Form 14737-A--Responsible Individual Personal Attestation

Form 14737--Request for Voluntary IRS Certification of a Professional Employer Organization (CPEO); Form 14737-A--Responsible Individual Personal Attestation

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.