Information Collection

Casualties and Thefts

IC 39670 under ICR 201108-1545-040 · OMB 1545-0177.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0177 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4684 Casualties and Thefts	Form
Instruction_Form4684_2011.pdf	Instruction
4684 Casualties and Thefts Form4684_2011.pdf	Form
brdn_indiv.pdf Burden for Form 4684	IC Document

IC Title:

Casualties and Thefts

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4684	Casualties and Thefts	Form4684_2011.pdf		Yes	Yes	Fillable Fileable
Instruction			Instruction_Form4684_2011.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 268,350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 35 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	268,350	268,350
Annual IC Time Burden (Hours)	1,486,659	1,486,659
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Burden for Form 4684	brdn_indiv.pdf	08/29/2011

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