Information Collection

Form 8275 - Disclosure Statement

IC 39853 under ICR 201307-1545-029 · OMB 1545-0889.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0889 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 8275 Form 8275 - Disclosure Statement	Form
INST_8275_FEB2011.pdf	Instruction
8275 Disclosure Statement Form 8275.pdf	Form
2012 8275 burden.PDF 2012 Burden	IC Document

IC Title:

Form 8275 - Disclosure Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 1.6661 26 CFR 1.6662

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	8275	Disclosure Statement	Form 8275.pdf		Yes	Yes	Fillable Fileable
Instruction			INST_8275_FEB2011.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 666,666

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 1 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	333,333	333,333
Annual IC Time Burden (Hours)	1,893,332	1,893,332
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2012 Burden	2012 8275 burden.PDF	07/17/2013

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