Information Collection

Form 14420 - Verification of Reported Income

IC 204043 under ICR 201606-1545-006 · OMB 1545-2236.

Documents and Forms

Document Name Document Type
Form 14420 Form 14420 - Verification of Reported Income Form
14420 Verification of Reported Income Form 14420 (2015).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 14420 - Verification of Reported Income	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 26 CFR 1.6050W 26 CFR 1.6041 31 CFR 3406

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	14420	Verification of Reported Income	Form 14420 (2015).pdf		Yes	No	Paper Only

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 Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,000	0	-4,600	5,600
Annual IC Time Burden (Hours)	3,000	-12,008	-7,392	22,400
Annual IC Cost Burden (Dollars)	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.