Transcription of Form 433-A (OIC) Collection Information Statement for …
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Form 433-A (OIC) Collection Information Statement for …
Department of the Treasury Internal Revenue Service Form 433-A (OIC) Collection Information Statement for Wage Earners and (Rev. May 2012). Self-Employed Individuals Use this form if you are An individual who owes income tax on a Form 1040, An individual who is personally responsible for a Individual Income Tax Return partnership liability An individual with a personal liability for Excise Tax An individual who is self-employed or has self-employment income. You are considered to be self-employed if you are in An individual responsible for a Trust Fund Recovery Penalty business for yourself, or carry on a trade or business. Wage earners Complete sections 1, 3, 4 (Box 1), 6, and 7 including signature line on page 7. Self-employed individuals Complete all sections and signature line on page 7.
An individual with a personal liability for Excise Tax ... Cash value of life insurance policies Name of Insurance Company Policy Number Current Cash Value $ Less Loan Balance – $ = (4a) ... professional equipment, etc.) (23) $ Utilities/telephones (24) $ Vehicle costs (gas, oil, repairs, maintenance) (25) $ Business Insurance (26) $
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