Information Collection

Form 4684 - Casualties and Thefts

IC 39670 under ICR 201305-1545-012 · OMB 1545-0177.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0177 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4684 Form 4684 - Casualties and Thefts	Form
Instr 4684--2014.pdf	Instruction
4684 Casualties and Thefts Form 4684--2014.pdf	Form
Burden 2013.PDF 2013 Burden	IC Document
Burden-Change in Responses.PDF 2013 Change in Response Burden	IC Document
Pub 547- 2013-.pdf Pub 547	IC Document

IC Title:

Form 4684 - Casualties and Thefts

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	4684	Casualties and Thefts	Form 4684--2014.pdf		Yes	Yes	Fillable Fileable
Instruction			Instr 4684--2014.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	320,000	0	51,650	268,350
Annual IC Time Burden (Hours)	1,830,400	57,600	286,141	1,486,659
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2013 Burden	Burden 2013.PDF	05/10/2013
2013 Change in Response Burden	Burden-Change in Responses.PDF	05/10/2013
Pub 547	Pub 547- 2013-.pdf	11/26/2014

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