Information Collection

Form 8821-A, IRS Disclosure Authorization for Victims of Identity Theft

IC 201801 under ICR 201204-1545-003 · OMB 1545-1165.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1165 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 8821-A Form 8821-A, IRS Disclosure Authorization for Victims of Identity Theft	Form and Instruction
8821-A IRS Disclosure Authorization for Victims of Identity The Form 8821-A_59482C12_r8.pdf	Form and Instruction

IC Title:

Form 8821-A, IRS Disclosure Authorization for Victims of Identity Theft

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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 and Instruction	8821-A	IRS Disclosure Authorization for Victims of Identity Theft	Form 8821-A_59482C12_r8.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	7,500	7,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.