You may omit
printing the expiration date on this form. You may continue to use
the 1989 form through December 31, 1989. The PRA notice should be
corrected to include the OMB number in the address. Remarks entered
September 17, 1991 - Your request dated September 10, 1991 for a
check box to indicate a change in the name for Social Security
purposes is approved.
Inventory as of this Action
Requested
Previously Approved
08/31/1992
08/31/1992
10/31/1989
53,405,000
0
53,415,000
112,150,500
0
14,395,556
0
0
0
EMPLOYEES FILE THIS FORM TO TELL
EMPLOYERS (1) THE NUMBER OF WITHHOLDING ALLOWANCES CLAIMED, (2)
DOLLAR AMOUNT THEY WANT WITHHOLDIN INCREASED EACH PAY PERIOD, (3)
IF THEY ARE ENTITLED TO CLAIM EXEMPTION FROM WITHHOLDING. EMPLOYERS
USE THIS INFORMATION TO FIGURE THE CORRECT TO WITHHOLD FROM THE
EMPLOYEES WAGES.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.