Information Collection

Form 14420 - Verification of Reported Income

IC 204043 under ICR 201209-1545-007 · OMB 1545-2236.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2236 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 14420 Form 14420 - Verification of Reported Income	Form
14420 Verification of Reported Income Form 14420_59955J12_r16.pdf	Form
PRA Language - Form 14420 v1.doc Draft of PRA Section	IC Document

IC Title:

Form 14420 - Verification of Reported Income

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 26 CFR 1.6050W 26 CFR 1.6041 31 CFR 3406

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	14420	Verification of Reported Income	Form 14420_59955J12_r16.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,600

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	5,600	5,600
Annual IC Time Burden (Hours)	22,400	22,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Draft of PRA Section	PRA Language - Form 14420 v1.doc	10/05/2012

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