Form A-771 at a glance
What it is: A-771 is the Wisconsin Department of Revenue form to Request a Payment Plan.
Where and when to file: The Wisconsin Department of Revenue is at PO Box 8901 Madison WI 53708-8901.
A filled-in Form A-771 example: a Wisconsin filer proposes a monthly payment plan
How to fill out Form A-771, box by box
Part A: Proposed Payment Plan
In Part A: Proposed Payment Plan, enter the Payment Amount, mark the Frequency Monthly, Bi-weekly or Weekly, and enter the First Payment Date (must be 1‑28 of the month).
Part B: Your Information
In Part B: Your Information, enter your Name, Date of Birth, SSN, Mailing Address, Phone, City, State and Zip, and list the Dependents names and ages.
Employer in Part B
Under Employer in Part B, enter the Name, Phone, Job Title / Position, Gross Income / month and Net Income / month.
Other Income in Part B
If you have Other Income in Part B, enter General Assistance, Wisconsin Works Payments, Social Security / SSI and Other (list).
Part C: Your Spouse
In Part C: Your Spouse, mark I am not married. Skip to Part D. if you are not married.
In Part C, enter the Name, Date of Birth, SSN, Mailing Address, Phone, City, State and Zip.
Under Employer in Part C, enter the Name, Phone, Job Title / Position, Gross Income / month and Net Income / month.
If you have Other Income in Part C, enter General Assistance, Wisconsin Works Payments, Social Security / SSI and Other (list).
Part D: Banks and Other Financial Institutions
In Part D: Banks and Other Financial Institutions, list all, attach separately if necessary: enter the Name, Type (checking, savings, IRA, CD, money market, etc.) and Balance.
Part E: Motor Vehicles, Boats, Motorcycles, Snowmobiles, ATV's, etc.
In Part E: Motor Vehicles, Boats, Motorcycles, Snowmobiles, ATV's, etc., list all, attach separately if necessary: for Vehicle 1 enter the Year, Make, Model, Fair Market Value, Balance Owed and Lien Holder.
For Vehicle 2 in Part E, enter the Year, Make, Model, Fair Market Value, Balance Owed and Lien Holder.
Part F: Real Estate
In Part F: Real Estate, list all, attach separately if necessary: enter the Location, Fair Market Value, Mortgage Holder and Balance Due.
Part G: Expenses
In Part G: Expenses, for each expense enter the Monthly Payment, Total Balance Owed, and Note any payments that are behind and how much, for Mortgage (include escrow) or Rent.
Enter Vehicle Payments, Gasoline / Oil, Home Heating, Electric, Telephone, Water and Cable / Internet, under Utilities.
Then list Loans, Credit Cards, Food, Insurance (all), IRS - Delinquent Payment and Entertainment /Other (attach list if needed).
Enter the Total Monthly Expenses, Total Net Monthly Income and Net Difference.
More rules for Form A-771
DOR will charge you a collection fee on DOR tax debt equal to 6.5% of your amount due, with a minimum charge of $35 (checked November 8, 2026). The collection fee for state debt referred by another agency is 15% of the amount due, with a minimum charge of $35 (checked November 8, 2026).
A payment plan will not prevent the filing of a delinquent tax warrant. A warrant is a lien against your property and, as public record, may affect your credit rating. The filing of a tax warrant will add a fee to your balance.
Your Wisconsin, federal and other states' tax refunds, vendor payments, unclaimed property and lottery winnings will be used to pay the amount due and will not be considered installment payments on your plan.
All returns and taxes must be filed and paid as they become due.
The department reserves the right to end any plan if the department determines it was made based on false or incorrect information, there is a significant change in your financial condition, or if you default the terms of the plan.
If you fail to make payments as agreed or your plan is ended, DOR will take collection actions allowed by law without further notice.
If your situation is different
Part H: Signature
In Part H: Signature, sign Your Signature and Date; Spouse Signature and Date. I have read and understand the terms of a payment plan. I have completed all information requested and attached additional pages if more room was needed. The information provided is true and correct to the best of my knowledge.
Upon receipt
Upon receipt, the department will review your request and determine if additional information or written verification is required. If so, you will be notified and given a deadline to provide the additional documentation. After all documentation is received and reviewed the department will accept your proposal, issue a counter proposal, or reject your proposal.
Common questions about Form A-771
Where do I file it?
The Wisconsin Department of Revenue is at PO Box 8901 Madison WI 53708-8901.
Are there fees?
A $20 fee will be added to your balance when a payment plan is accepted by the department (checked November 8, 2026).
Sources
[1] Form A-771, Request a Payment Plan, Wisconsin Department of Revenue (the Official source link on this page).