Information Collection

Intake/Interview and Quality Review Sheet (English & 9 Translations)

IC 19697 under ICR 201603-1545-009 · OMB 1545-1964.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1964 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13614-C Intake/Interview and Quality Review Sheet (English & 9 Translations)	Form
13614-C Intake/Interview & Quality Review Sheet Form 13614-c--2015-10-00.pdf	Form
13614-C (AR) Intake/Interview & Quality Review Sheet - Arabic Form 13614-c AR--2015-10-00.pdf	Form
13614-C (CN Simpli Intake/Interview & Quality Review Sheet - Chinese (Simpl Form 13614-c CN-Simp--2015-10-00.pdf	Form
13614-C (CN Tradit Intake/Interview & Quality Review Sheet - Chinese Tradit Form 13614-c_CN-trad2015-10-00.pdf	Form
13614-C (TL) Intake/Interview & Quality Review Sheet - Tagalog Form 13614-c_TL--2015-10-00.pd.pdf	Form
13614-C (VN) Intake/Interview & Quality Review Sheet - Vietnamese Form 13614-c_VN--2015-10-00.pdf	Form
13614-C (PL) Intake/Interview & Quality Review Sheet - Polish Form13614-c_PL--2015-10-00.pdf	Form
13614-C (PT) Intake/Interview & Quality Review Sheet - (Portuguese) Form13614-c_PT--2015-10-00.pdf	Form
13614-C (KR) Intake/Interview & Quality Review Sheet - Korean Form 13614-c_KR--2015-10-00.pdf	Form
13614-C (HT) Intake/Interview & Quality Review Sheet - Creole French Form 13614-c_HT--2015-10-00.pdf	Form

IC Title:

Intake/Interview and Quality Review Sheet (English & 9 Translations)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	13614-C	Intake/Interview & Quality Review Sheet	Form 13614-c--2015-10-00.pdf	Yes	No	Fillable Printable
Form	13614-C (AR)	Intake/Interview & Quality Review Sheet - Arabic	Form 13614-c AR--2015-10-00.pdf	Yes	No	Fillable Printable
Form	13614-C (CN Simplified)	Intake/Interview & Quality Review Sheet - Chinese (Simplified)	Form 13614-c CN-Simp--2015-10-00.pdf	Yes	No	Fillable Printable
Form	13614-C (CN Traditional)	Intake/Interview & Quality Review Sheet - Chinese Traditional	Form 13614-c_CN-trad2015-10-00.pdf	Yes	No	Fillable Printable
Form	13614-C (TL)	Intake/Interview & Quality Review Sheet - Tagalog	Form 13614-c_TL--2015-10-00.pd.pdf	Yes	No	Fillable Printable
Form	13614-C (VN)	Intake/Interview & Quality Review Sheet - Vietnamese	Form 13614-c_VN--2015-10-00.pdf	Yes	No	Fillable Printable
Form	13614-C (PL)	Intake/Interview & Quality Review Sheet - Polish	Form13614-c_PL--2015-10-00.pdf	Yes	No	Fillable Printable
Form	13614-C (PT)	Intake/Interview & Quality Review Sheet - (Portuguese)	Form13614-c_PT--2015-10-00.pdf	Yes	No	Fillable Printable
Form	13614-C (KR)	Intake/Interview & Quality Review Sheet - Korean	Form 13614-c_KR--2015-10-00.pdf	Yes	No	Fillable Printable
Form	13614-C (HT)	Intake/Interview & Quality Review Sheet - Creole French	Form 13614-c_HT--2015-10-00.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,330,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,330,000	180,000	3,150,000
Annual IC Time Burden (Hours)	555,000	30,000	525,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.