Prior Government Service Information

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1919 can be found here:

Documents and Forms

Document Name Document Type
Form 12854 Prior Government Service Information Form
12854 Prior Government Service Information 12854.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Prior Government Service Information	Agency IC Tracking Number:	ah-1919-004

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	12854	Prior Government Service Information	12854.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24,813	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	24,813	24,813
Annual IC Time Burden (Hours)	6,203	6,203
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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