📋 Form 433-F — Fill-In Framework (Example)

A reusable template for anyone preparing for an IRS Collection Information Statement call — every value shown is a placeholder example, not real data.

📋 This is a public, generic example. All institution names and dollar figures shown are placeholders so you can see the shape of the form filled in, then replace them with your own information in your own private copy. Nothing on this page reflects any specific person's real financial data.

☎️ Opening the call — example script

"I'm calling to formally establish Currently Not Collectible status and would like to complete Form 433-F with you directly."

If asked about the origin of a tax balance, state your actual circumstances plainly and factually — the IRS is assessing your current ability to pay, not judging why the balance exists.

🧾 About this framework

Mirrors the real IRS Form 433-F sections, in plain language
Built and open-sourced by the maintainer while preparing his own CNC application
Deliberately excludes any field for SSN, EIN, or full account numbers — build that discipline into your own copy too
Cryptocurrency is treated as property, not currency, by the IRS — use fair-market value as of today

📎 Documents to have physically on hand

Check off before the call so nothing stalls the conversation.

Most recent IRS notice (has the exact balance + notice number)
Last pay stub(s) or 1099s for current income
Bank statements for all open accounts (balance only needed, not full statement)
Retirement account statements showing the withdrawal dates/amounts
Any 1099-R forms for the retirement liquidations
Rent/mortgage statement
Health insurance premium amount
List of monthly bills (utilities, phone, car, insurance)
Current vehicle registration / loan payoff amount if financed

👤 A1 · Household & Filing Basics

County, phone numbers, household size. Never SSN.

County of residence

Household size (under 65)

Household size (65+)

Home phone

Work phone

Cell phone

🏦 A2 · Bank Accounts & Investments

Institution + account type + current balance only. NO account numbers

Institution name

Account type

Current balance

Institution name

Account type

Current balance

Institution name

Account type

Current balance

🪙 A3 · Digital Assets (Crypto)

Type, exchange/wallet name, current USD value as of today. NO wallet addresses / private keys

Type of currency

Exchange / wallet name

Current USD value

🏠 B · Real Estate

Description, current value, balance owed, resulting equity.

Description / location

Current value

Balance owed

Equity (value - owed)

🚗 C · Other Assets

Vehicles, life insurance cash value, other valuables.

Description (make/model/year)

Current value

Balance owed

💳 D · Credit Cards

Type/issuer, credit limit, balance owed, minimum payment. NO account numbers

Type / issuer

Credit limit

Balance owed

Minimum payment

💼 F · Employment

Current employer (or "self-employed")

Pay frequency

Gross per pay period

How long at current employer

💵 G · Non-Wage Household Income

Net self-employment income (monthly)

Unemployment income

Other (specify)

🧮 H · Monthly Necessary Living Expenses

Actual amounts — the IRS applies its own "allowed" standard where yours is lower.

Food / personal care

Transportation

Housing & utilities

Health insurance

Out-of-pocket medical

Court-ordered support/alimony

Student loan minimum

Term life insurance

Other (specify)

📝 Call Notes

Call notes

Generated from scripts/render_433f.py --mode public · form-433f-data.csv is the single source of truth