Interview and Intake Sheet

ICR 200604-1545-017

OMB: 1545-1985

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
19731 Migrated
ICR Details
1545-1985 200604-1545-017
Historical Active 200512-1545-015
TREAS/IRS
Interview and Intake Sheet
Extension without change of a currently approved collection   No
Regular
Approved without change 07/03/2006
Retrieve Notice of Action (NOA) 04/11/2006
  Inventory as of this Action Requested Previously Approved
07/31/2009 07/31/2009 06/30/2006
85,540 0 85,540
17,108 0 17,108
0 0 0

This Spanish version of Form 13614 is used by screeners, preparers, or others involved in the return preparation process to more accurately complete tax return of Spanish speaking taxpayers having low to moderate incomes. These persons need assistance having their return prepared so they can fully comply with the law.

None
None


No

1
IC Title Form No. Form Name
Interview and Intake Sheet 13614-SP

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 85,540 85,540 0 0 0 0
Annual Time Burden (Hours) 17,108 17,108 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
04/11/2006


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