creditor                                   Date of final payment 
  Own       $
Current market value                                     Minus loan balance
                                                                               Total value of vehicle (if the vehicle 
$                    X .8 =  $                           –  $                  is leased, enter 0 as the total value)  = (4c) $ 
            Total value of vehicles listed from attachment [current market value X .8 minus any loan balance(s)]  (4d)  $ 
                                                                               Add lines (4a) through (4d) =  (4)  $ 

Catalog Number 55897B                                            www.irs.gov                                           Form  433-B (OIC) (Rev. 4-2023) 

                                                                                                                                                 Page 4 
Section 2 (Continued)       Business Asset Information (Domestic and Foreign) 
Other business equipment   
[If you have more than one piece of equipment, please list on a separate attachment and put the total of all equipment in box (5b)]
Type of equipment

Current market value                           Minus loan balance
                                                                            Total value of equipment 
                                                                 (if leased or used in the production of 
$                    X .8 =  $                      –  $         income enter 0 as the total value) =               (5a)  $ 
          Total value of equipment listed from attachment [current market value X .8 minus any loan balance(s)]  (5b)  $ 
                                                                 Total value of all business equipment 
                                                                 Add lines (5a) and (5b)  =                          (5)  $ 
                 Do not include amount on the lines with a letter beside the number. Round to the nearest dollar.   Box A 
                     Do not enter a negative number. If any line item is a negative number, enter "0" on that line. Available Equity in Assets 
                                     Add lines (1) through (5) and enter the amount in Box A =                      $
Section 3                   Business Income Information 
Enter the average gross monthly income of your business. To determine your gross monthly income use the most recent 6-12 months documentation of 
commissions, invoices, gross receipts from sales/services, etc.; most recent 6-12 months earnings statements, etc., from every other source of income (such as 
rental income, interest and dividends, or subsidies); or you may use the most recent 6-12 months Profit and Loss (P&L) to provide the  information of income and 
expenses. 
Note: If you provide a current profit and loss statement for the information below, enter the total gross monthly income in Box B below. Do not 
complete lines (6) - (10). 
Period provided beginning                                through
Gross receipts                                                                                                       (6)  $ 
Gross rental income                                                                                                  (7)  $ 
Interest income                                                                                                      (8)  $ 
Dividends                                                                                                            (9)  $ 
Other income (specify on attachment)                                                                                (10)  $ 
                                                                            Round to the nearest dollar.            Box B 
                     Do not enter a negative number. If any line item is a negative number, enter "0" on that line. Total Business Income 
                                     Add lines (6) through (10) and enter the amount in Box B =                     $
Section 4                   Business Expense Information 
Enter the average gross monthly expenses for your business using your most recent 6-12 months statements, bills, receipts, or other documents  
showing monthly recurring expenses. Deductions for non-cash expenses (e.g., depreciation, depletion, etc.) are not permitted as an expense for 
offer purposes. 
Note: If you provide a current profit and loss statement for the information below, enter the total monthly expenses in Box C below. Do not  
complete lines (11) - (20). 
Period provided beginning                                through
Materials purchased (e.g., items directly related to the production of a product or service)                        (11)  $ 
Inventory purchased (e.g., goods bought for resale)                                                                 (12)  $ 
Gross wages and salaries                                                                                            (13)  $ 
Rent                                                                                                                (14)  $ 
Supplies (items used to conduct business and used up within one year, e.g., books, office supplies, professional    
equipment, etc.)                                                                                                    (15)  $ 
Utilities/telephones                                                                                                (16)  $ 
Vehicle costs (gas, oil, repairs, maintenance)                                                                      (17)  $ 
Insurance (other than life)                                                                                         (18)  $ 
Current taxes (e.g., real estate, state, and local income tax, excise franchise, occupational, personal property,  
sales and employer's portion of employment taxes, etc.)                                                             (19)  $ 
Other expenses (e.g., secured debt payments. Specify on attachment. Do not include credit card payments)            (20)  $ 
                                                                            Round to the nearest dollar.            Box C 
                     Do not enter a negative number. If any line item is a negative number, enter "0" on that line. Total Business Expenses 
                                     Add lines (11) through (20) and enter the amount in Box C =                    $
                                                                            Round to the nearest dollar.            Box D 
                     Do not enter a negative number. If any line item is a negative number, enter "0" on that line. Remaining Monthly Income 
                                     Subtract Box C from Box B and enter the amount in Box D =                      $

Catalog Number 55897B                                           www.irs.gov                                         Form  433-B (OIC) (Rev. 4-2023) 

                                                                                                                                               Page 5
Section 5                   Calculate Your Minimum Offer Amount 
The next steps calculate your minimum offer amount. The amount of time you take to pay your offer in full will affect your minimum offer amount. Paying 
over a shorter period of time will result in a smaller minimum offer amount.   
Note: The multipliers below (12 and 24) and the calculated offer amount do not apply if IRS determines you have the ability to pay your tax 
debt in full within the legal period to collect. 
If you will pay your offer in 5 or fewer payments within 5 months or less, multiply "Remaining Monthly Income" (Box D) by 12 to get "Future Remaining 
Income." Do not enter a number less than zero. 
                                                                                                             Round to the nearest whole dollar.

Enter the total from Box D                                                                 Box E Future Remaining Income
$                                                                   X 12  =                $
If you will pay your offer in 6 to 24 months, multiply "Remaining Monthly Income" (Box D) by 24 to get "Future Remaining Income". Do not enter a 
number less than zero.
Enter the total from Box D                                                                 Box F Future Remaining Income
$                                                                   X 24  =                $
Determine your minimum offer amount by adding the total available assets from Box A to the amount in either Box E or Box F. Your offer amount must 
be more than zero. 
Enter the amount from Box A*                        Enter the amount from either                           Offer Amount  
                                                    Box E or Box F                                         Your offer must be more than zero ($0).  
                                                                                                           Do not leave blank. Use whole dollars only. 
                                                                                                           Place your offer amount on Form 656 
                                                                                                           Section 4, Payment Terms.
$                                           +       $                                      =               $ 

*You may exclude any equity in income producing assets (except real estate) shown in Section 2 of this form.

Section 6                   Other Information 
Additional information IRS needs to consider settlement of your tax debt. If this  business is currently in a bankruptcy proceeding, the 
business is not eligible to apply for an offer. 
Is the business currently in bankruptcy
  Yes       No
Has the business filed bankruptcy in the past 10 years 
  Yes       No
If yes, provide
Date filed (mm/dd/yyyy)                Date dismissed or discharged (mm/dd/yyyy) 
            Petition no.               Location filed 
Does this business have other business affiliations (e.g., subsidiary or parent companies)
  Yes       No
If yes, list the name and Employer Identification Number

Do any related parties (e.g., partners, officers, employees) owe money to the business
  Yes       No
Is the business currently, or in the past, party to litigation
  Yes       No
If yes, answer the following
  Plaintiff              Location of filing                   Represented by                                             Docket/Case number
  Defendant
Amount in dispute        Possible completion date (mmddyyyy)  Subject of litigation
$ 
Are you or have you been party to litigation involving the IRS/United States (including any tax litigation)
  Yes       No
If yes and the litigation included tax debt, provide the types of tax and periods involved.

Catalog Number 55897B                                         www.irs.gov                                    Form  433-B (OIC) (Rev. 4-2023) 

                                                                                                                               Page 6 
Section 6 (Continued) Other Information 
In the past 10 years, has the business transferred any asset with a fair market value of more than $10,000, including real property, for less than its full 
value
Yes       No
If yes, provide date, value, and type of asset transferred

In the past 3 years have you transferred any real property (land, house, etc.)
Yes       No
If yes, list the type of property, value, and date of the transfer

Has the business been located outside the U.S. for 6 months or longer in the past 10 years
Yes       No
Do you have any assets or own any real property outside the U.S.
Yes       No
If yes, please provide description, location, and value

Does the business have any funds being held in trust by a third party
Yes       No If yes, how much $                            Where
Does the business have any lines of credit
Yes       No If yes, credit limit $                        Amount owed $ 
             What property secures the line of credit
Section 7             Signatures 
Under penalties of perjury, I declare that I have examined this offer, including accompanying documents, and to the best of my knowledge it  
is true, correct, and complete. 
Signature of Taxpayer                                                Title                                   Date (mm/dd/yyyy) 

Remember to include all applicable attachments from the list below. 

     A current Profit and Loss statement covering at least the most recent 6–12 month period, if appropriate.

     Copies of the six most recent complete bank statements for each business account and copies of the three most recent 
     statements for each investment account.

     If an asset is used as collateral on a loan, include copies of the most recent statement from lender(s) on loans, monthly 
     payments, loan payoffs, and balances.

     Copies of the most recent statement of outstanding accounts and notes receivable.

     Copies of the most recent statements from lenders on loans, mortgages (including second mortgages), monthly payments, loan 
     payoffs, and balances.

     Copies of relevant supporting documentation of the special circumstances described in the “Explanation of Circumstances” on 
     Form 656, if applicable.

     Attach a Form 2848, Power of Attorney, if you would like your attorney, CPA, or enrolled agent to represent you and you do not 
     have a current form on file with the IRS. Ensure all years and forms involved in your offer are listed on Form 2848 and include 
     the current tax year. Check the appropriate box to ensure copies of communications are sent to your representative.

     Completed and current signed Form 656.

Catalog Number 55897B                                                www.irs.gov          Form  433-B (OIC) (Rev. 4-2023)