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 Account Number 
       
 Owner Name                                                                   Social Security No. or Corporate ID No. 
                                                                                    
 Business Name 
       
 Address (number and street) 
       
 City, State, and ZIP Code 
       
 Mailing Address (if different from above) 
       
 City, State, and ZIP Code 
       
                                                            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: 
 Name of Bank or Other Financial Institution                Current Employer’s Name  
                                                                  
 Address                                                    Address
                                                                 
 City, State, and ZIP Code                                  City, State, and ZIP Code 
                                                                 
 Proposed payment amount:  
 Frequency (check one):                 Monthly            Bi-weekly       Weekly                   $                              

 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. 
       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. 1 (4-12) (INTERNET)       P.O. 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) and/or the Financial Statement for Businesses (DE 926C) 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 888-745-3886. 
 
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: 
 
                                      EDD 
                                      P.O. Box 989150, MIC 92F 
                                      West Sacramento, CA 95798-9150 
                                       
To ensure proper posting of funds to your account, please make sure your employer account number 
is on your check or money order. 
 
More information on installment agreements can be found on theInformation Sheet:Installment 
Agreement (DE 631P). 
 
Forms and publications are available on the EDD’s website at 
www.edd.ca.gov/Payroll_Taxes/Forms_and_Publications.htm. To request forms or publications 
be mailed or faxed to you, please contact the Taxpayer Assistance Center at 888-745-3886. 

DE 927B Rev. 1 (4-12) (INTERNET) P.O. BOX 989150, MIC 92F   •WEST SACRAMENTO, CA 95798-9150         CU 
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