ebotCPA – IRS Form 433-A Intake

🚨

What IRS Notice Did You Receive?

This helps us prioritize your case immediately

Why this matters: Some IRS notices indicate imminent action (bank levies, wage garnishments). Identifying your notice type lets us assign the right response timeline and attorney.

🔴 Critical

Immediate Levy Risk

LT11 · CP90 · CP91 · CP297 · CP504 · LT16

Callback within 1 hour

🟠 High Priority

Balance / Assessment

CP11 · CP12 · CP14 · CP21 · CP22 · CP2000 · LT38

Callback within 4 hours

🔵 Standard

General / Info Requests

CP01 · CP05 · CP53 · CP75 · Letter 525 · Other

Callback next business day

Notice Type / Number * Required

Notice Date

Total Amount IRS Claims You Owe * Required

Step 1 of 8

👤

Section 1 – Personal Information

Taxpayer & household details

Taxpayer

Full Legal Name * Required

Social Security Number * Auto-formatted Required · format: XXX-XX-XXXX

Date of Birth * Required

Marital Status

Number of Dependents

Home Address * Required

City * Required

State

ZIP

County

Cell Phone * Required

Home Phone

Email Address * Required · valid email

Spouse / Joint Filer (if applicable)

Spouse Full Name

Spouse SSNAuto-formatted

Spouse Date of Birth

Spouse Cell Phone

Step 2 of 8

💼

Section 2 – Employment & Business

Current and recent employment details

Taxpayer Employment

Taxpayer Type * Required

Occupation / Job Title

Employer Name

Employer Phone

Employer Address

Pay Frequency

Length of Employment

Spouse Employment (if applicable)

Spouse Employer

Spouse Occupation

Business Information (if self-employed)

Business Name

Business EIN

Business Type

Monthly Gross Revenue

Step 3 of 8

🏠

Section 3 – Assets & Property

Cash, bank accounts, real estate, vehicles, and other assets

Cash & Bank Accounts

Real Estate

Do you own real estate?

Yes No

Vehicles

Investments & Retirement

Stocks / Bonds / Mutual Funds

Retirement Accounts (401k, IRA, etc.)

Life Insurance (Cash Value)

Other Assets (describe)

Step 4 of 8

💰

Section 4 – Monthly Income

All sources of gross monthly income for your household

Income Source	Taxpayer / Month	Spouse / Month
Wages / Salary (gross)
Self-Employment / Business Net
Social Security
Pension / Retirement
Child Support / Alimony Received
Rental Income
Other Income
Total Monthly Income	$0.00

Describe Other Income (if any)

Step 5 of 8

📊

Section 5 – Monthly Living Expenses

IRS uses these figures to calculate your ability to pay

Expense Category	Monthly Amount
Rent / Mortgage
Utilities
Food & Groceries
Clothing & Personal Care
Car Payment
Auto Insurance
Gas / Fuel
Health Insurance
Medical / Dental
Child Care
Child Support / Alimony Paid
Life Insurance
Student Loans
Other Secured Debt
Other Expenses
Total Monthly Expenses	$0.00

Describe Other Expenses (if any)

Step 6 of 8

📋

Section 6 – Financial Summary

Line 50 Net Difference — your ability to pay the IRS

Item	Amount
Total Monthly Income	$0.00
Total Monthly Expenses	$0.00
Line 50 — Net Difference	$0.00

⚖️

Monthly Surplus / Deficit

$0.00

Enter income and expenses to see your result.

Additional Information

Any pending lawsuits, judgments, or liens?

Prior IRS agreements or installment plans?

Anything else you'd like us to know?

Step 7 of 8

✍️

Section 7 – Certification & Signature

Review, sign, and submit your intake form

Declaration: Under penalties of perjury, I declare that to the best of my knowledge and belief, the information I have provided on this form is true, correct, and complete.

Today's Date *

Best Time to Call You Back

Taxpayer Signature

Draw your signature below using your mouse or finger:

I authorize ebotCPA to contact me regarding my IRS matter and to submit this information on my behalf.

⏳ Submitting your intake form…

⚠️ Something went wrong. Please try again or call us directly.

Step 8 of 8

✅

Your Intake Form Was Submitted!

Thank you. A member of the ebotCPA team will review your case and reach out shortly based on your urgency level.

What Happens Next

You'll receive a confirmation email shortly
A tax resolution specialist will call you
Have your IRS notice and tax returns ready
We'll outline your resolution options on the call