Information Collection

Taxpayer Advised Of Proposed Adjustment To His/her Account Based On State Certification

IC 130572 under ICR 198304-1545-012 · OMB 1545-0753.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

TAXPAYER ADVISED OF PROPOSED ADJUSTMENT TO HIS/HER ACCOUNT BASED ON STATE CERTIFICATION

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1761 SC				No	No
Form	LETTER				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 353

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	353	353
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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