Information Collection

Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions from Pension, Annuities, Retirement, or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.

IC 17260 under ICR 199808-1545-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Pension, Annuities, Retirement, or Profit-Sharing Plans, IRAs, 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	4852				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,500,000	200,000	1,300,000
Annual IC Time Burden (Hours)	450,000	60,000	390,000
Annual IC Cost Burden (Dollars)	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.