Information Collection

Substitute For Form W-2, Wage And Tax Statement, Or Form 1099r, Distributions From Pensions, Annuities, Retirement, Or Profit-sharing Plans, Ira's, Insurance Contracts, Etc.

IC 129958 under ICR 199304-1545-014 · OMB 1545-0458.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0458 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	SUBSTITUTE FOR FORM W-2, WAGE AND TAX STATEMENT, OR FORM 1099R, DISTRIBUTIONS FROM PENSIONS, ANNUITIES, RETIREMENT, OR PROFIT-SHARING PLANS, IRA'S, INSURANCE CONTRACTS, ETC.	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	FORM 4852				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,300,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,300,000	1,300,000
Annual IC Time Burden (Hours)	390,000	390,000
Annual IC Cost Burden (Dollars)	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.