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Multiple Payer Transmittal For Magnetic Media Reporting
MULTIPLE PAYER TRANSMITTAL FOR MAGNETIC MEDIA REPORTING
OMB: 1545-0398
IC ID: 129839
OMB.report
TREAS/IRS
OMB 1545-0398
ICR 198108-1545-193
IC 129839
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MULTIPLE PAYER TRANSMITTAL FOR MAGNETIC MEDIA REPORTING
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
FORMS 4802,
No
No
Form
4802 PR
No
No
Form
& 4802 SS
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,425
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
68,500
0
0
68,500
0
0
Annual IC Time Burden (Hours)
13,700
0
0
13,700
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.