Application for Exemption From Social Security and Medicare Taxes and Waiver of Benefits

Form 4029---Application for Exemption From Social Security and Medicare Taxes and Waiver of Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0064 can be found here:

Documents and Forms

Document Name Document Type
Form 4029 Application for Exemption From Social Security and Medicare Taxes and Waiver of Benefits Form and Instruction
4029 Application for Exemption From Social Security and Form 4029--2014-09.pdf Form and Instruction
Burden Form 4029 ty 2015.pdf Burden Calculation IC Document

Information Collection (IC) Details

IC Title:	Application for Exemption From Social Security and Medicare Taxes and Waiver of Benefits	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4029	Application for Exemption From Social Security and	Form 4029--2014-09.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,754	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,754	3,754
Annual IC Time Burden (Hours)	3,792	3,792
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Calculation	Burden Form 4029 ty 2015.pdf	04/06/2015

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