Information Collection

Form 4219 - Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes

IC 209679 under ICR 201312-1545-015 · OMB 1545-2254.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2254 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4219 Form 4219 - Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes	Form and Instruction
4219 Statement of Liability of Lender, Surety, or Other Perso Form 4219.pdf	Form and Instruction

IC Title:

Form 4219 - Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 31.3505-1

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	4219	Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes	Form 4219.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	12,833	12,833
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.