Installment Agreement Request 
On behalf of the business identified below, as an individual owner, partner or representative of the corporation, I request that 
the Employment Development Department (EDD) accept an installment agreement in order to liquidate debts due. The 
following is submitted, along with a Good Faith payment, in consideration of this request: 
Employer Payroll Tax Account Number 

Owner Name                                           Last 4 Digits of Social Security Number or Corporate ID Number 

Business Name 

Address (number and street) 

City, State, and ZIP Code 

Mailing Address (if different from above) 

City, State, and ZIP Code 

Name of Bank or Other Financial Institution          If you are an individual owner, partner, or a person assessed under 
                                                     section 1735 of the CUIC and no longer in business, complete the 
                                                     following: 
Bank Account Number           Routing Number         Current Employer’s Name 

Address                                              Address 

City, State, and ZIP Code                            City, State, and ZIP Code 

Proposed payment amount: 
Frequency (check one):            Semi-Monthly  Monthly     Day of the Month 
                                  Bi-Weekly     Weekly      Day of Week                    $ 

Good Faith payment enclosed:                                                               $ 
I understand: 
• The EDD has the right to refuse this installment agreement request.
• Installment agreements exceeding one year in length require full financial disclosure and documentation.
• Additional interest accrues daily on the unpaid balance at the rate prescribed by law.
• All missing and delinquent reports must be filed in order to request a payment arrangement.
• The EDD will file a Notice of State Tax Lien for outstanding liabilities.
• I will be subject to an offset of any state refund due to me, including state income tax refunds and lottery winnings, as
  well as any federal income tax refund due to me by the U.S. Department of the Treasury, as prescribed by law.
• The EDD may assess responsible individuals for any unpaid corporate, limited liability company, or limited liability
  partnership liability.
• Associations, corporations, LLCs and LLPs must complete and return with this form a Corporate Information Questionnaire
  (DE 204) (PDF).
• Failure to adhere to the installment agreement and/or incurring any additional liability may be considered a default, and
  involuntary collection action may be taken without further notice to me or to the organization listed above.

Signature (Owner/Responsible Party)            Title                                          Date 

Print Name                                     Phone Number                                Alternate Phone Number

Contact Person (please print)                  Phone Number                                Alternate Phone Number 
DE 927B Rev. 2 (3-19) (INTERNET)    PO BOX 989150, MIC 92F  •  WEST SACRAMENTO, CA 95798-9150                     CU 
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          INSTALLMENT AGREEMENT REQUEST (DE 927B) INSTRUCTIONS 
                                                 
Complete all requested information. Write “N/A” (not applicable) in those areas that do not apply to 
your business. If the form is incomplete or unsigned, we will not be able to consider your request for 
an installment agreement.  
 
If you are an individual owner, partner, or responsible person assessed under section 1735 of the 
California Unemployment Insurance Code (CUIC) and the business is no longer active, complete the 
section that requests information about your current employer. 
 
If the installment agreement you are requesting exceeds one year in length, you must complete a 
financial statement and submit the required documents for substantiation. The forms Financial 
Statement (DE 926B) (PDF)        and/or the Financial Statement for Businesses (DE 926C) (PDF) are 
available, but any recent financial statement which has substantially the same data is acceptable. 
 
For account balance information, please refer to the most recent Statement of Account (DE 2176) 
or call the Taxpayer Assistance Center at 1-888-745-3886. You can view your DE 2176 through  
e-Services_for_Business (edd.ca.gov/e-Services_for_Business). 
 
A Good Faith payment is required when requesting an installment agreement. 
 
All missing and delinquent reports must be filed before requesting an installment agreement. 
 
An approved installment agreement does not prevent an offset of any state or federal income tax 
refund; however, it may prevent involuntary collection actions. Any offset amount received will not 
affect your scheduled payments but may reduce the length of the agreement. 
 
An approved installment agreement does not prevent a lien from being filed. The EDD will file a 
Notice of State Tax Lien (DE 2181) for outstanding liabilities. 
 
Send Good Faith payment and completed DE 927B to: 
 
                                 Employment Development Department 
                                 PO Box 989150, MIC 92F 
                                 West Sacramento, CA 95798-9150 
                                  
To ensure proper posting of funds to your account, please make sure your employer payroll tax 
account number is on your check or money order. 
 
More information on installment agreements can be found on the   Information Sheet:Installment 
Agreement (DE 631P) (PDF). 
 
Forms and publications (edd.ca.gov/Payroll_Taxes/Forms_and_Publications) are available on the 
EDD website. To request forms or publications be mailed or faxed to you, please contact the 
Taxpayer Assistance Center at 1-888-745-3886. 

DE 927B Rev. 2 (3-19) (INTERNET) PO BOX 989150, MIC 92F  •  WEST SACRAMENTO, CA 95798-9150   CU 
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