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Form 433A: Collection Information Statement for Wage Earners and Self-Employed Individuals
IRS Form 433A is Collection Information Statement for Wage Earners and Self-Employed Individuals, used to report income/expenses to a collection agency. For wage earners, complete Sections 1 through 5, including the signature line on page 4.
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IRS Form 433A - Collection Information Statement for Wage Earners and Self-Employed Individuals
IRS Form 433A is Collection Information Statement for Wage Earners and Self-Employed Individuals, used to report income/expenses to a collection agency. For wage earners, complete Sections 1 through 5, including the signature line on page 4.
Risk Radar
Scan points- 1Ensure you calculate the Net difference (Line 34 minus Line 49) correctly on page 4.
- 2Failing to complete Section 6 and 7 when self-employed (required on page 4).
- 3Not completing the signature line on page 4, regardless of filer status.
- 4For wage earners, omitting completion of Sections 1, 2, 3, 4, or 5.
- 5When calculating wages, forgetting to multiply weekly gross by 4.3 or biweekly by 2.17.
Plain English
This form tells the IRS exactly how much money an individual or self-employed person earns each month and what they spend monthly. It provides detailed breakdowns of income sources like wages and business profit, as well as expenses such as housing and taxes paid. This information helps creditors collect debts owed to the government.
Submission Date
- Filing date: 2022-08-05 22:10:07
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when reporting income and expenses as part of a collection process for wage earners or self-employed individuals.
- Do not use Form 433A when the required information is only about personal assets, liabilities, and other details without detailing specific income/expenses.
- Check Publication 1854 instead when needing general guidance on how to prepare the Collection Information Statement.
Form selector
Use this form or another form?
Reporting expenses for a self-employed individual
Self-Employed Individuals must complete Sections 1, 3, 4, 5, 6, and 7.
✓ Check that all required sections are filled out.
Reporting real property ownership details (e.g., FMV, loan balance)
Real Property information is detailed across lines 17a, 17b, and 17c on page 3.
✓ Ensure the total equity calculation matches line 17c.
Reporting outstanding receivables/contracts
Section 5 allows listing Accounts/Notes Receivable with details like Amount Due and Status.
✓ Verify that the Total Outstanding Balance correctly sums lines 65a through 65e.
Deadline or filing window
The official source does not specify a filing deadline, but completion requires answering all questions or writing N/A if applicable. The form must be completed before being submitted for review by the IRS.
Checklist
What you need before filling it out
Wage Earners
Complete Sections 1, 2, 3, 4, and 5 (including signature line) · Page 1
Self-Employed Individuals
Complete Sections 1, 3, 4, 5, 6, and 7 (including signature line) · Page 1
Real Property Details
Purchase Date, FMV, Loan Balance, Monthly Payment, Equity · Lines 17a, 17b, 17c on page 3
Gross Wages Calculation
Enter gross monthly wages/salaries; multiply weekly by 4.3 if paid weekly · Line 50 on page 4
Allowable Expenses
Total of Food, Clothing, Misc (Line 7) and Housing/Utilities (Line 8) · Page 4
Receivables Amount Due
Specific dollar amounts for listed accounts · Lines 65a through 65e on page 5
Before you submit
- 1Complete Section 1 (Personal Information) entirely.
- 2For Wage Earners, ensure Sections 2, 3, 4, and 5 are fully answered or marked N/A.
- 3For Self-Employed Individuals, verify that Sections 6 and 7 are included in the completion.
- 4Confirm all Real Property lines (17a, 17b) have a listed Location.
- 5Verify that Line 49 (Total Living Expenses) correctly sums Lines 35 through 48.
- 6Check that the Total Outstanding Balance on page 5 accurately reflects line items and attachments.
- 7Ensure both the Taxpayer's Signature and Spouse's signature are dated on page 4.
How to file this form
- 1Complete Sections 1 through 7 (adjusting based on filer status) by answering all questions or writing N/A, referencing Publication 1854 for guidance.
- 2Detail assets and liabilities by filling out the appropriate lines on pages 3 and 5, ensuring totals are calculated correctly (e.g., Line 17c).
- 3Calculate total living expenses on page 4 (Lines 35-48) to determine the final Net Difference on Line 50.
- 4Sign and date the form on page 4 under the Taxpayer's signature line, and include the spouse's signature if applicable.
- 5Attach any supporting documentation (such as a list of secured debts or receivables details) before sending.
Known limitations
- 1Self-Employed Individuals must complete Sections 1, 3, 4, 5, 6, and 7 of Form 433-A.
- 2Wage Earners must complete Sections 1, 2, 3, 4, and 5 of Form 433-A.
- 3If a self-employed individual is not a sole proprietorship (filing Schedule C), they must complete Form 433-B instead.
- 4For wage earners, if a question is not applicable, the filer writes N/A in the space provided on Form 433-A.
- 5If self-employed, Sections 6 and 7 of Form 433-A must be completed before continuing to Section 5.
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
Almost done reviewing the fields?
Fillable formOpen in Editor->The current edition listed is Form 433-A (Rev. 7-2022), which was dated in July 2022. The official source does not point to a specific page for the latest information, but it references Publication 1854.
What changed or needs a fresh check
- Edition date — confirm the revision date reads July 2022.
- Catalog Number — confirm the number is 20312N.
- Filer requirement (Wage Earner) — confirm Sections 1, 2, 3, 4, and 5 are completed.
- Filer requirement (Self-Employed) — confirm Sections 1, 3, 4, 5, 6, and 7 are completed.
- Signature — ensure both the Taxpayer's Signature and Spouse's signature are present on page 4.
Quick Facts
Downloads
After you file
- 1Keep a copy of the completed IRS Form 433-A for records.
- 2If additional space is needed to respond completely to any question, include attachments with the filing.
- 3For guidance on completing the form, refer to Publication 1854, "How To Prepare a Collection Information Statement."
- 4The revision date currently on file is July 2022 (Rev. 7-2022).
- 5If an error occurs, the filer should correct it and resubmit the form.
Sources
- SRCInstructions p.1 — The current revision is Form 433-A (July 2022) and the Catalog Number is 20312N.
- SRCInstructions p.1 — Wage Earners must complete Sections 1, 2, 3, 4, and 5, including the signature line on page 4.
- SRCInstructions p.1 — Self-Employed Individuals must complete Sections 1, 3, 4, 5, 6, and 7, plus the signature line on page 4.
- SRCInstructions p.2 — Section 4 (Personal Asset Information) requires listing assets located in foreign countries or jurisdictions if applicable.
- SRCInstructions p.4 — For wage earners, when calculating Gross Monthly Wages for Line 20, weekly wages are multiplied by 4.3; biweekly wages by 2.17; and semimonthly wages by 2.
- SRCInstructions p.6 — Business Assets must include all tools, books, machinery, equipment, inventory, or other assets used in trade or business.
Common confusion points
What do I enter for 'Total Income' in Section 5?
This is the sum of lines 20 through 33 on page 4.
→ Ensure all listed income sources are added together.
When calculating Gross Monthly Wages (Line 20), how should a weekly payment be treated?
Multiply the weekly gross wages by 4.3.
→ Example: $425.89 multiplied by 4.3 equals $1,831.33.
For Net Business Income (Line 23), what if my business had a loss?
Enter "0" for the amount in Line 23.
→ Do not enter a negative number.
What expenses are generally NOT allowed on Form 433-A?
Tuition for private schools, public or private college expenses, charitable contributions, voluntary retirement contributions, or payments on unsecured debts are generally disallowed.
→ Check Publication 1854 for exceptions to these rules.
How do I calculate the Total Living Expenses (Line 50)?
Add up all items from Line 35 through Line 48.
→ This total is used to determine the Net difference against your Total Income.
If I am self-employed, which section must be completed first?
Sections 6 and 7 must be completed before continuing with Section 5 (Monthly Income and Expenses).
→ Confirm that you are filling out these sections if you are filing as a business owner.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 433-B (If you must complete this form instead of the main body)
Questions about IRS Form 433A
What is IRS Form 433A used for?
This form tells the IRS exactly how much money an individual or self-employed person earns each month and what they spend monthly. It provides detailed breakdowns of income sources like wages and business profit, as well as expenses such as housing and taxes paid. This information helps creditors collect debts owed to the government.
Who must file IRS Form 433A?
Wage Earners must complete Form 433A by completing Sections 1, 2, 3, 4, and 5 for themselves or their spouse. Self-Employed Individuals must complete Sections 1, 3, 4, 5, 6, and 7.
What information does IRS Form 433A require?
The form collects personal details in Section 1, employment data in Section 2 (for wage earners), monthly income/expenses in Section 5, and detailed expense items like Food, Clothing and Misc. on page 4. The Net difference is calculated on line 50 of the Monthly Income and Expenses Statement.
Where do I file IRS Form 433A?
The form should be filed with the Internal Revenue Service. Additional information can refer to Publication 1854 for filing guidance.
How do I complete IRS Form 433A?
Wage Earners must complete Sections 1 through 5 before signing. Self-Employed Individuals must complete Sections 1, 3, 4, 5, 6, and 7 before signing on page 4. The taxpayer signs the form under penalty of perjury.
What happens if IRS Form 433A is filed incorrectly?
If documentation review reveals discrepancies, the filer may be asked to provide verification of the reported assets, income, and expenses under penalties of perjury.
What do I enter for 'Total Income' in Section 5?
This is the sum of lines 20 through 33 on page 4. Ensure all listed income sources are added together.
When calculating Gross Monthly Wages (Line 20), how should a weekly payment be treated?
Multiply the weekly gross wages by 4.3. Example: $425.89 multiplied by 4.3 equals $1,831.33.
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