Information Collection

Responsible Individual Personal Attestation

IC 220963 under ICR 201612-1545-017 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 14737-A Responsible Individual Personal Attestation Form
14737-A CPEO Responsible Individual Personal Attestation.pdf CPEO Responsible Individual Personal Attestation.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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
Form	14737-A	CPEO Responsible Individual Personal Attestation.pdf	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: 100 %

	Approved	Change Due to Potential Violation of the PRA
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.