Form 433-A, Section by Section, for a Hardship Request

Form 433-A, Collection Information Statement for Wage Earners and Self-Employed Individuals, is a six page financial confession signed under penalties of perjury. Sections 6 and 7 add two more pages if you are self-employed. Revenue officers use it to decide whether you can pay, how much, and from what. If you are asking for hardship status, this form is your case.

The current revision is Form 433-A (Rev. 6-2026). Line numbers below refer to that revision. If you are working from an older copy, the line numbers may be different, so download the current form from irs.gov before you start.

Who fills out which sections

The form tells you on page one. Wage earners complete Sections 1, 2, 3, 4, and 5, including the signature line on page 6. Self-employed individuals complete Sections 1, 3, 4, 5, 6, and 7, including the signature line. Answer every question or write N/A. A blank looks like an evasion, even when it is not.

The form also points to Publication 1854, How To Prepare a Collection Information Statement. It is worth reading.

Section 1: Personal information

Name, address, county of residence, phone numbers, marital status, and everyone in the household. Line 2c asks for every other person in the household or claimed as a dependent, whether they are claimed on your Form 1040, and whether they contribute to household income.

Do not skim the county line. Your county of residence sets your Local Standard for housing and utilities. Household size drives your National Standards. Both numbers come straight from this section. Line 3a asks about outside business interests, including any interest in an LLC, partnership or corporation.

Section 2: Employment for wage earners

Employer names, addresses, how long you have worked there, occupation, and pay period for you and your spouse. The IRS uses this to verify income and to identify levy sources. Be accurate. The employee will compare it to wage and income records the IRS already has.

Section 3: Other financial information

This section is short and dangerous. It asks whether you are a party to a lawsuit, whether you anticipate an increase or decrease in income, whether you have ever filed bankruptcy, whether you have a U.S. passport, whether you lived abroad six months or longer in the past 10 years, dual citizenship, whether you are currently incarcerated, whether you are the beneficiary of a trust, estate or life insurance policy, whether you are a trustee, whether you have a safe deposit box, and line 11: whether in the past 10 years you transferred any assets with a fair market value of more than $10,000 for less than their full value.

Line 7, anticipated income changes, is where you tell the IRS your situation is getting worse or better. If you are about to lose a job, say so and attach proof. If you expect a raise next quarter, say that too. A hardship determination built on income you know will change is not going to hold.

Line 11 catches people who deeded a house to a child or "sold" a car to a friend for a dollar. The IRS has tools for transfers like that. Answer honestly and get advice before you submit if this applies.

Section 4: Personal assets

This is the equity section, and equity is what turns a hardship request into a "sell something first" conversation. It covers:

• Line 12, cash on hand, and lines 13a through 13e, personal bank accounts including online and mobile accounts like PayPal and stored value cards.
• Lines 14a through 14d, investments, which expressly include retirement assets like IRAs and 401(k) plans.
• Lines 15a through 15e, digital assets, with a request for who has access to private keys.
• Lines 16a through 16e, available credit on lines of credit and bank-issued credit cards.
• Lines 17a through 17f, life insurance with cash value.
• Lines 18a through 18d, real property, including property held through a life estate and, in community property states, community property interests.
• Lines 19a through 19d, vehicles, including boats, RVs, motorcycles and trailers.
• Lines 20a through 20c, other personal assets like jewelry, collections, and intangibles.

The IRS does not value assets at what you think they are worth. IRM 5.15.1.21 uses fair market value and often quick sale value, which is generally 80 percent of fair market value. See equity in hardship cases for how that math works.

Section 5: Monthly income and expenses

This is the heart of a hardship request. Income goes on lines 21 through 34 and totals on line 35. Living expenses go on lines 36 through 49 and total on line 50. Line 51 is the net difference, line 35 minus line 50.

The expense lines are:

The form's own instructions say that payments on unsecured debts, voluntary retirement contributions, charitable contributions, and private school or college tuition are generally not allowed unless proven necessary for health and welfare or the production of income.

Two income instructions trip people up. Wages are gross, not take-home: multiply weekly gross by 4.3, biweekly by 2.17, and semimonthly by 2. And if net business income or net rental income is a loss, you enter zero. Do not enter a negative number.

Sections 6 and 7: Self-employed only

If you operate a sole proprietorship that files Schedule C, you complete Section 6 (business information, accounts, receivables, business assets) and Section 7 (monthly business income and expenses on lines 68 through 90). Line 90, net business income, carries back to line 24 in Section 5. The form tells you to use a 3, 6, 9 or 12 month period to determine typical business income and expenses. Other business entities use Form 433-B. I go deeper on this in self-employed income in a hardship analysis.

The signature and what comes after

The certification says, under penalties of perjury, that the statement is "true, correct, and complete." Both spouses sign if both are liable. The form warns that you may be asked for verification: tax returns, pay statements, bank and investment statements, loan statements, and bills for recurring expenses.

Five mistakes I see on hardship 433-As

• Reporting take-home pay instead of gross pay on lines 21 and 22. The IRS adds your withholding back as an expense on line 46. Net pay double counts it against you.
• Listing the mortgage twice, once on line 18 and again inside line 37 with no explanation of how the payment breaks down.
• Leaving out a spouse's income because the spouse does not owe the tax. The household picture matters even when only one person is liable. See shared household expenses.
• Ignoring the 401(k) because "the IRS can't touch it." Retirement accounts are assets the IRS considers.
• Rounding everything to the nearest hundred. Real numbers, backed by real statements, carry weight. Round numbers invite questions.

My advice is to gather that proof before you submit, not after. The hardship documentation checklist lays it out.

A clean, complete, documented Form 433-A tells a revenue officer that you are serious and honest. That impression is worth more than any argument you can make on the phone.