Form 9465 — Installment Agreement Request

Part I sets up your monthly payment plan. Part II is only needed in certain situations (you defaulted on a plan in the last 12 months, you owe between $25,000 and $50,000, or your proposed payment is below the line-10 amount).

Free to prepare and e-file. The IRS may charge its own setup fee, paid directly to the IRS.

Fields marked * are required.

Taxpayer (Part I, lines 1–4)

First name & initial *Last name *

Social Security Number *9 digits, no dashes.This is a joint request (add spouse)This is for a business that is out of operation (line 2)In care of (optional)Street address *

Apt / suiteCity *State *ZIP *

My address has changed since I last filed (line 1b)

Home phone (line 3)Best time to call at homeWork phone (line 4)

Ext.Best time to call at work

Your request (Part I, lines 5–12)

This request is for which form(s)?

For most individuals this is Form 1040.

FORM 1040FORM 1040NRFORM 1040SSFORM 940FORM 941FORM 943FORM 944FORM 945FORM 720FORM 2290

Tax yearThe year the tax is for, e.g. 2024.Tax period beginTax period end

5. Total amount you owe per your return / notice *6. Additional balance due not on line 57. Total balance due (lines 5 + 6) *8. Payment you are including with this request9. Amount owed (line 7 − line 8)10. Line 9 ÷ 7211a. Amount you can pay each month11b. Revised monthly payment

I cannot increase my payment to the line-10 amount (11b)12. Day of month for your payment *1–28. No date later than the 28th.14. I want to pay through payroll deduction (Form 2159 attached)

Direct debit (Part I, line 13)

Direct debit is the easiest way to make your payments on time, and it lowers the IRS setup fee.

Withdraw my monthly payment automatically from my bank account

Part II — Additional Information (lines 15–27)

Complete this part only if: you defaulted on an installment agreement in the last 12 months; the amount you owe is more than $25,000 but not more than $50,000; or the amount on line 11a (or 11b) is less than line 10.

My situation requires Part II — show these questions

Signature

Your 5-digit signature PIN *Any 5 digits you choose; this signs the form electronically.