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NOT LEGAL ADVICE. NOT TAX ADVICE.

Excite Tax is not a law firm, and no one at Excite Tax is an attorney.
These templates are general information. Sharing them is not legal advice or tax advice, and it creates no attorney-client relationship and no preparer-client relationship with Excite Tax.
Before you send anything, check the current IRS instructions for your notice or form; forms, deadlines and addresses change.
For free or low-cost help, contact a Low Income Taxpayer Clinic (https://www.taxpayeradvocate.irs.gov/litc) or the Taxpayer Advocate Service (https://www.taxpayeradvocate.irs.gov/).
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COLLECTION DUE PROCESS HEARING REQUEST (FORM 12153 COMPANION)
From: https://excite-tax.vercel.app/templates/collection-due-process-hearing-request
Official sources were read on 2026-09-23; check them again before you use this template.
Replace every [BRACKETED] field. Delete any line that does not apply.

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[DATE]

[IRS ADDRESS — copy it exactly from your notice]

Re: Request for a Collection Due Process hearing — Form 12153 enclosed
Taxpayer name: [BUSINESS OR INDIVIDUAL NAME, exactly as on the return]
Taxpayer identification number: [EIN or last four digits of SSN, as the notice shows it]
Tax form: [e.g. Form 1120-S, Form 1065, Form 941, Form 1040]
Tax period(s): [e.g. tax year 2024, or quarter ending 03/31/2025]
Notice or letter number: [e.g. CP14, CP2000, LT11 — top or bottom right corner] dated [NOTICE DATE]

To the IRS Independent Office of Appeals:

Enclosed is a signed Form 12153, Request for a Collection Due Process or Equivalent Hearing, and a copy of the notice listed above.

I am requesting a hearing about the [proposed levy / filed notice of federal tax lien / both] for [TAX FORM AND PERIODS].

The reason for this request: [Choose what applies and explain in plain words. Examples: "I cannot pay the balance in full and ask Appeals to consider an installment agreement of $[AMOUNT] per month." / "I ask Appeals to consider placing the account in currently-not-collectible status because of financial hardship." / "I ask for withdrawal of the lien because [REASON]." / "I did not receive a deficiency notice for this liability and dispute the amount because [REASON]."]

[IF PROPOSING A PAYMENT ALTERNATIVE: A completed Form 433-A (individual) and/or Form 433-B (business) with supporting documents is enclosed.]

Please send hearing correspondence to the address above. I have kept a copy of this request and proof of the date it was sent.

Sincerely,

[SIGNATURE]
[PRINTED NAME], [TITLE — e.g. Owner, Managing Member, President]
[BUSINESS NAME]
[DAYTIME PHONE]

Enclosures: Form 12153; copy of the CDP notice; [Form 433-A / Form 433-B and supporting documents]

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WHAT TO ATTACH
- Form 12153, completed and signed (download it from the IRS link below).
- A copy of the CDP notice (LT11, L-1058 or Letter 3172).
- Form 433-A (individual) and/or Form 433-B (business) with supporting documents, if you want Appeals to consider a payment plan, hardship status or another alternative.

WHERE TO SEND IT (check the current official instructions)
- Form 12153 says to send it to the address for requesting a hearing shown on the CDP notice, not the payment address. Source: https://www.irs.gov/pub/irs-pdf/f12153.pdf
- Include a copy of the CDP notice so the request is handled properly. Source: https://www.irs.gov/pub/irs-pdf/f12153.pdf
- To discuss a collection alternative, the form asks for Form 433-A (individual) and/or Form 433-B (business) with the request. Source: https://www.irs.gov/pub/irs-pdf/f12153.pdf
- Keep a copy of the request and proof of the date you sent it. Source: https://www.irs.gov/pub/irs-pdf/f12153.pdf

SOURCES
- IRS — Low Income Taxpayer Clinics: https://www.irs.gov/advocate/low-income-taxpayer-clinics (retrieved 2026-09-23)
- IRS — Instructions for Form 9465 (07/2024): https://www.irs.gov/instructions/i9465 (retrieved 2026-09-23)
- IRS — Collection due process (CDP) FAQs: https://www.irs.gov/appeals/collection-due-process-cdp-faqs (retrieved 2026-09-23)
- IRS — Form 12153, Request for a Collection Due Process or Equivalent Hearing (Rev. 7-2022): https://www.irs.gov/pub/irs-pdf/f12153.pdf (retrieved 2026-09-23)