Summary of Changes

IRS - OMB REVIEW REQUEST FORM
Request for OMB review of currently approved document:
Date:

09/22/2010

Name: Cassandra

Daniels

Office Symbols: SE:W:ETA:S:RM
Phone Number:

(202)283-2178

Summary of Changes
Form 13775 is used by Electronic Tax Administration Advisory Committee (ETAAC) applicants applying for
membership and/or annual tax checks for current members.
Form 13775 was created to better solicit and maintain all of the applicant information for those interested in becoming
members of the ETA Advisory Council. Form 13775 must be completed by those individuals interested in applying
for ETAAC.
The creation of this form results in an additional 75 hours to the total burden.

Impact on Approved Collection
Public
Law No.

Regulation
No.

Other
Code
References

SAMPLE:
PL 109-567

REG-345675-08

RP 2009-134

+/- 5

Change In IRS Form
& Instructions
No. of Filers
Words

+/- 20,000

+/- 500

Attachments

+/- 1

*Please insert how this new (PL, REG, or other), document will affect the currently approved collection.