OMB No. 1545-1350

Form 9465 Installment Agreement Request

Department of the Treasury

Internal Revenue Service

© See instructions below and on back.

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If you can’t pay the full amount you owe, you can ask to make monthly installment payments. If we approve your

request, you will be charged a $43 fee. Do not include the fee with this form. We will send you a bill for the fee when

we approve your request. We will usually let you know within 30 days after we receive your request whether it is

approved or denied. But 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.

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

Your current address (number and street). If you have a P.O. box and no home delivery, show box number. Apt. number

City, town or post office, state, and ZIP code. If a foreign address, show city, state or province, postal code, and full name of country.

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

Your home phone number

Enter the tax return for which you are making this request (for example, Form 1040). But if you are

filing this form in response to a notice, don’t complete lines 7 through 9. Instead, attach the

bottom section of the notice to this form and go to line 10

Enter the tax year for which you are making this request (for example, 1994)

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

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

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

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

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5 6 Name of your bank or other financial institution:

Cat. No. 14842Y

(Rev. January 1995)

Form 9465 (Rev. 1-95)

Best time for us to call Ext.

Your employer’s name: 

Address

City, state, and ZIP code

Address

City, state, and ZIP code

Your work phone number

( )

Best time for us to call

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Caution: A Notice of Federal Tax Lien may be filed to protect the government’s interest until you pay in full.

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

Privacy Act and Paperwork Reduction Act Notice.—Our

legal right to ask for the information on this form is Internal

Revenue Code 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

To ask for an installment agreement, complete this form. Attach it to the front of your return when you file. If you

have already filed your return or you are filing this form in response to a notice, see How Do I File Form 9465? on

page 2. If you have any questions about this request, call 1-800-829-1040.

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access to the tax information in our files and properly

respond to your request. If you do not enter the information,

we may not be able to process your request. We may give

this information to the Department of Justice as provided by

law. We may also give it to cities, states, and the District of

Columbia to carry out their tax laws.

Note: Do not file this form if you are currently making payments on an installment agreement. You must pay your other

Federal tax liabilities in full or you will be in default on your agreement.
Form 9465 (Rev. 1-95) Page 2

If you live in: Use this address:

Florida, Georgia, South Carolina Atlanta, GA

39901

New Jersey, New York (New York City and counties of

Nassau, Rockland, Suffolk, and Westchester)

Holtsville, NY

00501

New York (all other counties), Connecticut, Maine,

Massachusetts, New Hampshire, Rhode Island, Vermont

Andover, MA

05501

Illinois, Iowa, Minnesota, Missouri, Wisconsin Kansas City, MO

64999

Delaware, District of Columbia, Maryland,

Pennsylvania, Virginia

Philadelphia, PA

19255

Indiana, Kentucky, Michigan, Ohio, West Virginia Cincinnati, OH

45999

Kansas, New Mexico, Oklahoma, Texas Austin, TX

73301

Alabama, Arkansas, Louisiana, Mississippi,

North Carolina, Tennessee

Memphis, TN

37501

Alaska, Arizona, California (counties of Alpine, Amador,

Butte, Calaveras, Colusa, Contra Costa, Del Norte,

El Dorado, Glenn, Humboldt, Lake, Lassen, Marin,

Mendocino, Modoc, Napa, Nevada, Placer, Plumas,

Sacramento, San Joaquin, Shasta, Sierra, Siskiyou,

Solano, Sonoma, Sutter, Tehama, Trinity, Yolo, and

Yuba), Colorado, Idaho, Montana, Nebraska, Nevada,

North Dakota, Oregon, South Dakota, Utah,

Washington, Wyoming

Ogden, UT

84201

California (all other counties), Hawaii Fresno, CA

93888

American Samoa

Guam: Nonpermanent residents only*

Philadelphia, PA

19255

Foreign country (or if a dual-status alien):

U.S. citizens and those filing Form 2555,

2555-EZ, or 4563

All APO and FPO addresses

Bankruptcy—Offer-in-Compromise.—If you are in

bankruptcy or we have accepted your offer-in-compromise,

do not file this form. Instead, call your local IRS District

Office Special Procedures function. You can get the number

by calling 1-800-829-1040.

How Do I File Form 9465?

Printed on recycled paper

*Permanent residents of Guam and the Virgin Islands cannot use Form 9465.

General Instructions

If you cannot pay the full amount you owe shown on your

tax return (or on a notice we sent you), you can ask to make

monthly installment payments. However, you will 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. To limit the interest and penalty

charges, file your return on time and pay as much of the tax

as possible with your return (or notice). But before requesting

an installment agreement, you should consider other less

costly alternatives, such as a bank loan.

You will be charged a $43 fee if your request is approved.

Do not include the fee with this form. We will send you a

letter telling you your request has been approved, how to

pay the fee, and how to make your first installment payment.

After we receive each payment, we will send you a letter

showing the remaining amount you owe, and the due date

and amount of your next payment.

By approving your request, we agree to let you pay the tax

you owe in monthly installments instead of paying the

amount immediately 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 adequate

withholding or estimated tax payments so that your tax

liability for future years is paid in full when you timely file

your return. If you do not make your payments on time or

you have an outstanding past-due amount in a future year,

you will be in default on your agreement and we may take

enforcement actions to collect the entire amount you owe.

Specific Instructions

Line 1

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

names and SSNs in the same order as shown on your tax

return.

Line 10

Even if you can’t pay the full amount you owe now, you

should pay as much of it as possible to limit penalty and

interest charges. If you are filing this form with your tax

return, make the payment with your return. If you are filing

this form separately, for example, in response to a notice,

include a check or money order payable to the Internal

Revenue Service with this form. On your payment, write your

name, address, social security number, daytime phone

number, and the tax year and tax return for which you are

making this request (for example, “1994 Form 1040”).

Line 11

You should try to make your payments large enough so that

your balance due will be paid off by the due date of your

next tax return.

Line 12

You can choose the date each month that you want to make

your payments. For example, if your rent or mortgage

payment is due on the first 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 date

that your first payment is due. If we have not replied by the

date you choose for your first payment, you may send your

first payment to the Internal Revenue Service Center at the

address shown on this page for the place where you live.

Make your check or money order payable to the Internal

Revenue Service. See the instructions for line 10 for what to

write on your payment.

● If you have already filed your return, you are filing your

return electronically, or you are filing this form in response to

a notice, mail it to the Internal Revenue Service Center at

the address shown below for the place where you live. No

street address is needed.

Puerto Rico (or if excluding income

under section 933)

Virgin Islands: Nonpermanent residents only*

The time needed to complete and file this form will vary

depending on individual circumstances. The estimated

average time is: Learning about the law or the form,

2 min.; Preparing the form, 31 min.; Copying, assembling,

and sending the form to the IRS, 20 min.

If you have comments concerning the accuracy of this

time estimate or suggestions for making this form simpler,

we would be happy to hear from you. You can write to the

Internal Revenue Service, Attention: Tax Forms Committee,

PC:FP, Washington, DC 20224. DO NOT send the form to

this address. Instead, see How Do I File Form 9465? on this

page.

● If you haven’t filed your return, attach Form 9465 to the

front of your return.