OMB No. 1545-0074

Form 9465 Installment Agreement Request

Department of the Treasury

Internal Revenue Service

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

front of the return. Otherwise, see instructions.

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.

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

Your home phone number

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

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

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

2

3 4 ( )

7

9

11

5 Name of your bank or other financial institution: 6

(Rev. December 2008)

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

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

10

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.

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.

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

General Instructions

9

8

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 9 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.

© a Routing number

© b Account number

7

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.

● 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.

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.

● 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.

Do not use Form 9465 if:

This request is for Form(s) (for example, Form 1040) © and for tax year(s) (for example, 2007 and 2008) ©

8

● 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.
Form 9465 (Rev. 12-2008) Page 2

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

Alabama, Florida, Georgia, North

Carolina, South Carolina, Virginia

Department of the Treasury

Internal Revenue Service Center

Atlanta, GA 39901

District of Columbia, Maine,

Maryland, Massachusetts,

New Hampshire, Vermont

Department of the Treasury

Internal Revenue Service Center

Andover, MA 05501

Arkansas, Connecticut, Delaware,

Indiana, Michigan, Missouri, New

Jersey, New York, Ohio,

Pennsylvania, Rhode Island,

West Virginia

Department of the Treasury

Internal Revenue Service Center

Kansas City, MO 64999

Alaska, Arizona, California, Colorado,

Hawaii, Idaho, Illinois, Iowa, Kansas,

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

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.

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.

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. All payments received will be

applied to your account in the best interests of the United

States. 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.

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.

How the Installment Agreement Works

If you live in American Samoa or Puerto Rico (or exclude income

under section 933); are a nonpermanent resident of Guam or the

Virgin Islands*, have a foreign address; are a dual-status alien; or file

Form 2555, 2555-EZ, or 4563, use this address: Department of the

Treasury, Internal Revenue Service Center, Austin, TX 73301, USA

* Permanent residents of Guam or the Virgin Islands cannot use

Form 9465.

Kentucky, Louisiana, Mississippi,

Tennessee, Texas, APO, FPO

Department of the Treasury

Internal Revenue Service Center

Austin, TX 73301

A Notice of Federal Tax Lien may be filed to protect

the government’s interests until you pay in full.

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.

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).

CAUTION

Payment method

Electronic funds withdrawal

Payroll deduction installment agreement

Applicable fee

$ 52

$105

For additional information on the IRS collection process, see

Pub. 594, The IRS Collection Process.

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).

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.

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.

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

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

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.”

Check, money order, or credit card $105
Form 9465 (Rev. 12-2008) Page 3

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.

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.

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.

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.

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 on this

page, the account number is 20202086. Do not include the

check number.

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.

Lines 11a and 11b

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.

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.

TIP

The electronic funds withdrawal from your checking

account will not be approved unless you (and your

spouse if a joint return) sign Form 9465.

TIP

Do not include

the check number.

1234

SAMPLE

DWAINE MAPLE

ROBYN MAPLE

123 Pear Lane

Anyplace, VA 20000

15-0000/0000

PAY TO THE

ORDER OF $

DOLLARS

ANYPLACE BANK

Anyplace, VA 20000

For

|:250250025| 1234

The routing and account numbers may be in

different places on your check.

(line 11a) (line 11b)

Routing

number

Account

number

Ä

Ä

Sample Check—Lines 11a and 11b

TIP

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

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.

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, “2008 Form

1040”) for which you are making this request.

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 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.

CAUTION

Line 7

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

(or notice).

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 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.

Specific Instructions

:202020"’86".