Information Collection

Form 14737-A--Responsible Individual Personal Attestation

IC 220963 under ICR 201604-1545-006 · OMB 1545-2266.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2266 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 14737-A Form 14737-A--Responsible Individual Personal Attestation	Form
14737-A Responsible Individual Personal Attestation Form 14737-A (2016-03-00--r1).pdf	Form

IC Title:

Form 14737-A--Responsible Individual Personal Attestation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	14737-A	Responsible Individual Personal Attestation	Form 14737-A (2016-03-00--r1).pdf		Yes	Yes	Fillable Fileable

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	40,000	40,000
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.