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Installment Agreement Request
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INSTALLMENT AGREEMENT REQUEST

(Federal Income, Employment, Excise, and/or Related Tax Liabilities)

[// GUIDANCE: This template is designed for attorneys representing a taxpayer (individual or business) seeking to negotiate a customized installment agreement with the Internal Revenue Service (“IRS”) pursuant to 26 U.S.C. § 6159. It supplements—NOT replaces—IRS Forms 433-D, 9465, or 433-B/A/OI, which must still be filed. Customize bracketed items and attach required IRS forms and financial statements.]


TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block
Exhibit A – Payment Schedule
Exhibit B – Collection Information Statement Index


I. DOCUMENT HEADER

Installment Agreement Request and Proposal
“Agreement Request” effective as of [EFFECTIVE DATE] (the “Effective Date”), by and between:

[TAXPAYER LEGAL NAME], a [STATE] [ENTITY TYPE OR “individual”], EIN/SSN [###-##-####], with principal place of business/residence at [ADDRESS] (“Taxpayer”); and
• The Internal Revenue Service, United States Department of the Treasury (“IRS”).

Recitals

A. On [ASSESSMENT DATE] the IRS assessed federal tax, penalties, and interest against Taxpayer in the aggregate amount of $[TOTAL LIABILITY] (the “Assessed Liability”).
B. Pursuant to 26 U.S.C. § 6159(a), the IRS may enter into written agreements allowing full payment in installments if such agreement will facilitate collection.
C. Taxpayer desires, and by executing Form 433-D the IRS may agree, to liquidate the Assessed Liability through periodic payments on the terms herein.
D. In consideration of the mutual covenants set forth below, Taxpayer submits this Agreement Request for IRS review and possible acceptance.


II. DEFINITIONS

For purposes of this Agreement Request, capitalized terms have the meanings set forth below:

“Agreement” – A binding Installment Agreement arising upon IRS countersignature of Form 433-D referencing this Agreement Request.

“Assessed Liability” – The aggregate unpaid federal tax, penalties, and interest described in Recital A, plus any statutory additions accruing under 26 U.S.C. §§ 6601, 6621.

“Code” – The Internal Revenue Code of 1986, as amended (26 U.S.C.).

“Collection Division” – The IRS unit with administrative responsibility for collecting the Assessed Liability.

“Due Date” – The [DAY] day of each calendar month (or next business day) on which a Scheduled Payment is required.

“Scheduled Payment” – The [MONTHLY/BI-WEEKLY] amount set forth in Section 3.2 and Exhibit A.


III. OPERATIVE PROVISIONS

3.1 Submission & Scope

(a) This Agreement Request, together with completed IRS Forms 9465 and 433-D, constitutes Taxpayer’s formal request under 26 U.S.C. § 6159.
(b) Acceptance occurs only upon written approval by an authorized IRS official. Until acceptance, levy is generally suspended under 26 U.S.C. § 6331(k)(2).

3.2 Payment Terms

(a) Commencing [FIRST PAYMENT DATE], Taxpayer shall remit a Scheduled Payment of $[AMOUNT] on each Due Date until the earlier of (i) full satisfaction of the Assessed Liability or (ii) [FINAL PAYMENT DATE].
(b) Payments shall be made by [DIRECT DEBIT/EFTPS/PAYROLL DEDUCTION] from Account No. [XXXX] at [FINANCIAL INSTITUTION].
[// GUIDANCE: Direct-debit is strongly preferred by IRS and reduces default risk.]

3.3 Conditions Precedent

IRS acceptance is conditioned upon:
1. Submission of an accurate and complete Form 433-[A/B/OI] and supporting documentation listed in Exhibit B;
2. Payment of a user fee in the amount prescribed by 31 C.F.R. Part 300; and
3. Taxpayer’s filing of all required federal tax returns through the most recent period.

3.4 Application of Payments

Payments shall be applied in the order specified by the Code and IRS policy (currently, outstanding tax, penalty, then interest, oldest periods first).

3.5 No Acceleration of Interest

Interest and penalties will continue to accrue under 26 U.S.C. §§ 6601, 6651 until full payment; no provision herein waives such statutory additions.


IV. REPRESENTATIONS & WARRANTIES

4.1 Taxpayer represents and warrants that:
(a) All financial information furnished to the IRS is true, correct, and complete in all material respects.
(b) Taxpayer is not a debtor in any pending bankruptcy case.
(c) Taxpayer has the legal capacity and authority to enter into and perform under the Agreement.

4.2 Survival. The representations and warranties survive IRS acceptance and remain in effect until the Assessed Liability is fully satisfied.


V. COVENANTS & RESTRICTIONS

5.1 Affirmative Covenants
(a) Compliance: Taxpayer shall timely file all future federal tax returns and pay all taxes that become due during the term of the Agreement.
(b) Information Updates: Within ten (10) days of any material financial change or address change, Taxpayer shall provide written notice to the Collection Division.

5.2 Negative Covenants
Taxpayer shall not, without prior IRS consent, dispose of assets outside the ordinary course of business if such disposition would materially impair the IRS’s ability to collect the Assessed Liability.


VI. DEFAULT & REMEDIES

6.1 Events of Default
(a) Failure to make any Scheduled Payment within ten (10) calendar days after the Due Date;
(b) Submission of materially false or misleading information;
(c) Failure to remain current on post-Agreement tax obligations;
(d) Institution of bankruptcy proceedings.

6.2 Cure Period
Upon default, IRS will issue a written notice allowing a thirty (30) day cure period unless immediate action is mandated by law or public policy.

6.3 Remedies
If default is not timely cured, IRS may:
1. Terminate the Agreement under 26 U.S.C. § 6159(b);
2. Accelerate the unpaid balance;
3. Resume enforced collection, including levy and lien action; and
4. Offset any federal payments due to Taxpayer.

6.4 Attorneys’ Fees
Each party bears its own administrative and litigation costs except as otherwise provided under 26 U.S.C. § 7430.


VII. RISK ALLOCATION

7.1 Indemnification
Not applicable; liabilities are statutory.

7.2 Limitation of Liability
Taxpayer’s liability is limited to the Assessed Liability plus statutory accruals. IRS liability is governed exclusively by federal law, including the Federal Tort Claims Act where applicable.

7.3 Force Majeure
Neither party shall be deemed in default for delays caused by acts of God, war, terrorism, or other events beyond reasonable control; however, statutory interest will continue to accrue.


VIII. DISPUTE RESOLUTION

8.1 Governing Law
This Agreement shall be governed exclusively by federal tax law, including 26 U.S.C. § 6159 and associated Treasury Regulations.

8.2 Forum Selection
All disputes shall be resolved through IRS administrative procedures (Collection Appeals Program, Collection Due Process hearing, or other applicable forum). No arbitration is available.

8.3 Jury Waiver
As matters are resolved administratively, jury trial rights are inapplicable.

8.4 Injunctive Relief
Collection action is automatically stayed while this Agreement Request is pending and, if accepted, while the Agreement remains in effect, pursuant to 26 U.S.C. § 6331(k).


IX. GENERAL PROVISIONS

9.1 Amendments
Any amendment must be in writing and signed by an authorized IRS official and the Taxpayer.

9.2 Waiver
Failure of the IRS to enforce any provision shall not constitute a waiver of future enforcement.

9.3 Assignment
This Agreement is personal to Taxpayer and may not be assigned absent express IRS written consent.

9.4 Severability
If any provision is held invalid, the remaining provisions shall remain in full force to the extent practicable.

9.5 Entire Agreement
This Agreement Request, together with Forms 433-D, 9465, and attached exhibits, constitutes the entire understanding regarding installment payment of the Assessed Liability.

9.6 Counterparts; Electronic Signatures
The parties may execute this Agreement Request in counterparts, including by electronic signature compliant with the Electronic Signatures in Global and National Commerce Act (15 U.S.C. §§ 7001-7006).


X. EXECUTION BLOCK

IN WITNESS WHEREOF, the undersigned have executed this Agreement Request as of the Effective Date.

Taxpayer


[NAME], [TITLE if entity]
Date: _________

Internal Revenue Service

(Subject to formal acceptance on Form 433-D)


Authorized Revenue Officer / Advisor
Date: _________

[// GUIDANCE: After execution, attach this document to Form 433-D for the IRS signature block. IRS acceptance is NOT effective until the official signs Form 433-D.]


Exhibit A – Payment Schedule

Payment No. Due Date Amount Cumulative Balance
1 [DATE] $[ ] $[ ]

[// GUIDANCE: Extend table through final payment date.]


Exhibit B – Collection Information Statement Index

  1. Form 433-[A/B/OI] dated [DATE]
  2. Six (6) months bank statements ([DATES])
  3. Recent pay stubs / profit-and-loss statement
  4. Asset valuations (real property, vehicles, investments)
  5. Proof of expenses exceeding national/local standards (if any)

[// GUIDANCE: Submit completed Agreement Request, exhibits, and required IRS forms to the assigned Revenue Officer or appropriate IRS campus per IRM 5.14 procedures. Confirm user-fee payment and retain proof of delivery.]


Statutory References: 26 U.S.C. § 6159 (Installment Agreements); 26 U.S.C. § 6331(k) (Restriction on levy while agreement pending/in effect).

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