Information Collection

Revised Form W4 Usability

IC 234528 under ICR 201704-1545-039 · OMB 1545-2256.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2256 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
W-4 Usability Test Protocol.docx	Other-survey
W-4 Usability Testing Screening phone.docx	Other-Survey
Intro Letter for W4 Usability Testing.docx	Other-Letter
Consent Form.docx	Other-Letter
W-4 Usability Scenarios and Vignettes.docx	Other-survey
MITRE Invitation Letter.docx	Other-Letter
W4 Usability Testing Research Plan.docx	Other-Survey
RevisedForm W4 Usability - Short Form.docx Short Form	IC Document

IC Title:

Revised Form W4 Usability

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-survey	W-4 Usability Test Protocol.docx	No	Paper Only
Other-Survey	W-4 Usability Testing Screening phone.docx	No	Paper Only
Other-Letter	Intro Letter for W4 Usability Testing.docx	No	Paper Only
Other-Letter	Consent Form.docx	No	Paper Only
Other-survey	W-4 Usability Scenarios and Vignettes.docx	No	Paper Only
Other-Letter	MITRE Invitation Letter.docx	No	Paper Only
Other-Survey	W4 Usability Testing Research Plan.docx	No	Paper Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	166	166
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Short Form	RevisedForm W4 Usability - Short Form.docx	12/17/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.