Responsible Individual Personal Attestation

Request for Voluntary IRS Certification of a Professional Employer Organization (CPEO); 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⚠️ Notice: This information collection may be referencing outdated material.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
CPEO Responsible Individual Personal Attestation.pdf Other-null

Information Collection (IC) Details

IC Title:	Responsible Individual Personal Attestation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-null			CPEO Responsible Individual Personal Attestation.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	Previously Approved
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.