Form 13930-A

Application for Central Withholding Agreement; Directed Withholding and Deposit Verification; Application for Central Withholding Agreement Less than $10,000

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2102 can be found here:

Documents and Forms

Document Name Document Type
Form 13930-A Form 13930-A Form and Instruction
13930-A Application for Central Withholding Agreement Less than f13930-A_2019 revision.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Form 13930-A	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 1.1441-4(b)(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13930-A	Application for Central Withholding Agreement Less than $10,000	f13930-A_2019 revision.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: IRS 24.030 Individual Master File	FR Citation: 83 FR 42980

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	10,500	10,500
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.