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Kentucky Income Tax Installment Agreement Request

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Kentucky Individual Income Tax Installment Agreement Request

GENERAL INSTRUCTIONS

If you are unable to pay the full amount due with your individual income tax return, you may request an installment agreement by completing this form and mailing it to: Division of Collections, P. O. Box 491, Frankfort, Kentucky 40602-0491. Specify the amount of the monthly payment you propose to make in the block marked “Proposed Monthly Payment Amount.” Payments should be as large as possible to lower penalty and interest charges. Requested Installment Agreements must be created by the Division of Collections after a tax notice has been issued.

You can make installment payments in three ways. Credit cards or ACH Debits will save you the time and trouble of mailing monthly payments and may help save you additional penalties, interest or fees.

• Pay by Credit Card—To charge your monthly payments to MasterCard, VISA, American Express or Discover provide the account number and other information on the form below. You must also provide the cardholder’s name and billing address exactly as it appears on the credit card billing statement. You may also arrange credit card installments by phone. For more information, call (502) 564-4921, ext. 5354. A convenience fee may apply to each monthly payment. Please indicate date for credit card payment.

• Pay by ACH Debit—To request that your monthly payments be withdrawn electronically from a bank account, enclose a voided check with the completed form below. You may also call (502) 564-4921, ext. 5354 to request this option. Please indicate date for ACH Debit payment.

• Pay by Mail—Make your checks or money orders payable to the Kentucky State Treasurer. Include the taxpayer’s full name(s), Social Security number(s), and the tax period you are paying. Mail the payments to the Division of Collections, P.O. Box 491, Frankfort, KY 40602-0491.

You will be advised if your request for an installment agreement is approved or denied. If you do not receive a response to this request within 90 days from the date you file your return, please call the Division of Collections, (502) 564-4921, ext. 5354.

DEPARTMENT OF REVENUE

KENTUCKY INDIVIDUAL INCOME TAX
INSTALLMENT AGREEMENT REQUEST

Taxpayer full name(s) as shown on return

Taxpayer Social Security number

Spouse Social Security number

Address

City

State

ZIP Code

Home telephone number

Convenient time to call

Amount paid with return

Amount you owe (Form 740, Form 740-EZ, Form 740-NP)

PROPOSED MONTHLY PAYMENT AMOUNT

Amount I am able to pay each month

Date of first payment

Date each month I am able to pay

Type of credit card

Credit card number

Expiration date

Pay by ACH Debit

Name and address as it appears on card (if different from taxpayer)

Cardholder’s signature

Date

Your signature/Spouse’s signature (joint or combined returns only)

Date

GENERAL INFORMATION

A Kentucky taxpayer has the right to consideration of an installment agreement for the payment of delinquent taxes, interest, penalties and fees. The right to an installment agreement is provided for in KRS 131.081(9) and is primarily dependent on the taxpayer’s inability to pay the amount due in full.

Eligibility for an Installment Agreement
An installment agreement should be requested only when there is no other way of paying the liability on time and in full.

A taxpayer must clearly demonstrate an inability to pay the liability in full and the agreement must facilitate collection. Generally this means that taxpayers who have the ability to pay with available funds or borrow from a financial institution are not eligible.

Proposed Monthly Payment Amount
The monthly payment amount will be based upon the taxpayer’s ability to pay after considering the taxpayer’s monthly income and reasonable expenses. Allowable expenses generally include reasonable amounts for food, clothing, housing (and associated expenses), installment payments and other necessary living expenses. The proposed monthly payment amount should be as much as possible to minimize the length of the agreement and the accrual of interest, penalties and fees.

Interest, Penalties, Fees and Refund Offsets
The law provides for the assessment of interest, penalties and fees for tax liabilities paid after the due date. Interest accrues at the tax interest rate (6 percent for 2018). In addition, penalties of 2 percent per month may be assessed on the unpaid tax. A 25 percent Cost of Collection Fee is imposed on tax due which becomes due and payable (generally 46 days after the assessment date). Interest, penalties and fees continue to accumulate while an installment agreement is in place. Also, any money Kentucky may owe you (tax refunds, etc.) will be offset to your outstanding liability. Additionally, any federal income tax refund that may become due to you may be offset to this liability pursuant to 26 USC §6402(e).

Setting up the Agreement
Taxpayers who believe they qualify for an installment agreement should complete Form 12A200, Individual Income Tax Installment Agreement Request, and mail it to the Division of Collections, P. O. Box 491, Frankfort, Kentucky 40602-0491.

State Tax Lien
Depending on the amount and length of the agreement, a State Tax Lien may be filed. If a lien is filed, it will remain on the taxpayer’s credit record for up to seven years after the liability is paid and the lien is released.

Assistance
Questions should be directed to: Division of Collections, Kentucky Department of Revenue, P.O. Box 491, Frankfort, KY 40602-0491, (502) 564-4921, ext. 5354.

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What the Kentucky Income Tax Installment Agreement Request Is

The Kentucky Income Tax Installment Agreement Request is a formal application a taxpayer submits to the Kentucky Department of Revenue to propose a scheduled payment plan for unpaid state income tax. The form documents taxpayer identity, tax year, total amount owed, desired payment frequency, and an initial payment or proposed start date. It provides the department the information needed to evaluate ability to pay, to calculate interest and penalties, and to approve, modify, or deny a payment arrangement under state collection procedures and administrative rules.

Why a Formal Installment Request Matters

Submitting a formal installment request documents your proposed repayment plan, reduces collection friction, and may limit additional collection actions while under review. Properly completed requests help the revenue agency assess affordability and set clear payment terms.

Why a Formal Installment Request Matters

Who Typically Completes This Request

Typical filers include individuals, small business owners, and tax practitioners representing clients who cannot pay the full tax balance immediately.

  • Individual taxpayers managing unexpected tax liabilities or cash-flow shortfalls.
  • Tax professionals and CPAs submitting requests on behalf of clients.
  • Small businesses or pass-through entities arranging payments for outstanding income tax.

Each filer should supply accurate identity and income details to avoid processing delays or denied arrangements.

Step-by-step: completing the request

Follow these sequential steps to prepare a complete, review-ready installment agreement request for Kentucky income tax.

  • 01
    Assemble documents: Collect returns, pay history, and proof of income.
  • 02
    Complete form: Enter identity, TIN, amount owed, and schedule.
  • 03
    Attach supporting proof: Include bank statements and pay stubs for affordability.
  • 04
    Submit and track: File through the chosen channel and retain a copy.

How to set up an online submission workflow

Configure a digital workflow to collect signatures and supporting documents while preserving an audit trail and secure storage.

Field Configuration
Authentication Email verification or SMS code for signer identity
Signature Type Allow drawn, typed, or click-to-sign per ESIGN requirements
Attachments Require PDF or image uploads for bank statements
Notifications Enable reminders and completion receipts by email

Where and how the request is reviewed

The department reviews the request, verifies account balances, and communicates approval or alternative terms; processing paths vary by submission method.

  • Online Portal: Submit via the department's electronic filing system.
  • Mail Submission: Send the signed request and attachments by postal mail.
  • Agent Filing: Authorized representatives may file on behalf of taxpayers.
  • In-Person Delivery: Deliver documents to a revenue office for receipt stamping.

Digital submission and platform requirements

Use electronic filing tools that preserve audit trails, support common file formats, and meet authentication needs.

  • Integrations: Salesforce, NetSuite, Microsoft 365 and others supported
  • File formats: PDF, DOCX, HTML, Excel accepted by most portals
  • Security controls: TLS and AES encryption for data in transit and at rest

Confirm the submission channel accepts e-signed documents and maintain local copies with audit metadata for compliance.

Timing and common deadline considerations

Be aware of federal and state tax deadlines and how they affect installment proposals and payment start dates.

Federal return due date:

Form 1040 is due April 15; extensions to October 15 may apply

State return due date:

Kentucky individual income returns generally follow federal due dates

Installment request timing:

Submit before missing payments to limit collection escalation

Payment start date:

Set initial payment on or before proposed schedule to show good faith

Follow-up deadlines:

Respond promptly to department requests to avoid denial

Key milestones in the review process

A typical review follows numbered milestones from submission to first payment; track each stage to ensure compliance.

01

Submission Received

Agency logs and acknowledges the request for review.

02

Account Verification

Balances and prior filings are verified by collections staff.

03

Payment Terms Offered

Agency proposes schedule or accepts taxpayer's plan.

04

First Payment Processed

Initial installment posts and the arrangement becomes active.

Penalties and risks to consider

Late-payment penalties: Interest and state penalties may continue
Agreement denial: Unacceptable proposals can be rejected
Collection actions: Liens or levies may proceed if unpaid
Incorrect TIN: May trigger backup withholding (24%)
False statements: Risk of civil or criminal penalties
Missed payments: Arrangement can be terminated

Required data elements and record controls

Taxpayer Identity: Full legal name and TIN
Liability Details: Tax year and amount owed
Payment Schedule: Frequency and proposed amounts
Supporting Proof: Income and asset documentation
Audit Trail: Timestamped signing record required
Encryption: TLS and AES-256 protection

Comparing eSignature provider pricing and features

Below is a high-level pricing and feature comparison for commonly used eSignature providers; signNow is listed first per page guidelines.

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Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
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Bulk Send Yes (Business Premium) Yes Yes Yes Varies
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies by plan Varies by plan Varies by plan

Real-world examples of online installment and signing workflows

These brief examples show how organizations used electronic forms and signatures to speed approvals and maintain compliance.

Optica Ventures LLC

The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers.

  • Used standardized templates for recurring agreements.
  • The streamlined process reduced turnaround time and improved customer satisfaction while preserving an auditable signing history for finance and compliance.

Martin Properties

I can process and execute all of these documents online with 100% compliance and built-in security.

  • Deployed mobile-friendly signing for tenants.
  • Mobile and offline signing capability allowed remote closures and maintained a secure, retrievable audit trail for accounting and legal review.

Frequently asked questions

Answers to common questions about completing, signing, and submitting a Kentucky Income Tax Installment Agreement Request.


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