Information Collection

Statement by Person(s) Receiving Gambling Winnings

IC 43856 under ICR 201211-1545-016 · OMB 1545-0239.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0239 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 5754 Statement by Person(s) Receiving Gambling Winnings	Form and Instruction
Form 5754 Statement by Person(s) Receiving Gambling Winnings Form 5754.pdf	Form and Instruction
brdn_spec.pdf 2012 Burden	IC Document

IC Title:

Statement by Person(s) Receiving Gambling Winnings

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 and Instruction	Form 5754	Statement by Person(s) Receiving Gambling Winnings	Form 5754.pdf		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 204,000

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	Previously Approved
Annual Number of Responses for this IC	204,000	204,000
Annual IC Time Burden (Hours)	40,800	40,800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2012 Burden	brdn_spec.pdf	11/14/2012

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