Information Collection

CFPB IRS Tax Check Waiver Form

IC 204713 under ICR 201304-3170-003 · OMB 3170-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3170-XXXX CFPB IRS Tax Check Waiver Form	Form
3170-XXXX CFPB IRA Tax Check Waiver Form CFPB IRS Tax Check Waiver Form.pdf	Form

IC Title:

CFPB IRS Tax Check Waiver Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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	3170-XXXX	CFPB IRA Tax Check Waiver Form	CFPB IRS Tax Check Waiver Form.pdf		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: CFPB Advisory Boards and Committees

FR Citation: 77 FR 12034

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	100	-100
Annual IC Time Burden (Hours)	17	-17
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.