Form 9465

(Rev. December 2009) 

Department of the Treasury 

Internal Revenue Service 

Installment Agreement Request 

© If you are filing this form with your tax return, attach it to the 

front of the return. Otherwise, see instructions. 

OMB No. 1545-0074

Caution: Do not file this form if you are currently making payments on an installment agreement or can pay your balance due in full 

within 120 days. Instead, call 1-800-829-1040. If you are in bankruptcy or we have accepted your offer-in-compromise, see

Bankruptcy or offer-in-compromise on page 2. 

This request is for Form(s) (for example, Form 1040) © and for tax year(s) (for example, 2008 and 2009) ©

1 Your first name and initial Last name Your social security number 

If a joint return, spouse’s first name and initial Last name Spouse’s social security number 

Current address (number and street). If you have a P.O. box and no home delivery, enter your box number. Apt. number 

City, town or post office, state, and ZIP code. If a foreign address, enter city, province or state, and country. Follow the country’s practice for entering the postal code. 

2 If this address is new since you filed your last tax return, check here . . . . . . . . . . . . . . . . . ©

3 

Your home phone number Best time for us to call 

4 

Your work phone number Ext. Best time for us to call 

5 Name of your bank or other financial institution: 

Address 

City, state, and ZIP code 

6 Your employer’s name: 

Address 

City, state, and ZIP code 

7 Enter the total amount you owe as shown on your tax return(s) (or notice(s)) . . . . . . . . 7 

8 Enter the amount of any payment you are making with your tax return(s) (or notice(s)). See instructions 8 

9 Enter the amount you can pay each month. Make your payments as large as possible to limit 

interest and penalty charges. The charges will continue until you pay in full . . . . . . . 9 

10 Enter the day you want to make your payment each month. Do not enter a day later than the 28th ©

11 If you want to make your payments by electronic funds withdrawal from your checking account, see the instructions and fill in

lines 11a and 11b. This is the most convenient way to make your payments and it will ensure that they are made on time. 

© a Routing number 

© b Account number 

I authorize the U.S. Treasury and its designated Financial Agent to initiate a monthly ACH electronic funds withdrawal entry to 

the financial institution account indicated for payments of my federal taxes owed, and the financial institution to debit the entry 

to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to 

terminate the authorization. To revoke payment, I must contact the U.S. Treasury Financial Agent at 1-800-829-1040 no later 

than 10 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the

processing of the electronic payments of taxes to receive confidential information necessary to answer inquiries and resolve 

issues related to the payments. 

Your signature Date Spouse’s signature. If a joint return, both must sign. Date 

General Instructions 

Section references are to the Internal Revenue Code. 

Purpose of Form 

Use Form 9465 to request a monthly installment plan if you 

cannot pay the full amount you owe shown on your tax return 

(or on a notice we sent you). Generally, you can have up to 60 

months to pay. In certain circumstances, you can have longer 

to pay or your agreement can be approved for an amount that 

is less than the amount of tax you owe. However, before 

requesting an installment agreement, you should consider other 

less costly alternatives, such as getting a bank loan or using 

available credit on a credit card. If you have any questions 

about this request, call 1-800-829-1040. 

Do not use Form 9465 if: 

● You can pay the full amount you owe within 120 days (see 

page 2), or 

● You want to request an online payment agreement. See 

Applying online for a payment agreement on page 2. 

Guaranteed installment agreement. Your request for an 

installment agreement cannot be turned down if the tax you 

owe is not more than $10,000 and all three of the following

apply.

● 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 have not entered into an installment 

agreement for payment of income tax.

● The IRS determines that you cannot pay the tax owed in full 

when it is due and you give the IRS any information needed to 

make that determination. 

● 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.

For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 14842Y Form 9465 (Rev. 12-2009)
Form 9465 (Rev. 12-2009) Page 2 

¶!

CAUTION

A Notice of Federal Tax Lien may be filed to protect 

the government’s interests until you pay in full. 

Can you pay in full within 120 days? If you can pay the full 

amount you owe within 120 days, call 1-800-829-1040 to 

establish your request to pay in full. If you can do this, you can 

avoid paying the fee to set up an installment agreement. 

Instead of calling, you can apply online. 

Applying online for a payment agreement. Instead of filing 

Form 9465, you can apply online for a payment agreement. To 

do that, go to www.irs.gov, use the pull-down menu under “I 

need to . . .” and select “Set Up a Payment Plan.” 

Bankruptcy or offer-in-compromise. If you are in bankruptcy 

or we have accepted your offer-in-compromise, do not file this 

form. Instead, call 1-800-829-1040 to get the number of your 

local IRS Insolvency function for bankruptcy or Technical 

Support function for offer-in-compromise. 

How the Installment Agreement Works 

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 fee of $105 ($52 if you make your 

payments by electronic funds withdrawal). However, you may 

qualify to pay a reduced fee of $43 if your income is below a 

certain level. The IRS will let you know whether you qualify for 

the reduced fee. If the IRS does not say you qualify for the 

reduced fee, you can request the reduced fee using Form 

13844, Application For Reduced User Fee For Installment 

Agreements. 

You will also be charged interest and may be charged 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. 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 will be applied to your account in 

the best interests of the United States. 

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 

liabilities. This means that you must have enough withholding or 

estimated tax payments so that your tax liability for future years 

is paid in full when you timely file your return. Your request for 

an installment agreement will be denied if all required tax returns 

have not been filed. Any refund due you in a future year will be 

applied against the amount you owe. If your refund is applied to 

your balance, you are still required to make your regular monthly 

installment payment. 

Payment methods. You can make your payments by check, 

money order, credit card, or one of the other payment methods 

shown next. The fee for each payment method is also shown. 

Payment method Applicable fee 

Check, money order, or credit card $105 

Electronic funds withdrawal $ 52 

Payroll deduction installment agreement $105 

For details on how to pay, see your tax return instructions, 

visit www.irs.gov, or call 1-800-829-1040. 

After we receive each payment, 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, you will not receive a notice. Your bank statement is

your record of payment. We will also 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. 

If you do not make your payments on time or do not pay any 

balance due on a return you file later, you will be in default on 

your agreement and we may take enforcement actions, such as 

the filing of a Notice of Federal Tax Lien or an IRS levy action, to 

collect the entire amount you owe. To ensure that your 

payments are made timely, you should consider making them 

by electronic funds withdrawal (see the instructions for lines 11a 

and 11b on page 3). 

Requests to modify or terminate an installment agreement. 

After an installment agreement is approved, you may submit a 

request to modify or terminate an installment agreement. This 

request will not suspend the statute of limitations on collection. 

While the IRS considers your request to modify or terminate the 

installment agreement, you must comply with the existing 

agreement.

TIP

An installment agreement may be terminated if you 

provide materially incomplete or inaccurate 

information in response to an IRS request for a 

financial update.

For additional information on the IRS collection process, see 

Pub. 594, The IRS Collection Process. 

Where To File 

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 are filing this form in response to a 

notice, file Form 9465 by itself with the Internal Revenue Service 

Center at the address below that applies to you. No street 

address is needed. 

IF you live in . . . THEN use this address . . . 

Florida, Georgia, North Carolina, 

South Carolina

Department of the Treasury 

Internal Revenue Service Center 

Atlanta, GA 39901 

Alabama, Kentucky, Louisiana, 

Mississippi, Tennessee, Texas

Department of the Treasury 

Internal Revenue Service Center 

Austin, TX 73301 

Alaska, Arizona, California, Colorado, 

Hawaii, Idaho, Illinois, Indiana, Iowa, 

Kansas, Michigan, Minnesota, 

Montana, Nebraska, Nevada, New 

Mexico, North Dakota, Oklahoma, 

Oregon, South Dakota, Utah, 

Washington, Wisconsin, Wyoming

Department of the Treasury 

Internal Revenue Service Center 

Fresno, CA 93888 

Arkansas, Connecticut, Delaware, 

District of Columbia, Maine, 

Maryland, Massachusetts, Missouri, 

New Hampshire, New Jersey, New 

York, Ohio, Pennsylvania, Rhode 

Island, Vermont, Virginia, West Virgina

Department of the Treasury 

Internal Revenue Service Center 

Kansas City, MO 64999 

A foreign country, American Samoa, 

or Puerto Rico (or are excluding 

income under Internal Revenue Code 

section 933), or use an APO or FPO 

address, or file Form 2555, 2555-EZ, 

or 4563, or are a dual-status alien or 

nonpermanent resident of Guam or 

the Virgin Islands*

Department of the Treasury 

Internal Revenue Service Center 

Austin, TX 73301 

* Permanent residents of Guam or the Virgin Islands cannot use Form 

9465. 
Form 9465 (Rev. 12-2009) Page 3 

Specific Instructions 

Line 1 

If you are making this request for a joint tax return, show the 

names and social security numbers (SSNs) in the same order 

as on your tax return. 

Line 7 

Enter the total amount you owe as shown on your tax return (or 

notice). 

¶!

CAUTION

If the total amount you owe is more than $25,000 

(including any amounts you owe from prior years), 

complete and attach Form 433-F, Collection 

Information Statement. You can get Form 433-F by visiting the 

IRS website at www.irs.gov. 

Line 8 

Even if you cannot pay the full amount you owe now, you 

should pay as much as possible to limit penalty and interest 

charges. If you are 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 are filing this form by itself, such as in response to a 

notice, attach a check or money order payable to the “United 

States Treasury.” Do not send cash. Be sure to include: 

● Your name, address, SSN, and daytime phone number. 

● The tax year and tax return (for example, “2009 Form 1040”) 

for which you are making this request. 

Line 9 

You should try to make your payments large enough so that 

your balance due will be paid off as quickly as possible without 

causing you a financial burden. 

Line 10 

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. 

If we have not 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 on page 2 that 

applies to you. See the instructions for line 8 above for details 

on what to write on your payment. 

Lines 11a and 11b 

TIP

Making your payments by electronic funds withdrawal 

will help ensure that your payments are made timely 

and that you are not in default of this agreement. 

To pay by electronic funds withdrawal from your checking 

account at a bank or other financial institution (such as mutual 

fund, brokerage firm, or credit union), fill in lines 11a and 11b. 

Check with your financial institution to make sure that an 

electronic funds withdrawal is allowed and to get the correct 

routing and account numbers. 

Note. We will send you a bill for the first payment and the fee. 

You must send us your first payment. All other payments will be 

electronically withdrawn. 

Line 11a. 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 on this page, 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, 

do not use the routing number on that check. Instead, contact 

your financial institution for the correct routing number. 

Line 11b. 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 below, the 

account number is 20202086. Do not include the check 

number. 

TIP

The electronic funds withdrawal from your checking 

account will not be approved unless you (and your 

spouse if filing a joint return) sign Form 9465. 

Sample Check—Lines 11a and 11b 

DWAINE MAPLE 

ROBYN MAPLE 

123 Pear Lane 

Anyplace, VA 20000 

SAMPLE

1234

¶ 15-0000/0000

PAY TO THE 

ORDER OF $

DOLLARS

Routing 

number 

(line 11a)

Account 

number 

(line 11b) ANYPLACE BANK 

Anyplace, VA 20000 Do not include

the check number.

For

| | :250250025 :202020"'86". 1234 §

TIP The routing and account numbers may be in different 

places on your check. 

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 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 are not required to 

request an installment agreement. If you do request an 

installment agreement, you are 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 or penalties. 

You are not 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 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, and the District of Columbia 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. 

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.