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Form 14039 - Identity Theft Affidavit
Identity Theft Affidavit
OMB: 1545-2139
IC ID: 188032
OMB.report
TREAS/IRS
OMB 1545-2139
ICR 201510-1545-021
IC 188032
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2139 can be found here:
2022-08-31 - Revision of a currently approved collection
2019-02-22 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Form 14039 - Identity Theft Affidavit
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Taxation Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
80,000
0
0
0
0
80,000
Annual IC Time Burden (Hours)
20,000
0
0
0
0
20,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.