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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.